Obsessive-compulsive disorder (OCD) involves unwanted, distressing thoughts and repetitive behaviours that take up time and interfere with daily life. Cognitive behaviour therapy (CBT) is the first-line treatment. A randomised clinical trial in BMC Psychiatry tested whether adding virtual reality to CBT helps people whose OCD centres on contamination.
Thirty-six adults with contamination-type OCD were randomly assigned to two groups. One group received 60-minute CBT sessions that included a virtual environment designed to feel contaminated. The other received standard CBT. Twenty-nine people completed the 12 weekly sessions. Symptoms were measured at the start, at 12 weeks and at a three-month follow-up.
Scores on the Yale-Brown Obsessive-Compulsive Scale, the standard measure of OCD severity, dropped significantly in the virtual reality group. Depression and anxiety scores fell in both groups, with no significant difference between them. The groups did differ on a measure of obsessive beliefs and on a measure of disability.
The authors concluded that virtual reality exposure and response prevention was effective for the contamination subtype and can be used within CBT as an alternative exposure tool. The trial was small, so it is best read as encouraging rather than settled.
If OCD is taking up your time, a GP or psychologist can help you start effective treatment.
What the study set out to do
Obsessive-compulsive disorder (OCD) is characterised by disturbing and unwanted thoughts and by repetitive, time-consuming behaviours that interfere with performance. Cognitive behaviour therapy (CBT) has shown beneficial effects on reducing OCD symptoms and is the first line of treatment. Virtual reality (VR) has become a more feasible and accessible intervention for OCD in recent years. This trial evaluated virtual reality exposure and response prevention (VRERP) in the treatment of the contamination subtype of OCD.
How it was done
Thirty-six adults with the contamination subtype were registered and randomly assigned to an intervention group or a control group. The intervention group received a 60-minute CBT session that included a contaminated virtual environment, while the control group received CBT as the standardised treatment. Twenty-nine patients completed the treatment, which ran over 12 weekly sessions.
Participants completed the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Beck Depression Inventory-II (BDI-II), the Beck Anxiety Inventory (BAI), the Obsessive Beliefs Questionnaire-44 (OBQ-44) and the World Health Organization Disability Assessment Scale-2 (WHODAS-2). These were completed at week 0, at week 12 and after a three-month follow-up. The analysis used repeated measures analysis of variance.
The questionnaires cover different ground. The Y-BOCS is the OCD severity measure, the BDI-II measures depression, the BAI measures anxiety, the OBQ-44 measures obsessive beliefs, and the WHODAS-2 measures disability. Using several lets the researchers ask whether any benefit reaches beyond obsessions and compulsions to everyday functioning. Repeated measures analysis compares the same people across the time points, which suits a study that follows participants for months.
What it found
The total scores of the obsession and compulsion subscales of the Y-BOCS decreased significantly in the intervention group, and this was the primary outcome. BDI-II and BAI scores were reduced in both groups, with no significant difference between them. There was, however, a significant difference between the groups on the OBQ-44 and on the total WHODAS-2 score.
The authors concluded that the study demonstrated the effectiveness of VRERP in the treatment of the OCD contamination subtype, and that VRERP can be used in CBT as an alternative exposure tool.
What it means, and what to keep in mind
Exposure and response prevention asks a person to face what triggers their obsession without performing the compulsion that usually follows. For contamination fears, arranging the right situations can be difficult, and a virtual environment is one way of making them available in a controlled setting.
The trial was small, with 36 people at the start and 29 finishing, and the abstract does not say in which direction the group differences on the belief and disability measures fell. The result is encouraging evidence, not a final answer. The control group also received CBT, so the comparison was between two forms of therapy and not between treatment and no treatment.
If OCD is taking up your time or your life, speaking with your GP or a psychologist is a sound first step.