Mixed reality exposure therapy may have a role in obsessive-compulsive disorder

1. In this randomized clinical trial, mixed reality exposure and response prevention (MERP) was a feasible treatment for contamination obsessive-compulsive disorder (C-OCD); however, it did not significantly outperform self-guided exposure response prevention (SERP). 

Evidence Rating Level: 1 (Excellent) 

Obsessive-compulsive disorder (OCD) is a mental health disorder affecting 1-3% of individuals worldwide. The first line recommended treatment for OCD is cognitive behavioural therapy (CBT) with exposure and response prevention (ERP). Although this is the treatment with the best evidence in prior literature, its use in practice remains limited. Exposure therapy in virtual reality (VR) is a novel way to treat patients under optimal conditions, however, the research on EPR in VR (VERP) is limited. To assess this research gap, this randomized clinical trial (RCT) aimed to evaluate the efficacy of ERP in mixed reality (MERP) by comparing it to an active control group, namely self-guided ERP (SERP), in patients with contamination OCD (C-OCD). Assessments were conducted at baseline, 6 weeks, and 3 months post-treatment. Participants were randomized 1:1 into either the MERP or SERP group. The MERP sessions were conducted once a week for 6 weeks, with each one lasting between 60 and 90 minutes. The SERP participants were instructed to follow 1 self-guided exercise per week for 4 weeks, selecting real objects for their ERPs. To assess the severity of OCD symptoms, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used. A total of 36 participants (mean [SD] age 35.42 [14.03]) were included, with 18 in each group. Severe OCD symptoms were present in both groups, with the baseline Y-BOCS score slightly higher in the MERP group compared to the SERP group (26.94 vs. 24.22). The most common comorbid diagnosis was major depressive disorder (23 [63.9%]). The post-intervention and follow-up assessments were completed by 29 participants (80.6%). The MERP and SERP groups showed comparable reductions in OCD symptoms (Y-BOCS) with mean differences of 3.15 and 1.47, respectively, np² = 0.002; 95% CI, -3.187 to 3.893).  The MERP group significantly improved from baseline to post-treatment (Cohen d, 0.584-0.931; 95% CI, 0.026-1.551). This randomized clinical trial found that MERP may be a promising treatment for C-OCD however, there was no significant advantage over SERP.  

Click to read the study in JAMA Network Open

Image: PD

©2025 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.