JMIR Publications

ABSTRACT

Background:

Despite being highly effective and guideline-recommended for obsessive-compulsive disorder (OCD), exposure with response prevention (ERP) is often underused due to barriers from both therapists and patients. Virtual reality (VR) may help address these barriers.

Objective:

This study aimed to assess the efficacy and acceptance of VR-supported ERP (VERP) in patients with contamination OCD (washers) and checking OCD (checkers) and to identify factors influencing treatment success.

Methods:

A randomized controlled trial with 80 participants (40 washers, 40 checkers) assigned participants to either an intervention group receiving six weekly VERP sessions or a control group with access to outpatient care as usual (CAU). Assessments occurred at baseline (t0), post-intervention (t1), and at three month follow-up (t2). The reduction in obsessive-compulsive (OC) symptoms, as measured with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), served as primary outcome.

Results:

Overall, OC symptoms showed no greater improvement in the VERP group compared to the CAU group from t0 to t1 or t2 (ηp2 = .008 - .015). Subsample analyses revealed a significant interaction effect showing greater reduction in obsessions among checkers from t0 to t1 (F(1,53) = 4.19, p = .046, ηp2 = .073) and greater anxiety reduction among washers from t0 to t2 (F(1,45) = 4.11, p = .048, ηp2 = .084). Moderation analysis suggested VERP was more effective for those in the VERP group who had not prematurely discontinued prior psychological treatment and those with high obsessions and checking behavior. Sense of presence was only moderate, unrelated to outcome, and patient satisfaction with VERP was positive overall.

Conclusions:

While overall symptom reduction did not significantly differ between groups, VERP showed promising differential effects for specific OCD subtypes and patient profiles. These findings suggest that VERP may be a valuable augmentation for individuals with particular clinical characteristics, highlighting the potential of VR to enhance personalized OCD treatment. Further research should examine whether VERP offers greater efficacy than standard treatments with extended intervention periods and advanced virtual environments, as well as in comparison to in vivo ERP. Studies should also investigate how sense of presence relates to treatment outcomes, and assess VERP’s effectiveness for other OCD types. Clinical Trial: German registry for clinical trials (DRKS00016929)