Cognitive Flexibility Training in Virtual Reality for Patients with Obsessive–Compulsive Disorder: Feasibility Study

Obsessive–compulsive disorder (OCD) is characterized by obsessions (intrusive, anxiety-provoking thoughts) and compulsions (repetitive behaviors that temporarily relieve this anxiety). Emerging evidence suggests OCD patients exhibit impaired cognitive flexibility (CF), which may be amenable to targeted training. This study evaluated the feasibility of integrating Virtual Reality-based Cognitive Training (VRCT) into an inpatient group cognitive-behavioral therapy (CBT) program for OCD, with exploratory cognitive outcomes as a secondary aim. Seventeen inpatients with OCD (ICD-10 F42; ICD-11 6B20) completed a VRCT program alongside standard CBT. We assessed feasibility via adherence rates, task completion, and subjective experience (presence, cybersickness; IPQ, SUS, SSQ). Pre- and post-training assessments included neuropsychological tests of cognitive flexibility (Trail Making Test, Stroop Task, Verbal Fluency, Go/No-Go, Berg’s Card Sorting Test), self-report measure of cognitive flexibility (CFI), and an assessment of OCD symptom severity (Yale–Brown Obsessive Compulsive Scale, Y-BOCS). VRCT integration into the inpatient CBT program was feasible and well-tolerated, with high adherence rates, minimal cybersickness, and positive subjective reception. In the exploratory effectivity analysis, nominal improvements were observed in processing speed (TMT A) and interference control (Stroop Task), but neither remained significant after correction for multiple comparisons. Self-reported cognitive flexibility (CFI) showed no significant change.CFI scores correlated poorly with neuropsychological measures overall, with only isolated subscale-level associations. Baseline Stroop interference, semantic fluency, and Go/No-Go accuracy were moderately associated with early VR training performance, though these associations weakened over subsequent sessions. A consistent within-session pattern emerged: performance dipped at session onset before recovering. VRCT can be feasibly and acceptably integrated into inpatient CBT for OCD. Exploratory effectivity analysis yielded no significant results.