inducing an anxiety response using a contaminated virtual environment: validation of a therapeutic tool for obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is characterized by the presence of unwanted and repetitive thoughts triggering significant anxiety, as well as the presence of ritual behaviours or mental acts carried out in response to obsessions to reduce the associated distress. In the contamination subtype, individuals are scared of germs and bacteria, are excessively concerned with cleaning, fear contamination and the spread of disease, and may have a very strong aversion to bodily secretions. A few studies on virtual reality have been conducted with people suffering from OCD, but they all focus on the subtype characterized by checking rituals. The goal of this study is to confirm the potential of a contaminated virtual environment in inducing anxiety in 12 adults suffering from contamination-subtype OCD compared to 20 adults without OCD (N = 32) using a within-between protocol. Subjective (questionnaire) and objective (heart rate) measurements were compiled. Participants were immersed in a control virtual environment (empty and clean room) and a contaminated virtual environment (filthy public restroom) designed for the treatment of OCD. Immersions were conducted in a 6-wall CAVE-like system. As hypothesized, the results of repeated-measures ANCOVAs revealed the significant impact of immersion in a filthy public restroom for participants suffering from OCD on both measures. Presence was correlated with anxiety in OCD participants and no difference in presence was observed between groups. Unwanted negative side effects induced by immersions in virtual reality were higher in the OCD group. The clinical implications of the results and directions for further studies are discussed.