Volume 4, Issue 2 (June 2025)
IJER 2025, 4(2): 1-15 |
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Shayesteh Mehr S, Taklavi S, Ghaffari O. (2025). Examining the Effectiveness of Mixed Reality-Based Exposure and Response Prevention Therapy on Disgust, Anger, and Anxiety in Individuals with Obsessive-Compulsive Disorder. IJER. 4(2), 1-15.
URL: http://ijer.hormozgan.ac.ir/article-1-391-en.html
URL: http://ijer.hormozgan.ac.ir/article-1-391-en.html
1- Department of Psychology, Ard.c, Islamic Azad University, Ardabil, Iran
2- Department of Psychology, Ard.c, Islamic Azad University, Ardabil, Iran ,staklavi@iau.ac.ir
3- Department of Psychology, Ard.c, Islamic Azad University, Ardabil, Iran
2- Department of Psychology, Ard.c, Islamic Azad University, Ardabil, Iran ,
3- Department of Psychology, Ard.c, Islamic Azad University, Ardabil, Iran
Abstract: (1611 Views)
Objective: The aim of this study was to investigate the effectiveness of exposure and response inhibition therapy based on mixed reality on reducing these emotions in people with obsessive-compulsive disorder.
Methods: This study was conducted in a quasi-experimental manner with a pretest-posttest design with a control group and a six-month follow-up. 40 participants diagnosed with obsessive-compulsive disorder using the Yale-Brown Obsessive-Compulsive Scale were selected and randomly assigned to two intervention and control groups. The intervention group underwent exposure and response inhibition therapy based on mixed reality for 12 sessions. Data were collected using the Haidt Disgust Sensitivity Questionnaire, the Spielberger Anger Questionnaire, and the Beck Anxiety Inventory. Data analysis was performed using repeated measures analysis of variance and Bonferroni post hoc test.
Results: The results showed that mixed reality therapy led to a significant reduction in disgust, anger, and anxiety scores in the intervention group compared to the control group at the post-test and follow-up stages (p < 0.001). The stage, group, and interaction effects in the analysis of variance were significant for all three emotions, and the effect size (η²) was reported to be 0.951 for disgust, 0.972 for anger, and 0.946 for anxiety, respectively. The difference between post-test and follow-up was small but stable, indicating the relative persistence of the treatment effects.
Conclusions: Mixed reality technology, as an interactive, safe, and controllable platform for exposure to arousing stimuli, was able to significantly increase the effectiveness of exposure and response inhibition therapy in reducing harmful emotions in OCD patients. Using this new technology allows for more effective emotion regulation, reduced avoidance behaviors, and improved quality of life.
Methods: This study was conducted in a quasi-experimental manner with a pretest-posttest design with a control group and a six-month follow-up. 40 participants diagnosed with obsessive-compulsive disorder using the Yale-Brown Obsessive-Compulsive Scale were selected and randomly assigned to two intervention and control groups. The intervention group underwent exposure and response inhibition therapy based on mixed reality for 12 sessions. Data were collected using the Haidt Disgust Sensitivity Questionnaire, the Spielberger Anger Questionnaire, and the Beck Anxiety Inventory. Data analysis was performed using repeated measures analysis of variance and Bonferroni post hoc test.
Results: The results showed that mixed reality therapy led to a significant reduction in disgust, anger, and anxiety scores in the intervention group compared to the control group at the post-test and follow-up stages (p < 0.001). The stage, group, and interaction effects in the analysis of variance were significant for all three emotions, and the effect size (η²) was reported to be 0.951 for disgust, 0.972 for anger, and 0.946 for anxiety, respectively. The difference between post-test and follow-up was small but stable, indicating the relative persistence of the treatment effects.
Conclusions: Mixed reality technology, as an interactive, safe, and controllable platform for exposure to arousing stimuli, was able to significantly increase the effectiveness of exposure and response inhibition therapy in reducing harmful emotions in OCD patients. Using this new technology allows for more effective emotion regulation, reduced avoidance behaviors, and improved quality of life.
Keywords: Obsessive-compulsive disorder, Disgust, Anger, Anxiety, Exposure and response inhibition, Mixed reality
Type of Study: Original |
Subject:
Educational Studies
Received: 2025/01/10 | Accepted: 2025/03/27 | Published: 2025/06/1
Received: 2025/01/10 | Accepted: 2025/03/27 | Published: 2025/06/1
References
1. Abramowitz, J. S., & Blakey, S. M. (2017). Obsessive‐compulsive and related disorders. Psychopathology: History, Diagnosis, and Empirical Foundations, Third Edition, 187-215. [DOI:10.1002/9781394258949.ch5]
2. Angelakis, I., Gooding, P., Tarrier, N., & Panagioti, M. (2015). Suicidality in obsessive compulsive disorder (OCD): a systematic review and meta-analysis. Clinical psychology review, 39, 1-15. [DOI:10.1016/j.cpr.2015.03.002]
3. Asghari Moghadam, M. A., Dibajnia, P., & Moghaddisin, M. (2011). The Reliability and Criterion Validity of a Farsi Version of the State-Trait Anger Expression Inventory-2 (STAXI-2) in a Clinical Sample. Clinical Psychology and Personality, 9(2), 75-94. https://cpap.shahed.ac.ir/article_2656_14fc34d5887615d2b13e00b486beea24.pdf
4. Beck, A. T., Steer, R. A., & Carbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical psychology review, 8(1), 77-100. [DOI:10.1016/0272-7358(88)90050-5]
5. Bennett, D., Sutcliffe, K., Tan, N. P.-J., Smillie, L. D., & Bode, S. (2021). Anxious and obsessive-compulsive traits are independently associated with valuation of noninstrumental information. Journal of Experimental Psychology: General, 150(4), 739. [DOI:10.1037/xge0000966]
6. Cludius, B., Mannsfeld, A. K., Schmidt, A. F., & Jelinek, L. (2021). Anger and aggressiveness in obsessive-compulsive disorder (OCD) and the mediating role of responsibility, non-acceptance of emotions, and social desirability. European archives of psychiatry and clinical neuroscience, 271(6), 1179-1191. [DOI:10.1007/s00406-020-01199-8]
7. D'Mello, R. J., & Kumar, A. (2022). Experience of disgust and symptom severity in contamination subtype of obsessive-compulsive disorder: Role of experiential avoidance. Indian Journal of Psychological Medicine, 44(6), 580-585. [DOI:10.1177/02537176221116267]
8. Dehghan, B., Saeidimehr, S., Sayyah, M., & Rahim, F. (2022). The effect of virtual reality on emotional response and symptoms provocation in patients with OCD: a systematic review and meta-analysis. Frontiers in psychiatry, 12, 733584. [DOI:10.3389/fpsyt.2021.733584]
9. Del Casale, A., Sorice, S., Padovano, A., Simmaco, M., Ferracuti, S., Lamis, D. A., . . . Kotzalidis, G. D. (2019). Psychopharmacological treatment of obsessive-compulsive disorder (OCD). Current neuropharmacology, 17(8), 710-736. [DOI:10.2174/1570159X16666180813155017]
10. Efe, A. (2022). Taking virtual reality and augmented reality to the next level: Artificial intelligence with mixed reality. Kamu Yönetimi ve Teknoloji Dergisi, 4(2), 141-165. [DOI:10.58307/kaytek.1185712]
11. Fakhri, A., Mohsenikhah, M., Hamedpour, H., Sadeghi, B., Davarpanah, M., Delshad, E., . . . Moradi-Joo, E. Comparison of Obsessive Beliefs, Depression and Anxiety in Patients with Suspected COVID-19 and Healthy Patients in Razi Hospital, Ahvaz. International journal of health sciences, 6(S8), 382-392. [DOI:10.53730/ijhs.v6nS8.10272]
12. Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Fleischmann, R. L., Hill, C. L., . . . Charney, D. S. (1989). The Yale-Brown obsessive compulsive scale: I. Development, use, and reliability. Archives of general psychiatry, 46(11), 1006-1011. [DOI:10.1001/archpsyc.1989.01810110048007]
13. Haidt, J., McCauley, C., & Rozin, P. (1994). Individual differences in sensitivity to disgust: A scale sampling seven domains of disgust elicitors. Personality and individual differences, 16(5), 701-713. [DOI:10.1016/0191-8869(94)90212-7]
14. Hirschtritt, M. E., Bloch, M. H., & Mathews, C. A. (2017). Obsessive-compulsive disorder: advances in diagnosis and treatment. Jama, 317(13), 1358-1367. [DOI:10.1001/jama.2017.2200]
15. Homayuni, A. (2023). Investigating the correlation between perceived stress and health anxiety with obsessive-compulsive disorder and quality of life during COVID-19 pandemic. BMC psychology, 11(1), 54. [DOI:10.1186/s40359-023-01090-w]
16. Hossein Kaviani, H., & Mousavi, A. (2008). Psychometric properties of the Persian version of Beck Anxiety Inventory (BAI). Tehran University Medical Journal, 66(2), 136-140. http://tumj.tums.ac.ir/article-1-641-fa.html
17. Izadi, R., & Abedi, M. R. (2013). Alleviation of obsessive symptoms in treatment-resistant obsessive-compulsive disorder using acceptance and commitment-based therapy [Research]. Feyz Medical Sciences Journal, 17(3), 275-286. http://feyz.kaums.ac.ir/article-1-1963-fa.html
18. Javdan, M., & Shahri, F. (2023). Defense Mechanisms, Impaired Emotion Regulation and Intolerance of Uncertainty in Students with and without Social Anxiety: A Comparative Study. Iranian Evolutionary Educational Psychology Journal, 5(1), 171-181. [DOI:10.52547/ieepj.5.1.171]
19. Jones, A. C., Brake, C. A., & Badour, C. L. (2020). Disgust in PTSD. In Emotion in posttraumatic stress disorder (pp. 117-143). Elsevier. [DOI:10.1016/B978-0-12-816022-0.00005-3]
20. Karsazi, H., & Nasiri, M. (2016). Factor Analysis and Evaluation of Internal Structure of Disgust Sensitivity Scale. Journal of Clinical Psychology, 8(4), 49-62. [DOI:10.22075/jcp.2017.2253]
21. Keshavarz, N., Hashemi, T., Beyrami, M., Mahmoud alilou, M., & Bakhshipour, A. (2021). Effectiveness of virtual reality -based worry exposure therapy on the symptoms of generalized anxiety disorder [Research]. Rooyesh-e-Ravanshenasi Journal(RRJ), 10(1), 121-132. http://frooyesh.ir/article-1-2440-fa.html
22. Linde, E. S., Varga, T. V., & Clotworthy, A. (2022). Obsessive-compulsive disorder during the COVID-19 pandemic-a systematic review. Frontiers in psychiatry, 13, 806872. [DOI:10.3389/fpsyt.2022.806872]
23. Liu, L., Liu, C., & Zhao, X. (2017). Mapping the paths from styles of anger experience and expression to obsessive-compulsive symptoms: the moderating roles of family cohesion and adaptability. Frontiers in psychology, 8, 671. [DOI:10.3389/fpsyg.2017.00671]
24. Lohse, L., Jelinek, L., Moritz, S., Blömer, J., Bücker, L., & Miegel, F. (2023). Efficacy of exposure and response prevention therapy in mixed reality for patients with obsessive-compulsive disorder: study protocol for a randomized controlled trial. BMC psychology, 11(1), 113. [DOI:10.1186/s40359-023-01116-3]
25. Lopez-Espada, C., & Linares-Palomino, J. (2023). Mixed reality: a promising technology for Therapeutic Patient Education. In: Hogrefe AG. [DOI:10.1024/0301-1526/a001065]
26. Mayer, G., Gronewold, N., Polte, K., Hummel, S., Barniske, J., Korbel, J. J., . . . Schultz, J.-H. (2022). Experiences of patients and therapists testing a virtual reality exposure app for symptoms of claustrophobia: mixed methods study. JMIR Mental Health, 9(12), e40056. [DOI:10.2196/40056]
27. Miegel, F., Jelinek, L., Moritz, S., Lohse, L., Yassari, A. H., & Bücker, L. (2023). Mixed results for exposure and response prevention therapy in mixed reality for patients with contamination‐related obsessive‐compulsive disorder: A randomized controlled pilot study. Journal of Clinical Psychology, 79(10), 2317-2336. [DOI:10.1002/jclp.23550]
28. Moradi Motlagh, M., Nainian, M. R., Fata, L., Gholami Fesharaki, M., & Ghaedi, G. (2019). Investigation of the moderating role of perceived vulnerability to infectious diseases regarding the relationship between disgust and fear of contamination. Avicenna journal of clinical medicine, 26(1), 34-43. [DOI:10.29252/ajcm.26.1.34]
29. Novara, C., Lebrun, C., Macgregor, A., Vivet, B., Thérouanne, P., Capdevielle, D., & Raffard, S. (2021). Acquisition and maintenance of disgust reactions in an OCD analogue sample: Efficiency of extinction strategies through a counter-conditioning procedure. PLoS One, 16(7), e0254592. [DOI:10.1371/journal.pone.0254592]
30. Ólafsson, R. P., Emmelkamp, P. M., Ólason, D. Þ., & Kristjánsson, Á. (2020). Disgust and contamination concerns: The mediating role of harm avoidance and incompleteness. International Journal of Cognitive Therapy, 13(3), 251-270. [DOI:10.1007/s41811-020-00076-5]
31. Pardo, M., Sandín, B., Valiente, R. M., & Chorot, P. (2022). Factores de riesgo y de protección asociados al trastorno obsesivo-compulsivo en niños y adolescentes: Una revisión sistemática. Revista de psicopatología y psicología clínica, 27(3), 217-232. [DOI:10.5944/rppc.31598]
32. Rahman, M. A., Brown, D. J., Mahmud, M., Harris, M., Shopland, N., Heym, N., . . . Downes, D. (2023). Enhancing biofeedback-driven self-guided virtual reality exposure therapy through arousal detection from multimodal data using machine learning. Brain Informatics, 10(1), 14. [DOI:10.1186/s40708-023-00193-9]
33. Rowe, E. G., Harris, C. D., Dzafic, I., & Garrido, M. I. (2023). Anxiety attenuates learning advantages conferred by statistical stability and induces loss of volatility‐attuning in brain activity. Human Brain Mapping, 44(6), 2557-2571. [DOI:10.1002/hbm.26230]
34. Rubin, M., Muller, K., Hayhoe, M. M., & Telch, M. J. (2022). Attention guidance augmentation of virtual reality exposure therapy for social anxiety disorder: a pilot randomized controlled trial. Cognitive Behaviour Therapy, 51(5), 371-387. [DOI:10.1080/16506073.2022.2053882]
35. Saha, A., Maheshwari, D., Das, A., Biswas, S., & Saha, P. (2022). Obsessive-Compulsive disorder is a severe threat to society. Bionatura, 7(2). [DOI:10.21931/RB/2022.07.02.11]
36. Spielberger, C. (1999). State-Trait Anger Expression Inventory-2 (STAXI-2). Odessa, FL: Psychological Assessment Resources. In: Inc.
37. Thayer, K. K., DeRiso, M., Warren, J., Wilson, A., & Vance, S. (2021). What therapists need to know about the treatment of OCD when disgust is part of the clinical presentation. Journal of Affective Disorders Reports, 6, 100209. [DOI:10.1016/j.jadr.2021.100209]
38. XIAO, T., DONG, J., LIANG, F., WANG, F., & LI, Y. (2023). The relationship between disgust and suicidal behavior. Advances in Psychological Science, 31(1), 87. [DOI:10.3724/SP.J.1042.2023.00087]
39. Zamanifard, S., & Robb, A. (2023). Social virtual reality is my therapist: overcoming social anxiety disorder through using social virtual reality. Extended abstracts of the 2023 CHI conference on human factors in computing systems, [DOI:10.1145/3544549.3585888]
40. Zhang, Y.-y., Gong, H.-f., Zhang, X.-l., Liu, W.-j., Jin, H.-y., Fang, F., . . . Goodman, W. K. (2019). Incidence and clinical correlates of anger attacks in Chinese patients with obsessive-compulsive disorder. Journal of Zhejiang University-SCIENCE B, 20(4), 363-370. [DOI:10.1631/jzus.B1800450]
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