Although there have yet to be any e-health interventions developed specifically for co-occurring OCD and AOD use, there have been several e-health interventions developed for OCD as a single disorder, some of which include CBT and ERP-based videoconferencing and telehealth programs, smartphone, internet, computer, and virtual reality-based interventions [1249]. A meta-analysis examining remote CBT programs for OCD symptoms delivered via telephone, videoconference, computer and the internet found evidence of effectiveness [1250], with effects similar to those found in clinician-delivered CBT sustained up to four months [1250–1254].
There is evidence to suggest a dose-response relationship with regards to computerised CBT programs, with greater symptom improvements found among those who have completed more homework [1255]. However, studies have found that clinician-assisted programs are associated with greater adherence, lower dropout rates, and better outcomes than computerised programs with no human contact [1256]. There are also a number of self-guided CBT-based programs which have been developed for single disorder OCD, including smartphone applications and internet-based programs [1257]. Although there is limited evidence suggesting that some self-guided programs may reduce OCD symptoms from baseline to post-completion [1258–1261], the evidence-base underpinning many of these programs remains unclear.
Several self-help and therapist-delivered e-health programs based on ERP have also been developed; however, the findings from studies examining the efficacy of computerised ERP interventions are mixed. A computerised ERP intervention called BT Steps/OC Fighter was found to be less efficacious in reducing OCD symptoms than a more expensive clinician-delivered ERP, but more efficacious than relaxation training [1255]. The findings from this study suggest that the primary benefit of having a clinician was to ensure people maintain their engagement in the exposure process [1236]. Given these findings, the UK NICE Guidelines recommend that BT Steps/OC Fighter should not be used in the treatment of OCD [1262].
Another ERP program, iCBT, has been found to be more efficacious in reducing OCD and depressive symptoms, and improving general functioning compared to both an active control (online, non-directive supportive therapy) [1252], and baseline symptoms and functioning [1263]. Data from a further two trials assessing LiveOCDFree and nOCD also found that ERP-based smartphone applications significantly decreased symptoms of OCD compared to baseline, among those with single disorder OCD [1264, 1265]. Evidence from a randomised trial similarly suggests that using either of two smartphone applications targeting cognitive flexibility for a week reduced OCD symptoms relative to a control, among people with single disorder OCD [1266]. Additional research suggests that virtual reality may be a promising avenue for treatment, with significant reductions in OCD symptoms evident after engaging in 12 virtual ERP sessions relative to pre-treatment, and effects sustained up to four months post-treatment [1267]. Although encouraging, further research is needed.