Clinical Summary: Exposure-Based Video Therapy for Obsessive-Compulsive Disorder and Posttraumatic Stress Disorder: Clinical Outcomes From a Large Real-World Sample of Adults
Patients with comorbid obsessive-compulsive disorder and posttraumatic stress disorder often have more severe, interacting symptoms and poorer outcomes when only 1 disorder is treated. This study addresses a common clinical dilemma: whether exposure and response prevention and prolonged exposure can be delivered together by video therapy in routine care and still produce meaningful improvement in both conditions.
Key Findings
- By the final session, PCL-5 scores decreased 17.1 points from baseline (mean =43.5, SD =14.2) to final session (mean=26.4, SD =17.6) (-17.1 points, 39.3%; F1,180 =194.13, P<.001; Hedges g=1.03, 95% CI: 0.85–1.21).
- By the final session, DOCS scores decreased 15.7 points from baseline (mean=35.2, SD =13.7) to final session (mean=19.5, SD=13.9) (-15.7 points, 44.7%; F1,180 =244.55, P<.001; Hedges g=1.16, 95% CI: 0.97–1.35).
- At the final session, 67.4% (122/181) achieved ≥10-point PCL-5 reduction, 75.7% (137/181) achieved ≥25% DOCS reduction, 64.1% (116/181) achieved ≥35% DOCS reduction, and 49.2% (89/181) achieved combined response (≥35% DOCS and ≥10-point PCL-5 reduction).
- Improvement was evident by session 20: PCL-5 scores fell from 43.5 (SD = 14.2) to 35.0 (SD = 15.4) (-8.5 points, 19.5%; Hedges g = 0.56, 95% CI: 0.39–0.73, n = 157), and DOCS scores fell from 35.2 (SD = 13.7) to 24.5 (SD = 14.4) (-10.7 points, 30.4%; Hedges g = 0.77, 95% CI: 0.59–0.95, n = 158).
- Among patients who achieved and maintained response through their final session, median time to first response was 11 sessions (IQR: 8–19) for OCD and 15 sessions (IQR: 8–23) for PTSD; dual response first occurred at a median of 20 sessions (IQR: 13–27), and 13.5% required more than 40 sessions.
Concurrent exposure and response prevention plus prolonged exposure delivered by video therapy produced clinically meaningful improvement in both obsessive-compulsive disorder and posttraumatic stress disorder in this real-world sample. Many patients improved within 20 sessions, but a substantial subset needed extended treatment to achieve response in both conditions.
Practice Implications
- Consider treating obsessive-compulsive disorder and posttraumatic stress disorder within the same treatment episode when symptoms interact, rather than waiting to complete 1 protocol before addressing the other.
- Set expectations that meaningful gains can emerge by session 20, but plan flexibly for longer courses when both disorders are active; 42.5% reached session 40 and 13.5% of dual responders required more than 40 sessions.
- Monitor both symptom domains throughout treatment using disorder-specific measures, since response rates differed by condition and dual response lagged behind single-disorder response.
- Do not assume baseline psychiatric medication use determines psychotherapy benefit here; medication status did not significantly moderate treatment outcomes for either PTSD or OCD symptoms.
