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Evidence-supported therapy for obsessive-compulsive disorder (OCD) is often difficult to access, especially in niral and remote areas. Videoconferencing is gaining momentum as a means of improving access. Metacognitive therapy (MCT) has already been found to be effective for OCD when delivered face-to-face. This preliminary study explored whether videoconference-based MCT can be effective for OCD. Three participants completed a brief course of MCT using videoconferencing. Participants experienced clinically significant reductions in OCD symptoms, depression, anxiety, and stress, some of which were maintained after a 6- to 8-week follow-up period. Results suggest that videoconferencing MCT can be effective for OCD. Implications for clinicians are discussed.
* Keywords: Obsessive-compulsive disorder, videoconferencing, metacognitive therapy
Exposure and ritual prevention (ERP) is an efficacious treatment for obsessive compulsive disorder (OCD) with an established evidence base (Eddy, Dutra, Bradley, &. Westen, 2004). ERP uses a habituation paradigm to reduce anxiety associated with stimuli that trigger intrusive thoughts (Franklin & Foa, 2008). Cognitive therapy and cognitive-behavioural therapy (CBT) are based on Salkovskis' ( 1985) cognitive model of OCD and seek to modify distorted appraisals of intrusive thoughts, particularly a sense of inflated responsibility for preventing harm. These appraisals are modified by thought challenging and behavioural experiments (e.g., Whittal, Thordarson, & McLean, 2005). ERP has been found to be slightly more effective than CBT, and is considered the treatment of choice for OCD (McLean et al., 2001; Whittal et al., 2005).
Recovery rates among people treated with ERP are approximately 40-60%, with about 40% of people remaining unchanged in their level of symptomatology (Fisher & Wells, 2005; McLean et al., 2001). Furthermore, only around 25% of people treated with ERP or cognitive therapy are asymptomatic after treatment (Fisher & Wells, 2005). A majority of people who undergo ERP treatment continue to experience symptoms, despite being classified in outcome studies as 'recovered', and full remission of symptoms is extremely uncommon (Stanley & Turner, 1995). Attrition and treatment refusal are problems often encountered in ERP therapy. ERP tends to have higher refusal and drop-out rates in comparison to other types of therapy, because the demands of exposure can make ERP less acceptable to clients than cognitive therapies (Franklin & Foa, 2008; McLean et al., 2001). Drop-out rates for ERP are routinely 20-30% (Fisher &...