The Advantages of Video Therapy for OCD
Jonah Lakin PsyD
Our decision to make the OCD & Anxiety Center of Cleveland a completely virtual clinic happened somewhat organically. We’ve been offering virtual sessions since we opened in 2018. We know there are clinical benefits to virtual therapy, and many clients expressed that they preferred this modality. Nonetheless, many people believe that video therapy is less effective than face-to-face treatment. This is often because there is a sense that it feels less personal to meet via video, and therefore it will be harder to open up and connect with another person. While it’s true that the platform is different, it’s often the case that virtual therapy is significantly more effective when it comes to treating OCD and anxiety disorders. This is because you can do your exposures in the settings where you’re experiencing fear. Consider a few examples:
A client with Contamination OCD who can’t touch the doorknob to their house without washing, can actually practice touching that doorknob and not washing in session with the support of their therapist.
A client with Harm OCD who is afraid to go anywhere near their knives can actually pick up their own knives from their kitchen in session with the support of their therapist.
A client who is afraid to drive over bridges can actually drive over a bridge while on speaker phone in session with the support of their therapist.
A client who has to make their bed a certain way, or step on a tile a certain way, can practice doing these things differently in session with the support of their therapist.
A client whose terrified of getting shots can actually carry their provider (virtually) into the doctor’s appointment with them to get their shot.
It would be a mistake to consider these benefits small; these are huge advantages of virtual treatment! I have completed exposures just like this with many clients over the years, and we did them far before anyone had ever heard of COVID-19.
You may wonder, why is it so important to do these things in session? The reason is simple: they are very unlikely to get done out of session. This makes sense, because OCD and anxiety disorders always involve a prolonged pattern of avoidance. Clients often struggle to show up to therapy and suddenly stop avoiding everything that causes them intense fear. Doing exposures with the therapist is a great way to ensure exposures get done (rather than just planned). And since anxiety and obsessions happen to clients in the real world, therapy should take place in the real world - not the therapist’s office.
But what if virtual treatment just doesn’t feel right to me?
Another barrier to virtual treatment is simply that it’s new and different, and so many are naturally reluctant to give it a try. This has an intuitive appeal to it; one might think “therapy has always been in person. Maybe it could work virtually, but why mess with it?” Or, “Maybe it really does work for most people, but it wouldn’t work for me.”
I’d like to offer a little data that may help people rethink this. When people initially reach out to the OCD & Anxiety Center of Cleveland, about 50% of them decline virtual visits fully. About another 25% say they are willing to try it, but would prefer in-person sessions as soon as possible. So, in total, about 75% of people we speak to have reservations about virtual treatments. In contrast, during the height of the pandemic our work was 100% virtual. At one point it seemed that the pandemic was ending, (cases dropped dramatically, deaths were down and it was summer so people were outside a lot more—this was right before the Delta variant appeared), and we offered every single existing client the opportunity to come back to the office for in-person visits. 100% of them declined. Many of those clients were seen in person before the pandemic, but after trying virtual visits, nobody had reservations about them. In addition to the obvious exposure benefits, most people said they’d prefer not to have to deal with driving and parking, and that the virtual visits were working great! This feedback from our clients was a major factor in our decision to take the practice completely virtual. Over time, we started to realize that an office just isn’t very useful to our work.
Lastly, we often hear from clients that they tried virtual treatments in the past and “they don’t work for me.” This is almost always a case of the specific treatment not working, rather than the virtual format being the problem. If you have OCD or anxiety and you went to therapy that did not involve systematic exposure tasks every single session, then it’s not surprising to learn that you didn’t improve. It doesn’t matter if that was virtual or in person. The problem was the treatment, not the format.
Is there ever a situation in which virtual is not more effective?
Yes; if a person doesn’t have a reliable internet connection or cannot find a private space in their home for the sessions, then being in a private office face-to-face with a therapist would be preferable. In such a situation, we’d be happy to provide a referral to a provider who can provide face-to-face treatment.