How Does Online ERP Work? What to Expect From Telehealth for OCD
TL; DR
Online ERP for OCD is just as effective as in-person treatment. In some ways, it has a distinct advantage, since exposures happen in the client's actual environment where real triggers live. Sessions follow the same structure as traditional therapy, with check-ins, exposure planning, and between-session practice assignments. That said, virtual OCD therapy isn't the right fit for everyone. Clients who need a higher level of care due to severe symptom interference, lack of private technology access, or significant safety concerns may be better served by in-person or intensive treatment options. For everyone else, telehealth offers a flexible, evidence-based path to OCD recovery worth considering.
The Rise of Telehealth for OCD Treatment
Ever since the COVID-19 pandemic hit, virtual medical and mental health care have blown up. The need for social distancing led to a boom in the development and use of telehealth software and services. While many people went back to receive their healthcare in person, many others found that telehealth allowed them to more flexibly get their needs met while balancing work, family obligations, and fun! This includes folks with obsessive-compulsive disorder (OCD).
Wider availability of virtual therapy for mental health also allowed therapists to be able to serve clients in areas with few mental health resources, especially when there is a need for specialty care (like with OCD). It has helped folks with busy jobs or who have caretaking responsibilities who can’t commute to the therapist's office and be away for over an hour. It also allows access for people who have challenges driving or who can’t get around easily to receive care.
It’s important to recognize that just because something is convenient doesn’t mean it is effective or recommended. Potential clients may have questions about whether online therapy can actually work for OCD, or what exposure and response prevention (ERP) looks like when done while the client is at home instead of in the therapist's office. The truth is, there are some clients who wouldn’t be a good fit for virtual therapy, and that’s ok. My goal is to help answer some of those questions.
Does Online Therapy Work as Well As In-Person?
As someone who values science, I had the same question before opening a virtual practice. Studies have shown that telehealth-delivered ERP for OCD improves symptoms and is as efficacious as in-person services. This is true not just for OCD, but also for other affective disorders such as depression and anxiety disorders, especially when the treatment being used is cognitive-behavioral therapy (CBT). Long story short, online therapy for OCD works just as well as in-person treatment. There are even some advantages to a person being at home while receiving treatment. For example, I can do an exposure session while the client is in their home, where many of their usual triggers are. This can allow for exposures that feel more “real” vs feeling “contrived” at times in the therapy office.
What Does a Telehealth Exposure Session Look Like?
At Leap Counseling, I use SimplePractice as my HIPAA-compliant videoconferencing software. Once a session is scheduled, SimplePractice sends email reminders with a link to the client portal. If the client chooses, they may download the SimplePractice app and join the sessions easily on their smartphone. Once the client requests to join the session and it is time to start, I can allow them to join, and we get started!
The actual structure of the session is very similar to that of an in-person session. I start by checking in with the client about their week and what their symptoms have been like. We then review assignments that were completed between sessions and problem-solve if necessary. Next, we will agree upon the next exposure to complete and plan for it. The client then completes the exposure in session, and I offer any guidance as needed. We process the exposure and what the client learned. Before ending, we agree on what the client will practice before the next session.
How Do Therapists Guide Exposures Virtually?
The short answer is that we do it the same way that it’s done in-person. There is usually nothing too different from when I am in the room with the patient compared to online. In person, I would be using observation of the client’s behaviors, most of which I can observe via video, and I would be talking to offer guidance, challenges, or validation.
Of course, there are some exposures that could not be done virtually. For example, I could not physically help with exposures around fear of harming others because I cannot create a situation where the client could physically harm me. On the flip side of that, there are so many exposures that can be done when a person is in their daily environment that can’t be replicated well in the therapy office. Some examples are:
Petting the client’s own dog
Changing their child’s diaper
Holding a knife while their loved one is present (given there is a release of information for the loved one)
Contaminating surfaces of their home that they and their loved ones will touch
Creating “hazards” in the home, such as putting an object on the ground that someone could trip over
How Do I Know if Virtual ERP is Not Appropriate For Me?
There are a few reasons why online therapy for OCD may not be a good fit for some adult clients:
Level of functioning.
OCD is too severe for a weekly, outpatient level of care. The severity of symptoms themselves does not always mean that virtual therapy isn’t recommended. However, if a person is no longer able to function at work or at home, they may need a higher “dose” of treatment than 1-2 hours each week. Some people require a higher level of care, such as intensive outpatient (a few hours 3-5 days a week), partial hospitalization (around 5 hours 5 days a week), or even residential treatment (living in a facility for a few months for daily treatment and support). Sometimes it can be helpful to try weekly sessions first, and if progress isn’t being made, a higher level of care may be recommended.
Private technology access.
To participate in telehealth therapy, clients need:
A smartphone or computer with a camera and a microphone
Stable internet connection
A private room where they can be undisturbed
Sufficient technological literacy to independently navigate a computer or smartphone in order to join the sessions
If clients do not have access to these resources, in-person therapy may be necessary.
Significant safety concerns.
If a client is regularly experiencing crises, is at high risk of suicide or suicidal behavior, or engages in significant, severe self-harm behaviors, online therapy is generally not recommended.
The client prefers in-person therapy.
If the client prefers in-person therapy, that’s what they should look for. It’s important for the client to feel comfortable and engaged in sessions. Unless there is a reason that they can’t do in-person therapy, they should follow their heart, so to speak. Client preferences matter too!
Weighing the Pros and Cons
Online therapy for OCD and anxiety has many benefits, but it may not be appropriate for every client. If you’re not sure but want to try telehealth treatment for OCD, reach out to a virtual therapist. When the therapist does their assessment, you and they can decide together if online therapy is the right fit for you. You can also reach out today to set up a free 15-minute consultation with Dr. Wood to ask any burning questions you might have about this form of treatment.
Ready to Try Online OCD Therapy? Here's How to Get Started in Wauwatosa, WI, & PSYPACT States
If you've been putting off OCD treatment because of a busy schedule, limited local resources, or uncertainty about whether virtual therapy could actually work, this is your sign to find out. Online ERP is evidence-based, effective, and designed to meet you exactly where you are, in the environment where your OCD actually shows up.
Leap Counseling and Consultation is a Wisconsin-based solo therapy practice led by Dr. Johanna Wood, who specializes in OCD and anxiety disorders and delivers treatment entirely online. Dr. Wood provides personalized, evidence-based ERP that takes full advantage of the virtual format, including real-world exposures in your own home, on your own terms. Getting started is straightforward:
Reach out to schedule a free 15-minute consultation to find out if virtual ERP is the right fit for you
Meet one-on-one with an experienced online OCD therapist in Wauwatosa, WI
Begin tackling OCD with evidence-based ERP from the comfort and convenience of your own space
Other Online Services Leap Counseling Offers From Wauwatosa, Wisconsin
Online ERP gives you access to effective, specialized OCD treatment without the commute, the scheduling gymnastics, or the need to live near a therapist who truly understands OCD. For many people, that access alone is the thing that finally makes treatment possible, and the results speak for themselves.
OCD treatment is the cornerstone of my Wisconsin-based online therapy practice, but it's far from the only thing I work with. If anxiety is showing up in other areas of your life alongside OCD, those concerns are just as worth addressing. I provide online therapy for a range of anxiety disorders, including Panic Disorder, Agoraphobia, Generalized Anxiety Disorder, Social Anxiety Disorder, and Phobias. As a licensed psychologist in Wisconsin and all PSYPACT states, I'm able to work with clients virtually across many locations, bringing specialized care to people who might not otherwise have access to it.
Whether you're dealing with OCD, another anxiety disorder, or a combination of both, effective treatment doesn't have to feel out of reach. Browse my mental health blog to learn more about online OCD and anxiety treatment, and reach out whenever you're ready to get started.
About the Author
Dr. Johanna Wood is a Wisconsin-based clinical psychologist specializing in evidence-based, virtual OCD treatment, including ERP. She earned her PhD in Clinical Psychology from Northern Illinois University and completed her doctoral internship at Rogers Behavioral Health in the OCD and Anxiety Adult Residential Program, where she later supervised clinical staff. In addition to her clinical training, she brings lived experience to her work. Having navigated the intrusive thoughts and anxiety spiral of relationship OCD herself and found her way through with ERP.
She is licensed in Wisconsin, holds PSYPACT authorization to practice across many states online, and is an active member of the International OCD Foundation, contributing to national education efforts on scrupulosity OCD. Her virtual practice is built on the belief that geography shouldn't determine who gets access to quality OCD care.
