This document discusses the development of an app called SPIRIT to help treat obsessive compulsive disorder (OCD). Exposure and response prevention (ERP) therapy is the most effective OCD treatment but has problems with high dropout rates and infrequent engagement with therapeutic exercises. SPIRIT uses gamification elements like narrative, goals, and fast feedback to empower OCD patients to regularly complete exposure exercises. The developers plan to test SPIRIT in a clinical trial with 200 OCD patients to evaluate outcomes compared to treatment without the app.

1. GAMES FOR HEALTH EUROPE CONFERENCE 2018
Carmen Scherbaum & Sander Boer
S P I R I T

2. Presentation Content
Background:
● Obsessive Compulsive Disorder (OCD)
● Exposure and Response Prevention (ERP)
● Treatment problem
Design of the app SPIRIT:
● Gamification elements of SPIRIT
(narrative, fast feedback, goals)
Future directions

3. Obsessive Compulsive Disorder cycle

4. ➔ ERP is considered as
the most effective
treatment for OCD
Exposure and Response Prevention (ERP)
Abramowitz JS. The psychological treatment of obsessive-compulsive
disorder. Canadian Journal of Psychiatry. 2006;51(7):407–416
WITHOUT
action for relief
(response)
exposure
(trigger)

5. Treatment problem
Aderka IM, Anholt GE, van Balkom AJLM, Smit JH, Hermesh H, Hofmann SG, et al.,Differences between early and late drop-outs
from treatment for obsessive-compulsive disorder. J Anxiety Disord. 2011;25:918–23. doi: 10.1016/j.janxdis.2011.05.004
100%Start treatment
Finish treatment

6. Treatment problem: high dropout rate
Aderka IM, Anholt GE, van Balkom AJLM, Smit JH, Hermesh H, Hofmann SG, et al.,Differences between early and late drop-outs
from treatment for obsessive-compulsive disorder. J Anxiety Disord. 2011;25:918–23. doi: 10.1016/j.janxdis.2011.05.004
About 25% of people who start the treatment drop out early
75%
25%
Start treatment
Finish treatment

7. Aderka IM, Anholt GE, van Balkom AJLM, Smit JH, Hermesh H, Hofmann SG, et al.,Differences between early and late drop-outs
from treatment for obsessive-compulsive disorder. J Anxiety Disord. 2011;25:918–23. doi: 10.1016/j.janxdis.2011.05.004
For those who continue with the therapy, many do not regularly engage in
the therapeutic ERP tasks
25%
5%
10%
60%
Start treatment
Finish treatment
Treatment problem: Infrequent engagement

8. Only 50% of the people offered ERP show recovery after therapy.
Treatment problem: low recovery
Aderka IM, Anholt GE, van Balkom AJLM, Smit JH, Hermesh H, Hofmann SG, et al.,Differences between early and late drop-outs
from treatment for obsessive-compulsive disorder. J Anxiety Disord. 2011;25:918–23. doi: 10.1016/j.janxdis.2011.05.004
Start treatment
Finish treatment
25%
50%
5%
10%
5%
5%

9. “How can we empower OCD patients to do their
exposure exercises on a regular basis?”
Treatment challenge

10. Gamification for Health Behaviour Change
NARRATIVE GOALSFAST
FEEDBACK

11. NARRATIVE

12. Climb up the
fear ladder
with exercises
Individual list of
exposure tasks
NARRATIVE
van Oppen P, de Haan E, van Balkom AJ et al. Cognitive therapy and exposure in
vivo in the treatment of obsessive compulsive disorder. 1995

13. NARRATIVE

14. FAST FEEDBACK
Anxiety rating

15. FAST FEEDBACK
Progress
Diary of
exercises

16. GOALS
Monsters
& levels
Personal
mission

17. Future directions
200 patients with OCD
100 patients with SPIRIT
100 patients without SPIRIT
EVALUATION
of outcomes
LAUNCHING
the SPIRIT app
CLINICAL TRIAL
6 months
6 months

18. THANK YOU!
Carmen Scherbaum
carmenscherbaum91@gmail.com
Sander Boer
mail@sanderboer.nl
Special thanks for kind help:
Prof. Steffen Moritz, MD., Hamburg
Prof. Gabriele Ferri, Amsterdam