Exposure-Based Video Therapy for Obsessive-Compulsive Disorder and Posttraumatic Stress Disorder: Clinical Outcomes From a Large Real-World Sample of Adults

Nicholas R. Farrell, PhD; Clare C. Beatty, PhD; Andreas Rhode, PhD; Mia Nuñez, PhD; Patrick B. McGrath, PhD; Larry Trusky, BS; Stephen M. Smith, BA; Jamie D. Feusner, MD

J Clin Psychiatry 2026;87(3):25m16180

Abstract

Objective: Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are often comorbid. While exposure-based treatments can be effective for each, given that comorbid OCD and PTSD symptoms often interact dynamically, concurrent treatment may be most beneficial. The aim of the current analysis was to examine the naturalistic effectiveness of concurrently delivered exposure and response prevention (ERP) and prolonged exposure (PE) therapy among individuals with comorbid OCD and PTSD.

Methods: This retrospective, observational analysis examined clinical data from adults (N=181) diagnosed with comorbid OCD and PTSD who were treated with concurrent ERP and PE through an online specialty therapy platform. PTSD symptoms were assessed using the PTSD Checklist for DSM-5 (PCL-5) and OCD symptoms using the Dimensional Obsessive-Compulsive Scale (DOCS). Linear mixed models examined symptom change from baseline to three timepoints: (1) session 20, (2) session 40, and (3) the final assessment timepoint completed by each patient.

Results: PTSD symptoms decreased from mean=43.5 (SD=14.2) at baseline to mean=26.4 (SD=17.6) at final session (Hedges g=1.03, 95% CI: 0.85–1.21). OCD symptoms decreased from mean=35.2 (SD=13.7) to mean=19.5 (SD=13.9) (Hedges g=1.16, 95% CI: 0.97–1.35). By the final session, median percent improvement was 40.9% (interquartile range [IQR]: 11.5%–70.7%) for PTSD and 50.0% (IQR: 25%–67.6%) for OCD. A total of 67.4% of patients achieved a clinically significant PTSD response (≥10-point PCL-5 reduction), 64.1% achieved a clinically significant OCD response (≥35% DOCS reduction), and 49.2% achieved a clinically significant PTSD and OCD response. Analyses of secondary treatment outcomes showed significant reductions in depressive and anxiety symptoms and disability, along with improvements in quality of life.

Conclusion: Findings suggest that concurrent ERP and PE, delivered remotely via video therapy in a real-world setting, may be a clinically effective treatment approach for individuals with comorbid OCD and PTSD.

J Clin Psychiatry 2026;87(3):25m16180

Author affiliations are listed at the end of this article.

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