Management of obsessive–compulsive disorder with virtual reality-based exposure

Little information is available about use of virtual reality exposure for management of obsessive compulsive disorder (OCD). We present a patient with OCD, who presented with significant dysfunction related to his OC symptoms and was managed with virtual reality based exposure therapy. A 27-year-old male, presented with a history suggestive of OCD for last 8 years. His symptoms were characterized by obsessive images of known people, leading to significant anxiety and distress. To get rid of his anxiety and distress, he would repeat the acts at hand, multiple times till these images would subside or till he would be able to replace these images by desirable images. These symptoms led to marked socio-occupational dysfunction. The treatment history was suggestive of minimal response to adequate trials of multiple selective serotonin reuptake inhibitors and he was on capsule fluoxetine 80 mg/day at the time of presentation. Exposure and Response therapy was tried in the past by using imaginal exposure, but this was unsuccessful, as the patient would avoid imagining the anxiety-provoking images. Hence, he was exposed to the anxiety provoking images by using virtual reality which involved presenting him with videos containing pictures of known and unknown people arranged randomly, along with the anxiety-provoking images. Over a period of 2 months, 60 sessions of ERP were carried out and the whole hierarchy was completed. This case demonstrates that virtual reality can be used in behaviour therapy for OCD, by using virtual reality techniques, and there is a need to develop software and programs for assessment and management of OCD.