Introduction: Clinical guidelines for the treatment for obsessive-compulsive disorder (OCD) have remained unchanged since 2005, wherein gold-standard treatment centers around voluntary exposure to feared stimuli and disengagement of safety-seeking behaviors. While effective evidence-based treatments exist, many patients do not receive them due to barriers such as limited availability of specialized therapists, stigma, long waiting lists, and high costs. Furthermore, it is common for sufferers of OCD to present to treatment more than a decade after initial symptom onset. It is thus imperative to seek ways to break some of the barriers to treatment and deliver gold-standard therapy earlier to sufferers. This presentation will showcaseZeroOCD, a novel AR-CBT app-based intervention which was designed to target these barriers, and provide preliminary insights from a randomized controlled trial.

Methods: The ZeroOCD project is an ongoing international collaboration between institutions in Sweden, Switzerland, the Netherlands, and Belgium. The ZeroOCD app combines augmented reality (AR) exposure therapy and CBT principles to ameliorate OCD symptoms, with a focus on contamination-related symptoms (e.g., fear of dirt, germs, bodily fluids). It offers a module-based treatment program featuring evidence-based tools, including psychoeducation, immersive AR stimuli (both realistic and ambiguous to address disgust and uncertainty intolerance), in vitro and in vivo exposure and response prevention, and relapse prevention. AR allows for exposure exercises in the patient's natural home environment, bridging the gap between clinical settings and real-world triggers.

Results: The presentation will provide preliminary insights from the active treatment arms of the ZeroOCD project (currently recruiting). It will showcase the app's functionality and user environment, and delineate the specific mechanisms of change targeted by the intervention regarding contamination-related symptoms. As such, this presentation provides attendees with a unique opportunity to better understand the future of AR-CBT interventions generally, and the future of accessible OCD interventions.

Introduction: Clinical guidelines for the treatment for obsessive-compulsive disorder (OCD) have remained unchanged since 2005, wherein gold-standard treatment centers around voluntary exposure to feared stimuli and disengagement of safety-seeking behaviors. Alarmingly, OCD sufferers far too often present to treatment a decade after initial symptom onset. As such, investigating novel ways of providing accessible gold-standard treatment is imperative to help ameliorate the burden of OCD. This presentation will provide attendees with preliminary insights from a randomized controlled trial within the ZeroOCD project, which investigates a smartphone-based treatment for OCD leveraging augmented reality.

Methods: The ZeroOCD project is an ongoing international collaboration between institutions in Sweden, Switzerland, the Netherlands, and Belgium. The ZeroOCD app combines augmented reality (AR) exposure therapy and CBT principles to ameliorate OCD symptoms, with a focus on contamination-related symptoms (e.g., fear of dirt, germs, bodily fluids). It offers a module-based treatment program featuring evidence-based tools, including psychoeducation, immersive AR stimuli (both realistic and ambiguous to address disgust and uncertainty intolerance), in vitro and in vivo exposure and response prevention.

Results: The ZeroOCD project has a relatively low threshold for intake (e.g., inclusion criteria include a Y-BOCS score of 7 or higher). Nevertheless, the average symptom severity at baseline is substantially higher than anticipated. Other preliminary insights will be shared orally at SWEsrii.

Conclusions: Although the trial is currently ongoing, a few key insights about implementation of a smartphone-based treatment application have already emerged. This presentation provides attendees with an opportunity to better understand the future of AR-CBT interventions generally, the future of accessible OCD interventions, and derive preliminary learnings from the ZeroOCD project.

Introduction: Fear of contamination is one of the most reported symptoms among individuals with obsessive-compulsive disorder (OCD). Digital interventions may address treatment gap caused by geographical constraints, long waiting lists, or reluctance to seek help. Yet, involvement of people with lived experience is necessary for effective implementation and sensible use of resources in health care innovations. We developed ZeroOCD, an augmented reality exposure therapy smartphone application for fear of contamination, while involving experts-by-experience in the whole development, from the first draft to user testing of the final version of the application.

Methods: Following the co-creation framework, we conducted focus groups with eight experts-by-experience and four OCD therapists to address their needs and preferences. Upon the development of the app, we conducted user testing with the same sample to address user-friendliness. We consequently conducted a feasibility study involving 20 participants who followed the intervention with therapeutic support on request.

Results: Based on the insights of the participants, we iteratively co-created nine modules of the app, and the content of the augmented reality exposure. User-centered methodology enabled us to identify topics the participants were particularly interested in, such as specific exposure focus, accessible therapist involvement, or flexible gamification-based reward system, address design challenges, and improve user satisfaction.

Conclusions: Employing co-creation framework involving experts-by-experience may identify unexpected challenges in the intervention design and shed light on content necessary to improve user satisfaction. Thus, it is highly beneficial in the development of mental health innovation and may lead to adherence improvement.

Introduction: Despite the growing availability of digital mental health interventions, real-world implementation remains challenging. Engagement rates for evidence-based XR (virtual and augmented reality) apps are low. ZeroOCDis an augmented reality cognitive behavioral therapy (AR-CBT) intervention designed to provide scalable, low-cost treatment for contamination-related OCD symptoms. This presentation introduces the ZeroOCDrandomized controlled trial (RCT) and includes an interactive discussion on facilitators and barriers to XR-based mental health implementation.

Methods: This multinational two-arm RCT evaluates ZeroOCD’s efficacy and cost-effectiveness. 180 participants will be randomized to ZeroOCD (minimal therapist support) or CBT via videoconferencing (active control). Assessments occur at baseline, post-treatment (10 weeks), and follow-up (6 months), with weekly symptom monitoring. The primary outcome is OCD symptom severity; secondary outcomes include fear of contamination, depressive symptoms, anxiety, distress, quality of life, and treatment satisfaction.

Results: Preliminary findings on the implementation landscape of digital interventions will be presented, including data on evidence-based app availability versus real-world uptake. Discussion topics include engagement strategies, clinician involvement, and structural barriers. Insights from the interactive session will inform the ongoing process evaluation of ZeroOCD.

Conclusions: This talk is conceptualized as the last part of a symposium on XR interventions and ZeroOCD. It aims to emphasize that understanding XR intervention implementation barriers is crucial for bridging the gap between research and practice. This session will spark discussions on the under-researched disconnect between RCT outcomes and real-world implementation.

Background: Research suggests that individuals with autism spectrum disorder (ASD) have difficulties in emotion recognition (ER), which could lead to social difficulties. ER can be enhanced through targeted interventions, but generalization to everyday functioning poses a challenge. Using dynamic multimodal emotional expressions for training may increase similarities to everyday situations. This pilot study investigated the feasibility of internet-based multimodal emotion recognition training (iMERAT) for adolescents with ASD.

Method: Eight adolescents with ASD and nine typically developing (TD) adolescents took part in the iMERAT intervention, which included brief online training sessions conducted each weekday during a 3-week period. Training was performed on dynamic facial, vocal and multimodal emotional expressions, with outcome feedback provided after each response. A survey was conducted to explore participants' experiences of the training. ER was measured pre- and post-training using a multimodal ER test.

Results: Participants reported that the training was moderately difficult, instructions were relatively easy to understand, and the duration of training was appropriate. Content analysis of open-ended responses suggested further adaptations, such as providing more explanations of emotions and further tailoring content and language for adolescents. ER increased from pre- to post-intervention, with large effect sizes for both ASD and TD adolescents.

Conclusion: Results suggest that the iMERAT intervention is feasible for adolescents with ASD. Gains in ER ability were observed, but the small sample size and lack of a control group render these findings tentative. Further research is required to assess the effectiveness of the iMERAT and possible impact on broader social skills.

Obsessive-compulsive disorder (OCD) is characterized by persistent obsessions and/or compulsions, significantly impacting daily functioning, and imposing high economic costs. Despite the availability of evidence-based treatments, many OCD patients do not receive adequate care due to barriers related to affordability, accessibility, and scalability. This presentation will demonstrate how technology can be leveraged to deliver evidence-based treatment to OCD patients in their everyday environment.

Alongside the overview of current state-of-the-art Internet-based treatments for OCD, a novel intervention, ZeroOCD, will be presented. ZeroOCD is a smartphone-based augmented reality (AR) therapy that combines conventional exposure and ritual prevention principles with CBT techniques in an effort to ameliorate OCD symptoms. Its focus is on facilitating the treatment and reduction of contamination-related symptoms (e.g., fear of dirt, germs, bodily fluids)—the most common subtype of OCD.

Several technology-based self-help tools for OCD are available (e.g., smartphone apps and bibliotherapy). However, many of these self-help tools, particularly commercially available smartphone apps, still lack empirical support. In contrast, evidence-based Internet-delivered treatments for OCD like the Karolinska ICBT program show promise. Still, even these interventions face scalability limitations as therapists must allocate time to provide individualized feedback to each patient.

While effective, evidence-based treatments exist, many patients do not receive them due to barriers such as a shortage of specialized therapists, stigma, long waiting lists, and high costs. Worse still, only about 50% achieve remission with current state-of-the-art treatments for OCD. ZeroOCD offers a promising approach by providing AR to deliver accessible, scalable, and ecologically valid treatment for OCD once fully automated (i.e., available in app stores with no therapist time needed).

Obsessive-compulsive disorder (OCD) is classified within its own diagnostic category, separate from anxiety disorders, yet clinical practitioners still treat it as an anxiety disorder; both conceptually and therapeutically. This paper examines the rationale for seperating OCD from the anxiety disorders by contrasting cognitive models of anxiety disorders and OCD, and reviewing phenomenological and psychobiological evidence for OCD's distinctiveness. We compare OCD's behavioral functions with those of specific phobia, panic disorder, agoraphobia, social anxiety disorder, generalized anxiety disorder, and health anxiety disorder. Our review finds no compelling evidence that OCD differs sufficiently from anxiety disorders to warrant its own category. The same functional behaviors are evident in OCD and other anxiety disorders, with the foci of threat being the differentiating factor between disorders (e.g., fear of public speaking vs. fear of contamination in social anxiety and contamination-OCD, respectively). Consequently, we conclude by emphasizing that future research should focus on behavioral function when studying mental disorders, since descriptive similarities may not indicate clinical or functional equivalence. For diagnostic manuals to maintain validity and clinical utility, they must incorporate a functional analytic perspective. Failure to do so may result in inadequate diagnostic categories and stagnant treatment advances (cf. clinical guidelines for OCD have remained unchanged since 2005). While diagnostic manuals are meant to guide treatment selection, descriptive diagnoses need complementary theory-driven case conceptualizations to advance our understanding of maintaining factors and mechanisms of change during treatment. Without this approach, theoretical progress in OCD may stall, ultimately affecting patient outcomes.

Introduction: Globally, access to evidence-based psychological treatments is limited, but virtual and augmented reality (XR) offer scalable solutions. This presentation overviews the evidence base for XR cognitive behavioral therapy (CBT) in treating Specific Phobia and Obsessive-Compulsive Disorder (OCD). Specifically, I will present three VR/AR studies on specific phobia (ZeroPhobia) and introduce an ongoing AR study for OCD targeting contamination fears (ZeroOCD).

Methods: The broader evidence base supporting XR interventions will be reviewed, followed by a discussion of three single-blind randomized clinical trials evaluating the ZeroPhobia program. These trials compared a self-guided XR CBT app with a wait-list control among Dutch participants (aged 18–65) with acrophobia, aviophobia, or arachnophobia. The intervention comprised six animated modules and gamified XR environments delivered over a three- to six-week period.

Results: Current evidence supports VR/AR treatments, including self-guided XR-CBT, as effective for specific phobias—producing significant, lasting symptom reductions and serving as an alternative to traditional therapy. For OCD, AR treatments for contamination fears are in early stages but show promise. ZeroPhobia trials demonstrated significant symptom reductions with large effect sizes (d = 0.98–1.29), maintained at both 3- and 12-month follow-ups.

Conclusions: Preliminary findings suggest that low-cost, self-guided XR CBT can effectively reduce phobic symptoms and improve accessibility to evidence-based care. Although AR-based interventions for OCD remain emerging, early studies indicate they may offer an effective, accessible alternative to intensive traditional therapies, warranting further investigation.

Introduction: Obsessive-compulsive disorder (OCD) affects 1.1%–1.8% of the global population and is characterized by persistent obsessions and/or compulsions that interfere with daily functioning. While effective, evidence-based treatments exist, many patients do not receive them due to barriers such as limited availability of specialized therapists, stigma, long waiting lists, and high costs. Although recent investigations with augmented reality (AR) stimuli in OCD treatment show promise, no effectiveness studies have yet been conducted to our knowledge. This presentation will demonstrate what such treatment could look like, emphasizing on showcasing the user experience and functionality of ZeroOCD, a novel AR-CBT app-based intervention.

Methods: ZeroOCD combines augmented reality (AR) exposure therapy and CBT principles to ameliorate OCD symptoms, with a focus on contamination-related symptoms (e.g., fear of dirt, germs, bodily fluids). For instance, the app can transform the user’s smartphone into a magnifying glass that reveals virtual germs and viruses. It offers a module-based treatment program featuring evidence-based tools, including psychoeducation, immersive AR stimuli (both realistic and ambiguous to address disgust and uncertainty intolerance), in vitro and in vivo exposure and response prevention, and relapse prevention.

Results: The presentation will showcase the ZeroOCD app's functionality and user environment, demonstrating its modules, and how modules were designed to reduce OCD symptoms in general, and specifically contamination-related OCD symptoms.

Conclusions: While the presentation does not include results per se, it does provide a unique opportunity for attendees to better understand the future of AR-CBT interventions generally, and the future of accessible OCD interventions more specifically.