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Exposure Therapy in Mixed Reality for Obsessive-Compulsive Disorder: A Randomized Clinical Trial.

Franziska Miegel¹, Lena Jelinek¹, Luzie Lohse¹

¹Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

JAMA Network Open

|May 20, 2025

Summary

Mixed reality exposure and response prevention (MERP) showed some effectiveness for contamination-related obsessive-compulsive disorder (C-OCD), though not significantly better than self-guided ERP. Future research should focus on enhancing MERP immersion and impact.

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Area of Science:

Psychiatry
Clinical Psychology
Human-Computer Interaction

Background:

Virtual reality (VR) exposure therapy is established for anxiety, but VR-based exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD) faces challenges with weak presence.
Mixed reality (MR) offers a potential solution by integrating virtual elements with the real world, possibly enhancing the sense of presence crucial for therapeutic effectiveness.

Purpose of the Study:

To evaluate the feasibility and efficacy of ERP delivered via mixed reality (MERP) compared to self-guided ERP (SERP).
To assess MERP's impact on OCD symptom severity, sense of presence, and subjective appraisal in individuals with contamination-related OCD (C-OCD).

Main Methods:

A randomized clinical trial (RCT) involving 36 adults with C-OCD, comparing 6 sessions of MERP to SERP.
Symptom severity was measured using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at baseline, post-intervention, and 3-month follow-up.
Secondary outcomes included sense of presence and subjective appraisal, with Y-BOCS scores analyzed for between-group and within-group changes.

Main Results:

No significant differences in OCD symptom reduction were found between the MERP and SERP groups.
However, the MERP group demonstrated significant within-group improvements in OCD symptoms and other psychopathological variables.
Sense of presence in MERP was moderate, and subjective appraisal was heterogeneous.

Conclusions:

MERP shows some level of effectiveness for C-OCD, indicated by within-group improvements, but did not outperform SERP in this trial.
The study suggests that the full potential of MERP may not yet be realized.
Future research should focus on improving MERP's immersion and overall therapeutic impact.