An evidence-based overview for licensed therapists
At NOCD, clinical quality and outcomes research guide everything we do—from therapist training to the technology that supports treatment delivery. As virtual care becomes increasingly central to mental health practice, therapists rightly ask: Does it work? For whom? And under what conditions?
Below is an overview of our peer‑reviewed and widely cited studies examining NOCD’s virtual treatment model across obsessive-compulsive disorder (OCD) and related conditions. Together, these studies demonstrate the effectiveness, scalability, and clinical integrity of teletherapy delivered by NOCD specialists trained in evidence‑based protocols. This research shows the effectiveness of our care and is proof of our clinical excellence.
Large‑Scale Outcomes in Adults of NOCD’s Virtual OCD Treatment Model
Citation: Feusner JD, Farrell NR, Kreyling J, McGrath PB, Rhode A, Faneuff T, Lonsway S, Mohideen R, Jurich JE, Trusky L, Smith SM. Online Video Teletherapy Treatment of Obsessive-Compulsive Disorder Using Exposure and Response Prevention: Clinical Outcomes From a Retrospective Longitudinal Observational Study. J Med Internet Res. 2022 May 19;24(5):e36431. doi: 10.2196/36431. PMID: 35587365; PMCID: PMC9164091.
Outcomes of a Digital Health Treatment Program for Obsessive‑Compulsive Disorder Journal of Medical Internet Research (JMIR), 2022
Overview
While many telehealth studies focus on small or controlled samples, this study evaluated outcomes from a large, real‑world patient adult population receiving care through NOCD’s digital treatment program.
About the study
- Evaluated sample of thousands of adults with OCD
- Examined the impact of exposure and response prevention (ERP) delivered virtually by licensed clinicians with specialized training. Plus, the integration of synchronous therapy and digital tools
- Used a measurement‑based care validated OCD symptom scales to evaluate impact of NOCD’s treatment program
Key findings
- 43.4% symptom reduction on average, and 62.9% met criteria for a full response
- Outcomes comparable to or exceeding benchmarks from in‑person ERP studies
- Results achieved in less than half the total therapist time compared with standard-of-care once-weekly outpatient ERP treatment
- Demonstrated scalability without loss of treatment quality
Clinical implications
This effectiveness study in adults provides strong evidence that high‑quality, outcomes‑driven OCD care can be delivered at scale through a virtual‑first model.
Virtual ERP for Children and Adolescents With OCD
Citation: Feusner JD, Farrell NR, Nunez M, Lume N, MacDonald CW, McGrath PB, Trusky L, Smith S, Rhode A. Effectiveness of Video Teletherapy in Treating Obsessive-Compulsive Disorder in Children and Adolescents With Exposure and Response Prevention: Retrospective Longitudinal Observational Study. J Med Internet Res. 2025 Jan 27;27:e66715. doi: 10.2196/66715. PMID: 39869894; PMCID: PMC11811664.
Conditions studied: Pediatric obsessive‑compulsive disorder (OCD)
Overview
OCD frequently begins in childhood or adolescence, yet access to pediatric exposure and response prevention (ERP) specialists remains limited—particularly outside major metropolitan areas. This study examined whether ERP, the first‑line treatment for OCD, could be delivered virtually to younger populations with comparable effectiveness.
About the study
- Population studied was children and adolescents diagnosed with OCD
- Evaluated treatment delivered by ERP‑trained therapists via telehealth, with parent involvement integrated as clinically appropriate
- Tracked symptom severity over the course of care, and longitudinal assessments up to 1 year
Key findings
- Robust reductions in OCD symptoms following virtual ERP.
- Specifically, 38.46% median decrease in OCD symptoms at 13-17 weeks, and 53.4% of youth met full response criteria at this point
- Clinically meaningful improvements sustained across treatment, and up to 1 year
- Treatment was similarly effective for those with mild, moderate, and severe OCD
- Results achieved in approximately 65% fewer sessions than standard-of-care outpatient ERP
Clinical implications
For therapists working with pediatric populations, this study underscores the adaptability of ERP across developmental stages and treatment settings. It also demonstrates how virtual care can reduce barriers for families who might otherwise delay or forgo specialty treatment.
Virtual Therapy for Body‑Focused Repetitive Behaviors (BFRBs)
Citation: Feusner JD, Beatty CC, Murphy C, McGrath PB, Farrell NR, Nuñez M, Lume N, Mohideen R, Trusky L, Smith SM, Rhode A. Therapist-Delivered Video Therapy Habit Reversal Training for Body-Focused Repetitive Behaviors: Clinical Outcomes From a Large Real-World Sample of Youth and Adults. J Clin Psychiatry. 2026 Jan 12;87(1):25m15834. doi: 10.4088/JCP.25m15834. PMID: 41532844.
Conditions studied: Trichotillomania, excoriation (skin‑picking) disorder, and related BFRBs
Overview
Body‑focused repetitive behaviors (BFRBs) are often underdiagnosed and undertreated, in part due to limited access to clinicians trained in evidence-based treatments such as Habit Reversal Training (HRT). This study evaluated whether HRT—long considered the gold‑standard behavioral treatment for BFRBs—could be effectively delivered via video teletherapy.
About the study
- Studied adults with diagnosed BFRBs
- Structured video‑based HRT delivered by trained therapists
- Standardized symptom severity measures administered pre‑ and post‑treatment
Key findings
- Significant reductions in BFRB symptom severity across participants
- After just 14-16 weeks, HRT with a NOCD Therapist delivered a median 33% reduction in the severity of both hair pulling and skin picking, with nearly 50% of participants achieving at least a 35% reduction.
- Improvements comparable to outcomes reported in in‑person HRT trials
- High treatment engagement and satisfaction, in a fully virtual setting
Clinical implications
This study supports the feasibility of delivering specialized behavioral interventions remotely, even for conditions traditionally treated in niche specialty clinics. For therapists, it highlights how fidelity to protocol—not physical location—drives outcomes when evidence‑based care is delivered correctly.
Targeted Peer Support to Improve Adherence to Virtual ERP for OCD
Citation: Murphy CE, Rhode A, Kreyling J, Appel S, Heintz J, Osborn K, Lucas K, Mohideen R, Trusky L, Smith S, Feusner JD (2023). A targeted strategic peer support intervention to increase adherence to video teletherapy exposure and response prevention treatment for obsessive-compulsive disorder: a retrospective observational analysis. Frontiers in Human Neuroscience.
Conditions studied: Obsessive-compulsive disorder (OCD) treatment adherence
Overview:
One of the key barriers to effective OCD treatment—even when delivered virtually—is treatment adherence: many patients struggle to complete recommended sessions due to distress, life demands, or other obstacles. This study tested whether targeted peer support could help increase engagement and improve outcomes for patients receiving NOCD’s video ERP teletherapy.
About the study
- Retrospective observational analysis of clinical data from patients receiving NOCD’s ERP teletherapy. A machine learning prediction algorithm identified patients at risk for poor adherence based on baseline and early treatment data
- “Member Advocates”—people with lived OCD experience who had successfully completed ERP—provided peer support outreach via digital messaging to those identified as at-risk
- Compared those who engaged with peer support to those who did not in terms of therapy hours completed and symptom change
Key findings
- Patients who engaged with peer support completed significantly more therapy hours (30%) within the first 60 days than at-risk patients who did not engage
- Engaged patients also showed significantly greater reductions in OCD symptom severity
- Peer support outreach was linked to better real-world engagement with virtual therapy, without altering the core ERP protocol
Clinical implications
- Adding a strategic, data-informed peer support layer can help enhance adherence to virtual ERP, which is critical for achieving therapeutic gains
- Peer support interventions—especially when targeted via predictive modeling—can address engagement challenges that might otherwise limit the effectiveness of teletherapy
- This model shows how digital tools, data science, and human support can be integrated to strengthen virtual treatment delivery and outcomes for OCD populations
What These Studies Show
For licensed therapists, this growing body of research supports virtual specialty practice not as a stopgap—but as a durable, evidence‑supported model of care. These studies show:
- Evidence‑based behavioral treatments like ERP and HRT retain their effectiveness when delivered virtually
- Therapist training, clinical fidelity, and outcome tracking are the primary determinants of success
- Virtual care expands access without compromising clinical rigor
Practicing Evidence‑Based Virtual Care at NOCD
At NOCD, we’re focused on delivering evidence-based care, and ensuring our training and treatment approaches continue to uphold and improve upon these studies’ findings:
- Specialized training in ERP and related protocols
- Ongoing consultation and supervision
- Measurement‑informed care and outcomes monitoring
- Technology designed to support—not replace—clinical judgment
If you’re interested in applying innovative evidence‑based treatment in a virtual setting while working alongside other specialists, you can learn more about clinical roles at NOCD on our Therapist Careers page.
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