Why Online ERP Therapy Works for OCD and Anxiety - Real Results from the Comfort of Home
When I first started my job almost 4 years ago at a virtual OCD and Complex Anxiety Partial Hospitalization and Intensive Outpatient program, I remember being asked with skepticism, “Is therapy online really effective?” and “Do people really want therapy online?”
These questions were—and still are—really fair! Online therapy, or Telehealth, is still relatively new to the mental health field. It is actually one of the few benefits that have emerged from COVID-19.
If you are curious or skeptical about the benefits of online therapy for OCD and anxiety, you’re in the right place. After nearly four years of providing Exposure and Response Prevention (ERP) therapy virtually, I’ve seen firsthand how powerful and effective it can be.
What exactly is Online Therapy?
COVID-19 changed the mental health landscape almost overnight. Along with a rise in anxiety - especially health and contamination-related anxiety - came an abrupt loss of access to in-person care.
This led to online therapy being a viable and effective treatment option for many. It was so effective during the pandemic that Telehealth is now a permanent, evidence-based part of mental health care. Online Therapy, born out of necessity, is conducted remotely through HIPAA-compliant video platforms, ensuring privacy and security.
Virtual therapy enables individuals to connect with trained therapists from anywhere within their state. It is accessible, flexible, and often removes the barriers that keep people from starting or maintaining treatment, especially for people with OCD and anxiety disorders.
Potential Barriers to In-Person Therapy
When most people think of therapy, they imagine meeting a therapist in a cozy, professional office space. And while in-person therapy remains an excellent option, it’s not always accessible or practical for everyone, especially those managing OCD or anxiety disorders.
Here are a few common barriers that can make it hard to book an appointment or attend in-person sessions consistently:
Finding time in your busy schedule
Let’s be real, it can be challenging to find the time to set aside for therapy. Maybe you’re a busy parent who is managing multiple schedules, maybe you’re working multiple jobs, or working a demanding job with little flexibility. Whatever the case, it can often be hard to step away for a 50-minute session plus travel time. This can be especially true for OCD and anxiety, where avoidance is a primary coping strategy. Avoidance can often be sneaky and sound reasonable: “There is no way I can get away for therapy, there is no time!” This can lead to a delay in scheduling appointments or frequent cancellations.
The stress of travel
Travel can be stressful for anyone, especially if you are in a rural area and need to commute a long distance to see an ERP specialist. Other potential stressors related to traveling for therapy are considering taking public transportation or driving in general. Many people with OCD and Complex anxiety have driving-related anxiety, which can significantly hinder their ability to make it to their therapy appointments as planned consistently.
Walking into the unknown
Being in a new environment, even a therapist's office or waiting room, can be intimidating. There can be fears of “what if someone I know sees me?” or feeling a sense of general discomfort being in a new space and meeting a new person. If you struggle with contamination OCD, this can be particularly difficult, having thoughts such as “what if the space isn’t clean enough and I get sick?”
Challenge of creating effective exposures in the office
While in-person ERP therapy is effective, and one study shows it may be more effective for severe cases of OCD, there can be barriers to creating effective exposures in an office. Exposures in an office need to recreate triggering events to be effective. For example, if someone struggles with contamination OCD, the therapist would simulate an exposure where the client touches something they view as “dirty,” like a doorknob, and resists their compulsion, like handwashing or sanitizing. These exposures, although helpful, may not fully replicate the intensity of the client’s triggers and response to them in their typical environments, such as their home or workplace.
Benefits of Online Therapy for OCD/Anxiety
If you are like many who struggle to attend therapy appointments consistently or even to get started with therapy, you are not alone! OCD and anxiety often make avoidance feel justified. Seeking support can be an intimidating process, and it is a big step to take. Combine that with the barriers above, and it can feel downright impossible. That’s where online therapy can be a great tool and a helpful starting point for your therapy journey.
Therapy that fits your schedule and needs
Virtual therapy increases accessibility in two ways. First, you can join from anywhere in the state where your therapist is licensed, as long as you participate from a confidential space. This is especially important for those living in rural areas who need to see an ERP specialist. Second, online therapy eliminates travel time and potential costs associated with travel.
Online therapy requires no commute, no travel, and allows you to meet with your therapist during a lunch break at work, when you are between errands, or during any 50-minute block of time that fits your schedule.
Comfort of your own environment
ERP therapy can be intimidating to get started with. It is inherently uncomfortable because you will learn to approach stressors that trigger unwanted intrusive thoughts without engaging in compulsions to neutralize the thoughts and cope with anxiety. All of this is an essential part of the treatment to learn to tolerate uncertainty and cope with anxiety. Being in the comfort of your own environment can help alleviate this anxiety and create a better sense of felt safety.
Feeling safe and connected to your therapist is an essential part of treatment with any therapeutic technique, and it is especially important with ERP. Feeling safe and connected can help increase your willingness to do the exposures you and your therapist discuss and plan together. Safety and trust can be established in person, and the added comfort of attending therapy from the convenience of your own home is a unique benefit of online therapy.
Exposures where you need them most
Your home and work environments are often where your obsessions and compulsions occur most frequently, and it is also where most of your distress is felt and functioning is impaired. These environments are where you really need support. Online ERP therapy, with a trained specialist, offers that support. Research with 3,552 adults with a primary OCD diagnosis demonstrated that virtual ERP therapy was “effective in reducing obsessive-compulsive and comorbid symptoms and improved quality of life.”
As a virtual ERP therapist, I am trained to support you in identifying your triggers for obsessions and compulsions, understanding what fears underlie them, and collaborating with you in planning gradual exposures, which I call “doable challenges,” to begin to learn to tolerate the discomfort and uncertainty they bring without engaging in the compulsive behavior that has developed as a safety behavior. After the preparation is complete for exposures, I support you in completing a planned exposure in session within the natural environment where the challenging thoughts and behaviors occur.
Increased confidence in your capabilities
I always say that anxiety does two things: it overestimates the danger of a situation and it underestimates your capabilities to cope with hard things. As you progress in exposures in your own environment, with the support of your therapist and as homework, you will most likely notice an increased confidence in yourself to tolerate and handle discomfort. You realize: I can handle this.
My hope and goal for my clients is that they ultimately feel empowered through the process of completing exposures in their own homes, and begin to learn to think like an exposure therapist, so that they can start doing exposures on their own with confidence.
Final Thoughts: Is Online ERP Therapy Right for You?
In many cases, both experience and research confirm that exposure therapy from home is an effective treatment option. While in-person therapy remains ideal for some, especially for complex exposures or when technology is limited, virtual ERP therapy for OCD and complex anxiety is a flexible, evidence-based, and empowering alternative for many.
The benefits of Telehealth can remove barriers that have previously made access to consistent treatment challenging. Virtual therapy saves time, works with your schedule, and helps you access ERP specialists without traveling long distances. It can also provide a sense of felt safety and comfort by allowing you to attend from the comfort of your own home. Exposure therapy from the comfort of your own home has the added benefit of participating in planned exposures in the environment where you need them most - your own home.
If these benefits of virtual ERP therapy resonate with you, I’d love to help. I offer a complimentary 30-minute consultation to discuss your needs, symptoms, and goals, to ensure that virtual care is the right fit for you.