The most recent and high-quality publication on VRET for obsessive-compulsive disorders
The randomized controlled study of Miegel et al. (2025), The study published in JAMA Network Open examined Mixed Reality Exposure and Response Prevention (MERP) for contamination-related obsessive-compulsive disorders for the first time and represents an important advancement over traditional Virtual Reality.
- 36 patients with contamination-related obsessive-compulsive disorder (C-OCD), randomized controlled trial (RCT)
- 6-weekly MERP sessions vs. self-guided ERP (SERP)
- MERP showed no significant differences compared to the control group regarding the Y-BOCS reduction
- Moderate to large improvements within the MERP group (Cohen's d = 0.584-0.931)
- The sense of presence was suboptimal with an average of ≤3.24 out of 7 points
- 94.4% of patients found the confrontation in Mixed Reality easier than in reality
Other significant current studies (2024-2025)
A groundbreaking security study by Lohse et al. (2025) investigated the side effects of VRET in obsessive-compulsive disorders:
- 80 patients with washing or control compulsions
- No serious side effects or worsening of symptoms
- 47% of participants experienced at least one side effect, but significantly fewer in the VRET group (p < 0.001)
- VR-specific side effects in 55% of patients
- Cyber sickness remained stable (p = 0.098)
A comprehensive meta-analysis of 55 studies with 3031 participants (Zeng et al., 2025) showed:
- Low to very low evidence quality for VR interventions in most mental disorders
- Over 50% of the studies showed a high risk of bias
- Significant effects in specific phobias and social anxiety, but insufficient data for OCD
UKE Hamburg - Leading in VRET-OCD Research
The University Medical Center Hamburg-Eppendorf is a leader in German VRET-OCD research:
- Current study (DRKS00020969): 64 patients with mixed reality therapy(Miegel et al., 2024
- Exposure Therapy Readiness Study (DRKS00025154): Investigation of whether VR exposure increases readiness for in-vivo therapy (UKE Hamburg, 2024
- Published research on technical improvements and sense of presence (Miegel et al., 2023
Contamination-specific insights
Current studies show that VRET is best researched for contamination-related obsessive-compulsive disorders (Miegel et al., 2023 and2024):
- Disgust Modulation: VRET can successfully trigger and reduce disgust emotions
- Biophysical parameters: Skin conductivity and heart rate show measurable responses
- Proximity to Reality: The limited proximity to reality of current VR systems is identified as a major obstacle
Augmented/Mixed Reality as a Future Technology
The latest research shows a clear trend towards Augmented Reality (AR) and Mixed Reality (MR):
- CleanScape AR-System (Mohandessi et al., 2025): 22 patients showed increased anxiety reactions during AR exposure
- Better realism through the combination of virtual objects with the real environment
- Higher sense of presence than conventional VR(Miegel et al., 2025
Systematic Reviews and Meta-Analyses
The current evidence is supported by comprehensive reviews.(Islam et al., 2025), that show:
- Moderate effect sizes in VR-based interventions
- Methodological improvements required in recent studies
- Standardized protocols for VRET in OCD are being developed
Clinical Implications and Outlook
Current evidence shows:
- VRET is safe and well-tolerated for OCD patients
- Moderate effectiveness in contamination-related obsessions
- Technical improvements in the sense of presence are essential
- Mixed/Augmented Reality bietet vielversprechende Ansätze
Recommendations for Practice:
- Use VRET as a precursor to in-vivo exposure
- Combination with traditional ERP for optimal results
- Individual adaptation of virtual environments to specific constraints
The research shows that VRET is promising for obsessive-compulsive disorders but still needs development. The latest studies from 2025 provide important insights into safety and highlight pathways for future improvements.
