A pilot open trial of video telehealth-delivered exposure and response prevention for obsessive-compulsive disorder in rural Veterans

Terri L Fletcher; Derrecka M Boykin; Ashley Helm; Darius B Dawson; Anthony H Ecker; Jessica Freshour; Ellen Teng; Jan Lindsay; Natalie E Hundt

doi:10.1080/08995605.2021.1970983

A pilot open trial of video telehealth-delivered exposure and response prevention for obsessive-compulsive disorder in rural Veterans

Mil Psychol. 2021 Oct 28;34(1):83-90. doi: 10.1080/08995605.2021.1970983. eCollection 2022.

Authors

Terri L Fletcher^{1

2

3}, Derrecka M Boykin^{1

2

3}, Ashley Helm^{1

3}, Darius B Dawson^{1

2

3}, Anthony H Ecker^{1

2

3}, Jessica Freshour⁴, Ellen Teng^{2

4}, Jan Lindsay^{1

2

3}, Natalie E Hundt^{1

2

3}

Affiliations

¹ VA HSR&D Houston Center of Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas.
² Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.
³ VA South Central Mental Illness Research, Education and Clinical Center, Houston, Texas.
⁴ Mental Health Care Line, Michael E. DeBakey VA Medical Center, Houston, Texas.

Abstract

Exposure and response prevention (ERP) is the gold-standard, evidence-based psychotherapy for obsessive-compulsive disorder (OCD), but few receive it. Video telehealth can increase access to ERP for OCD and may enhance the salience of exposures. This study examined the feasibility, acceptability, and preliminary effectiveness of video telehealth-delivered ERP. We conducted a pilot open trial with 11 Veterans, using mixed quantitative and qualitative methods. Treatment completers (n = 9) had significantly reduced OCD and posttraumatic stress disorder symptoms posttreatment. Patients expressed greater comfort in engaging in ERP at home than in clinics. Therapists reported that seeing patients' home environments helped them understand their symptoms and identify relevant OCD exposures. Results suggest that video telehealth-delivered ERP is feasible and acceptable to patients and therapists and promising for reducing OCD symptoms. Future research should compare its effectiveness to usual care and evaluate patients' preferences for treatment delivery. Abbreviations: ERP: exposure and response prevention; GAD-7: Generalized Anxiety Disorder-7 scale; OCD: obsessive-compulsive disorder; OCI-R: Obsessive-Compulsive Inventory, Revised; PCL-5: PTSD Checklist; PHQ-9: Patient Health Questionnaire; PTSD: posttraumatic stress disorder; VA: epartment of Veterans Affairs; Y-BOCS: Yale-Brown Obsessive Compulsive Scale, self report form.

Keywords: OCD; Veterans; exposure and response prevention; pilot trial; video telehealth.

Grants and funding

This research was supported by a South Central MIRECC Pilot grant awarded to the first and last author and an HSR&D Career Development Award (CDA 13-264) given to the last author and partially supported by the VA HSR&D Houston Center for Innovations in Quality, Effectiveness and Safety (CIN# 13-413), Michael E. DeBakey VA Medical Center, Houston, Tx. The views expressed reflect those of the authors and not necessarily the policy or position of the Department of Veterans Affairs, the US government, or Baylor College of Medicine. None of these bodies played a role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication;South Central Mental Illness Research, Education and Clinical Center [Pilot Grant];U.S. Department of Veterans Affairs [CDA 13-264].