"It was Mentally Painful to Try and Stop": Design Opportunities for Just-in-Time Interventions for People with Obsessive-Compulsive Disorder in the Real World
Ru Wang, Kexin Zhang, Yuqing Wang, Keri Brown, Yuhang Zhao · 2025 · ASSETS 2025: 27th International ACM SIGACCESS Conference on Computers and Accessibility · doi:10.1145/3663547.3746394
Summary
This paper presents the first in-depth interview study examining the diverse triggers, compulsions, and self-management strategies of people with Obsessive-Compulsive Disorder to inform the design of just-in-time intervention technologies. The researchers interviewed 10 people with OCD (representing contamination, responsibility, harm, sexual, and just-right subtypes) and 7 OCD therapists specializing in evidence-based treatments including Exposure and Response Prevention (ERP), Cognitive Therapy, and Acceptance and Commitment Therapy (ACT). A key finding is that OCD triggers are far more diverse and nuanced than prior research has recognized: triggers can be physical objects, contexts, sounds, or even thoughts, and critically, it is the specific properties of triggers (such as a trash can's fullness, whether it has a lid, or its proximity) rather than the trigger type itself that determine distress intensity. The paper maps how triggers connect to five categories of compulsive behavior: direct trigger interaction (examining, checking), trigger avoidance, consequence mitigation (cleaning after contact), assisted compulsions (seeking help from others), and mental compulsions (rumination, internal counting, self-reassurance). The study also reveals important tensions between the coping strategies that people with OCD naturally adopt and those recommended by therapists — for example, relaxation techniques commonly used by OCD individuals were cautioned against by several professionals who worried they could become compulsive behaviors themselves. The findings highlight critical gaps in current self-management support, particularly around personalized symptom tracking, real-time trigger detection, and privacy protection for sensitive OCD-related data.
Key findings
OCD triggers extend well beyond standard clinical checklists, encompassing not just objects but contexts, sounds, weather, and abstract thoughts, with trigger intensity driven by specific properties (sensory attributes like color and texture, spatial attributes like quantity and proximity, affordances like handles requiring direct contact, familiarity with the trigger source, and internal states like stress and fatigue). None of the 10 OCD participants used any technology specifically designed for mental health self-management, despite therapists recommending various apps. Participants found traditional symptom tracking superficial and difficult to maintain, with privacy concerns about recording sensitive thoughts (especially taboo or violent obsessions) significantly hindering adoption. The study identified important conflicts between user-adopted and therapist-recommended strategies: breathing exercises and relaxation techniques were commonly used by participants during OCD episodes but were cautioned against by therapists who noted these could become compulsions themselves. Natural exposure practices (confronting unplanned triggers in real life) were perceived as more difficult than planned exposure due to their unpredictability and the absence of therapist support. ERP was acknowledged as effective for physical compulsions but limited for mental compulsions like rumination and self-reassurance, which persisted even when physical compulsive behaviors were reduced. Nine of 10 participants experienced challenges accessing OCD therapy due to long wait times, high costs, and stigma.
Relevance
This research makes important contributions to the growing field of mental health accessibility by deeply examining OCD as a disability that significantly impacts daily functioning, social participation, and quality of life. For accessibility practitioners and technologists, the paper offers concrete design implications: trigger detection systems should recognize not just trigger types but their fine-grained properties; symptom tracking needs to be personalized, automated where possible, and privacy-preserving; and just-in-time interventions should be carefully designed to avoid becoming compulsions themselves. The proposed augmented reality approach to compulsion prevention — using visual barriers to interrupt physical checking behaviors or gray-scale filters to encourage avoidance-based exposure — is novel and thought-provoking. The study's emphasis on the tension between user preferences and clinical best practices is particularly valuable, as it challenges technology designers to align tools with evidence-based treatment principles rather than simply reflecting user desires. The privacy considerations are especially critical given that OCD symptoms often involve taboo thoughts (violent, sexual) that carry extreme sensitivity, requiring on-device processing and content obfuscation strategies.
Tags: mental health · OCD · just-in-time intervention · exposure and response prevention · cognitive behavioral therapy · self-management · wearable technology · augmented reality · symptom tracking · privacy