App shown to help with OCD symptoms

29 October 2018

Interview with

Professor Barbara Sahakian, University of Cambridge

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OCD, or obsessive compulsive disorder, is a condition affecting just over 1 in 100 people. OCD often causes ritualised behaviours, like repeated hand washing, and a fear of contamination, which can have a serious impact on people’s work, their mental health, and their relationships. Now, a team from the University of Cambridge have designed a smartphone app for people with the condition, and early studies have shown it can help improve symptoms. Georgia Mills spoke to Barbara Sahakian, Professor of Clinical Neuroscience at the University of Cambridge.

Barbara - Although some people trivialise it because they think: “handwashing, that’s not too bad”. I mean the point is that some of these people are so severe in terms of their symptoms of contamination fears that they actually pour bleach on their hands, or even sometimes they can’t even leave the house because they’re so concerned that touching anything in a public place might contaminate them in some way. So it’s a very serious illness.

Georgia - What kind of therapies do exist at the moment?

Barbara - Well, at the moment, the most common one is a form of cognitive behavioural therapy and it’s called ‘Exposure and Response Prevention’, so it’s a very special form. What happens is maybe a psychologist or somebody helps them go through the treatment where, when they have contamination fears, they have to say touch a toilet seat, or maybe even put their hands down a toilet and then they’re prevented from washing their hands. Initially they get very anxious, as you might expect, but slowly they habituate in the exposure to this and makes them essentially become unafraid and they lose the contamination fear. But many patients don’t want to go through this treatment because it makes them so worried and anxious.

Georgia - Is this what inspired you? Why did you set out to design this app?

Barbara - Yeah. We set out to design the app because the two treatments that there are: the cognitive behaviour therapy or the drugs, which are the selective serotonin reuptake inhibitors or SSRIs, like Prozac, only about 60 percent of patients respond to that, so there’s about about 40 percent that get no relief from the treatments.

So what we’ve done, we’ve got these apps; one is an app where you see yourself washing your hands, and the other app is where you see yourself touching these sorts of disgusting objects, which are obviously related to contamination fears. And what we’ve found is that people do this four times a day for a week, they actually get much better in terms of their symptoms; their symptoms are greatly reduced. And also we find that they become more cognitively flexible because basically, cognitive rigidity is associated with carrying out these rituals, these habits and so forth.

Georgia - What do you mean when you say cognitive flexibility?

Barbara - Well, sort of being very adaptive to things and sort of being able to switch to think of new things and not get stuck in these ritualistic behaviours.

Georgia - Right. And so you mentioned there’s a video on the app of them washing their hands, so could you talk me through how someone using the app: when they’d use it and how they’d use it?

Barbara - They’re asked to use it four times a day and they’re sort of keyed when to use it, and they have a window of opportunity to use it. So they touch whether they’re feeling well and how they’re feeling, and they rate their anxiety levels at that point. And then they watch they app and we put circles on the app, which they have to recognise and count so we’re sure that they’re actually looking at the app. And they’ve been very accurate about that and so we know that they watch the app when it comes on. Then afterwards they rate again how anxious they are and we’ve had really good reports back.

Some of the people say “I didn’t used to be able to go on the bus because I didn’t want to touch anything and sit on seats that people had been sitting on, but now I find I can just look at my app and see myself washing my hands and I feel much better”. And other people who had the other one that’s more kin to a CBT type therapy say that “I used to not be able to wash the counter or take my bins out but now I find I don’t really have a problem with that. So they both seem to reduce the symptoms by about 21 percent which is great.”

Georgia - So, where as a cognitive behavioural therapy you can’t really carry that around with you in your pocket, but with an app it’s there for when you need it?

Barbara - Yes. And it’s really personalised medicine because it’s their own hands that they’re watching wash or touch these objects. Our paper was recently published in the journal Scientific Reports, and it’s available to download open access.

Georgia - When might people be able to download the app?

Barbara - We have one more experiment we’d like to conduct just to make sure that people with very severe symptoms also get benefits from it, and hopefully after that it will be released.

Georgia - You mentioned it has benefits compared to cognitive behavioural therapy but what percentage of people responded to it compared to the people who would respond to CBT?

Barbara - Basically, everybody continued and used the app the whole time, which is very good because often there’s a lot of dropout from the cognitive behavioural treatments or people can’t even engage with them. So actually we’ve got quite beneficial effects very consistently across the different participants.

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