Why Online ERP Therapy Can Be More Effective Than In-person Therapy
Teletherapy has been around for many years, and recently there has been an explosive increase in the use of telehealth services. The ability to access therapy online is not only convenient and time-efficient, but for many, it also opens up the door to specialized treatment that was previously inaccessible.
That’s especially true for Exposure and Response Prevention (ERP) therapy, the gold standard of treatment for obsessive-compulsive disorder (OCD). In the past, finding a therapist specialized in OCD and ERP had been notoriously difficult – if not almost impossible in some regions, especially in rural areas – given the regional mental health licensing laws and scarcity of ERP-trained providers.
This lack of resources has resulted in individuals with OCD either having to travel great distances for treatment, getting treatment from professionals who are not specifically trained to treat OCD (which can actually make OCD worse), or not getting treatment at all. When left untreated, people with OCD are 10 times more likely to die by suicide.
Online therapy bridges the access gap to ERP treatment by removing the location barrier. However, some people may have reservations about online therapy because of the mistaken belief that in-person therapy is the only way to get positive results.
The great news is that in many cases, online therapy for OCD specifically can be more effective than in-person therapy. That’s because your therapist can do exposure exercises with you in the places that trigger your symptoms, so you can confront your fears in the appropriate environment – and therefore begin to overcome them.
The Differences Between Online ERP And In-Person ERP
ERP treatment conducted online in a face-to-face environment follows the same evidence-based interventions as ERP treatment conducted in-person, which have been clinically proven to effectively treat OCD. Research has also found therapy administered online to be equally as – and sometimes more – effective as when it is conducted in person.
The greatest difference between ERP therapy in-person versus online is the setting in which the treatment is taking place. In-person, ERP might occur in a therapist’s office with the clinician in the same room. This may seem like a good option, as working with a therapist in a controlled environment can feel safer. People may have thoughts like, “if anything bad happens, I will be okay because I am in a clinical setting,” or, “my therapist would not let any harm come to me.”
While these thoughts may be reassuring, they may actually be counterproductive for ERP therapy. The goal of ERP is to confront the fears and anxieties in your daily life, not in the controlled setting of an office.
Online ERP sessions, however, most frequently occur in the person with OCD’s home or location of choice. This allows the therapist to work with you in settings and situations where your triggers are most likely present, and where obsessions or compulsions are most likely to occur.
What Can Make Online ERP Therapy More Effective?
Doing exposures in the places where a person suffers most means a therapist can easily “travel” with their patient and be with them “in the moment” to provide the highest levels of care and support.
By contrast, while an in-person therapist will do exposures with a patient, it’ll likely not be the ones the patient needs most, given the travel limitations. The other option is that the in-person therapist might assign the most-needed exposures after a session is completed, at a time when they won’t be present because the setting where the patient has to perform exposures is outside of their office. This means that while sessions themselves are done with the therapist, the actual exposures may need to be done alone by the patient, and the patient then has to describe them after. It’s also difficult for the therapist to know if the patient has properly done response prevention.
For example, an individual with contamination OCD may avoid straightening up their home due to a fear that the items on the ground will contaminate them. With in-person treatment, the ERP therapist would likely give the patient an assignment to clean a portion of their home and then discuss the experience with them during the following session, which could be much later.
An incredible advantage with online treatment is that the patient does not need to complete the exposure on their own, nor does the therapist need to wait until the next session to help the patient make progress. Rather, they can actually be “in the room” with their patient as they expose themselves to their triggers and work on refraining from responding with compulsions.
This is true no matter what the patient’s subtype is or what location is best for their exposures. A person with sexual intrusive thoughts who might normally avoid being in crowded public places for fear of acting out sexually inappropriate behaviors with others might be assigned an exposure to walk around their local mall. With online treatment, the therapist could be “there with them” virtually through the patient’s AirPods. In this way, the therapist is more involved as they face their triggers head-on and would be able to speak with the patient the entire time and guide them through the exposure.
Additionally, the online format allows the therapist and patient to engage in conversation around the exposure and response prevention experience immediately after, while the feelings are still fresh in the patient’s mind.
The Convenience of Online ERP Could Lead to Better Outcomes
Since patients will be attending therapy online from the comfort of their home or other location of their choice, they can schedule sessions for times that are the most convenient for them without the need to travel. This level of convenience that can only come from online ERP therapy can allow them to comply with treatment more easily, meaning they are less likely to miss sessions. Consistent care is what ultimately leads to better outcomes because treatment gains have a bigger impact, and it provides a more satisfying patient experience.
Online ERP Therapy is Also More Affordable
Traditionally, the cost of ERP therapy has been an additional barrier for people with OCD seeking treatment. ERP therapists are typically out-of-network and charge high cash-pay rates that are commensurate with the specialized treatment they offer. The cost of working with an ERP-trained therapist is around $350 (or more – even upwards of $500) per session, and most often, these costs are paid fully out-of-pocket. That’s why ERP has typically been extremely expensive and inaccessible.
Thankfully, online ERP at NOCD Therapy is significantly more affordable. At NOCD, ERP therapy for our members is typically less than half the price of standard, in-person ERP therapy you’ll find outside of NOCD, even though we offer more service than most ERP therapists.
We also partner with some of the nation’s leading insurance plans – including UnitedHealthcare, Cigna, Humana, many Blue Cross Blue Shield plans, and more – so members can receive OCD treatment through their behavioral health plan benefits. It’s one of the first times that traditional outpatient ERP therapy has ever been insurance-backed. As a result, most of our members using insurance only pay a small copay of $0 to $50 a session.
Where Can I Find Online ERP Therapy?
If you or someone you know is dealing with OCD, NOCD can help. We provide convenient, affordable, and effective treatment anywhere in the US and now outside of the US. Our therapy is 100% online, and all NOCD therapists are licensed and specialty-trained to treat OCD using ERP therapy through live face-to-face video sessions.
If you’d like to learn more about working with a NOCD therapist, you can get started by booking a free 15-minute call with our team today.
Dr. McGrath is a Licensed Clinical Psychologist and the Chief Clinical Officer at NOCD. He is a member of the Scientific and Clinical Advisory Boards of the International OCD Foundation, a Fellow of the Association for Cognitive and Behavioral Therapies, and the author of "The OCD Answer Book" and "Don't Try Harder, Try Different."
NOCD Therapists specialize in treating OCDView all therapists
Licensed Therapist, MA
I started as a therapist over 14 years ago, working in different mental health environments. Many people with OCD that weren't being treated for it crossed my path and weren't getting better. I decided that I wanted to help people with OCD, so I became an OCD therapist, and eventually, a clinical supervisor. I treated people using Exposure and Response Prevention (ERP) and saw people get better day in and day out. I continue to use ERP because nothing is more effective in treating OCD.
Licensed Therapist, LCMHC
When I started treating OCD, I quickly realized how much this type of work means to me because I had to learn how to be okay with discomfort and uncertainty myself. I’ve been practicing as a licensed therapist since 2016. My graduate work is in mental health counseling, and I use Exposure and Response Prevention (ERP) therapy because it’s the gold standard of OCD treatment.
Licensed Therapist, MA
I have personally struggled with OCD and know what it's like to feel controlled by intrusive thoughts and compulsions, and to also overcome it using the proper therapy. I’ve been a licensed therapist since 2017. I have an M.A. in Clinical Mental Health Counseling, and practice Exposure and Response Prevention (ERP) therapy. I know by experience how effective ERP is in treating OCD symptoms.