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

Table 1 Videoconferencing-delivered exposure and response prevention for obsessive-compulsive disorder

Modules	Description
Diagnostic evaluation	ICD-10 diagnosis of OCD established by detailed evaluation
Management plan	Pharmacological and psychosocial interventions for treatment
Brief psychoeducation	1-2 sessions explaining OCD and its treatment. Agreement on medication and ERP treatment between patients, family members, and therapists
Scale-based evaluations	YBOCS screen for OC symptoms not reported initially. YBOCS rating of the severity of OCD
Functional analysis	Structured behavioral analysis following the “ABC” paradigm[44]
Pre-treatment symptom tracking	1-2 weeks of daily record of symptoms in structured formats by patients and family members. Exchanged with the clinician using Google sheets or WhatsApp text messages
Hierarchy of symptoms	Ascending hierarchy of symptoms/situations rated on a 0%-100% scale of subjective distress; jointly constructed by patients, family members, and therapists.
ERP constituents	Detailed psychoeducation, symptom tracking within and between ERP sessions, anxiety management (Benson’s Relaxation Training[45], exposure sessions, post-session processing
	Post-session processing includes discussions about patients’ and family members’ experience of ERP, learning about ERP, reality of the patient’s obsessions, neutralizing strategies, and adaptive coping
VC-delivered sessions	All sessions at home are attended by patients and family members and supervised by therapists. Minimum duration 30 minutes. Average 1 session every 7-14 days. Patients are actively engaged by therapists during sessions to avoid unnecessary interruptions or distractions. Patients are carefully monitored during the sessions for obsessional thoughts, compulsions, or neutralizing acts. Additional advice by phone calls or WhatsApp text messages
Homework assignments	Daily exposure sessions supervised by the family member who was chosen by the patient as a co-therapist
Hybrid treatment	Combination of VC and in-person sessions. Alternative modes of communication were used to minimize disruptions when the VC connection failed
Preventing relapse	Regular VC follow-ups, further education, and booster sessions of ERP if required
Supervision	VC groups for training and regular supervision of therapist carrying out ERP

ICD-10: International Classification of Diseases, 10^th version criteria; OCD: Obsessive-compulsive disorder; YBOCS: Yale-Brown Obsessive-Compulsive Scale; OC: Obsessive-compulsive; ABC: Antecedents, behaviour, consequences; ERP: Exposure and response prevention; VC: Videoconferencing.