Exposure therapy in a virtual environment: Validation in obsessive compulsive disorder

Alison J Cullen; Nathan L Dowling; Rebecca Segrave; Adrian Carter; Murat Yücel

doi:10.1016/j.janxdis.2021.102404

Exposure therapy in a virtual environment: Validation in obsessive compulsive disorder

J Anxiety Disord. 2021 May:80:102404. doi: 10.1016/j.janxdis.2021.102404. Epub 2021 Apr 16.

Authors

Alison J Cullen¹, Nathan L Dowling², Rebecca Segrave³, Adrian Carter³, Murat Yücel⁴

Affiliations

¹ BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, 770 Blackburn Rd, Clayton, Victoria, Australia; The Melbourne Clinic Professorial Unit, Salisbury Street, Richmond, Victoria, Australia. Electronic address: ajcul5@student.monash.edu.
² BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, 770 Blackburn Rd, Clayton, Victoria, Australia; The Melbourne Clinic Professorial Unit, Salisbury Street, Richmond, Victoria, Australia.
³ BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, 770 Blackburn Rd, Clayton, Victoria, Australia.
⁴ BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, 770 Blackburn Rd, Clayton, Victoria, Australia. Electronic address: murat.yucel@monash.edu.

PMID: 33894550
DOI: 10.1016/j.janxdis.2021.102404

Abstract

Exposure and response prevention (ERP) is the current first-line psychological treatment for Obsessive-compulsive disorder (OCD). However, substantial inter-individual variability exists in treatment outcomes, including inadequate symptom improvements, and notable refusal and attrition rates. These are driven, in part, by impracticalities in simulating intrusive thoughts within clinical settings. Virtual reality (VR) offers the potential of overcoming these limitations in a manner that allows for finely controlled anxiety-provoking scenarios to be created within supportive clinical settings. To validate the potential of VR for treating contamination-based OCD, 22 patients undertook a VR ERP session and a matched session of the current gold-standard of in vivo ERP. In VR, patients were immersed within a contamination environment that permitted flexible delivery of customisable, graded exposure tasks. The VR environment utilised HTC Vive hardware, to allow for patients to both interact with, and physically move through the environment. Subjective and objective measures of distress were recorded, including heart and respiration rates. These measures indicate virtual and in vivo ERP sessions provoke consistent anxiety profiles across an exposure hierarchy. Virtual exposure was advantageous for engagement and adherence to tasks, and the therapeutic alliance was upheld. VR is a promising mechanism for ERP in contamination OCD.

Keywords: Anxiety; Exposure therapy; Obsessive compulsive disorder; Psychophysiology; Therapeutic alliance; Virtual reality.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Anxiety / therapy
Anxiety Disorders
Humans
Implosive Therapy*
Obsessive-Compulsive Disorder* / therapy
Treatment Outcome