The evidence here is stronger than for most remote therapy. Randomised trials of video-delivered ERP, including work from the Bergen group and several US teams, have found outcomes broadly comparable to face-to-face treatment, with similar effect sizes and similar durability at follow-up. Internet-delivered ERP with therapist support also has good evidence, particularly for mild to moderate presentations.
Given that ERP-trained clinicians are scarce and unevenly distributed, this matters more than it would for a treatment available on every high street. For a great many people the real comparison isn’t remote ERP versus in-person ERP; it’s remote ERP versus a local generalist who will make things worse.
Where video is actively better
This is the part that surprises people. For a substantial share of OCD, the home is where the illness lives, and in-office treatment has always had to work around that.
Contamination. Your own bathroom, your own kitchen, the specific doorhandle. In-person therapy means constructing an approximation in a clinic and hoping it transfers. On video the therapist can be present while you touch the actual thing.
Checking. Your own locks, your own stove, your own front door at the moment of leaving. Again, the real stimulus rather than a proxy.
Ordering and “just right” compulsions. Your own shelves. There’s no useful clinic version of this.
Anything involving family accommodation. The therapist can see the actual interaction rather than a report of it, and can coach the household in the room where it happens.
Where in-person still has an edge
Exposures requiring a shared physical environment — a crowded train, a public bathroom, a specific place in town — are harder to run remotely, though a good clinician will send you to do them as homework and debrief afterwards, sometimes with a call from the location itself.
Severe presentations with significant functional impairment, and anyone who needs a higher level of care, generally do better with in-person or hybrid programmes. And children often engage better in a room.
The thing to actually check
Not the delivery format. The training. Ask the five questions, and pay particular attention to how they answer the one about mental compulsions — remote or not, a clinician who can’t find your invisible compulsions won’t get you better.
Also confirm they’re licensed in your state. Therapy is regulated where you sit, not where they sit, which is the single fact that makes ERP reachable for people outside a major city.
One caution about app-only treatment
Guided self-help with a real clinician checking in has decent evidence. Fully automated app-based ERP with no human involved has much thinner support, and it has a specific failure mode: an app can’t detect that you’re performing mental compulsions during the exposures, which is the commonest reason ERP silently stops working. If you use one, use it alongside a clinician rather than instead of one.