Abidin Early Career Award Update

Abidin Early Career Award Update

By Joseph McGuire, PhD
2022 Abidin Award Winner

By Joseph McGuire, PhD
2022 Abidin Award Winner

The Abidin Award has played a critical role in determining whether virtual reality exposures can be utilized in the treatment of childhood OCD. Exposure and response prevention (ERP) is the frontline treatment for childhood OCD. However, a survey of OCD therapists in clinical practice identified that therapists had difficulty completing exposures for several OCD symptoms within an office setting (Ramsey et al., 2024). Additionally, therapists also reported challenges with patient compliance and/or motivation outside of therapy sessions were barriers to exposure homework completion. While mobile health (mHealth) applications show promise for increasing exposure homework adherence between ERP sessions (Tuerk, McGuire, & Piacentini, 2024), this would not address challenges identified by therapists of completing exposures within session due to access to exposure stimuli.

In response to these identified challenges, we investigated whether virtual reality (VR) exposures could be used in the treatment of childhood OCD. Towards this goal, we conducted a multi-modal examination to compare the behavioral, subjective, and physiological responses between youth with OCD and youth unaffected by any mental health condition—as determined by a structured diagnostic interview—when completing three common OCD exposures.

We used the Oculus Quest 2 and developed three VR exposures that could be paralleled in both the virtual world and real-world settings. We selected common activities of daily living that could be completed in ~3 minutes per exposure: (1) picking up and throwing pieces of “trash” in a room for a contamination exposure; (2) misaligning pictures on the wall for the symmetry exposure; and (3) only checking grade-level math homework once as quickly and as accurately as possible for the checking exposure.

Participants were randomly assigned to complete the VR exposures or in vivo exposure first. After completing one set of exposure tasks (VR or in vivo), participants had a ~15-minute break in which they completed rating scales before completing the other set of exposure tasks (VR or in vivo).  Participants returned on another day to complete VR exposures and in vivo exposures in the opposite order of the prior visit, with a ~15-minute rest period in between exposure sets to complete any remaining rating scales. Finally, participants were asked to express preference for a specific exposure modality.

While peer-reviewed publications are forthcoming, this Abidin funded project identified that: 

• VR exposures are feasible, acceptable, and primarily preferred by children and adolescents with and without OCD.
• Exposures—both VR or in vivo—elicited greater behavioral, subjective, and physiological responses among youth with OCD compared to youth without any mental health conditions. This finding demonstrates that VR and in vivo exposures served to elicit appropriate responses from youth with OCD.
• The within-subject repeated measure design highlighted that youth with OCD exhibited comparable behavioral and subjective responses to both VR exposures and in vivo exposures—with some differences between exposure modalities on physiological outcomes.

This project would not be possible without the support of the Abidin Award.

References

Ramsey, K. A., Browning, L. E., Chang, A. H., & McGuire, J. F. (2024). Clinician-reported challenges associated with delivery of exposure with response prevention for patients with obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders, 42, 100895.

Tuerk, P. W., McGuire, J. F., & Piacentini, J. (2024). A randomized controlled trial of OC-Go for childhood obsessive–compulsive disorder: augmenting homework compliance in exposure with response prevention treatment. Behavior Therapy, 55(2), 306-319.