Access Challenges and the Move Toward Remote Formats
Access to specialized OCD care has long varied by geography, provider availability, and individual circumstances. ERP often requires clinicians with specific training, which can limit availability in certain regions or settings.
Remote delivery formats have been explored as one way to address these constraints. By using secure video platforms, therapists and clients are able to connect without travel, allowing care to continue across distance while maintaining professional oversight. These models are discussed as an expansion of delivery options rather than a replacement for in-person care.
What Is Remote ERP?
Exposure and Response Prevention involves structured engagement with anxiety-provoking thoughts or situations while gradually reducing compulsive responses. Traditionally, this work takes place in face-to-face sessions, often supplemented by practice between visits.
In telehealth formats, ERP sessions are conducted through secure video conferencing. Some programs incorporate digital tools, such as shared documents, reminders, or messaging, to support organization and communication between sessions. These elements are intended to facilitate continuity rather than alter the core therapeutic approach.
Evidence Context: Online and In-Person ERP
A large observational study by Feusner et al. (2022) examined outcomes from internet-delivered ERP among adults receiving remote care. The authors reported symptom changes that were broadly comparable to those observed in prior in-person ERP studies, though individual responses varied.
Other studies and reviews have similarly explored whether remote formats influence engagement, completion rates, or reported outcomes. Across this literature, findings are generally framed as format-specific observations rather than definitive conclusions about superiority or universal effectiveness.
Experience, Setting, and Engagement
Some research has explored how receiving ERP in a home environment may influence the therapeutic experience. A 2024 nonrandomized study by Voderholzer et al. examined the addition of a videoconference-based ERP session to inpatient care, noting that participants often described reduced logistical strain and increased relevance of exposures conducted in familiar settings.
These observations highlight how context may shape engagement, though responses differ between individuals. Remote formats are generally discussed as one option within a broader range of care settings.
Practical and Ethical Considerations
Remote delivery of ERP introduces considerations related to privacy, data security, clinical appropriateness, and provider training. Not all individuals or situations are suited to telehealth formats, and some cases may still require in-person evaluation or additional support.
Guidelines emphasize the importance of clinician judgment when determining whether remote delivery is appropriate, as well as the need for clear communication about expectations and boundaries.
Ongoing Questions and Areas of Study
Research on online ERP continues to examine questions related to long-term outcomes, differences between guided and self-directed formats, and the impact of digital tools on therapist workload and care quality. Emerging technologies are being studied for their potential to support monitoring or organization, though these applications remain under evaluation.
As with many areas of digital mental health, current findings are best understood as contributing to an evolving evidence base rather than defining a single optimal model.
References
Feusner, J., et al. (2022). Online video teletherapy ERP for OCD: Outcomes in 3,552 adults. Journal of Medical Internet Research, 24(5), e36431. https://www.jmir.org/2022/5/e36431
Kissi, J., Annobil, C., Mensah, N.K. et al. (2023). Telehealth services for global emergencies: implications for COVID-19: a scoping review based on current evidence. BMC Health Serv Res 23, 56. https://doi.org/10.1186/s12913-023-09584-4
Voderhozer, U., et al. (2024). Effectiveness of One Videoconference-Based Exposure and Response Prevention Session at Home in Adjunction to Inpatient Treatment in Persons With Obsessive-Compulsive Disorder: Nonrandomized Study. JMIR Mental Health, 11, e52790. https://mental.jmir.org/2024/1/e52790
World Health Organization (2022). Consolidated telemedicine implementation guide. https://www.who.int/publications/i/item/9789240059184
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