Investigating the effectiveness of using a telemental health approach to manage obsessive-compulsive disorder: a systematic review

Abstract

Background

Obsessive-compulsive disorder is a mental disorder that leads to impairment in various cognitive functions. Telemental health is applied in providing several telemental health and psychiatric services. It can provide health and psychological care, such as counseling, diagnosis, and treatment. Therefore, this study systematically examines the effectiveness of using a telemental health approach to manage obsessive-compulsive disorder.

Methods

We searched PubMed, Web of Science, and Scopus using the keywords telepsychiatry, telemental health, telemedicine, telehealth, videoconferencing, obsessive-compulsive disorder, and OCD up to November 2023. In addition to searching the mentioned databases, references to related articles were also examined.

Results

In this study, based on the search strategy, we identified 130 articles, 4 duplicate articles were removed, and the title and abstract of 126 articles were reviewed. Considering the selection criteria, 104 articles were excluded and 22 articles were included in the study. In 77.27% of the articles, videoconference telecommunication methods were used for communication. In 8 articles, the participants were children and adolescents. Reviewing these studies indicates mentions concerning the effectiveness of this method in most of them.

Conclusions

In general, telemental health interventions increase access to treatment and can be promising for patients with certain conditions. This systematic review contributes to the expanding literature indicating that delivering CBT through telemental health methods, particularly videoconference-based approaches, is a feasible substitute for in-person treatments.

Introduction

Obsessive-compulsive disorder (OCD) is a mental disorder that leads to impairment in various cognitive functions. This disorder is associated with repetitive thoughts and behaviors that cause disability and impairment in daily functioning. The symptoms of this disorder include compulsive activities and obsessive thoughts [1] that start in childhood and adolescence [2]. More women suffer from this disorder in adulthood and men in childhood [2, 3]. Intrusive thoughts are usually associated with a feeling of not being complete and not right and lead to compulsive behaviors such as frequent checking [4]. Several factors such as genetics, childhood injuries, complications of pregnancy and childbirth, and stressful events can be effective in causing and aggravating the disease [5]. Many people suffer from this mental disorder worldwide [6]. OCD is considered one of the diseases that affects and severely reduces the quality of life [7]. Cognitive behavioral therapy (CBT) is among the basic methods of treating obsessions. This method emphasizes exposure and response prevention (ERP) and is the most extensively validated psychosocial treatment for individuals of all ages with OCD. Meta-analyses have demonstrated significant positive outcomes of this method concerning its effectiveness [8, 9]. This method aims at changing habits and rebuilding thoughts and minds. As a result, the patient can face his fear in stressful situations and reduce his compulsive behaviors [10]. However, there are many obstacles to accessing this type of treatment, such as the limitation of therapists, high treatment costs, stigmatization, and embarrassment for patients [11].

Telemedicine is a method to provide medical services through telecommunications technologies. This technique is mainly applied to provide services to remote and geographically distant areas. One of the most widely used technologies in telemedicine is videoconferencing, which makes it easy for therapists to see patients and give them advice in real-time. Cost-effectiveness and providing quality treatment are among the advantages of telemedicine [12]. Telemedicine can provide health and psychological care, such as counseling, diagnosis, and treatment [13]. However, the use of telemedicine still involves challenges such as patient privacy, confidentiality aspects, technical issues, and training of doctors and patients [14]. Telemental health is applied in providing several telemental health and psychiatric services [15]. Various studies [16,17,18,19,20] have investigated the use of telemental health for disease management of patients with OCD. Integrating telemental health technology with evidence-based treatments and drug therapy can facilitate the management and treatment of the disease and promote clinical benefits. Despite potential problems in this field, using communication technology in telemental health can be effective by focusing on an ERP method [21]. Therefore, this study systematically examines the effectiveness of using a telemental health approach to manage obsessive-compulsive disorder.

Methods

This systematic review study investigates the effectiveness of using a telemental health approach to manage OCD in 2023 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist [22]. Figure 1 shows the process of selecting articles.

Fig. 1

The flow diagram of the selection of articles

Data sources

We searched PubMed, Web of Science, and Scopus using the keywords telepsychiatry, telemental health, telemedicine, telehealth, videoconferencing, obsessive-compulsive disorder, and OCD up to November 2023. In addition to searching the mentioned databases, references to related articles were also examined.

Study selection

Two researchers independently retrieved relevant articles based on titles and abstracts. Then, the full text of the articles was reviewed, and the most relevant articles were selected considering the inclusion and exclusion criteria. The disagreement between the two authors was resolved by reaching a consensus with the third author. In the last step, data was extracted from the articles and organized in tables.

The inclusion criteria were (1) original articles and reports, (2) articles in English, and (3) articles related to the purpose of the study. Also, exclusion criteria were (1) review articles, systematic reviews, letters to the editor, and protocols, (2) articles not related to the purpose of the study, and (3) lack of access to the full text of the articles.

Data extraction

Two researchers reviewed the articles, extracted the desired data, and entered the tables. Data included authors, year, country, study objective, telecommunication method, participants, and outcome.

Results

In this study, based on the search strategy, we identified 130 articles, 4 duplicate articles were removed, and the title and abstract of 126 articles were reviewed. Considering the selection criteria, 104 articles were excluded and 22 articles were included in the study.

According to the results, most of the studies were conducted in the USA (n = 9), and the remaining studies were in Australia (n = 3), Japan (n = 2), Norway (n = 2), Germany (n = 2), China (n = 1), Canada (n = 1), India (n = 1), and Sweden (n = 1). Most studies were published in 2022 (n = 7) and 2014 (n = 5). In 77.27% of the articles [16,17,18,19,20, 23,24,25,26,27,28,29,30,31,32,33,34], video conference telecommunication methods were used for communication. Other methods provided included telephone calls [35, 36] and computer and online platforms [35, 37,38,39]. In 8 articles, the participants were children and adolescents [16, 18, 19, 27, 32, 35, 36, 39] with OCD. In the rest of the articles, the participants were adults [20, 23, 25, 26, 28,29,30,31, 33, 38] and veterans [24] with OCD. Using the results of these studies, the effectiveness of using telemental health was determined based on the positive results obtained in the treatment and management of OCD of the participants. Reviewing these studies indicates mentions concerning the effectiveness of this method in most of them. The main findings of these articles are summarized in Table 1.

Table 1 Main characteristics of the included studies

Discussion

OCD is a severe neurobehavioral condition that often leads to significant impairments in various aspects of a person’s life, persisting throughout their lifespan [40]. Improving access to evidence-based therapy can be accomplished by implementing more efficient therapy delivery models that maximize outreach while maintaining integrity and effectiveness [19]. Telemental health has long been extensively employed by medical professionals to efficiently treat behavioral disorders [34, 41, 42]. The objective of this systematic review was to evaluate the effectiveness of using a telemental health approach to manage obsessive-compulsive disorder.

After completing the search strategy, we obtained a total of 130 results. Of these studies, 22 unique papers were identified and included. The dissemination of more than 50% of the studies conducted in the last 2 years indicates that this type of care delivery is at the forefront of current research in OCD therapy. Overall, the studies aimed to assess the feasibility [16, 18, 24, 26, 29,30,31,32] and evaluate the effectiveness [16,17,18,19,20, 23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39], acceptance [20, 24, 26,27,28,29,30, 32, 38], satisfaction [16, 18, 24, 26,27,28,29, 32, 36], and perception of patients and practitioners using telemental health for treating OCD [24, 28]. Furthermore, their objective was to evaluate the efficacy of these interventions in comparison to traditional in-person methods [25, 34, 35, 37] or control groups that had not yet received any form of treatment [28, 36, 39]. In this respect, Orsolini et al. [13] also mentioned the effectiveness of telemental health to overcome the obstacles of mental health care.

Regarding the feasibility and effectiveness, the studies provide promising evidence that delivering CBT through telemental health approaches is feasible [16, 18, 24, 26, 29,30,31,32] and has the potential to be equally effective as in-person treatment across different age groups [25, 26, 28, 34, 35, 37, 39]. The results of the randomized clinical trial study showed that the CBT method using the computer is accepted by young people with mental problems [43].

The majority of the studies demonstrated effectiveness in terms of alleviating symptoms of depression, anxiety, and stress [16, 18,19,20, 24,25,26, 28, 30, 32, 34,35,36] and improving quality of life [20, 24, 26, 28, 32, 33, 35]. Studies also offer proof of effectiveness by demonstrating improvements in recovery rates and reductions in treatment duration [16, 19, 27, 28, 30, 32, 33, 36]. Furthermore, some studies provide evidence of effectiveness by highlighting the advantages of cost and time savings [18,19,20, 29, 30, 33]. The estimated timeframe for this improvement is predicted to be less than 50% of the total therapist time and less than 50% of the duration of a typical once-weekly in-person CBT session [20]. The results of a meta-analysis study have also emphasized the effectiveness of telemental health interventions and pointed to conducting more trial studies to investigate this method’s effectiveness, feasibility, and acceptability [44].

The coronavirus disease 2019 (COVID-19) pandemic and the need for physical separation accelerated the adoption and using of telemental health services for various behavioral disorders [45,46,47,48,49]. Telemental health practitioners have substantially augmented their daily use of telehealth to handle their patient workload, which has nearly doubled since the initiation of the COVID-19 pandemic [45]. Our research has discovered four papers that specifically investigated the effectiveness of telemental health strategies for delivering CBT during the global pandemic. These studies have highlighted the favorable impact of this technique in this specific context. Overall, these works have determined that telemental health services are effective and appropriate alternatives for in-person care, especially during the pandemic. By enabling convenient access to psychiatric care, they can overcome different barriers linked to traditional services, augment user satisfaction, and empower the underserved population residing in remote regions [25, 29, 31, 35].

Most of the studies identified in our research apply videoconferencing [16,17,18,19,20, 23,24,25,26,27,28,29, 32,33,34, 38, 39] as a central telemental health strategy for delivering CBT. In addition to this method, online and computer platforms [30, 31, 35, 36] and calls [30, 37] were also used to manage the disease However, videoconferencing is a highly valuable technique to deliver telemental health services, as it closely resembles well-accepted in-person therapy [27]. Besides, this service is highly accessible [20]. Recent experiments have introduced supplementary functionalities to videoconferencing, including chat features, a virtual whiteboard for material presentation, an online data cloud system for assignment and progress restoration, and a physiological wristband for setting timestamps for different events [18, 28].

In general, to manage OCD, it is possible to use a telemental health approach. Moreover, as a therapeutic support tool, it can improve OCD. Since it is possible to practice at home using the telemental health method, the effectiveness of the method will increase, thereby providing the therapists with more opportunities to understand and pay attention to the patient’s behavior [24]. Paying attention to the mental health of special age groups such as children and youth and integrating their treatment with available methods (e.g., telemental health) are points that future research should pay attention to.

One of the limitations of this study is the non-inclusion of articles that did not have access to their full text. A common limitation of any systematic review is that not every relevant study may be found. This issue was considered during the peer review process when another relevant study was revealed.

Conclusion

Telemental health interventions increase access to treatment and can be promising for patients with certain conditions. This systematic review contributes to the expanding literature indicating that delivering CBT through telemental health methods, particularly videoconference-based approaches, is a feasible substitute for in-person treatments. These approaches enhance the availability of state-of-the-art treatment and provide potential relief to individuals who would otherwise lack access to high-quality mental health care. This issue is especially crucial during a global pandemic.