A ‘brain training’ app developed at the University of Cambridge could help people who suffer from obsessive compulsive disorder (OCD) manage their symptoms, which may typically include excessive handwashing and contamination fears.
In a study published in the journal Scientific Reports, Baland Jalal and Professor Barbara Sahakian from the Department of Psychiatry, show how just one week of training can lead to significant improvements.
One of the most common types of OCD, affecting up to 46% of OCD patients, is characterized by severe contamination fears and excessive washing behavior. Excessive washing can be harmful as sometimes OCD patients use spirits, surface cleansers or even bleach to clean their hands. The behaviors can have a serious impact on people’s lives, their mental health, their relationships, and their ability to hold down jobs.
This repetitive and compulsive behavior is also associated with ‘cognitive rigidity’—in other words, an inability to adapt to new situations or new rules. Breaking out of compulsive habits, such as handwashing, requires cognitive flexibility so that the OCD patient can switch to new activities instead.
OCD is treated using a combination of medication such as Prozac and a form of cognitive behavioral therapy (‘talking therapy’) termed ‘exposure and response prevention’. This latter therapy often involves instructing OCD patients to touch contaminated surfaces, such as a toilet, but to refrain from then washing their hands.
These treatments are not particularly effective, however—as many as 40% of patients fail to show a good response to either treatment. This may be in part because often people with OCD have suffered for years prior to receiving a diagnosis and treatment. Another difficulty is that patients may fail to attend exposure and response prevention therapy as they find it too stressful to undertake.
For these reasons, Cambridge researchers developed a new treatment to help people with contamination fears and excessive washing. The intervention, which can be delivered through a smartphone app, involves patients watching videos of themselves washing their hands or touching fake contaminated surfaces.
Ninety-three healthy people who had indicated strong contamination fears as measured by high scores on the ‘Padua Inventory Contamination Fear Subscale’ participated in the study. The researchers used healthy volunteers rather than OCD patients in their study to ensure that the intervention did not potentially worsen symptoms.
The participants were divided into three groups: The first group watched videos on their smartphones of themselves washing their hands; the second group watched similar videos but of themselves touching fake contaminated surfaces; and the third, control group watched themselves making neutral hand movements on their smartphones.
After only one week of viewing their brief 30 second videos four times a day, participants from both of the first two groups—that is, those who had watched the hand washing video and those with the exposure and response prevention video—improved in terms of reductions in OCD symptoms and showed greater cognitive flexibility compared with the neutral control group. On average, participants in the first two groups saw their Yale-Brown Obsessive Compulsive Scale (YBOCS) scores improve by around 21%. YBOCS scores are the most widely used clinical assessments for assessing the severity of OCD.