Three decades of telemedicine in obsessive-compulsive disorder: A review across platforms

Background: The use of telemedicine in obsessive-compulsive disorder (OCD) represents some of the earliest technology-enabled interventions in mental health. A review of telemedicine efficacy data in OCD provides a window into the telemental revolution and informs us on the best-supported technology tools in OCD treatment. Methods: A PubMed database search of efficacy studies was conducted across telemental health platforms-computerized, internet, mobile, and virtual reality based. Results: Eleven randomized controlled trials (RCTs) were identified covering computerized cognitive behavioral therapy (CBT), online CBT and virtual reality exposure therapy. Studies included children, adolescents and adults, and represented various levels of clinician involvement (therapist-free, limited or full), as well as non-therapist support ("coach", technician or parent). Discussion: The best-supported modality represents CBT interventions in mild to moderate OCD, delivered over computerized, online or virtual reality platforms. No controlled data were retrieved on non-CBT psychotherapies, psychopharmacology, or mobile interventions. Overall, the hypothesis that adequate care can be delivered with minimal clinician involvement has motivated much research; while this could increase access and diminish cost, it might turn away some providers and patients. Conclusion: Several platforms as well as psychotherapeutic and psychopharmacological treatments remain untested. Meanwhile, a case can be made for using technology-mediated CBT in mild to moderate OCD, then escalated to interventions with more clinician involvement and a broader evidence base.