online ERP therapy, online OCD therapy, online OCD treatment

Online ERP Therapy for OCD: Benefits and Precautions


September 13, 2022 | Reading Time: 2 Minutes

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In a 2021 meta-analysis, Ephrem Fernandez and colleagues reported that telemental health services have numerous benefits for the patient and clients, often providing results that are as promising as face-to-face care. Among patients with Obsessive-Compulsive Disorder (OCD), there is substantial research support for the effectiveness of online OCD treatment like Exposure and Response Prevention therapy (ERP) or online ERP therapy, also known as telehealth ERP.

As with in-person ERP, online ERP gradually exposes the patient to anxiety triggers while asking them to resist compulsive behaviors. With time and repeated exposure, the patient learns that their distress will diminish despite their expectations of adverse events when refraining from engaging in compulsions. Online ERP therapy has provided patients struggling with this debilitating disorder with reduced symptoms and improved quality of life.

Patients and practitioners alike benefit from online ERP therapy. Patients enjoy greater access to treatment through online OCD therapy and greater convenience since they can attend sessions from home or the workplace. Providers benefit from the convenience of delivering online OCD therapy from their devices, and they generally have far fewer patient no-shows. Patients who may otherwise not seek treatment for various reasons, including anxiety associated with leaving their homes or going to a provider’s office, can benefit from online ERP therapy.

In a recent online ERP therapy study investigating perceptions of telehealth among providers,  researcher Ander Weiss and colleagues looked at 113 OCD therapists who rated the feasibility of delivering telehealth ERP relative to in-person for different (1) patient age groups, (2) levels of OCD severity, and (3) provider ability to identify and address factors interfering with ERP during in-person and telehealth ERP (e.g., cognitive avoidance, reassurance seeking, etc.).

Providers reported more feasibility of the model for delivering telehealth ERP to individuals between the ages of 13 to 65 years than when delivering similar services to the other age groups assessed. They also believed that telehealth ERP is more feasible for lower versus higher symptom severity levels. Third, providers felt better able to identify and address problematic factors in-person than online. The study confirms the beliefs that providers have expressed for decades regarding telehealth. Telehealth ERP is expected to be as effective for mild to moderate OCD as in-person ERP treatment protocols. COVID then has been effective at convincing OCD treatment professionals that telehealth can legitimately be used with OCD patients.


At least until more specific OCD telehealth ERP protocols are more thoroughly researched, these findings suggest that some telehealth OCD treatment cautions are appropriate for patients with more severe cases of OCD and when serving children under 13 years old.  

In outlining the study’s limitations, this research team also mentioned a general caution relevant to all telehealth interventions with avoidant behaviors. Namely, particularly with OCD telehealth, the therapy could cause some patients to engage in avoidant behaviors that providers may not be able to see during a telehealth session.

However, so long as providers practicing ERP therapy are aware of such issues brought about by telehealth, they can circumvent most problems that may interfere with delivering the utmost care to their patients. Online therapy remains a sought-after option for many patients seeking mental health treatment. For providers delivering ERP for disorders such as Social Anxiety Disorder and OCD, online ERP therapy has become a method of service delivery that mental health providers are increasingly considering. Providers must maintain ongoing communication with patients to ensure the effectiveness of ERP therapy.

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