Beating OCD and Learning Digitally (BOLD): an open trial of a therapist-supported, self-guided exposure and response...

Exposure and response prevention (EX/RP) is a first-line, evidence-based treatment for obsessive-compulsive disorder (OCD), yet its widespread implementation remains limited. Major barriers to EX/RP access are the intervention's intensity and lack of qualified providers. There is a growing need for scalable, technology-supported interventions that reduce treatment burden while preserving core therapeutic components. Therefore, we developed Beating OCD and Learning Digitally (BOLD), a self-guided EX/RP web application delivered with minimal therapist support. This small open trial (N = 16) evaluated the acceptability, feasibility, and preliminary outcomes of BOLD in adults with OCD. We found that BOLD significantly reduced OCD symptoms with large effect sizes among treatment completers (d = -1.27). Half of participants completed the full intervention and reported high satisfaction and gains in self-efficacy. Two-thirds (62.5%) of treatment completers were classified as treatment responders. When compared to a matched sample receiving traditional EX/RP, BOLD showed comparable treatment outcomes. Time-effectiveness analysis indicated that BOLD required 73.39% less therapist contact time to achieve equivalent symptom reduction than traditional EX/RP. These findings highlight BOLD's potential as a scalable, cost-effective intervention for OCD. Researchers should refine BOLD by optimizing engagement and reducing barriers to participation and investigate its effectiveness in a full-power randomized controlled trial.