An open trial of videoconference-mediated exposure and ritual prevention for obsessive-compulsive disorder Elizabeth M. Goetter a, b, *, James D. Herbert b , Evan M. Forman b , Erica K. Yuen c , J.Graham Thomas d a Massachusetts General Hospital, One Bowdoin Sq., 6th Floor, Boston, MA, USA b Drexel University, 3141 Chestnut St., Philadelphia, PA, USA c University of Tampa, 401 W. Kennedy Blvd., Tampa, FL, USA d Warren Alpert Medical School of Brown University, 196 Richmond St., Providence, RI, USA A R T I C L E I N F O Article history: Received 28 January 2014 Received in revised form 18 March 2014 Accepted 8 May 2014 Available online 17 May 2014 Keywords: Obsessive-compulsive disorder Exposure and ritual prevention Telehealth Telemental health Telepsychology Videoconferencing A B S T R A C T The gold-standard treatment for OCD is exposure and ritual prevention (ERP), yet despite its well- established efficacy, only a small percentage of OCD patients have access to this treatment. Remote treatments (e.g., videoconferencing) are becoming increasingly popular avenues for treatment delivery and show promise in increasing patient access to evidence-based mental health care. The current pilot study utilized an open trial to examine the feasibility and preliminary efficacy of videoconference- mediated, twice weekly, ERP for adults (n = 15) with OCD. Results revealed that ERP was associated with significant improvements in OCD symptoms and large within-group effect sizes. Among the 10 individuals who completed a 3-month follow-up assessment, 30% of participants no longer met DSM-IV- TR criteria for OCD and 80% of participants were rated as very much or much improved on the CGI. This study adds to the growing body of literature suggesting that videoconference-based interventions are viable alternatives to face-to-face treatment. ã 2014 Elsevier Ltd. All rights reserved. 1. Introduction Obsessive-compulsive disorder (OCD), a debilitating disorder characterized by a waxing and waning course, rarely remits without treatment (Franklin & Foa, 2008). Exposure and ritual prevention (ERP) is the first line behavioral intervention for OCD, yet only a very small percentage of OCD patients have access to this treatment (Blanco et al., 2006). Successful delivery of ERP is limited by insufficient graduate- level coursework and supervised clinical experience (Crits- Christoph, Frank, Chambless, Brody, & Karp, 1995), a relative dearth of specialized providers (i.e., a 2010 search of the members of the Association for Behavioral and Cognitive Therapies revealed that only 23% claim expertise in treating OCD), a geographic maldistribution of these providers (i.e., 90% of these providers are located in a metropolitan area), and continued use of non- evidence-based methods for treating OCD (Stobie, Taylor, Quigley, Ewing, & Salkovskis, 2007). Remote interventions demonstrate promise in bridging this significant research-practice gap (Yuen, Goetter, Herbert, & For- man, 2012). Videoconferencing interventions may be superior to other remote interventions (e.g., self-help, telephone-mediated psychotherapy) because they enhance the face-to-face element of therapy and increase patient accountability. Moreover, they offer unique benefits in the treatment of OCD (Goetter et al., 2013). Although two studies applying videoconferencing-based treat- ment to adults with OCD (Himle et al., 2006; Vogel et al., 2012) have been conducted, they had small samples and treatment utilized expensive videoconference equipment. Furthermore, no study to date has examined the efficacy of intensive, twice-weekly ERP via videoconference, which is the traditional mode of delivery. The current pilot study utilized an open trial to examine the feasibility and preliminary efficacy of in-home, videoconference- mediated, state-of-the-art, twice-weekly ERP therapy for adults with OCD. It was hypothesized that videoconferencing treatment of OCD would be rated as acceptable by participants and feasible to deliver by therapists and that OCD symptoms and quality of life would improve from pre- to post-treatment and from pre-treatment to 3-month follow-up. * Corresponding author at: Massachusetts General Hospital, Department of Psychiatry, One Bowdoin Square, 6th Floor, Boston, MA 02114, USA. Tel.: +1 617 643 8981; fax: +1 617 643 0730. E-mail address: egoetter@mgh.harvard.edu (E.M. Goetter). http://dx.doi.org/10.1016/j.janxdis.2014.05.004 0887-6185/ ã 2014 Elsevier Ltd. All rights reserved. Journal of Anxiety Disorders 28 (2014) 460–462 Contents lists available at ScienceDirect Journal of Anxiety Disorders