JMIR Publications

ABSTRACT

Background:

Obsessive-compulsive disorder (OCD) is a common mental health disorder that can cause significant impairment to occupational and social functioning. While effective treatments exist, outcomes are often hampered by issues outside of the treatment protocol. VR presents a potential solution to help support the effective administration of treatment, but its application in the field of OCD has thus far been limited to replicating real-world environments used in exposure exercises, despite the potential to generate environments and stimuli beyond what is possible in reality. Participatory design methods are an effective way to ensure the development of novel interventions are relevant to the intended end users and are grounded in their expertise and experiences.

Objective:

The aim of the workshops conducted in the present study was twofold. Firstly, to understand the opinions of relevant stakeholders (clinicians and people with lived experience of OCD) on the current state of OCD treatment. Secondly, to generate novel ideas with the direct input of stakeholders for how VR might effectively be applied to support the treatment of OCD.

Methods:

In total, six clinicians with experience of treating OCD and six people with lived experience of OCD participated in a combination of round table discussions in large groups and creative design exercises conducted in smaller groups and individual interviews. All workshops and interviews were audio recorded, transcribed and analyzed using collaborative qualitative analysis. Themes were then synthesized via narrative synthesis.

Results:

Three themes relating to the first aim were identified: socializing to the model, effective exposure work and therapeutic alliance (predominantly raised by people with lived experience of OCD). Five themes relating to the second aim were identified, with ideas for VR use covering five mechanisms by which it might support treatment: enabling effective exposure work, modelling, illustrating metaphors and the treatment framework, anxiety management and motivation.

Conclusions:

Findings from the first workshops emphasize the importance of clients developing a comprehensive shared understanding of the cognitive model of treatment with their therapist. People with lived experience of OCD also highlighted the importance of developing trust in their therapist’s expertise and ability to understand nuances of individual cases. Findings from the second workshop produced a wide variety of methods through which VR can support the treatment of OCD. Many of these go beyond the concept of simply enabling exposure work as seen in previous literature. Methods to increase client engagement with the cognitive model during treatment were described and people with lived experience proposed methods of managing anxiety experienced during treatment to facilitate approach behaviors. The number and novelty of ideas generated in this study demonstrates the value of participatory design with stakeholders. Avenues for further development of these ideas and areas for further refinement are discussed.