Videoconferencing-delivered psychotherapy for obsessive-compulsive disorder in low-resource settings: A pilot study from India

World J Psychiatry. 2026 Feb 19;16(2):111577. doi: 10.5498/wjp.v16.i2.111577. eCollection 2026 Feb 19.

ABSTRACT

BACKGROUND: Psychological treatments such as exposure and response prevention (ERP) or cognitive behavioral therapy are effective in obsessive-compulsive disorder (OCD), either on their own or in combination with medications. However, very few patients receive ERP or cognitive behavioral therapy. Digital-delivered psychotherapy can surmount many obstacles associated with conventional psychotherapy, but there are very few trials of videoconferencing (VC) delivered ERP for OCD, particularly from low-resource settings.

AIM: To examine the VC-delivered ERP’s feasibility, acceptability, efficacy, and long-term outcomes and compare its efficacy with inpatient ERP.

METHODS: This study compared VC ERP’s pre- and post-intervention efficacy (n = 20) with a matched group of patients who had undergone inpatient ERP (n = 17). The Yale-Brown Obsessive-Compulsive Scale (YBOCS) scores rated the efficacy of ERP. The feasibility outcomes for VC-delivered ERP included the operational capacity, treatment utilization, treatment engagement, use of other services, and adverse events. Treatment satisfaction and preferences among users determined acceptability. Long-term follow-up determined whether patients were in remission based on the YBOCS scores and other criteria.

RESULTS: The sample had 97 patients with OCD. The patients had severe (YBOCS score 27) and chronic (6 years) OCD with psychiatric comorbidity (51%). The refusal rate for VC-ERP was 11%, and the dropout rate was 19%. VC-ERP failed in 29% with treatment-resistant OCD. The 20 patients who completed VC-ERP had 85% reductions in the YBOCS scores and recovered completely. The two groups did not differ in the change in YBOCS scores with the treatment. Gains from VC-ERP persisted for more than 2 years. The VC platform could deliver ERP despite the fluctuating network connectivity and variable patient motivation. The VC treatment improved access to ERP for many more patients. Users found VC-ERP acceptable and appreciated its advantages over inpatient ERP.

CONCLUSION: Despite its methodological limitations, this study suggests that VC-delivered ERP is feasible, acceptable, and as efficacious as in-person ERP for OCD in the resource-constrained settings of low- and middle-income countries.

PMID:41641218 | PMC:PMC12865426 | DOI:10.5498/wjp.v16.i2.111577