In a study published in the journal Scientific Reports, Baland Jalal and Professor Barbara Sahakian from the Department of Psychiatry, show how just one week of training can lead to significant improvements. 
 
 One of the most common types of OCD, affecting up to 46% of OCD patients, is characterised by severe contamination fears and excessive washing behaviour. Excessive washing can be harmful as sometimes OCD patients use spirits, surface cleansers or even bleach to clean their hands. The behaviours can have a serious impact on people’s lives, their mental health, their relationships and their ability to hold down jobs. 
 
 This repetitive and compulsive behaviour is also associated with ‘cognitive rigidity’ – in other words, an inability to adapt to new situations or new rules. Breaking out of compulsive habits, such as handwashing, requires cognitive flexibility so that the OCD patient can switch to new activities instead. 
 
 OCD is treated using a combination of medication such as Prozac and a form of cognitive behavioural therapy (‘talking therapy’) termed ‘exposure and response prevention’. This latter therapy often involves instructing OCD patients to touch contaminated surfaces, such as a toilet, but to refrain from then washing their hands. 
 
 These treatments are not particularly effective, however – as many as 40% of patients fail to show a good response to either treatment. This may be in part because often people with OCD have suffered for years prior to receiving a diagnosis and treatment. Another difficulty is that patients may fail to attend exposure and response prevention therapy as they find it too stressful to undertake. 
 
 For these reasons, Cambridge researchers developed a new treatment to help people with contamination fears and excessive washing. The intervention, which can be delivered through a smartphone app, involves patients watching videos of themselves washing their hands or touching fake contaminated surfaces. 
 
 Ninety-three healthy people who had indicated strong contamination fears as measured by high scores on the ‘Padua Inventory Contamination Fear Subscale’ participated in the study. The researchers used healthy volunteers rather than OCD patients in their study to ensure that the intervention did not potentially worsen symptoms. 
 
 The participants were divided into three groups: the first group watched videos on their smartphones of themselves washing their hands; the second group watched similar videos but of themselves touching fake contaminated surfaces; and the third, control group watched themselves making neutral hand movements on their smartphones. 
 
 After only one week of viewing their brief 30 second videos four times a day, participants from both of the first two groups – that is, those who had watched the hand washing video and those with the exposure and response prevention video – improved in terms of reductions in OCD symptoms and showed greater cognitive flexibility compared with the neutral control group. On average, participants in the first two groups saw their Yale-Brown Obsessive Compulsive Scale (YBOCS) scores improve by around 21%. YBOCS scores are the most widely used clinical assessments for assessing the severity of OCD. 
 
 Importantly, completion rates for the study were excellent – all participants completed the one-week intervention, with participants viewing their video an average (mean) of 25 out of 28 times. 
 
 Mr Jalal said: “Participants told us that the smartphone washing app allowed them to easily engage in their daily activities. For example, one participant said ‘if I am commuting on the bus and touch something contaminated and can’t wash my hands for the next two hours, the app would be a sufficient substitute’.” 
 
 Professor Sahakian said: “This technology will allow people to gain help at any time within the environment where they live or work, rather than having to wait for appointments. The use of smartphone videos allows the treatment to be personalised to the individual. 
 
 “These results while very exciting and encouraging, require further research, examining the use of these smartphone interventions in people with a diagnosis of OCD.” 
 
 The smartphone app is not currently available for public use. Further research is required before the researchers can show conclusively that it is effective at helping patients with OCD. 
 
 The research was funded by the Wellcome Trust, NIHR Cambridge Biomedical Research Centre, the Medical Research Council and the Wallitt Foundation. 
 
 Researcher profile: Baland Jalal 
 
 “Cambridge is the perfect place for the ‘idealistic scholar’ – those who believe they can re-write the science textbooks. The culture—like no other—embraces novel ideas, even if outlandish and far-fetched on the surface,” says Baland Jalal, a neuroscientist at the Behavioural and Clinical Neuroscience Institute. 
 
 “It is no coincidence that the foremost scientists in history have stepped foot here, including my scientific hero Newton. One cannot help but feel inspired, as if part of a lineage of greatness—‘standing on the shoulder of giants’.” 
 
 Jalal considers himself fortunate to have been able to stand on the shoulders of proverbial giants throughout his research career. He received his initial training at the University of California in the laboratory of legendary neuroscientist VS Ramachandran. 
 
 “California was an enchanting experience. Rama and I would often go for long strolls on San Diego’s beaches where he would tell mesmerizing stories about the good-old-days when he was a Cambridge student and how he later invented his famous ‘mirror box’ for phantom limb pain. He was like a second father – a mentor who instilled in me a genuine love of science.” 
 
 Jalal now works with husband-and-wife team Professors Barbara Sahakian and Trevor Robbins, who he describes as embodying “the ‘Cambridge spirit’ of innovation”. His work is ultimately about developed new psychiatric treatments. “This often involves taking an unorthodox and somewhat radical approach—thinking ‘outside the box’ so to speak,” he says. Ideas include the above treatment for OCD and a second treatment based on the ‘rubber hand illusion’, making a fake hand feel like it is your own. 
 
 His other area of interest is in sleep paralysis—being paralyzed from head to toe while seeing ghosts and space aliens when waking up from sleep. He has studied this peculiar phenomenon around the world and recently invented a novel meditation-relaxation therapy for this condition, called MR Therapy. 
 
 “I hope my research will lead to new therapies that can help people in distress around the world - especially folks in low-income countries who don’t have adequate access to health care. The feeling I have when someone tells me that my work has helped alleviate their anguish is – simply – indescribable.” 
 
 Reference 
 
 Baland Jalal, Annette Bruhl, Claire O’Callaghan, Thomas Piercy, Rudolf N. Cardinal, Vilayanur S. Ramachandran and Barbara J. Sahakian. Novel smartphone interventions improve cognitive flexibility and obsessive-compulsive disorder symptoms in individuals with contamination fears. Scientific Reports; 23 Oct 2018 ||||| We present the case of a 23-year-old White British man who presented with persistent déjà vu in 2010. He reported experiencing these symptoms since early 2007 shortly after starting university. He had a history of feeling anxious, particularly in relation to contamination, which led him to wash his hands very frequently and to shower two to three times per day, and his anxiety worsened around the time he began university. Anxiety and low mood led him to take a break from university, and he then began experiencing déjà vu. His recollection of these early episodes was that they would last for minutes, but could also be extremely prolonged. For example, while on holiday in a destination that he had previously visited he reported feeling as though he had become ‘trapped in a time loop’. He reported finding these experiences very frightening. 
 
 He returned to university in 2007 and he described the déjà vu episodes as becoming more intense. He took lysergic acid diethylamide (LSD) once, and from then on the déjà vu was fairly continuous. In 2008 he was referred to specialists for neurological examination. Routine electroencephalogram (EEG) and magnetic resonance imaging were performed at a centre with experience in the diagnosis of epilepsy and were both normal. He was given a psychiatric diagnosis of depersonalisation and treated with a range of medications. His Dissociative Events Scale score (35.36) was abnormal (cut off =30) at the time of conducting the recognition memory task (October 2009). 
 
 He was assessed by AZ in 2010, at which point his persistent déjà vu caused him to avoid watching television and listening to the radio, as well as reading papers and magazines, as he felt he had already encountered the content before. His neurological examination was normal. At the time of assessment he reported a chronically low mood and felt anxious much of the time, although his compulsive behaviours were not a problem. There was a family history of obsessive compulsive disorder (OCD) on his paternal and possibly maternal side. Summary scores from his neuropsychological evaluation are presented in Table 1. His performance on the National Adult Reading Test was not dissimilar to that of controls, and his performance on the Wechsler Adult Intelligence Scale estimated his intelligence quotient as 112. 
 
 Table 1. Patient and control group characteristics 
 
 In October 2009 we assessed his performance on a recognition memory task previously used with patients who report similar persistent déjà vu experiences/recollective confabulation (see [6], Experiment 3 for methodology). A comparison group of 11 male undergraduates conducted the same memory task (see Table 1 for sample characteristics). The control group were within the normal range for depression and stress as measured by the Depression Anxiety and Stress Scales, DASS-21, but were defined as having mild anxiety: note, lower cut-off is 7. They were also asked whether they had heard of déjà vu, frequency of déjà vu in the last month, and whether it impacted on their daily life. Eight controls had heard of déjà vu, one had not and two did not answer. Of the eight who had heard of déjà vu, only three had experienced it in the past month: two, three and 12 times. Of interest, the participant who reported approximately 12 déjà vu experiences within the past month scored highly on all subscales of the DASS, and his anxiety score was rated ‘extremely severe’, although he did not report that déjà vu impacted on his daily life. In short, the procedure for the memory task is as follows: participants study 30 words for an immediate test. They are then read a list of 60 words (30 studied words and 30 foils) and report whether each word is old or new. If classified as old, they report whether they remember it (can justify how they encountered it), find it familiar (they feel they have encountered it but cannot justify) or are guessing. We have previously demonstrated in dementia that people with persistent déjà vu-like experiences make very high levels of false positives (FPs), identifying new words as previously seen [6]. We have linked this deficit to a subtype of déjà vu, a disorder in the subjective experience of memory, as identified in the reports of ‘remembering’ and familiarity, which we termed déjà vecu. Déjà vecu is a particularly strong sensation of ‘re-living’ the present moment; it was this type of experience of which our case complained: rather than simply the unsettling feelings of familiarity which are normally associated with déjà vu, he complained that it felt like he was actually retrieving previous experiences from memory, not just finding them familiar. 
 
 Performance on the task is summarised in Table 1. Contrary to our expectations, our case made no FPs. Recognition memory was measured across all items and for all subjective states using a discrimination index, where FPs are subtracted from hits. His performance suggests he does not have a memory deficit, but his conservative performance (relatively low number of remember hits compared to controls and no guesses) suggests that he may be less confident in his memory ability than controls.
– There literally does appear to be an app for almost everything, and treating symptoms of obsessive-compulsive disorder just got its own entry. Treatment for OCD (a condition in which patients can't stop having obsessive thoughts and engaging in repetitive behaviors) has been notoriously hit or miss: UPI reports that up to 40% of patients don't respond that well to either medication or "talk therapy" in dealing specifically with symptoms like extreme phobias related to contamination and excessive hand-washing. But a new study published in Scientific Reports says subjects with strong contamination fears—for ethical reasons, the scientists didn't study actual OCD patients for fear of worsening their symptoms—who used a "brain training" app found significant relief for their symptoms after just one week of intervention. University of Cambridge researchers split 93 otherwise healthy subjects into three groups. For seven days, they were told to watch a 30-second video four times a day. Depending on which group they were in, that video was either of themselves washing their hands, touching a fake contaminated surface, or simply moving their hands around in various gestures (the control group). The subjects in the two non-control groups experienced a noticeable decrease in their OCD-like symptoms, with about a 21% jump in their Yale-Brown Obsessive Compulsive Scale scores—the most commonly used gauge in assessing OCD, per a release. Although research involving actual OCD patients is needed, scientists are encouraged. (Workaholics may be prone to OCD.)