Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Lentzeallee 94, 14195, Berlin, Germany.
Psychiatr Q. 2022 Sep;93(3):861-882. doi: 10.1007/s11126-022-09992-5. Epub 2022 Jul 2.
Exposure therapy in virtual reality is successful in treating anxiety disorders. Studies on exposure and response prevention in virtual reality (VERP) in obsessive-compulsive disorder (OCD) are rare, and it is unclear whether distress associated with other emotions than anxiety (e.g., disgust) can be evoked. The present study aimed to investigate whether distress can be induced during VERP in patients with contamination-related OCD (C-OCD) and a primary feeling of disgust. We treated eight female patients with C-OCD with the primary emotion of disgust over six weeks with VERP and assessed their OC symptoms before and after the intervention period with the Y-BOCS. We measured subjective units of distress (SUD), heart rate and skin conductivity (arousal), sense of presence, and simulator sickness during four consecutive exposure sessions. VERP was able to induce distress and arousal. The qualitative feedback was heterogeneous and sense of presence moderate. Patients' OC symptoms reduced over the treatment period with medium to large effect sizes, but only two patients were considered responders; two patients discontinued treatment due to lack of treatment success. Although VERP was able to induce distress and arousal associated with disgust and evoked a moderate sense of presence, the low rate of symptom reduction diminishes the positive results. Possible reasons for the heterogeneous results and implications are discussed. Trial registration: German Registry for Clinical Studies (DRKS00016929), 10.04.2019.
虚拟现实暴露疗法在治疗焦虑症方面是成功的。关于虚拟现实中暴露和反应预防（VERP）在强迫症（OCD）中的研究很少，目前尚不清楚是否可以引发除焦虑以外的其他情绪（例如，厌恶）所带来的痛苦。本研究旨在探讨在与污染相关的 OCD（C-OCD）和主要的厌恶感患者中进行 VERP 是否可以引起痛苦。我们对八名患有 C-OCD 和主要厌恶感的女性患者进行了六周的 VERP 治疗，并在干预期前后使用 Y-BOCS 评估了他们的 OC 症状。我们在四个连续的暴露疗程中测量了主观痛苦单位（SUD）、心率和皮肤电导率（唤醒）、存在感和模拟器不适。VERP 能够引起痛苦和唤醒。定性反馈是多种多样的，存在感是适度的。患者的 OC 症状在治疗期间减少，具有中等至大的效应量，但只有两名患者被认为是有反应者；两名患者因缺乏治疗效果而停止治疗。尽管 VERP 能够引起与厌恶相关的痛苦和唤醒，并引起适度的存在感，但症状减少的比率较低，降低了积极的结果。讨论了结果异质性的可能原因及其影响。试验注册：德国临床研究注册处（DRKS00016929），2019 年 4 月 10 日。
