Exploring the efficacy of remote stepped care treatment for obsessive-compulsive disorder: A feasibility study.

In Step 1 of this stepped care treatment all participants will read a self-help book 'Stop Obsessing: How to Overcome Your Obsessions and Compulsions' by Edna Foa and Reid Wilson, which will be sent to them in the mail over an 8 week period, along with a suggested reading schedule. During these 8 weeks participants also receive weekly email support from a provisional psychologist or psychologist to answer any questions as they work through the book. Adherence to the readings will be monitored in the weekly emails to participants. We estimate that participants will spend approximately 1 hour per week reading the book and working on the skills. After completing Step 1, participants symptoms of obsessive-compulsive disorder (OCD) will be re-assessed. Participants whose symptoms of OCD do not improve according to the response criteria (Yale Brown Obsessive Compulsive Scale (YBOCS) reduction of greater than or equal to 25% and a Clinical Global Impression Improvement Scale (CGI-I) score of less than or equal to 3) will go onto receive Step 2 of the remote stepped care treatment. Step 2 of the stepped-care treatment consists of individually delivered internet-videoconferencing delivered CBT [(VCBT); 8 weekly 50-minute sessions)]. The VCBT will be manualised and will focus on the construction of an exposure hierarchy and graded exposure exercises to items on the exposure hierarchy, combined with refraining of engaging in compulsive behaviours (participants will be asked to cease their compulsions). Exposure hierarchy items will be individualised for each participant and may include items related to contamination/washing, responsibility/checking, unacceptable thoughts/mental rituals or symmetry obsessions/compulsions. The VCBT treatment will be provided by a provisional psychologist or psychologist with experience ranging from 1-5 years. Adherence to the treatment will be monitored by the clinician each week.