People with obsessive-compulsive disorder (OCD) may get relief simply from watching someone else perform their compulsive actions. If the finding holds up, we may be able to develop apps that help people with OCD stop needing to repeatedly wash their hands or pull their hair.
When we watch someone else perform an action, the same parts of our brains become active as when we do the action ourselves. This is called the mirror neuron system, and it is thought to help us understand the actions and feelings of others.
Baland Jalal at the University of Cambridge wondered whether this system could be used to help people with OCD. Working with his colleague Vilayanur Ramachandran, at the University of California, San Diego, he studied 10 people with OCD symptoms, who experience disgust when touching things they consider even mildly contaminated. The anxiety this causes forces them to wash their hands compulsively.
Touch and go
First, Jalal and Ramachandran showed each participant something to make them feel disgusted – either an open bag of vomit, a bowl containing blood-soaked bandages or a bedpan of faeces and toilet paper. The participants were unaware that each stimulus was in fact fake.
In a variety of conditions, either the participant or a researcher touched the bag, bowl or bedpan for 15 seconds while wearing latex gloves. The participants were then asked to rate how disgusted they felt, before being allowed to wash their hands, or watch the researcher do the same. They then rated how relieved they now felt.
All 10 people with OCD felt strong disgust after watching other people touch the faked objects. But they experienced significant relief just by watching a researchers’ handwashing – even if they themselves had been the one to touch the object.
“To our surprise, subjects would dictate how the experimenter’s cleansing ritual should be performed,” says Jalal. “They would say things like, ‘wash more on this side’, or ‘pour more water between these fingers’.”
Jalal says the results are very preliminary, and should be interpreted cautiously given the small size of the study. But if the finding is confirmed in larger placebo-controlled trials, he thinks this kind of “vicarious exposure” could lead to new therapies for people who have OCD.
“Watching a video of someone washing their hands might be enough to reduce the urge to perform the action in real life,” he says. “We could put these videos into an app.”
Exposure therapy is a popular treatment for OCD, and involves people experiencing their obsessive trigger without being allowed to perform the compulsion that makes them feel better. Jalal says that an app may make it possible to do this kind of treatment virtually, rather than with a therapist in a clinic, making it easier and accessible to more people.
At the very least, such an app could be a less harmful substitute for individuals who have compulsions that are bad for their health, he says: “For instance, we might be able to give people who pull their hair out obsessively relief from their urge by watching a video of themselves doing it instead. It might at least act as a kind of benign substitute that’s used alongside more conventional treatments.” The trial needs to involve at least 50 people with OCD and a credible control treatment to really test the efficacy of this idea, says Jon Abramowitz, a clinical psychologist at the University of North Carolina at Chapel Hill. “Conceptually, my guess would be that such an intervention might be helpful for some people, but not for others,” he says. “OCD is very heterogeneous and people would likely respond differently to this.”
Jalal says that not all people seem to respond to the vicarious relief equally and he wants to find out more. He has now begun two larger trials at Harvard and Cambridge. “One of the trials has finished and the results are really promising,” he says.
Journal reference: Neurocase, DOI: 10.1080/13554794.2017.1279638
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