Sarah Markham: Can virtual reality help patients with OCD?

The creative use of mobile and wearable health information and sensing technologies—also known as mHealth—may have the potential to reduce the cost of healthcare and improve wellbeing in numerous ways.

OxfordVR, a team based at Oxford University who are looking at the evidence behind immersive technology for mental health, have turned their attention to the treatment of Obsessive Compulsive Disorder (OCD). They are doing this in collaboration with the McPin Foundation, which puts the lived experience of people affected by mental health problems at the heart of research methods. I have OCD and I was keen to be involved with the development of this intervention, so I was pleased to become a member of the associated Lived Experience Advisory Panel (LEAP).

People with obsessive compulsive disorder experience obsessive and persistent thoughts. This can lead them to carry out compulsive actions such as repeatedly washing their hands or checking that they turned the oven off, in order to relieve anxieties. People with OCD may feel compelled to perform these tasks over and over again until they feel they have got it “right”. This can be incredibly stressful, not to say psychologically and emotionally painful, and can interfere with everyday life.

Mental pain is as real as physical pain and it needs to be treated effectively. It is thought that the anxiety reduction that follows from obeying the compulsions maintains the OCD cycle by reinforcing the benefit that yielding to one’s obsessive thoughts and feelings makes things better. The NICE Guidelines for the treatment of OCD recommends Cognitive Behavioural Therapy (CBT) including Exposure Response Prevention (ERP), a therapy that encourages people to face their fears and let obsessive thoughts occur without “putting them right” or “neutralising” them with compulsions.

Currently people with OCD are usually referred to Improving Access to Psychological Therapies (IAPT) services to receive these psychological therapies. However there may be long waiting lists to be seen by a therapist and the CBT-based ERP therapy offered involves directly resisting OCD urges which can exact a huge emotional and psychological cost. In contrast the VR OCD therapy under development doesn’t require a human therapist. Psychological advice and guidance is embedded into the virtual reality. Not being reliant on a human resource could promote accessibility to the therapy, allowing people to receive effective treatment sooner and at less financial cost, as it is anticipated that the VR headsets will cost significantly less than normal sessions with a psychologist.

It is currently unknown whether technologies such as virtual reality (VR) can help people with OCD. This is what the team at Oxford are trying to develop and research. Using the VR technology involves wearing a light headset and exploring a computer simulated environment. The software embeds a virtual psychotherapist or “virtual coach” whose role is to guide users through whatever thoughts, feelings, and responses they have to any triggers of OCD anxiety and behaviour they encounter in the virtual world. The advantage of using a virtual environment to experience, negotiate and challenge compulsions is that it allows the user to imagine taking the risk without taking a risk.

The current project aims to develop the virtual therapy to the point at which its efficacy can be tested in a small pilot study.  If this is successful it could lead to a full randomised controlled trial. A key aim of the project is for it to enable people to try to  challenge and reduce their compulsions in a safe artificial environment. By testing out and strengthening their ability to resist their anxieties and fears in the virtual world, it is hoped that they will be able to apply their experiential learning to the real world.

Initially the virtual therapy will be developed with a focus on treating compulsive checking behaviour. However the ambition is to extend it to tackle other aspects of OCD such as fear of contamination and obsessive tidiness.

McPin will ensure that the people with lived experience of OCD in the Lived Experience Advisory Panel are heard during the VR design process, as well as supporting them to advise and shape the rest of the project. This will involve suggesting and giving feedback on the content of the VR environment and the scenarios which the user will negotiate in receiving the therapy. Our contributions will also influence the design of the virtual coach; how she interacts with the user and her script; advice she offers. Our views on suitable therapy tasks or ‘homework’ to practice outside of VR sessions will also be sought. The purpose of these tasks will be to help the user translate their VR learning into real world practice.

It is a very powerful experience to work alongside fellow OCD patients and use our lived psychological pain to inform and shape the development of a technology which will hopefully help reduce the suffering of others. The technology experienced and discussed is to me as inspiring as it exciting as a potentially new intervention for OCD. As a patient and a scientist I am torn between regret that I am not permanently a part of this exciting field of research, and awe and gratitude for those academics and clinicians who are working so hard to develop digital means to help service users. 

Sarah Markham is an academic mathematician and patient representative currently pursuing a second PhD in theoretical computer science. She is a member of the BMJ Patient Advisory Panel. Twitter: @DrSMarkham

Competing interests: None declared.