Psychologists using exposure and response prevention therapy (ERP) to treat patients with obsessive-compulsive disorder (OCD) may need to adapt therapy to address contamination fears during coronavirus disease 2019 (COVID-19), and do so in a way that does not jeopardize patient care, progress, or physical health.
In a case report published in the Journal of Anxiety Disorders, the authors considered how psychologists treated OCD patients early in the AIDS epidemic when less was known about how the disease spread, as well as client-specific infection risks.
Then and now, psychologists have a duty to provide science-informed treatment while following public health guidelines. Providers can modify ERP — the most effective OCD intervention for patients with contamination-related OCD — to include video visits and/or pharmacotherapy. “Therapies should focus on maintaining, rather than improving, a patient’s current OCD symptoms,” the authors noted.
However, the process of facing triggers that pose risk should be adjusted to follow public health guidelines. Pausing treatment is not recommended. Patients who do not have contamination symptoms can receive their usual treatment, keeping CDC and WHO guidelines in mind. A medication-only approach is not recommended, the authors stated.
The case study profiled a patient with a 14-year contamination fear history. When businesses shut down at the beginning of the pandemic, her anxiety increased. After a one-month break, the patient continued treatment using video. During this time, she performed “safe” tasks such as walking outside without a mask when no people were around. Her COVID-19-related fears lessened after seven visits, at which time she and the psychologist focused on other fears.
“While ERP must be modified accordingly to accepted public health guidelines,” the authors conclude, “we caution against modifying therapies in a way that may jeopardize the efficacy of patient care or progress.”
Sheu JC, McKay D, Storch EA. COVID-19 and OCD: Potential impact of exposure and response prevention therapy [published online September 22, 2020]. J Anxiety Disord. doi: 10.1016/j.janxdis.2020.102314