Effectiveness of In Virtuo Exposure and Response Prevention Treatment Using Cognitive–Behavioral Therapy for Obsessive–Compulsive Disorder: A Study Based on a Single-Case Study Protocol

Abstract

Obsessive–compulsive disorder (OCD) is characterized by the presence of distressing, recurrent and intrusive thoughts, impulses, or doubts as well as behavioral or mental rituals. OCD has various subtypes, including the fear of contamination in which individuals fear bacteria, germs, disease, or bodily secretions, and engage in clinically significant cleaning and avoidance rituals. Cognitive–behavioral therapy (CBT) is an effective treatment for OCD and involves, among other therapeutic strategies, exposing patients to feared stimuli while preventing them to engage in compulsive behaviors. In recent years, virtual reality (VR) has shown the potential of in virtuo exposure with people suffering from anxiety disorders and OCD. The objective of this pilot study is to examine the effectiveness of a CBT program where exposure in conducted in virtuo. Three adults suffering from OCD with a dominant subtype of contamination were enrolled in a single-case design with multiple baselines across participants. The presence and intensity of obsessions and compulsions were assessed daily during baselines of 3-, 4-, or 5-week, and a 12-session treatment. Follow-up information was gathered after 4 and 8 months. Treatment outcome is assessed with visual inspection of the graphs and ARMA time-series analyses. Clinical information, self-reports, and details of the treatment are provided for each patient. Statistical analyses for the time-series data revealed a statistically significant improvement in all three participants, but global improvement is considered positive for only two. This study innovates in proving preliminary support for the usefulness of VR in the CBT of OCD with contamination features.

How New Technologies Can Improve Prediction, Assessment, and Intervention in Obsessive-Compulsive Disorder (e-OCD): Review

“…Laforest et al [77] enrolled 3 adults with contamination OCD and exposed them to 2 virtual environments: a training environment ( neutral ) and an experimental ( contaminated ) environment. They assessed the presence and intensity of obsessions and compulsions (baseline, 3, 4, and 5 weeks, and at the end of a 12-session treatment).…”

Inducing an Anxiety Response Using a Contaminated Virtual Environment: Validation of a Therapeutic Tool for Obsessive–Compulsive Disorder

“…In short, these results are congruent with ours and confirm that a virtual environment is capable of inducing an anxiety response in people suffering from anxiety disorders and OCD. The next studies should be pilot [e.g., Laforest et al (2016)] and larger scale control trials to design and test treatment programs using this virtual environment.…”

Das Potenzial der virtuellen Realität in der Verhaltenstherapie

“…Beispielsweise finden sich in der Literatur zu VR in der Psychotherapie der PTBS fast ausschließlich Untersuchungen mit militärischem Personal [21,22]. Auch der Einsatz von VRET bei Zwangsstörungen, bei denen ebenfalls Expositionstherapie (mit Reaktionsmanagement) indiziert ist, ist noch unzureichend erforscht [23]. Für die generalisierte Angststörung liegen einzelne Veröffentlichungen zu In-terventionsansätzen mittels VR vor; neben VR-unterstütztem Entspannungstraining mit Biofeedback [24] gibt es erste Versuche, Expositionsszenarien zu entwickeln, die Ungewissheit, Unsicherheit und den Eindruck latenter Gefahr auslösen können [25].…”