Brain Activation During Virtual Reality Symptom Provocation in Obsessive-Compulsive Disorder: Proof-of-Concept Study

Background Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by obsessions and compulsions. We previously showed that a virtual reality (VR) game can be used to provoke and measure anxiety and compulsions in patients with OCD. Here, we investigated whether this VR game activates brain regions associated with symptom provocation. Objective In this study, we aim to investigate the neural regions that are activated in patients with OCD when they are interactively confronted with a symptom-provoking event and when they are performing compulsive actions in VR. Methods In a proof-of-concept study, we investigated brain activation in response to the VR game in 9 patients with OCD and 9 healthy controls. Participants played the VR game while regional changes in blood oxygenation were measured using functional magnetic resonance imaging. We investigated brain activation in relation to OCD-related events and virtual compulsions in the VR game. Due to low statistical power because of the sample size, we also reported results at trend significance level with a threshold of P<.10. Additionally, we investigated correlations between OCD severity and brain activation. Results We observed a trend for increased activation in the left amygdala (P=.07) upon confrontation with OCD-related events and for increased activation in the bilateral amygdala (P=.06 and P=.09) and right insula (P=.09) when performing virtual compulsive actions in patients with OCD compared to healthy controls, but this did not attain statistical significance. The amygdala and insula activation did not correlate with OCD severity. Conclusions The findings of this proof-of-concept study indicate that VR elicits brain activation in line with previous provocation studies. Our findings need to be replicated in a study with a larger sample size. VR may be used as an innovative and unique method of interactive symptom provocation in future neuroimaging studies. Trial Registration Netherlands Trial Register NTR6420; https://onderzoekmetmensen.nl/nl/trial/25755