Artificial Intelligence-Powered Virtual Reality Exposure Therapy for OCD in College Students: A Proof-of-Concept Study

• Traditional Exposure and Response Prevention (ERP) (Other): Exposure and response prevention (ERP) is a specific type of cognitive behavioral therapy (CBT) that is the most effective, and first-line psychotherapy for children, adolescents, and adults. ERP is guided by a trained therapist and helps individuals extinguish fears and reduce or eliminate compulsive behaviors in a structured and supportive environment. ERP treatment begins by the therapist providing the patient with psychoeducation and then developing an exposure hierarchy or exposure list for the individual's OCD symptoms. The individual with OCD is then exposed to stimuli that elicit distress (exposure) and then prevented from engaging in compulsive, ritualistic, or avoidance behavior (response prevention). The exact ERP session varies depending on the individual's OCD symptoms and their readiness to engage in compulsions. The therapist and patient then collaboratively develop practice or homework assignments to complete between sessions.
• Artificial Intelligence-Powered Virtual Reality Exposure Therapy (AI-VRET) (Device): Virtual reality exposure therapy is a modality of exposure therapy that immerses individuals in computer-generated scenarios to gradually face their fears while wearing headsets that place them in the immersive environments. Artificial intelligence-powered virtual reality exposure therapy (AI-VRET), adds on to virtual reality exposure therapy by enabling the therapist to modify the virtual reality environment by use of artificial intelligence in real-time.

Primary outcomes

• Yale-Brown Obsessive Compulsive Scale-II (Y-BOCS-II) [Visits 1 (baseline) & 14 (post-treatment assessment, approximately 14 weeks following baseline)]

Secondary outcomes

• Florida Obsessive-Compulsive Inventory (FOCI) [Visits 1 (baseline) & 14 (post-treatment assessment, approximately 14 weeks following baseline)]
• Adult OCD Impact Scale (OCD-IS): [Visits 1 (baseline) & 14 (post-treatment assessment, approximately 14 weeks following baseline)]
• Sheehan Disability Scale (SDS) [Visits 1 (baseline) & 14 (post-treatment assessment, approximately 14 weeks following baseline)]
• Generalized Anxiety Disorder-7 (GAD-7): [Visits 1-14 (all study visits). Visit 1 is at baseline, and subsequent visits are approximately one week apart. The final visit is approximately 14 weeks after baseline.]
• Patient Health Questionnaire-9 (PHQ-9) [Visits 1-14 (all study visits). Visit 1 is at baseline, and subsequent visits are approximately one week apart. The final visit is approximately 14 weeks after baseline.]
• Presence Questionnaire (PQ) [Visits 2-13. Visit 2 is approximately one week following baseline, and subsequent visits are approximately one week apart. Visit 13 is approximately 13 weeks following baseline.]
• Cybersickness in Virtual Reality Questionnaire (CSQ-VR) [Visits 2-13. Visit 2 is approximately one week following baseline, and subsequent visits are approximately one week apart. Visit 13 is approximately 13 weeks following baseline.]

Sex: All, ages: 18 Years to 29 Years

Inclusion Criteria:

1. Sign and date informed consent form.
2. Stated willingness to comply with all study procedures and availability for the duration of the study.
3. Age 18-29 at time of enrollment.
4. Diagnosed with OCD as confirmed through clinical interview.
5. Currently enrolled as a college student and receiving psychiatric care in the University of California San Diego College Mental Health Program.

Exclusion Criteria:

1. Age under 18 or over 29 years at the time of enrollment.
2. Absence of a confirmed OCD diagnosis via clinical interview.
3. Not currently enrolled as a college student.
4. Presence of a contraindication for VR use, including a history of migraine, seizures, motion sickness, simulator sickness, or having an implanted medical device that could be impacted by magnetic or electromagnetic fields (e.g., cardiac pacemaker, defibrillator, or hearing aid).
5. Suicidal or parasuicidal behavior within the past 6 months.
6. Comorbid psychotic disorder.
7. Requirement for frequent medication changes that would preclude stable study participation.