Why Virtual Therapy Can Be As Effective As, Or Even More Effective Than, In-person Treatment For OCD
About two years ago, before COVID, there was some doubt about the clinical efficacy of virtual therapy services. While there were studies that showed that virtual therapy was a viable treatment option, and that results in virtual therapy were equivalent to results for in-person treatment, there were also concerns about the actual translation of treatment to virtual settings (i.e., how do we actually do it?).
My first experience with teletherapy was when I was in my postdoctoral fellowship. I was in St. Louis and there was a clinic in rural Missouri that had no access to psychiatrists. To provide that access, a special phone line was installed (I believe they called it a T1 line) to link to the psychiatrists in St. Louis and there was a very expensive setup with large cameras and bulky televisions. An entire room was needed for this experience and the equipment was not mobile.
While an experience like this was available in some clinics for a very large investment, until the last two years, almost no therapist training program focused on virtual treatment, and I would estimate that over 95% of therapists received only in-person session training. Due to this, most therapists also assumed that in-person treatment was the only way to actually do therapy.
Now that virtual therapy is more readily available, it’s becoming clear that it’s not only helping make much-needed treatment more accessible, but also that it’s just as effective – and in my experience, sometimes more effective – than in-person treatment. This is certainly true for people struggling with Obsessive-Compulsive Disorder (OCD).
While general talk therapy can be helpful for many different problems, it can be harmful for people with OCD, where specialized care is needed. Unfortunately, specialized care for individuals with OCD has almost always been accessible to people only in big cities, which left out a lot of the people in need of this treatment—that is, until virtual therapy began to become widely available.
With more people able to receive treatment, many clinicians are realizing the biggest benefit of virtual therapy for OCD is that it allows people to get care in the places that trigger them the most. Sessions done online allow a therapist to work with their members in the settings and situations where their triggers are most likely present—and where obsessions or compulsions are most likely to occur—which means that they can receive treatment that is more tailored to their needs.
How is OCD treated virtually?
OCD is the occurrence of obsessions—thoughts, images, or urges that one may find to be disgusting, unacceptable, shameful, guilt-ridden, or anxiety-provoking. To neutralize these obsessions, people with OCD will do compulsions—physical or mental acts—as an attempt to rid their minds of the thoughts, images, or urges. Compulsions work for a slight period of time, and then the obsessions creep back in, and the process starts all over again.
To treat OCD, we use exposure and response prevention (ERP) therapy, where we purposely expose people to their obsessions and teach them to live with them without doing compulsions to neutralize them. The therapy can be difficult, but is life-changing for people who do it.
Let’s say a person with OCD has a fear of leaving their stove on. They may continuously check their stove throughout the day to feel assured that it is off. This may take up a significant amount of time in their day, and the doubt and resulting distress may never fully dissipate when OCD is left untreated.
ERP would allow them to begin to face their fears. However, a live, virtual ERP session can make the treatment even more powerful in situations like this, as it allows me to work with them directly in the environment triggering their obsessions: their home kitchen. I can ask them to turn the stove on, then turn it off, and then walk away from it without checking it again for the rest of the session. That allows me to help them address their specific fears and concerns during the session, and I can teach them to live with the discomfort and doubt instead of going back, again and again, to see if the stove is on or off. For homework, I would instruct the member to continue to stay away from checking the stove and only go to use it when it was needed, not when OCD wanted it to be checked. They could begin working on the assignment right away.
Being in a person’s environment, instead of having them come into mine, has allowed them to face so many more of their fears than they ever could in my office. While I could do ERP in my office with people, it was never as good as I have experienced when people are doing ERP with their fears and obsessions in their own environment.
Working in a member’s environment might lead to stronger outcomes and better care in some cases
Due to virtual therapy, sessions can be done in your own home, office, or even out in your community—wherever your fears or obsessions are most likely to be triggered. Not only does this open up the option of getting the right care for more people, but doing treatment in your own environment with a therapist allows for the best coaching experience possible, especially for people with OCD.
Our therapists at NOCD have also found that working with members in their own environments can sometimes help members make more significant progress. They offer valuable insight into how virtual OCD therapy has strengthened the care they can provide as clinicians, and how it can lead to better results for their members:
“As a clinician at NOCD, it has been a great asset to be able to conduct ERP in the member’s setting. Rather than being in an office where clinicians need to find ways to creatively replicate triggers, virtual sessions allow the member to go directly to their trigger to complete exposure work. Members are then able to expose themselves to the triggers that are causing impairment in their day-to-day functioning. They can then increase their confidence in being able to approach these triggers on a daily basis, and continue with the homework practice from that setting.
In addition, members are able to enter a variety of public spaces to conduct the exposure work as needed, rather than relying on imaginal approaches that may need to be used when the trigger cannot be replicated in an office.”
“Simply put, teletherapy allows people to receive effective treatment in real-life situations that cannot be replicated through traditional in-person therapy, whether in an outpatient office or any other clinical setting. Having an ERP specialist available through teletherapy provides an added layer of support and direction that gives the member the distinct advantage of proving to themselves that they can learn how to resist their compulsive urges, tolerate their discomfort, and successfully manage their OCD symptoms in any real-life environment at any time, regardless of the circumstances. As a result, I have found that many individuals with OCD who participate in ERP via teletherapy tend to report progress in treatment much more quickly than they might have otherwise.”
“Being in the person’s home makes treatment more fruitful. When I worked at an in-person clinic, people would have to bring their belongings from home to do exposures, or would need to do most exposures off-site without their therapist. I feel that working with someone in the place where OCD is most likely to ‘reside’ makes the treatment more potent.
Overall, providing teletherapy has been really rewarding and makes me think of how much more accessible treatment is for our members. I’ve worked with people who were 3 hours away from the nearest OCD specialist’s office, and are now able to meet with someone right in their home.”
Tracie Zinman-Ibrahim, LMFT, CST
“I have been doing telehealth counseling for the past 8 years and found it to have benefits over in-person counseling on multiple levels. Telehealth allows a therapist and their member to take therapy outside of the traditional office setting, opening up a wide array of opportunities for treating OCD in the member’s environment. Overall, I have had greater success in building exposures we can do together that are highly effective and motivating to complete.”
“Having done ERP therapy predominantly in person for over a decade, I was admittedly skeptical about whether doing ERP virtually would be as good as the ‘real’ thing. But having now seen how well ERP works virtually over the last year, I can safely say it is truly as good as ERP in-person. In fact, there might even be a few advantages.
Doing ERP virtually allows the member and therapist to ‘take ERP where it needs to go.’ I have seen personally that doing ERP sessions via telehealth allows my members to accomplish tasks that previously would have been impossible in a traditional in-person format. And, because OCD so often involves the people that are close to the afflicted person, doing ERP virtually allows us to include these people in our sessions in a very meaningful way, which may not always happen in an office setting.”
“Teletherapy allows therapists to deliver the best possible care. An online platform allows for people across the globe to receive life-changing treatment, even in areas where there is little or no ERP specialist availability. And people with severe OCD can access treatment even if they are struggling with symptoms that cause them to be homebound or have difficulty arriving at in-person appointments on time.
NOCD, in particular, gives members a direct line to their therapists—between sessions, therapists can update ERP assignments, share resources and materials for exposures, and provide daily messaging support.”
Kellie Kintz, LCSW, ICSW, LICSW
“When I first began working with a young member whom I’ll call Joey, his mother lamented the ‘8 years of chaos in our house and in Joey’s life due to OCD.’ But both parents admitted that work schedules, after-school events, long commutes, and sheer exhaustion prevented them from seeking in-person help for him for years. Teletherapy provided them with an opportunity to get help not only for Joey, but for their entire family. The acceleration in rapport building, relationship building, and quality-of-life assessment that telehealth offers contributed to greater awareness than an in-office visit ever could, which helped me to better understand their needs.
Fast forward to today: both Joey and his family members participate in treatment via telehealth, as they acknowledge that they each play a role in Joey’s journey. They feel a sense of comfort sharing their deepest fears while knowing that each of their family members is included and feels seen, heard, and validated.
Through NOCD, Joey and his family members have changed the trajectory of their lives, all while sitting at a small wooden table from the comfort of their own home. I humbly share this as an example of the immeasurable impact of telehealth.”
How to begin virtual OCD treatment
The amazing gift of technology has allowed people to have access to specialists no matter where they live. As long as there is an internet connection, there is an opportunity to speak to a specialist who can help someone get through their most difficult times.
If you or someone you know is dealing with OCD, NOCD can help. Through NOCD, anyone can access convenient, effective, and affordable treatment for OCD virtually, both inside and outside the U.S. 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. We also accept many insurance plans to help make treatment more affordable.
To learn more about working with a licensed, specialty-trained NOCD therapist, book 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 Therapy, LMHC
I've been a licensed counselor since 2013, having run my private practice with a steady influx of OCD cases for several years. Out of all the approaches to OCD treatment that I've used, I find Exposure and Response Prevention (ERP) therapy to be the most effective. ERP goes beyond other methods and tackles the problem head-on. By using ERP in our sessions, you can look forward to better days ahead.