By Emma Young

Almost half of people with Obsessive Compulsive Disorder (OCD) have extreme fears about touching something they feel is “contaminated”. This can mean that after touching a doorknob, say, they then feel compelled to scrub their hands, in some cases even until they bleed.

Conventional treatments, which often involve a combination of a prescription drug (typically an “SSRI”, such as Prozac) plus cognitive behavioural therapy (CBT), help only about 60 per cent of people with OCD, so there’s an urgent need for additional treatments. Now in Scientific Reports, Baland Jalal at the University of Cambridge and colleagues present initial data suggesting that a simple video intervention, delivered via a phone app, might help.

For this exploratory study, the researchers recruited 93 people from the local community with higher than average fears about contamination but without a diagnosis of OCD. The researchers made this recruitment decision in case their experimental treatment inadvertently worsened their participants’ symptoms, which would likely have been more serious for people with full OCD. But thankfully, as hoped, their intervention was helpful – after just a week, participants in the two intervention groups showed significant improvements, whereas members of the control group did not.

The trial began with all the participants completing an initial battery of questionnaires and a clinical interview. The participants in the two intervention groups were then videoed for 30 seconds either touching toilet paper inside a bedpan that had been mocked up to look and smell as though it contained faeces, or washing their hands in a sink. The control participants were videoed making arbitrary hand gestures. These videos were then loaded into a smart-phone app, and on four occasions each day over the next 7 days, all the participants were then prompted, via the app, to watch their personalised video.

Watching the bedpan video was designed to be a potentially much less confronting, less time-consuming (and also less expensive) version of standard exposure-based CBT therapy. This involves progressively exposing the client to a “contaminated” object (like a toilet seat), which generates anxiety – but preventing them from washing themselves. By allowing clients to feel the eventual decrease in their anxiety levels, even in the absence of the washing, therapists help them to learn to overcome their contamination fears. The hand-washing video was designed with the hope that it would allow a kind of vicarious cleansing, assuaging the individual’s concerns about contamination without them having to actually go and wash their hands.

On the eighth day, all the participants came back into the lab for follow-up testing. Both intervention groups showed a significant decrease in OCD symptoms, measured using the Yale-Brown Obsessive-Compulsive Scale. They also got better at a test of cognitive flexibility, which entails being able to shift attention as a situation changes. Their scores on the contamination fears scale did not decrease, but that might be because a week wasn’t long enough for them to recognise changes within themselves, the researchers suggest. (Members of the control group showed no changes on any of the measures.)

Several participants described their own experiences. One in the hand-washing condition reported: “It felt as if I had washed my hands, so I didn’t need to wash my hands anymore…my hands were clean after using the app”. A member of the bedpan group said: “I have become desensitised to the video and other things as well. If I normally were to wipe a kitchen worktop, I would throw the cloth away because I felt it was disgusting to clean that cloth for another time. But since using the app I now use the cloth, clean it, and use it again another time.”

The next step is of course to investigate whether these interventions really can work as a treatment for OCD. As the researchers write, they are certainly worth investigating further, in part because they “are not only inexpensive and accessible but can be tailored for individual patients. They also have the potential for widespread implementation and could potentially reach communities that do not have access to adequate mental health care.”

—Novel Smartphone Interventions Improve Cognitive Flexibility and Obsessive-Compulsive Disorder Symptoms in Individuals with Contamination Fears

Emma Young (@EmmaELYoung) is Staff Writer at BPS Research Digest