Symptom provocation through Virtual Reality
in Obsessive-Compulsive Disorder
[email protected]!
[email protected]!
Martine van Bennekom, Ati Kasanmoentalib, Pelle de Koning, Damiaan Denys
Academic Medical Center, University of Amsterdam, Department of Psychiatry, Amsterdam, The Netherlands
Methods!
Introduction!
8 OCD patients and 8 controls (matched for age
and gender) navigated through the !
VR- environment and encountered 15 OCD
provocative situations (e.g. running gas). !
!
Participants rated the negative emotions provoked
in each situation on a 0-10 VAS scale, subdivided in
anxiety, unrest, uncertainty and need to control.
They were offered the option to perform
compulsive behavior in each situation.!
!
We hypothesized that the 15 OCD specific
situations, provoked negative emotions and
compulsive behavior!
Virtual Reality (VR) is a new and innovative
technique to create a realistic and dynamic
environment in which OCD symptoms can be
provoked in a controlled and standardized way. !
!
In this pilot study we tested a video based
interactive VR-environment that we designed
specifically to simultaneously provoke and
measure OCD symptoms. !
!
If this VR-environment is able to provoke OCD
symptoms in patients, this will take OCD
symptom provocation studies to the next level. !
!
Results!
Hhj
Figure 3: Mean provoked negative emotions !
in virtual environment!
Figure 4: Provoked compulsions !
in virtual environment!
Results!
Figure 1: Mean anxiety !
in each situation!
Figure 2: Mean compulsive behavior !
in each situation!
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!
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Conclusion!
!
!!!
This is the first study to investigate a video based
Virtual Reality environment for OCD symptom
provocation. !
!
The first results show that our VR environment is
able to provoke OCD specific symptoms in OCD
patients.!
!
Although more validation steps are needed, the
use of virtual reality in OCD research seems a
promising and innovative technique to enhance
OCD symptom provocation studies.!
P.4.b.021
Symptom provocation through virtual reality in obsessive-compulsive disorder aOCD)
M.S. Kasanmoentalib 1, M.J. Van Bennekom 1, D. Denys 1, P.P. De Koning 1
1Academic Medical Center Amsterdama Psychiatriea Amsterdama The Netherlands
Background: Symptom provocation is essential for OCD research. In a controlled environment, OCD symptom
provocation is preferably implied using static pictures of OCD specific cues. The use of pictures has, however,
important limitations in terms of presence and interaction, leading to a chasm between picture-induced and real
life OCD symptoms. Interestingly Virtual Reality aVR) can be used to create a more realistic and dynamic
environment in which OCD symptoms can be provoked in a controlled and standardized way. Our group
developed an OCD specific VR environment that is able to provoke and measure OCD symptoms simultaneously.
In the current study we hypothesized that a1) the VR environment will provoke distress and compulsive behavior
in reaction to the VR cues in OCD patients as compared to healthy controls, a2) levels of distress in OCD patients
will decrease following compulsive behavior performed in the VR environment and that a3) autonomic neural
activity will adapt in reaction to the cues in OCD patients as compared to healthy controls.
Methods: 12 OCD patients and 12 healthy controls amatched for age and gender) were included in this pilotstudy. Participants navigated through the VR environment on a laptop computer wearing a headphone, while skin
conductance and heart rate were recorded. The VR environment is created out of realistic video-images of a
family home, filmed from a first person perspective. Participants navigated through the family house and
encountered 15 OCD specific provocative situations, e.g. a dirty toilet or running gas. When they encountered
one of those situations they had to rate the levels of distress, subdivided in anxiety, unrest, insecurity and need
to control. They could perform compulsive behavior in each situation and subsequently rate the levels of distress
for a second time. The distress before and after compulsive behavior, the amount of compulsive behavior and
the autonomic responses were analyzed and compared between both groups, and correlated with autonomic
responses.
Results: 12 OCD patients with a mean YBOCS score of 19 a5–27) and 12 healthy controls were currently included
in this pilot study. All OCD patients performed compulsive behavior in more than one situation in the VR
environment and experienced increased levels of distress. Preliminary results show that OCD patients performed
twice as many compulsions and experienced a significantly higher level of distress than healthy controls. OCD
patients showed the OCD specific reduction of distress following the execution of compulsions in the VR
environment.
Conclusions: This is the first study to investigate a video based Virtual Reality environment for OCD symptom
provocation. It is also the first study that analyses autonomic responses in association with affective changes.
The results show that our VR environment is able to provoke OCD specific symptoms in OCD patients. Although
more validation steps are needed, the use of Virtual Reality for symptom provocation in OCD research seems a
promising and innovating technique.
Citation: Eur Neuropsychopharmacol. 2014;24aSuppl 2):S599
Keywords
Obsessive compulsive disorders
New research
Neurophysiology: clinical