Exposure and response prevention is a first-line treatment for obsessive-compulsive disorder, yet many people with contamination worries never reach care. A pilot study in JMIR Serious Games tested whether a single virtual reality session could be a feasible and acceptable way in.
Sixteen adults aged 18 to 32 took part. All had elevated contamination concerns, but none had a formal OCD diagnosis. In the laboratory, each completed an exposure session in a virtual public toilet, followed by a survey one month later.
Anxiety rose during the exposure tasks and fell after virtual hand washing. That is the pattern exposure therapy relies on. The session was feasible. Usability was adequate. Contamination symptoms a month later were not significantly different from baseline (mean change 1.30, 95% CI -0.36 to 2.96, P = .12). More than a third of participants, 37.5%, did not complete the follow-up survey, so that result is uncertain.
The authors conclude that a single session is feasible and acceptable but that adequately powered multisession trials are needed. This study shows that the approach can be delivered. It does not show that one session changes symptoms.
If contamination worries are affecting your life, a GP or psychologist can help.
What the study set out to do
Exposure and response prevention is a first-line intervention for obsessive-compulsive disorder (OCD), yet many people with contamination concerns do not access care. Virtual reality exposure-based therapy (VRET) may improve scalability and acceptability. This pilot evaluated the feasibility and acceptability of a standardised single-session VRET protocol aimed at contamination concerns. It also asked whether the session produced anxiety during exposure and whether contamination symptoms changed at one-month follow-up, as an exploratory question.
How it was done
This was a single-arm pilot, meaning there was no comparison group. Participants were adults with elevated contamination concerns and no formal OCD diagnosis, recruited by convenience sampling. They completed a baseline survey, an in-laboratory VRET session in a standardised virtual public toilet environment, and a follow-up survey.
Outcomes included momentary anxiety on the Subjective Units of Distress Scale during exposure, affect across time points, and contamination symptoms on the contamination subscale of the Obsessive-Compulsive Inventory-Revised. Usability was assessed with the System Usability Scale, and VR sickness was also measured. Missing data were handled by multiple imputation, because 37.5% of participants did not complete the follow-up survey.
Several terms need explaining. A pilot study is a small first test, designed to answer whether an approach is practical and acceptable, not whether it works. Single-arm means every participant received the same session, so even a change in symptoms could not be credited to the session itself. Multiple imputation is a statistical method that fills gaps left by missing answers with estimates, repeated several times, so that people who did not return the follow-up survey are not simply discarded. The System Usability Scale is a standard questionnaire about how easy a system is to use.
What it found
Sixteen participants aged 18 to 32 were included. Anxiety increased during the exposure tasks and decreased after virtual hand washing in both trials. Negative and positive affect both changed significantly across time points. Contamination symptoms did not change significantly from baseline to follow-up (mean change 1.30, SD 3.39; 95% CI -0.36 to 2.96; P = .12). Usability was adequate, with a System Usability Scale mean of 69.5 (95% CI 62.79 to 76.21).
What it means, and what to keep in mind
The authors describe this as among the first systematic evaluations of a standardised single-session, contamination-focused VRET protocol in adults who had elevated concerns but did not meet diagnostic criteria for OCD. That group is underrepresented in earlier VRET research, which has concentrated on clinically diagnosed samples and multisession protocols.
The protocol proved feasible and acceptable, and it brought on anxiety during the session. The symptom result is the cautious part. Change at one month was not statistically significant, and the effect size estimate was sensitive to the assumptions made about missing data. The sample was small, and the authors state that adequately powered multisession designs are needed. They also suggest that self-administered or minimally supervised delivery deserves evaluation.
For readers, the plain message is that a short virtual session is practical and tolerable, but this study cannot say it reduces contamination symptoms. If contamination worries are interfering with your life, speak with your GP or a psychologist.