Promising Treatments for Obsessive-Compulsive Disorder: A Call for Additional Research

Virtual reality in the diagnostic and therapy for mental disorders: A systematic review

BACKGROUND

Virtual reality (VR) technologies are playing an increasingly important role in the diagnostics and treatment of mental disorders.

OBJECTIVE

To systematically review the current evidence regarding the use of VR in the diagnostics and treatment of mental disorders.

DATA SOURCE

Systematic literature searches via PubMed (last literature update: 9^th of May 2022) were conducted for the following areas of psychopathology: Specific phobias, panic disorder and agoraphobia, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, dementia disorders, attention-deficit/hyperactivity disorder, depression, autism spectrum disorder, schizophrenia spectrum disorders, and addiction disorders.

ELIGIBILITY CRITERIA

To be eligible, studies had to be published in English, to be peer-reviewed, to report original research data, to be VR-related, and to deal with one of the above-mentioned areas of psychopathology.

STUDY EVALUATION

For each study included, various study characteristics (including interventions and conditions, comparators, major outcomes and study designs) were retrieved and a risk of bias score was calculated based on predefined study quality criteria.

RESULTS

Across all areas of psychopathology, k = 9315 studies were inspected, of which k = 721 studies met the eligibility criteria. From these studies, 43.97% were considered assessment-related, 55.48% therapy-related, and 0.55% were mixed. The highest research activity was found for VR exposure therapy in anxiety disorders, PTSD and addiction disorders, where the most convincing evidence was found, as well as for cognitive trainings in dementia and social skill trainings in autism spectrum disorder.

CONCLUSION

While VR exposure therapy will likely find its way successively into regular patient care, there are also many other promising approaches, but most are not yet mature enough for clinical application.

REVIEW REGISTRATION

PROSPERO register CRD42020188436.

FUNDING

The review was funded by budgets from the University of Bonn. No third party funding was involved.

Investigation of a Mobile "Serious Game" in the Treatment of Obsessive-Compulsive Disorder: A Pilot Study

OBJECTIVE

Exposure and response prevention (ERP) therapy is considered a first-line treatment for obsessive-compulsive disorder (OCD). Dysregulation in the cortico-striato-thalamo-cortical (CSTC) circuit has been implicated in the pathophysiology of OCD, as have decreased functional connectivity (FC) between the dorsal anterior cingulate cortex (dACC) and the prefrontal cortex and increased FC between the dACC and the basal ganglia. We hypothesized that a new ERP-inspired mobile "serious game" would improve clinical symptoms in OCD and that symptom improvement would be associated with altered FC within CSTC.

MATERIALS AND METHODS

Fifteen OCD subjects and 15 healthy controls were recruited. All subjects completed questionnaires covering demographic data, the Yale-Brown Obsessive-Compulsive Scale, the Beck Depressive Inventory, and the Beck Anxiety Inventory. In addition, all subjects were scanned at baseline to assess brain FC using resting-state functional magnetic resonance imaging.

RESULTS

After 3 weeks of gameplay, FC from the left dACC seed to the right frontal precentral gyrus and from the right dACC seed to the left inferior frontal gyrus and the right middle frontal gyrus, increased in the OCD group. Responders showed increased brain connectivity from the left dACC seed to the right superior frontal gyrus compared with nonresponders.

CONCLUSION

Our results suggest that serious games may improve symptoms in OCD and that this improvement may be related to increased brain connectivity between the dACC and the prefrontal cortex. Further exploration is needed to assess the potential role of serious games in OCD treatment.