Using Technology to Treat OCD...A Good Idea or Not?
For people who are suffering for any reason, the internet can offer ready-made support. Those with OCD, for example, can visit blogs, forums, mental health sites, and individual health care provider sites dedicated to their disorder. Now it seems things have gone one step further. A recent pilot study of the effectiveness of ICBT (Internet Based Cognitive Behavioral Therapy) shows promising results. Twenty-three patients underwent a fifteen week ICBT program "with therapist support consisting of psychoeducation, cognitive restructuring and exposure with response prevention. At post-treatment, 61% of participants had a clinically significant improvement and 43% no longer fulfilled the diagnostic criteria of OCD. The treatment also resulted in statistically significant improvements in self-rated OCD symptoms, general functioning and depression."
OCFighter, based in the United Kingdom, is a CCBT (Computer-aided CBT) program that has been used widely for over six years. While it began as a phone-interactive-voice response program that included a workbook, it is now in the process of being adapted to the internet. Shown to be quite successful in multiple studies, OCFighter has been used in the United Kingdom, United States, and Canada.
The benefits of these ICBT programs are many. In the United Kingdom, where there is a one to two year wait to receive Cognitive Behavioral Therapy, OCFighter has the potential to help OCD sufferers who otherwise might just languish on a waiting list. For those who live in rural areas, have limited financial resources, or want complete privacy, this form of therapy could be a good option. Because ICBT is home-based with 24/7 access, the flexibility it affords decreases the need to deal with scheduling conflicts, babysitters, and travel time. And for those with OCD so severe they cannot leave their homes, ICBT could be a lifesaver.
As is often the case with the internet, one site begets another. There are now apps that you can download to your iPhone to help you beat OCD. One such app is OCD Manager and is touted as "Cognitive Therapy in the Palm of Your Hand." Another is iCounselor: OCD which will help you "learn skills to resist obsessions and compulsions." My guess is there are more out there as well. Both of these apps profess that they are not a substitute for professional help; they aretoolsto assist the OCD sufferer with Exposure Response Prevention Therapy, the Cognitive Behavioral Therapy commonly used in treating OCD.Of course, once ICBT becomes more well-known and widespread, it is likely that there will be many moresites popping up all over the internet. As you would do before seeking any kind of treatment, it is of the utmost importance to check out the credentials of the sites and/or therapists you will be dealing with. The IOCDF is always a good place to start.
I do believe these various types of ICBT have their place in the treatment of OCD. But I have concerns as well. I know when my son Dan was battling severe OCD, he would not have had success with any ICBT programs. In fact, he was often not even able to use his computer or cell phone. I hate the thought of someone with OCD downloading an app, struggling with the program, and then writing off therapy altogether.
While OCFighter does involve a thirty minute screening interview with a therapist (either by phone or face to face) before beginning treatment, and there are ways to seek help from an on-call therapist, the OCD sufferers are, for the most part, on their own. And that, for me, is the biggest negative of ICBT. There are no therapists meeting regularly with clients, nobody actually looking the OCD sufferers in the eye, reading their faces or body language. There is nobody to regularly screen for coexisting conditions, or to talk with, listen to, or support those with OCD.
And so while there is no question there are positive aspects to ICBT, many professionals feel it should only be pursued if face to face therapy is not a realistic option. Because as effective as these ICBT programs may be, the bottom line is that they are not human. They cannot empathize, understand, or care about a person, and when someone is suffering, isn't that what they need the most?