Response prevention – OCD

Response prevention is a method of cognitive-behavioral therapy that is used for Obsessive Compulsive Disorder. This module is done after the five psychotherapy sessions that precede the exposure to virtual reality and is only for people suffering from OCD.

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1. THE BEGINNING OF THE RITUALS

Patients with OCD need rituals (hand washing, cup counting). The exposure therapy you do with your patient afterwards will get them to stop doing their rituals. You can’t ask a patient to stop doing them, it’s too abrupt and will traumatize the patient. You have to do things slowly and gradually so that they can decrease them as they go along. To do this, you will have to touch several parameters of these rituals. This means that you need to be aware of your patients’ practices. For example: How long do they last? What triggers them? What do you use? 

The first thing to do with your patient is to list the situations in which they occur. Structure it in a way that answers the questions: When? When? How? With whom? How long? You can also give him a sheet of paper with about 50 empty boxes so that he can count them. Beforehand, you should list all the situations and rituals, whether they are behavioral (checking the locks, cleaning) or thought-related (counting)Once all the key situations and rituals are outlined, you can begin to modify them with the patient. On the basis of the parameters mentioned, you will progressively modify each of the parameters which will lead to a cessation of this ritual after several months, or even after a year.

2. THE FREQUENCY OF THE RITUAL

The first parameter to change is the frequency of the ritual. If the patient washes their hands 50 times a day, you can reduce that to 45 times. To change it, patients have to be committed and have to be able to do it. The goal is that they can actually change that frequency in that ritual. Ask, “If we go from 60 times a day to 45 times a day, can you do it?” Once the commitment is made, you can give her another chart with the ground rules. (I must change my rituals, I must follow my therapies, I must apply my therapies).The other parameter on which we can play is the duration of the ritual, if your patient washes his hands for 5 min, you can propose to him to wash them only 4 min 30. 

3. TRIGGERING THE RITUAL

Another factor to consider is the delay in initiating the ritual. For example, tell your patients that when they are anxious and wash their hands, it is possible for them not to wash their hands right away, but to wait 30 seconds. In the meantime, suggest that they do some meditation, some relaxation methods, to repeat slogans, mental imagery seen in previous therapies.

4. REMOVAL OF THE ELEMENTS

It is also possible to play on the removal of certain elements associated with rituals. For example: the use of a specific brand of soap to wash the hands. Suggest that they change the brand of soap. In the example seen throughout this article, the patient who is going to wash his hands 50 times a day will no longer wash 50 times but 40 times and not 5 min but 4 min 30, so he will be delayed by 30 seconds and will not wash with the same soap. All these modifications, associated with the ritual, will be noted on the patient’s chart so that he/she will remember them. 

The parameters will be modified progressively by playing on the frequency and duration until the ritual is completely extinguished. If unfortunately the patient has not been able to follow the modifications of all these parameters, propose only one or two. 

5. THE IMPULSE PHOBIA

Let’s talk in this last part about impulse phobia. This is a false friend, it’s not a phobia but an impulse OCD. These are patients who will say: instead of falling down, I’m going to throw myself, or I’m going to strangle my husband, I’m going to kick the grandmother’s poodle. Everyone has this kind of thought, most people just don’t pay attention. In impulse phobia, patients will stay focused on these thoughts. By trying to stay in control and trying not to think about it, they will reinforce these thoughts and they will keep coming back. Having crazy thoughts is a normal phenomenon, it is the process of brain function. It is normal to have violent, blasphemous, transgressive thoughts. In the impulse toc, there is no acting out because the patient is afraid of acting out.

Discover the Jacobson’s progressive muscle relaxation method, and the AWARE method.

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FAQ

Virtual reality (VR) is an innovative technology that enables patients to be exposed to immersive and controlled environments, facilitating the management of numerous psychological and psychiatric disorders. Its use in mental health offers several advantages:
  • Gradual and Controlled Exposure: VR allows patients to confront anxiety-inducing situations in a secure environment, gradually adjusting the intensity of stimuli to promote habituation and emotional regulation.
  • Realistic and Reproducible Environments: Unlike traditional techniques, VR provides immersive scenarios that can be consistently reproduced, ensuring a coherent and effective approach.
  • Increased Patient Engagement: The interactive and immersive nature of VR enhances treatment adherence and motivates patients to continue their therapy.
  • Personalized Treatment: Virtual environments can be adapted to meet the specific needs of each patient.
  • Versatile Applications: VR is used to treat anxiety disorders (phobias, post-traumatic stress disorder, obsessive-compulsive disorders), addictions, mood disorders, and even cognitive remediation.
The use of virtual reality in healthcare is not new! It has been studied and utilized for over 30 years in the medical and psychological fields. As early as the 1990s, researchers began exploring its potential for treating anxiety disorders, particularly phobias and post-traumatic stress disorder. Since then, numerous scientific studies have confirmed its effectiveness in addressing various psychiatric, neurological, and cognitive disorders.
Today, VR is widely integrated into therapeutic and medical practices, with clinically validated protocols. It is used in hospitals, clinics, and psychologists' offices worldwide to provide patients with innovative, effective, and safe treatments.
To use virtual reality, one must immerse themselves in a virtual environment. There are several ways to achieve this.
In the past, the CAVE system (Cave Automatic Virtual Environment), a 3D setup consisting of multiple screen walls, was the primary method used. This system allowed users to be fully immersed in the virtual world, with their movements detected in real-time. However, this technology was expensive and not widely accessible.
Since around 2016, with the introduction of virtual reality headsets like the Oculus Rift and HTC Vive, VR has become much more accessible. These headsets immerse users in virtual reality through an enclosed screen that projects digital images. The user's head movements are tracked, enabling them to look around and interact with the environment as they would in the real world.
Today, VR headsets are wireless and standalone, providing maximum comfort and ease of use without requiring external sensors or cables.
A virtual environment is an immersive digital simulation created through virtual reality. It allows users to navigate in a 3D space that accurately replicates everyday situations or specific contexts.
In mental health, these environments are designed to help individuals gradually face certain situations, manage their emotions, or enhance cognitive skills. By interacting with these virtual spaces, patients can engage in meaningful experiences tailored to their needs.
You need to equip yourself with a virtual reality headset. Our software is compatible with Meta Quest 2, 3, and 3S. 
You will then only need an internet connection. 
Numerous studies confirm that virtual reality is safe to use. However, some restrictions are in place to protect users from potential adverse effects.
For instance, individuals with epilepsy and pregnant women should avoid this type of therapy.
As with any immersive technology, prolonged use may cause visual fatigue or mild discomfort, particularly for those sensitive to motion sickness. Therefore, it is recommended to take regular breaks and adjust session durations according to individual needs.
Virtual environments are designed to be gradual and controlled, minimizing the risk of excessive anxiety. Most users quickly adapt to immersion and experience the benefits of this innovative approach from the first sessions.
Anxiety disorders and phobias can be effectively treated using virtual reality. Patients are gradually and progressively exposed to anxiety-inducing situations in various environments while remaining in a safe space. This process helps develop a sense of habituation, ultimately reducing or even eliminating anxiety over time.
Behavioral and substance addictions can also be addressed through virtual reality. By incorporating synthetic stimuli into the environments that trigger craving responses, patients struggling with addiction can work on their cravings to diminish the urge to consume.
Additionally, multiple environments—such as bars, casinos, and social settings—enable cognitive work on dysfunctional beliefs associated with specific temptation scenarios.
Regarding eating disorders, virtual reality software helps target key etiological factors, such as body dysmorphia, allocentric lock (a tendency to focus on others rather than oneself), and food cravings.
Currently, our TERV (Virtual Reality Exposure Therapy) solutions include multiple software programs designed to address critical psychiatric, psychological, and neuropsychological determinants such as relaxation, cognitive stimulation, behavioral activation, and social skills training.
Reminiscence therapy is also a major therapeutic tool in treating depression. By allowing patients to relive sensations linked to past pleasurable activities (such as sports, driving, or traveling), virtual reality stimulates hypoactive brain areas, enhancing therapeutic success. VR serves as an excellent mediator for reigniting engagement in enjoyable activities.
Moreover, cognitive stimulation for elderly individuals is another area where virtual reality proves beneficial. By leveraging technology to make stimulation activities more engaging and accessible, patients and nursing home residents can improve executive functions and memory through specially designed applications.
Today, virtual reality in mental health care is advancing rapidly. Researchers, clinicians, and developers continue to explore new therapeutic targets to offer innovative and effective treatment solutions in the near future.
VR can be used by all healthcare professionals assisting patients with anxiety, phobias, post-traumatic stress disorders, addictions, or other psychological challenges.
It is particularly beneficial for psychologists, psychiatrists, neuropsychologists, specialized nurses, as well as psychomotor therapists, physiotherapists, dietitians, sophrologists, and hypnotherapists. With a wide range of immersive environments, VR enhances therapeutic approaches and provides innovative tools to improve patient care.
Healthcare providers incorporating virtual reality exposure therapy (VRET) expand their range of treatment options. VRET is a well-established therapeutic technique with scientific validation from cognitive-behavioral therapy research.
  • Professional Differentiation: Integrating VR into practice allows therapists to stand out from traditional treatment options.
  • Scientific Validation: VRET is backed by extensive research, reinforcing its credibility as an effective treatment method.
  • Improved Patient Engagement: The interactive nature of VR fosters greater patient involvement in therapy.
  • Time-Saving: VR provides direct access to various exposure environments without needing external logistics.

One of the considerable advantages of virtual reality is that it is effective on a wide spectrum of populations. Existing data from the literature on the subject shows us that it is entirely possible to expose a wide age group to virtual reality, with real therapeutic benefits.

The studies attest, in fact, to excellent feasibility and significant results; particularly in adults, in the treatment of anxiety disorders (including school phobia), autism, addictions, eating disorders, neuropsychological disorders, psychotic disorders and mood disorders.

The results are identical for adolescents with a significant added value concerning therapeutic engagement where virtual reality promotes adolescents' interest in their therapy.

Among elderly subjects, study results encourage the use of virtual reality with the aim of working on cognitive stimulation, on behavioral disorders but also on anxiety.

One of the major advantages of virtual reality is its effectiveness across a broad spectrum of the population. Existing literature on the subject shows that virtual reality can be used with individuals of various age groups, providing significant therapeutic benefits.
Studies confirm excellent feasibility and significant results, particularly among adults in the treatment of anxiety disorders (including school phobia), autism, addictions, eating disorders, neuropsychological disorders, psychotic disorders, and mood disorders.
The results are equally promising for adolescents, with a notable advantage in terms of therapeutic engagement, as virtual reality enhances their interest and participation in treatment.
For older adults, research supports the use of virtual reality to improve cognitive stimulation, behavioral disorders, and anxiety management.
However, people with epilepsy and pregnant individuals are not advised to undergo this type of therapy.
Yes, all our environments are grouped within a single application.
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