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TOPLINE:

Mixed reality exposure and response prevention (MERP) therapy showed no significant advantage over self-guided exposure and response prevention (SERP) therapy among individuals with contamination-related obsessive-compulsive disorder (OCD), a new trial showed. However, improvements within the MERP group suggested potential, highlighting the need for enhanced immersion for improved effectiveness.

METHODOLOGY:

• This randomised clinical trial (2022-2024) included 36 adults (mean age, 35.42 years; 66.7% women) with contamination-related OCD. Those with schizophrenia, bipolar disorder, severe substance use disorder, acute suicidality, and ongoing inpatient treatment were excluded.
• Participants received six weekly sessions of either MERP (n = 18) or SERP (n = 18) therapy.
• The primary outcome was the severity of OCD symptoms in the past 7 days, assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) before and after the intervention and at 3 months.
• Secondary outcomes included the sense of presence, measured using the Temple Presence Inventory, and subjective appraisal.

TAKEAWAY:

• Severe OCD symptoms were observed in both MERP and SERP groups at baseline (mean Y-BOCS score, 26.94 and 24.22, respectively).
• Both groups showed no significant differences for any of the outcome variables. The MERP group demonstrated significant within-group improvements across psychopathological variables (P = .02).
• The sense of presence in the MERP group was moderate. Most participants (94.4%) reported greater ease of confronting their OCD in the mixed reality environment than in real life.
• Subjective appraisal varied among participants, limited by the constant awareness among them that the scenario in MERP was virtual, with no real risk for contamination.

IN PRACTICE:

"While MERP may have potential in addressing OCD and related symptoms, further research is needed to address limitations," the authors wrote. "Subjective evaluations suggest that MERP could be considered as a preliminary approach before traditional ERP in vivo," they added.

SOURCE:

This study was led by Franziska Miegel, PhD, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. It was published online on May 20 in JAMA Network Open.

LIMITATIONS:

The relatively small sample size, limited to patients with contamination-related OCD, restricted the study's generalisability. The retrospective assessment in the SERP group may not have fully captured the actual use. Additionally, the concurrent use of ERP and the lack of medication dosage data challenged the assessment of MERP-specific effects and treatment adequacy, respectively.

DISCLOSURES:

This research was supported by the Freie und Hansestadt Hamburg and the Hamburgische Investitions und Förderbank from EU funding. Several authors reported receiving research funding and personal fees from various sources outside the submitted work. One author reported serving on the advisory board of a pharma company. Details are provided in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.