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  • Dr. Dug

Case Study of BZ and OCD: Session #2

BZ's first session gave us a chance to get a sense of her concerns and how treatment was going to progress. In this next session, BZ gets introduced to Virtual Reality Exposure Therapy (VRET) and creates an exposure hierarchy.

A Mindful Foundation

We commenced our session with a grounding mindfulness exercise. This exercise served a dual purpose: first, to help BZ become more aware of her internal experiences, and second, to set the stage for the work ahead. With a clear mind, we reviewed our agenda for the day and revisited BZ's homework, discussing how her progress would integrate into today's session.

Building the Exposure Hierarchy

A pivotal moment in our session was the creation of BZ's exposure hierarchy. This tool allows us to systematically assess BZ's willingness to confront the discomfort associated with various actions. Each behavior was rated on a scale of 0 to 10, with 0 indicating no willingness to experience discomfort and 10 signifying total willingness.

Let's take a look at BZ's hierarchy:


​Willingness to Experience Discomfort

Only checking once to make sure lights are off


Leaving home without checking that lights are off


Only checking once to make sure the windows are all closed


Only checking once to make sure stove is off


Returning home only once to make sure garage door is closed


Leaving home without checking that the windows are all closed


Leaving home without checking that the stove is off


Checking that garage door is closed only when driving away


Based on this hierarchy, we decided to start with "Only checking once to make sure lights are off" because BZ indicated the highest willingness to experience the discomfort associated with this action.

The Immersive VR Experience

BZ put on her VR goggles, and we then transported her into a virtual house. The setting was intentionally chosen to be dark and stormy outside, setting the stage for heightened anxiety. BZ was then gently guided through an exchange designed to evoke feelings of anxiety, simulating a stressful morning scenario where being late for work was imminent. The rain outside symbolized potential traffic chaos.

In this virtual environment, BZ embarked on her checking routine, including lights, windows, and the stove. She was given the freedom to turn back and check the windows and stove multiple times but not the lights. I asked her how willing she was to experience the discomfort of not checking the lights again and she said “8/10.” BZ made her rounds a few times and then walked out the door.

Choosing a Different Path

BZ came out of the VR environment and we talked in more detail about what a meaningful life would look like. This included the richness of relationships, the hope that every morning brings, and the satisfaction of moving forward. BZ went back into the virtual environment and the next time I asked her about her willingness, she said “10/10.” The third time we went through the exercise, she again said “10/10.”

Before parting ways, BZ received her homework assignments. She was tasked with another Values homework exercise to remind her of what a meaningful life meant to her. Additionally, BZ committed to practicing this specific exposure exercise daily, reinforcing her newfound success. The mindfulness virtual reality environment was also integrated into her daily routine to foster mindfulness and awareness.

In Session #2, we witnessed the first success BZ made in her journey toward a more meaningful life. VRET, coupled with mindfulness and a clear sense of purpose, is helping BZ to reset her priorities back to what really matters. Stay tuned for BZ's third session!

Case studies provide readers with an opportunity to become familiar with Virtual Reality Exposure Therapy. Each case study will unfold over multiple articles. Future case studies will explore a variety of problems. Leave a comment if there is a specific problem or disorder of which you would like to see a case study.

Wishing everyone well! #DrDug #LittleThingsFromDrDug

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