(PS3-D76) Identified Challenges and Innovative Solutions for Implementing Exposure with Response Prevention (ERP) Among Frontline OCD Therapists

Background: Obsessive-Compulsive Disorder (OCD) is a heterogeneous neuropsychiatric disorder that affects ~3% of the population, causes significant impairment, and represents a leading cause of disability worldwide. Despite exposure with response prevention (ERP) serving as the recommended frontline treatment, several challenges exist when implementing ERP in clinical practice (e.g., access to exposure stimuli). To better understand these challenges, OCD therapists were surveyed about the difficulties they experienced when implementing ERP for patients with OCD in everyday clinical practice.  

Methods: Therapists who specialize in OCD treatment were surveyed about their experiences providing ERP to patients with OCD in clinical practice. The survey was administered via Qualtrics between September 2021 and November 2021. Survey items inquired about therapists’ level of experience, evidence-based therapeutic approaches, and challenges implementing ERP approaches for common OCD symptoms.  

Results: Respondents included 249 professional OCD therapists, who were predominantly female (70.7%) and White (91.5%). Therapists had an average of 7-10 years of experience, with 37.1% treating more than over 100 OCD cases. Therapists identified that: (1) contamination obsessions and compulsions (2) harm-related obsessions, (3) checking/doubt-related compulsions, and (4) reassurance seeking behaviors were the most common OCD symptoms for which ERP was used. When asked about OCD symptoms for which ERP was challenging to implement in clinical practice, respondents endorsed: (1) saving / hoarding obsessions and compulsions, (2) checking/doubt-related obsessions and compulsions, and (3) sexual obsessions. Beyond difficulty conducting ERP for these specific OCD symptoms, common challenges with implementing ERP included patient motivation and patient compliance. Therapists (84.6%) expressed interest in solutions such as digital mental health apps (DHMAs) and virtual reality (VR) to overcome challenges with ERP implementation for OCD.  

Discussion: Although ERP is the recommended frontline treatment for OCD, experienced OCD therapists can still have difficulty implementing ERP for specific OCD symptoms. There is an identified need and interest for solutions to improve the implementation of ERP in clinical practice for OCD. While VR and DHMAs are promising solutions, further research is needed to test these innovative tools before widespread adoption and implementation among OCD therapists.