Virtual Reality Exposure Therapy for Obsessive-Compulsive Disorder: Outpatients Trial

Virtual Reality Exposure Therapy in Patients With Obsessive-Compulsive Disorder: A Randomized Controlled Trial in Outpatients

The aim of this study is to evaluate the efficacy of virtual reality exposure therapy (VRET) as a treatment for obsessive-compulsive disorder (OCD). This study focuses on patients receiving treatment in outpatient psychiatry or clinical psychology settings, utilizing a within-subject design for comparison. Patients first complete informed consent and baseline questionnaires and are placed on a waiting list for five weeks. After this period, they are reassigned to the active (experimental) group, which will receive five sessions of exposure therapy in virtual reality over a subsequent five-week period. The treatment effect will be evaluated using pre/post assessments, as well as monitoring adherence to exposure and response prevention assignments.

The virtual environment of so called "OCD house" is used as a tool for the therapy. Immersive VR glasses Meta Quest 2 are used to visualize the environment.

During exposure therapy, relevant virtual stimuli can be freely combined involving common objects and situations in the home that may trigger OCD symptoms and hoarding. Target stimuli (VR elements) are divided into several sets corresponding to OCD subtypes. During the session, the therapist can modify the level of difficulty via four standardized levels according to the individual needs of clients.

The therapeutic application enables direct interaction with stimuli in the environment of the virtual house and garden, thanks to hand tracking. The hand tracking and hand gestures are used also to control the movement in the environment by the patients, but direct head and body rotations and small movements are enabled by the VR headset. The psychotherapist can follow the patient actions and control the settings of the environment (e.g.selection of relevant stimuli, level of difficulty) using a streaming app on the tablet or a mobile phone and advise the patient where necessary. The level of difficulty is gradually increased during the progress of the therapy.

Inclusion Criteria:

• Diagnosis of OCD (F42) using currently valid DSM-V and ICD-11
• Fluent in Czech

Exclusion Criteria:

• Any other psychiatric, neurological and serious somatic illness
• Substance abuse
• Psychotropic medication (e.g. benzodiazepines) except antidepressants, antipsychotic medication and hypnotics.
• Contradictions to using a virtual reality (e.g., epilepsy, balance problems)
• Pregnancy
• Cardiostimulator and mental implants