Improving Patient Care Through Objective Monitoring of At-Home Repetitive Ritual Behaviors in Obsessive-Compulsive Disorder

Project Summary Obsessive-compulsive disorder (OCD) is characterized by intrusive, distressing thoughts (obsessions) in response to which an individual feels compelled to perform a repetitive behavior (compulsions), which are performed in order to reduce the acute distress experienced by the patient but which perpetuate OCD symptoms. Effective treatment requires accurate reporting of compulsive behaviors, and a key challenge is that patients often underreport their behaviors to their providers because the short-term anxiety relief brought about by engaging in the compulsion is preferable to the long-term challenge of resisting the compulsions in order to treat the condition, thereby impairing the efficacy of these treatments. Available objective monitoring tools, such as electrocardiogram (ECG) monitors, can detect periods of increased anxiety, while wrist-worn devices can monitor behaviors such as hair pulling, but they have limited accuracy for detecting hand-washing compulsions which are common in OCD and are thus not indicated for use in these patients. The overall goals of this Phase 1 STTR are to address this key gap by developing and testing the feasibility of a technological innovation involving a novel wearable smart-ring recording modality that is unintrusive and provides a more objective measure of compulsive behavior to both patients and their therapists in order to appreciably improve the effectiveness of OCD treatment. This ring device offers several innovations: It is a smart ring (1) that can detect cleaning agents like water or alcohol (2) as well as repetitive behaviors (3) in order to objectively monitor obsessive hand-washing or other ritualistic events (4). This information would be sent to a dashboard (5) with a real-time log for a therapist to objectively measure the number of behaviors the ring detects and monitor wear- time compliance (6). Specific aims of this proposal are to: 1) Optimize acceptability, feasibility and utility of the ring device and its associated smartphone app/web interface through iterative 1:1 feedback from the range of users of this technology (patients/providers); 2) Develop a prototype activity recording smart ring and associated software system based on Aim 1 findings. The smart ring will be a miniature system that records movement, temperature, and wetness. It will record while worn and wirelessly download data, pairing with a smartphone app which will sync with a cloud storage modality; 3) Conduct a multi-phased acceptability, feasibility and experimental assessment protocol first with healthy adults and then with patients with OCD, followed by in-depth feedback interviews with clinicians. Advanced Medical Electronics has extensive experience in biomedical development, and academic partners (Asnaani, Gooneratne) have expertise in OCD, experimental methodology, mHealth, biomedical entrepreneurship, along with a prior track record of successful collaboration on previous STTR funded studies and proposals. If successful, this project will provide patients and health care providers with an unintrusive and more accurate tool for real-time monitoring of typical compulsive behaviors in order to appreciably improve the efficacy of front-line treatments for OCD.