The first step was to carry out a literature review for the design and development of different AR stimuli for the treating of cleaning OCD. We found that the stimuli that generate more anxiety and compulsions in cleaning-OCD patients are those they perceive as objects with germs, virus, fungi, or some other kind of toxic material that can provoke illnesses or cross-contaminations. Among the examples that were mentioned repeatedly in relevant studies are decomposed food (such as rotten meat or food with mold), objects on which dirt can be observed, and objects the person considers can transmit contamination because they were or are in contact with objects, people, or places infected or dirty (Breiter et al., 1996; Rachman, 2004; Armstrong and Olatunji, 2017; Mathes et al., 2019). Based on this, the four aversive stimuli developed in this project were a sealed plastic bag (full of garbage), bread with mold, rotten meat, and sports shoes with dirt on their surface.

After designing and developing the virtual stimuli, the validation study proceeded. Trained team members administered the Y-BOCS and the SCID-I structured interview to identify participants with cleaning-OCD symptoms. In addition, the symptom checklist–revised (SLQ) was administered to screen for the presence of other psychological disorders. Based on the results obtained in that assessment, two groups were formed: the cleaning-OCD group, consisting of participants with scores >13 on the Y-BOCS and who showed contamination/cleaning-OCD symptoms when performing the structured interview (SCID-I), and a control group, including participants with no cleaning-OCD symptomatology and scores <13 on the Y_BOCS.

Once the groups were formed, AR devices were used, presenting the participants with the four stimuli designed for the treatment of cleaning OCD. They were presented in the following order (1) sealed garbage bag, (2) moldy bread, (3) dirty sneakers, and (4) rotten meat. They each presented for 3 min. In the first 2 min, they were to look at the stimulus. They were asked what they could see and described the observed object. The leaf was rotated 90 degrees every 30 s. At the beginning of the last minute, participants were asked to get as close as possible to the stimulus with their hands. After being exposed to each of them, the participant had to complete the STAI (state subscale), and once exposed to the four stimuli, the IPQ.

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