OCD is a very common mental health condition but which doesn't come up that often in conversations. People often make jokes about individuals who like to be neat or clean their house that they have OCD, but the condition itself is much more debilitating in severe cases.

Virtual Reality as a treatment solution for People With OCD

First of all what is OCD? Many of you may have heard about it but you might have difficulty defining it. And this is not surprising seeing how this condition is often misdiagnosed with some patients reportedly having been given the wrong treatment for 10 to 15 years. Obsessive compulsive disorder (OCD) is in fact a mental health disorder that affects people of all ages and walks of life, and occurs when a person gets caught in a cycle of obsessions and compulsions . Obsessions are unwanted, intrusive thoughts, images, or urges that trigger intensely distressing feelings, while compulsions are behaviors an individual engages in to attempt to get rid of the obsessions and/or decrease distress.

Most people have obsessive thoughts and/or compulsive behaviors at some point in their lives, but that does not mean that we all have “some OCD.” In order for a diagnosis of OCD to be made, this cycle of obsessions and compulsions must be so extreme that it consumes a lot of time (more than an hour every day), causes intense distress, or gets in the way of important activities that the person values. But this is precisely why it is so hard to diagnose since it shares a lot of the same symptoms with general anxiety disorder and also with depression.

Could I have OCD?

It would not be a big leap for you to ask yourself this question, after all, the most common image people have of OCD symptoms is that you like things to be symmetrical and wash your hands often. There is even a joke among some psychologists who have people come into their clinic because they have been misdiagnosed that the biggest referral to OCD seems to be Google, this time quite unironically. So before even discussing possible treatments we need to properly identify and diagnose the condition. By that I don't mean google, no matter how effective that may be, you should still consult a specialist. But saying this, it doesn't hurt to have a little bit of knowledge on the symptoms. As previously stated there are two factors that combined lead to OCD, obsessions and compulsions. Not all of them, of course, this should be know throughout this article, that we are referring to severe and extreme cases of obsessions and compulsions, not to the fact that you crave ice-cream from time to time.

Let's look at some common obsessions in OCD. Obsessions are repeated, persistent and unwanted thoughts, urges or images that are intrusive and cause distress or anxiety. You might try to ignore them or get rid of them by performing a compulsive behavior or ritual. These obsessions typically intrude when you're trying to think of or do other things. Some of the obsession symptoms include:

Contamination Obsessions

  • Fear of coming into contact with perceived contaminated substances/things, such as:
  • Body fluids (e.g. urine, feces)
  • Germs/disease (e.g. herpes, HIV, COVID-19)
  • Environmental contaminants (e.g. asbestos, radiation)
  • Household chemicals (e.g. cleaners, solvents, battery acid)
  • Dirt

Violent Obsessions

  • Fear of acting on an impulse to harm oneself
  • Fear of acting on an impulse to harm others
  • Fear of violent or horrific images in one's mind

Responsibility Obsessions

  • Fear of being responsible for something terrible happening (e.g. fire, burglary, car accident)
  • Fear of harming others because of not being careful enough (e.g. dropping something on the ground that might cause someone to slip and themselves)

Perfectionism-related Obsessions

  • Excessive concern about evenness or exactness
  • Excessive concern with a need to know or remember
  • Fear of losing or forgetting important information when throwing something out
  • Excessive concern with performing tasks "perfectly" or "correctly"
  • Fear of making mistakes

Sexual Obsessions

  • Unwanted thoughts or mental images related to sex, including:
  • Fear of acting on a sex-related impulse
  • Fears about sexually harming children, relatives, or others
  • Fears about aggressive sexual behaviors towards others

Religious/Moral Obsessions (Scrupulosity)

  • Excessive concern with offending God, damnation, and/or concern about blasphemy
  • Excessive concern with right/wrong or morality

Identity Obsessions

  • Excessive concern with one's sexual orientation.
  • Excessive concern with one's gender identity.

Other Obsessions

  • Relationship-related obsessions (e.g. excessive concern about whether one’s partner is “the one," the partner’s flaws and qualities)
  • These types of obsessions can center around romantic partners, relatives, friends, and other relationships.
  • Obsessions about death/existence (e.g. excessive preoccupation with existential and philosophical themes, such as death, the universe, and one’s role in “the grand scheme.”
  • Real event/false memory obsessions (e.g. excessive concern about things that happened in the past and what impacts they may have had)
  • Emotional contamination obsessions (e.g. fear of "catching" personality traits or personal characteristics of other individuals)

Now let's look at OCD compulsions. Compulsions are repetitive behaviors that you feel driven to perform. These repetitive behaviors or mental acts are meant to reduce anxiety related to your obsessions or prevent something bad from happening. However, engaging in the compulsions brings no pleasure and may offer only a temporary relief from anxiety. The most common symptoms are:

Washing and Cleaning

  • Washing hands excessively or in a certain way
  • Excessive showering, bathing, tooth-brushing, grooming ,or toilet routines
  • Cleaning household items or other objects excessively
  • Doing other things to prevent or remove contact with contaminants


  • Checking that you did not/will not harm others
  • Checking that you did not/will not harm yourself
  • Checking that nothing terrible happened
  • Checking that you did not make a mistake
  • Checking some parts of your physical condition or body


  • Rereading or rewriting
  • Repeating routine activities (examples: going in or out doors, getting up or down from chairs)
  • Repeating body movements (example: tapping, touching, blinking)
  • Repeating activities in "multiples" (examples: doing a task three times because three is a "good," "right," "safe" number)

Mental Compulsions

  • Mental review of events to prevent harm (to oneself others, to prevent terrible consequences)
  • Praying to prevent harm (to oneself others, to prevent terrible consequences)
  • Counting while performing a task to end on a "good," "right," or "safe" number
  • "Cancelling" or "Undoing" (example: replacing a "bad" word with a "good" word to cancel it out)

Other Compulsions

  • Putting things in order or arranging things until it "feels right"
  • Telling asking or confessing to get reassurance
  • Avoiding situations that might trigger your obsessions

OCD usually begins in the teen or young adult years, but it can start in childhood. Symptoms usually begin gradually and tend to vary in severity throughout life. The types of obsessions and compulsions you experience can also change over time. Symptoms generally worsen when you experience greater stress. OCD, usually considered a lifelong disorder, can have mild to moderate symptoms or be so severe and time-consuming that it becomes disabling.

So how can Virtual Reality help?

Now that we know some of the most common symptoms and how OCD manifests, the next question would be: how do you treat it? As mentioned above, there are varying degrees of severity when it comes to OCD as with most mental health conditions. In some cases patients can overcome their OCD relatively easily but other patients could suffer for years trying various treatments. People suffering from such severe cases reported manifesting insomnia for months on end after forgetting or trying to skip past one of the compulsive rituals.

Now when it comes to treatment the most effective method is still Exposure therapy which is a type of cognitive behavior therapy. This method could also be couple with some form of medication in the form of inhibitors such as SSRI's (Selective Serotonin reuptake inhibitors).

Support groups are also often a greater help than given credit. Talking and hearing about similar stories, some of who may have managed to overcome their difficulties can give a huge boost of confidence and commitment to the treatment. Now they way traditional therapy works in OCD cases is something like this. The first step is for you to describe all of your obsessions and compulsions. Then you and the therapist will arrange them in a list, ordering them from things that don’t bother you much to things that are the most frightening. Next, the therapist will ask you to face your fear of something on your list, starting with the easiest. Let’s say you have an obsessive fear of germs in public places, and that fear is pretty low in how much it scares you. Your therapist will design a task for you that exposes you to that fear. Your task might for you to touch a public doorknob. Here’s where the response-prevention part comes in. If your usual response is to wash your hands immediately after touching the doorknob, the therapist would ask you to wait before you wash your hands. As you repeat this exposure task, the therapist will ask you to wait longer and longer before washing your hands. Over time, this gradual exposure and delayed response would help you learn to control your fear of germs in public places without washing your hands.

Now imagine the same treatment but in virtual reality with many added benefits. First, you can undergo treatment in the comfort of your own home, no need for traffic and other annoyances. Second if you have a natural aversion of discussing with strangers and have a hard time opening up to people when you talk to them face-to-face, you needn't worry. In a virtual world you will only interact with your doctor's avatar if that at all. There are also A.I. assisted therapy sessions or your therapist can just guide you with their voice in virtual reality with no need to even see their representation. But maybe the most important benefit of this technology is the fact that you can still get the exposure therapy needed but in an environment which you can easily tweak and control to adjust to your situation. Not to mention that you can experience different scenarios at the click of a button without the need to go to the actual location like in vivo therapy (in real life).

So if you need to experience the triggers that get you to count things or move/do a certain action in a certain scenario, you can do that with the assurance that nothing could go wrong. You can also repeat the exact same scenario until your are satisfied with your results. Your therapist can also more easily engage in cognitive therapy in virtual reality since they can show you examples of scenarios. Cognitive therapy for OCD focuses on the experience of negative thoughts. While most people easily dismiss such thoughts (e.g., “That’s a silly thing to think”), some people have certain beliefs that thoughts are always important. So instead of being able to just forget about these negative thoughts, their beliefs cause them to react differently and might make them think “I’m a bad person for having such a thought!” Research shows that believing that negative thoughts are important and attempting not to have “bad” thoughts actually produces the opposite effect.

OCD is a condition which takes a great degree of time and commitment in order to treat. Not only that difficulties arise from trying to expose the patients to their triggers, difficulties such as locations, environment, tools, people, there are many variables. Thankfully virtual reality is an excellent tool to offset these variables and help both the therapist and the patient. In virtual reality you can recreate everything you need for the patient's compulsions in order to test and treat them. And for the people that think that a cartoon-like environment will not be sufficient to trigger the OCD, they are completely wrong. The way our brains work is that even if we are acutely aware that what we see is not really we will still react. A very easy to understand example is when you see a horror movie. You know at the back of your mind that it is not real. You are looking at a monster on a tv screen. But you will still get scared. It is even more so with virtual reality where the immersion is so much greater. With all this, maybe in the future OCD disorders will not be such a scary condition to have knowing that there is a tool which can more easily help you manage and treat it.

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Julian Sanda
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