Virtual reality environment for exposure therapy in obsessive–compulsive disorder: a validation study

Abstract

Introduction: Obsessive–compulsive disorder (OCD) is characterised by recurrent, repetitive, and unwanted thoughts or impulses triggering significant anxiety. Exposure and response prevention is currently the first-line therapy for OCD. The goal of this validation study was to confirm the potential of the VR house environment that incorporates OCD-specific items that cluster around major symptom dimensions: ‘contamination’, ‘symmetry’, ‘checking’ and ‘hoarding’ to induce anxiety and compulsive behaviour in patients with OCD. Method: We assessed a sample of OCD patients (n = 44) that was compared to a group of healthy controls (n = 31). The severity of OCD symptoms was assessed in all subjects. During a single session, participants were asked to approach a set of 10 stimuli (covering four OCD dimensions) and rate their current intensity of distress/anxiety and compulsive tendencies (scales 0–5) provoked by observing each stimulus. Before and after the VR exposure, participants completed questionnaires assessing subjective levels of anxiety (before/after VR exposure), their sense of presence in VR and experienced simulator sickness. Results: The results show that the OCD group reports elevated levels of distress and compulsive behaviour when confronted with VR exposure stimuli compared to the control group, but no increase in anxiety levels has been observed after the VR exposure. The subjective ratings of provoked distress and compulsive behaviour are not associated with severity of OCD symptoms, perceived sense of presence, association with cybersickness symptoms is weak. Conclusion: Our data suggest that the VR house environment is a suitable tool for VR exposure therapy in OCD patients as it demonstrates OCD symptom provocation relevant for individual patients.