Abstract
Introduction: Fear of contamination is a major dimension of disabling symptoms in obsessive-compulsive disorder (OCD), and there appears to be a direct link between fear, anxiety, and the resulting washing compulsions. Exposure and response prevention (ERP) has long been the treatment of choice, although in-vivo exposure has encountered several barriers to this process. Augmented reality (AR), including virtual reality (VR), AR, and mixed reality (MR), provides a controlled, safe, and repeatable setting in which exposure becomes a direct process. This review provides insight into the use of extended reality (XR) in inducing target emotions and reducing symptoms in OCD.
Methods: A systematic search was conducted using the PRISMA statement guidelines for PubMed, Scopus, and Web of Science databases, with a focus on studies utilizing VR, AR, or MR for evaluating and treating contamination fear or OCD symptoms. Fourteen studies fitted the inclusion criteria. Quality was assessed using the Cochrane Handbook RoB2 tool when assessing randomized controlled trials, and the Joanna Briggs Institute quality assessment instrument was applied to non-randomized studies.
Results: Overall, ten studies demonstrated positive results, including reductions in OCD symptoms, positive changes in contamination-related cognitive themes, and successful induction of anxiety and disgust. Nonetheless, the remaining four studies provided conflicting results, mainly due to less presence, less than expected improvements in symptoms, and limitations of the technology. No studies showed negative clinical outcomes. The evidence for the use of VR was strongest, particularly when combined with ERP. Moreover, AR was consistently successful in inducing contamination-related anxiety in real-life situations, and MR had some preliminary and inconclusive findings.
Conclusion: In general, XR has great potential as an adjunct or alternative treatment to standard ERP due to its ability to induce anxiety and disgust responses, patient engagement, and exposure. However, the mentioned limitations, including the use of small samples, variability in protocols, and short duration of follow-ups, highlight the need for larger studies.