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Michelle Craske is asking patients to dive into coral reefs, ride on bullet trains rushing past pine trees, and cheer on soccer teams from the stands — at least virtually — in a bid to tackle a symptom long sidelined in depression treatment.

The University of California, Los Angeles, psychiatry researcher and her colleagues are testing whether virtual reality can curb anhedonia, a symptom of depression and other serious mental health conditions that’s marked by a lack of interest or ability to feel pleasure. They’re putting patients into pleasant scenarios — like a stroll through a sun-soaked forest while piano music plays — and coaching them to pay close attention to the positive parts.The idea is to help patients learn to plan positive activities, take part in them, and soak up the good feelings in the process.

It’s an unconventional strategy — not just for its use of virtual reality, but also for how it approaches a patient’s symptoms. Treatments for depression and other serious mental health conditions primarily target negative symptoms, like hopelessness, sadness, and anxiety — but they often don’t help with the lack of positive feelings that some patients experience.

“Most treatments, up until now, have done an OK job at reducing negative [symptoms of depression], but a very poor job at helping patients become more positive,” said Craske.

There aren’t data yet to determine whether virtual reality treatment can make a meaningful difference in anhedonia. But the technology is increasingly popular in mental health care. Other studies have suggested virtual reality can be useful in easing certain phobias, helping people with psychotic disorders experience less paranoia and anxiety in public settings, and reducing social anxiety.

“It goes to the heart of the very best of psychological therapy — going into environments that cause difficulties and learning different ways of thinking, feeling, and behaving,” said Dr. Daniel Freeman, a University of Oxford psychologist who is studying whether it’s possible to use virtual reality to automate therapy for certain conditions, such as a fear of heights. Researchers elsewhere are using virtual reality for everything from treating PTSD in people who’ve experienced sexual trauma to equipping service members with coping skills they’ll need in combat zones.

“Mental health and the environment are inseparable,” said Freeman. “The brilliant thing about virtual reality is that you can provide simulations in the environment and have people repeatedly go into them,” he added.

Anhedonia has proven to be a particularly stubborn symptom to treat. Even when a patient’s other symptoms improve with treatment, anhedonia often doesn’t.

“It’s only one part of many symptoms, but it’s a symptom that’s especially impairing,” said Dr. Erika Forbes, a University of Pittsburgh psychologist who studies anhedonia. Research suggests people who have anhedonia are more likely to have longer, more difficult to treat cases of depression.

Scientists don’t know the exact biology behind the symptom, but believe that it’s tied to problems with the brain’s reward circuitry. There aren’t treatments that specifically target the symptom, but a handful of research groups are working on possible interventions.

The foundation of Craske’s approach is an intervention developed by Craske and her colleagues known as positive affect therapy. The gist: put a person into a situation that might be pleasurable, talk to them about it in painstaking detail, repeat. That might look like going to a museum, taking in the art, and then talking with a therapist about everything from the vivid shades of red in a painting to the feeling of their shoulders relaxing while standing in front of it.

In a paper accepted earlier this year by the Journal of Consulting and Clinical Psychology, Craske’s team found the treatment was more effective than cognitive behavioral therapy at boosting people’s positive feelings. Participants who went through the positive affect treatment also reported lower levels of depression, anxiety, and other negative symptoms than their peers in the standard treatment group.

But for some patients with severe anhedonia, depression, or other limitations, getting out into settings like museums or social gatherings isn’t a realistic first step. That’s where the virtual reality comes in.

“You bring the world to them,” Forbes said.

Craske is running two virtual reality studies on anhedonia. The first was a small pilot study of six patients with severe cases. The patients ventured into new environments using virtual reality, going through weeks of therapy designed to drill into positive emotions. The researchers also used functional MRI scans of the brain to see if the practice produced any changes in the brain, though they haven’t analyzed those scans yet.

Now, the researchers are running a larger study with dozens of patients with anxiety and depression who have anhedonia. In a bid to make virtual reality treatment easier and more accessible, patients are equipped with VR gear that they can use with their smartphones at home. Over 13 virtual reality sessions, patients are immersed in a series of scenarios, such as gliding through the canals in Venice. They’re encouraged to observe their thoughts, feelings, and physical reactions, then jot those down in an online diary after each session. They’ll also hear a guided mindfulness recording after each session that’s intended to reinforce the idea that certain activities can be rewarding.

After each session, participants rate their mood on a scale. Their results will be compared to a control group of peers who aren’t receiving the virtual reality treatment, but will be offered the option to do it once the trial wraps up.

“It sounds like a creative and promising way to address [anhedonia],” Forbes said.

If the studies support the virtual reality treatment, there are still kinks to be worked out in the system, including giving the virtual reality scenarios an upgrade. Craske and her colleagues are planning to work with a virtual reality company to design an interactive program that adapts to a patient’s responses. If, for example, a patient smiles at a VR character who waves and says hello, that character might walk over and strike up a friendly conversation.

“That’s where I want to go with this — make it much more interactive,” she said.

Moving virtual reality into mental health care will take a collaborative effort. Freeman said that having a well-designed program and good hardware are critical for using VR in health care — and key to making sure it doesn’t cause any unpleasant side effects that some people experience with VR, like nausea.

As the technology is refined and studied, experts say it could become a useful tool in treating psychiatric conditions and other health issues. But researchers still need to pinpoint which conditions and patient groups might benefit from virtual reality, and which won’t.

“Mental health is complex. There is no one solution,” said Freeman. “There won’t be one tech solution either.”


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Virtual reality (VR) may be the next big thing in computer games, but the state-of-the-art technology could also combat depression.

Scientists believe putting patients in a simulated environment where they 'dive' in coral reefs, 'ride' trains through forests or 'celebrate' their favourite football team's glory could boost their mood.

The technique is thought to help overcome anhedonia, when a patient loses the ability to enjoy pleasurable activities - a common symptom of depression.

By coaching patients to observe the positive things happening around them, the scientists hope they will be more motivated to plan fun activities and take the time to 'soak up' everyday tasks.

The scientists, from the University of California, Los Angeles (UCLA), are conducting two experiments to determine if VR boosts a depressed patient's mood.

The research is being led by Professor Michelle Craske, director of the Anxiety and Depression Research Center at UCLA. 

Depression is the leading cause of disability in those aged 15-to-44 in the US and affects more than 16.1million American adults every year, according to the Anxiety and Depression Society of America.

And in the UK, 19.7 per cent of people over 16 showed symptoms of depression or anxiety in 2014, Mental Health Foundation statistics reveal.

To get to the bottom of VR's affect in anhedonia sufferers, the researchers first put six patients in a simulated environment most would consider pleasurable.

In a technique known as positive affect therapy, counsellors then explained in detail every aspect of the situation.

For example if the simulated environment was a gallery, the patient was allowed to take in the art before speaking to a therapist about the vivid shades in a painting and how relaxed their shoulders felt while looking at it. 

MRI scans were also taken to determine if the patient's brain underwent any functional changes. Results of the experiment have yet to be analysed but the scientists are hopeful.

The researchers are now looking at dozens of anxiety and depression sufferers who battle anhedonia. To make VR more accessible, these patients have had the technology uploaded onto their phones to use at home.

The patients have been asked to observe their thoughts, emotions and physical reactions while, for example, being taken on a gondola ride in Venice. 

They will complete 13 sessions, each followed by a guided mindfulness course to reinforce the idea that certain situations can be pleasurable. 

The patients will rate their mood after each session, which will be compared against those with mental health problems who did not receive VR treatment. The control group will have the opportunity to try it once the experiment has ended. 

If the treatment is successful, the scientists hope it can be adapted to each patient. For example, if they respond well to a particular character, this character may appear more often.  

As well as VR being novel in itself, the treatment is also unusual in that it aims to boost a patient's positive emotions rather than dampening their negative ones, such as hopelessness, anger or lack of energy.

'Most treatments, up until now, have done an okay job at reducing negative [symptoms of depression], but a very poor job at helping patients become more positive,' Professor Craske told STAT.

Anhedonia is traditionally tricky to treat, even when other symptoms of depression improve. Those who struggle to enjoy pleasurable activities have also been shown to have longer and more severe mental health problems.

But past research by the UCLA scientists found VR overcomes anhedonia more effectively than cognitive behavioural therapy (CBT). CBT is a talking therapy that can help patients manage their problems by changing how they think and act.   

VR has previously been useful in helping patients overcome phobias, paranoia and social anxiety. It also helps those who may benefit from these enjoyable surroundings but lack the energy to venture out the house. 

Dr Erika Forbes, a University of Pittsburgh psychologist - who is not involved in the research - added: 'Mental health and the environment are inseparable.

'[With VR] you bring the world to them.' 

The researchers stress, however, there is no 'one size fits all' approach to treating depression and not all patients are expected to benefit from VR.   



While it is normal to feel down from time to time, people with depression may feel persistently unhappy for weeks or months on end.

Depression can affect anyone at any age and is fairly common – approximately one in ten people are likely to experience it at some point in their life. 

Depression is a genuine health condition which people cannot just ignore or 'snap out of it'.

Symptoms and effects vary, but can include constantly feeling upset or hopeless, or losing interest in things you used to enjoy.

It can also cause physical symptoms such as problems sleeping, tiredness, having a low appetite or sex drive, and even feeling physical pain.

In extreme cases it can lead to suicidal thoughts.

Traumatic events can trigger it, and people with a family history may be more at risk.

It is important to see a doctor if you think you or someone you know has depression, as it can be managed with lifestyle changes, therapy or medication. 


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London: Researchers have warned that immersion in virtual reality (VR) can cause behavioural changes in consumers that may last even after they leave the virtual environment.

The technological capacity for generating virtual worlds from home computers will soon be widely available to the general public, as special head-mounted displays are brought to market that create the illusion of being immersed in virtual three-dimensional worlds.

But citing recent studies, Michael Madary and Thomas Metzinger from Johannes Gutenberg University of Mainz in Germany said that VR may create vast opportunities for psychological manipulation - a risk that has received far less attention so far.

"These studies suggest that VR poses risks that are novel, that go beyond the risks of traditional psychological experiments in isolated environments, and that go beyond the risks of existing media technology for the general public," the researchers wrote in a recently published article in the journal Frontiers in Robotics and AI.

Based on their analysis of the risks, both researchers offered concrete recommendations for the use of VR.


For example, in experimental work developing new clinical applications, researchers should be careful not to create false hopes in patients. They should repeatedly remind them of the merely experimental nature of the research.

Madary and Metzinger also noted that a code of ethical conduct, however important it may be, can never function as a substitute for ethical reasoning itself on the part of researchers.

They warned about content such as violence and pornography, where the advanced technology may increase the risk of psychological trauma.

“Users should be clearly informed of these dangers, as well as risks of hallucinations, personality changes, and the powerful unconscious influence of advertising in VR,” they said.




Background: Depression is the leading cause of disability in youth, with a global economic burden of US >$210 billion annually. However, up to 70% of youth with depression do not receive services. Even among those who do access treatment, 30% to 65% fail to respond and many dropout prematurely, demonstrating a need for more potent, accessible interventions. In a previous trial, a single-session Web-based growth mindset (GM) intervention significantly reduced depressive symptoms in high-symptom adolescents; however, this intervention did not benefit adolescents uniformly. For instance, the intervention reduced depression in adolescents who reported post intervention increases in perceived control, but it did not lead to significant depression reductions in adolescents who reported no significant post intervention increases in perceived control.

Objective: The goal of this project is to test the acceptability and efficacy of a novel, single-session, virtual reality (VR) depression intervention—the VR Personality Project—teaching GM, the belief that personal attributes are malleable rather than fixed. The VR Personality Project was designed to systematically target and increase adolescents’ perceived control by offering a more immersive, engaging, user-directed intervention experience than the Web-based intervention can provide. By targeting an identified predictor of intervention response, the VR Personality Project may lead to larger reductions in depressive symptoms than existing Web-based mindset interventions.

Methods: Adolescents with elevated depressive symptoms or a recent history of depression (N=159; ages 12 to 16 years) will be randomized to one of 3 intervention conditions: the VR Personality Project; the Web-based GM intervention tested previously; or an active, Web-based control. Adolescents and their parents will report on the adolescents’ depression symptoms, perceived control, and related domains of functioning at preintervention, postintervention, and at 3- and 9-month follow-up assessments.

Results: We predict that the VR and Web-based mindset interventions will both lead to larger reductions in adolescent symptoms than the control intervention. Additionally, we predict that the VR-based single session intervention will lead to larger reductions in depression than the online mindset intervention and that these symptom reductions will be mediated by increases in adolescents’ perceived control from pre- to postintervention.

Conclusions: The results may suggest an efficient strategy for reducing adolescent depressive symptoms: One that is mechanism-targeted, relatively affordable (less than US $200 for a commercially available VR headset, a fraction of the cost of long-term psychotherapy) and potentially engaging to adolescents experiencing mood-related distress.

Trial Registration: NCT0385881; (Archived by WebCite at

International Registered Report Identifier (IRRID): DERR1-10.2196/13368

JMIR Res Protoc 2019;8(7):e13368





Psychiatric disorders are the leading cause of disability worldwide, and 40.5% of this burden is attributable to depressive symptoms and disorder. Levels of depressive symptoms increase markedly in adolescence with nearly 20% of the youth experiencing a depressive disorder between ages 12 and 18 years [1]. Adolescent-onset depression accounts for 66% of lifetime depression cases and predicts interpersonal problems, substance abuse, and a 20-fold increased risk of attempting suicide. Despite this early onset and protracted course, up to 70% of adolescents with depression symptoms and disorders do not receive services [2-4]. Even among those who do access psychosocial or medication-based treatment, 30% to 65% fail to respond [5] and many drop out of clinic-based services prematurely—after 3.9 sessions on average [6]. These findings highlight the urgent need for more potent and accessible interventions for adolescent depression.

Emerging work suggests that single-session interventions (SSIs) can increase accessibility of potent interventions for youth depressive symptoms and disorders [7]. SSIs include core elements of comprehensive, evidence-based treatments, but their brevity makes them easier to disseminate to diverse settings. Indeed, SSIs can successfully treat youth psychiatric problems: In a meta-analysis of 50 randomized trials [4], SSIs for youth psychological problems demonstrated significant beneficial effects (mean g=.32) across various levels of youth problem severity, suggesting the potential of SSIs for youths with diagnosable and subclinical psychopathology. Furthermore, significant effects emerged even for self-administered (eg, Web-based) interventions (mean g=.32). Notably, SSIs’ overall effects are slightly smaller than those observed for multisession psychotherapy [8]. However, their high potential to render services more scalable and accessible—especially for youths who might otherwise go without services entirely—could magnify their benefits for youth psychological health on a large scale.

One SSI in particular has shown promise in reducing adolescent depressive symptoms: the growth mindset (GM) SSI, which encourages youths to view traits and attributes as malleable (a GM) as opposed to unchangeable (a fixed mindset). Youths holding fixed mindsets of personal traits tend to report higher levels of psychopathology [9] and increased internalizing problems over time [10,11]. Recent research suggests that encouraging GMs via brief, targeted interventions can help shift this trajectory: 30- to 90-min self-administered GM SSIs have prevented adolescent depression symptoms in nonclinical samples (OR=.55, with the GM group showing lower odds of reporting clinically elevated levels of depression 9 months later [12]). In a randomized controlled trial (RCT) targeting high-symptom adolescents, a GM SSI led to postintervention increases in adolescents’ perceived control over behavior (d=.34, P<.001) and emotions (d=.19, P=.03) relative to a comparison (supportive therapy [ST]) SSI [13]. The GM SSI also predicted steeper 9-month declines in youth depression symptoms per parent (B=–0.99, P=.047) and adolescent reports (B=–1.37, P=.03) [14].

Although multiple versions of GM SSIs have been developed to fit varying settings and populations, they are generally self-administered by youths; teach the brain science behind why it is possible for a trait (eg, personality, loneliness, and anxiety) to change; include testimonial quotes from peers reinforcing the possibility of personal change; and involve the completion of at least one self-persuasion exercise wherein youths write about how change is possible to help a peer who is struggling [15]. Thus, the GM SSI may help remove barriers to adolescents asking for help and for expanding effort rather than withdrawing in the face of setbacks and failure.

Despite its promising effects, it is notable that the GM SSI does not reduce depression in all adolescents. For instance, in the most relevant RCT, the GM SSI reduced depressive symptoms in adolescents who reported postintervention increases in perceived control over their personal behaviors, but it did not lead to significant depression symptom reductions in adolescents who reported small or no increases in perceived control [16]. Thus, the potency of GM SSIs for adolescent depression has yet to be optimized. Such potency may be advanced by developing new iterations of GM interventions (GMIs), which are designed to more systematically target predictors and mechanisms of clinical outcomes, such as low levels of perceived control: a predictor and risk factor for depression [17-21] that GM SSIs have successfully mitigated, both in the short-term [13] and over time [14]. Such efforts may increase the promise of GMIs to produce larger, longer lasting symptom reductions for a greater proportion of youth.


Accordingly, the goal of this 3-arm RCT is to evaluate the acceptability and efficacy of a novel, single-session virtual reality (VR)-based GM SSI—the VR Personality Project —for depressive symptoms in adolescents compared with both a Web-based GM-SSI and an active, Web-based control program. Immersive VR creates interactive, computer-generated worlds, which substitute real-world sensory perceptions with digitally generated ones, producing the sensation of actually being in new life-sized environments. The last 2 decades have seen a significant increase in the use of VR technology in mental health interventions, with research suggesting benefits of VR-mediated interventions for various anxiety disorders, specific phobias, posttraumatic stress disorder, substance use, and eating disorders [22-27], largely through graded exposure to feared stimuli and situations. VR has also been extended to the adjunctive treatment of psychotic symptoms, delivering cognitive rehabilitation, and social skills training interventions in ecologically valid virtual environments [28,29]. For this study, the VR Personality Project was designed in collaboration with Limbix Inc to systematically target and increase adolescents’ sense of perceived control by offering a more immersive, active, and user-directed intervention experience than Web-based GM SSIs have provided. Within the VR program, participants can exert control over their intervention experience by actively engaging with characters in the VR world, autonomously navigating through various environments and speaking directly to (eg, offering verbal advice) same-aged peers. By strengthening adolescents’ interactions with the program content, lessons, and characters and providing a more ecologically valid environment (relative to that offered by a computer-based program) for youths to rehearse and apply newly acquired skills, the VR Personality Project may engage an identified predictor of response to GM SSIs in turn producing larger reductions in depression than Web-based versions. Thus, the VR Personality Project may represent a mechanism-targeted, efficient strategy for reducing adolescent depression: one that is both relatively affordable (less than US $200 for any commercially available VR headset; a fraction of the cost of long-term psychotherapy) and potentially engaging to adolescents experiencing mood-related distress.

Notably, a recent systematic review of studies evaluating VR applications for mental health identified only 2 studies that have tested immersive VR mental health treatment approaches; both were uncontrolled feasibility trials targeting adults [19]. Thus, to our knowledge, this study will be the first randomized trial evaluating a brief VR intervention for adolescent depressive symptoms.

This research has 4 specific aims. Our first aim is to replicate past research suggesting that GM SSIs can significantly reduce depressive symptoms in at-risk adolescents. We hypothesize that adolescents aged 12 to 16 years who participate in a GMI (Web-based or VR–based) will show larger reductions in depression symptoms from baseline through the 9-month follow-up assessment compared with adolescents who receive an active, Web-based control program.

Our second aim is to evaluate new, single-session, VR GMI including a comparative efficacy study. Our second aim is to also evaluate whether the new VR–based GM SSI (the VR Personality Project) can reduce depressive symptoms in adolescents, both relative to an active control program and to the previously tested Web-based GM SSI [13,14]. We hypothesize that adolescents who participate in the VR–based GM SSI will show larger reductions in depressive symptoms from baseline through the 9-month follow-up assessment compared with adolescents who receive the Web-based GMI and compared with adolescents who receive the active Web-based control program.

Our third aim is to test whether shifts in perceived control mediate intervention effects on adolescent depressive symptoms. The VR Personality Project was designed to target and increase adolescents’ perceived control by offering a more immersive, active, and user-directed intervention experience than the Web-based GM SSI can provide. Thus, the third goal of this study is to examine whether the VR Personality Project does, in fact, reduce adolescent depressive symptoms by eliciting proximal increases in perceived control. We hypothesize that the VR Personality Project will lead to larger increases in immediate postintervention perceived control than the Web-based intervention from pre- to postintervention and that these increases will mediate subsequent reductions in adolescent depression across the follow up period.

Our fourth aim is to gauge acceptability of the VR intervention. Adolescents’ perceptions of any intervention can impact completion rates, program engagement, and ultimately intervention effectiveness. Thus, an additional aim of this research is to examine whether adolescents view the VR Personality Project as more engaging, helpful, and interesting than the Web-based GMI or the Web-based control intervention.


Summary of Overall Study Design

This study will be a 3-arm RCT, including 2 active intervention conditions and 1 active control condition. Study procedures were preregistered in before enrollment of the first participant (NCT03858881; recruitment start date: March 2019). The Stony Brook University Institutional Review Board (IRB) has approved all study procedures described below. Participants will be randomly assigned to one of 3 conditions in equal numbers. We opted for equal allocation across groups (a relatively conservative approach) rather than weighted allocation to the active intervention groups, owing to the novelty of the VR intervention being evaluated and the resulting need for a rigorous, controlled test of its efficacy. After qualifying for participation based on a phone screen, adolescents (and 1 caregiver per adolescent) will visit the Department of Psychology at Stony Brook University for a 2-hour laboratory visit. Adolescents and parents will complete baseline questionnaires (see below for details). Adolescents will then be randomized to receive one of 3 interventions using a computer-based random number generator: the VR GM intervention (VR GMI), the online GM intervention (online GMI), or an online active control program designed to replicate ST and tested previously [13,14]. Immediately after intervention completion, adolescents will complete a postintervention questionnaire battery. Adolescents and parents will then be asked to complete online follow-up questionnaire batteries 3- and 9-month postintervention.

Subjects, Projected Screen Failure Rate, and Power Analysis

We intend to recruit 159 adolescents aged 12 to 16 years (inclusive). G*Power 3.1 ( University of Duesseldorf) was used to calculate the sample size needed to achieve sufficient power, (1- β) to detect mean group differences (based on an omnibus F test) of small (.2), medium (.5), and large intervention effects (.8) on depression symptoms, measured continuously, with alpha=.05 and power at 0.80 for a 3-arm randomized trial. Sample sizes calculated were 969, 159, and 66 for effects of .2, .5, and .8, respectively, for an omnibus one-way analysis of variance (ANOVA). Power to detect a small effect size is ideal, but logistical constraints necessitate a more conservative sample size. The sample size of 159 (53 per SSI condition) reflects power to detect a medium (d=.5) between-group effect size.

Detailed Study Procedures

Recruitment and Screening

Youth participants will be recruited from community groups, after-school and extracurricular programs, parent organizations, private psychiatric and pediatric primary care clinics, and religious organizations in the Stony Brook area. Eligibility for participation will be ascertained through a parent phone screen conducted by a trained member of the research team. Parents will be informed at the end of the phone screen whether or not their adolescent qualifies for study participation. Youths must be living with at least 1 parent or legal guardian and both must speak English well enough to complete study interventions. Additional inclusion criteria will include the following: (1) the youth is aged 12 to 16 years (inclusive) with 1 parent willing to participate (2) the youth reports elevated depressive symptoms (>80 percentile for age and sex, reflecting subclinical or higher symptom elevations) based on the parent-report version of the Children’s Depression Inventory-2 (CDI-2). Exclusion criteria will include intellectual disability (based on parent report) and hospitalization of the adolescent within the past 2 months for suicide attempt or self-harm, as the interventions being evaluated in this study are not designed for youth with acute medical or psychiatric need. Concurrent treatment will not preclude eligibility. Youths prone to seizures will also be eligible to participate; risks of participating will be discussed with prospective participants and families before study participation. This study will focus on youth aged 12 to 16 years because depression increases markedly in adolescence, and youth in this age range have responded well to GMI [13,14].

Laboratory-Based Study Session

On the basis of the parent phone screen, parents of eligible youths will be invited to schedule a laboratory-based study session, which they and their adolescent will attend together. This session will last approximately 2 hours and will be led by 2 research assistants at the postbaccalaureate, master’s, or advanced undergraduate level. Before guiding participants through the study, each research assistant will have received individual training from the principal investigator in each step of the study protocol, including 2 start-to-finish practice runs with mock participants.

At the start of this laboratory-based study session, the youth and parent will have the opportunity to provide consent or parental permission and youth assent; all study procedures will be explained to the family at this time, and the youth and parent will be reminded that they can choose to leave the study at any time. After providing parental permission and youth assent, study procedures will begin. The youth participant will be escorted to a separate room by a member of the study team to complete study procedures; the parent will remain in the room in which consent and assent was obtained to complete his or her portion of the study procedures (ie, a questionnaire battery). One member of the study team will remain with the youth for the duration of the session; a second member of the study team will provide instructions to the parent and remain available to answer any additional questions the parent has during the laboratory visit.

After consenting, youths will be asked to complete a battery of questionnaires (detailed below) via Qualtrics, a secure collection platform. Subsequently, a random number generator (embedded within the last slide of the Qualtrics survey including youths’ baseline questionnaires) will be used to assign youths to one of 3 intervention conditions: VR GMI, Web-based GMI, or Web-based ST. No personally identifying data or information will be collected during intervention administration.

Notably, for youths randomly assigned to the VR GMI, both the youth and experimenter will be aware of the condition assignment (only one of the 3 programs involves VR technology). However, for youths randomly assigned to either of the 2 Web-based interventions neither the youth nor the experimenter will be aware of which Web-based intervention they received; randomization to these 2 conditions will occur without experimenter involvement as part of the youth’s Qualtrics survey.


Web-Based Growth Mindset Intervention

The Web-based GMI [13,14], called Project Personality, is delivered via Qualtrics and takes approximately 30 min to complete. All intervention activities are self-administered by the youth and delivered in a Web-based format, including illustrations and audio-recordings of text. Intervention content is designed to maximize relevance for youths experiencing symptoms of depression, including excessive sadness and hopelessness. The intervention includes 5 components: (1) an introduction to the brain, including a lesson on the concept of neuroplasticity, describing how and why our behaviors are controlled by thoughts and feelings in their brains, which have potential for change; (2) written testimonials from older youths who describe their beliefs that people’s personal traits (eg, sadness and anxiety) are malleable, given the brain’s plasticity; (3) additional vignettes written by older youths, describing times when they used GMs to persevere through social and emotional setbacks; (4) a summary of scientific studies suggesting that personality can, and often does, change in positive ways over time; and (5) exercises in which the participants write notes to peers, drawing on scientific information to describe the malleability of people’s personal traits.

Virtual Reality Growth Mindset Intervention

The VR intervention, called the VR Personality Project, will be administered through an adjustable VR headset that includes a stereoscopic display powered by a Samsung smartphone (Galaxy S6TM) mounted on a lightweight (345 g) wireless, off-the-shelf head-mounted display with a 101-degree field of view for users (Samsung Gear Virtual Reality (VR)™). A focus wheel on the VR goggles will be adjusted to find a comfortable focal length for each participant. Sound is delivered through the head-mounted display. A lightweight (295 g) wireless Bluetooth controller (MOGA PROTM POWER controller) that requires only one hand to operate will be used by each adolescent to interact with the VR environment. For infection control reasons and because the same hardware will be used for all participants, disposable coverings will be used on the head-mounted display. All equipment will be cleaned between participants using disposable wipes and dried for at least 20 min.

Similar to the Web-based analogue, the VR Personality Project takes approximately 30 min for youths to complete. It contains each of the components included in the Web-based GMI, including a lesson on neuroplasticity (Figure 1); testimonials from older peers; information about research suggesting the malleability of personal traits (Figure 2); and a self-persuasion exercise wherein the participant provides advice to a student in the VR environment who has just experienced a peer-related setback. Content is delivered by characters in the VR environment (adolescent and adult actors hired and filmed for the creation of this intervention), who are matched to an adolescent’s self-identified gender identity for a more personalized experience (Figure 3). These characters help guide the youth participant through each stage of the program, providing scientific information and personal stories. The primary difference between the VR and Web-based GMI involves the content delivery system and, by extension, the level of immersion each intervention offers. The VR program is designed to be immersive, fun, and interactive; the youth have an opportunity to choose to speak to various scientists and students within the VR environment and can navigate from one scene to the next; by contrast, in the online program, participants are automatically exposed to a series of text-based activities. Additionally, the VR Personality Projects provides participants the opportunity to provide advice (by speaking aloud to a student) in the VR environment, immediately after the student experiences a setback. Thus, the intervention offers a more self-directed, active experience for participants, as opposed to the passive experience of progressing through a largely text-based online program. Distinctions and similarities in user experience and content between the Web-based and VR GMIs are outlined in Table 1.

Youths who become dizzy or experience discomfort during the VR experience will be permitted to take breaks, or stop participating, at any time. Generally, glasses fit within the VR headset and may be worn during the intervention; however, the choice to wear or remove glasses (for participants who wear them) will be made on a person-to-person basis, based on personal preference and comfort. Youths will be reminded of this at the start of the laboratory session and again before starting the VR experience for those randomized to this condition.

see original article for Table "Similarities and differences between the virtual reality (VR) and computer-based personality project interventions"

Web-Based Supportive Therapy

The Web-based ST [13,14] intervention, called the Sharing Feelings Program, is delivered entirely via Qualtrics, is self-administered by youths, and takes approximately 30 min to complete. It is structurally similar to the Web-based GMI, but it is designed to mimic ST. The goals of the ST intervention are to encourage youths to identify and express feelings to close others; the intervention does not teach or emphasize specific skills or beliefs. In a previous trial, ST led to smaller improvements in adolescent stress recovery, perceived control, and internalizing problems compared with a GM program [13,14]. The ST SSI is designed to control for nonspecific aspects of intervention, including engagement in a computer program. It includes the same number of reading and writing activities as the Web-based mindset intervention; it also mirrors the Web-based mindset intervention’s structure, including vignettes written by older peers describing times when they benefited from sharing feelings with close others. Immediately following intervention completion, all youths (regardless of condition assignment) will be asked to complete the same battery of questionnaires immediately postintervention to index immediate shifts in proximal outcomes.

After both the youth and the parent have completed their respective portions of the study, the laboratory visit will conclude. All study participants will be offered referral information for psychotherapy and/or pharmacologic treatment at Stony Brook and the surrounding community. Participants will not be excluded from completing study procedures if they begin receiving treatment for psychological distress during the study.

Before the youth and parent leave the laboratory, study personnel will inspect the youth and parent questionnaire responses on items inquiring about suicidal ideation. If there is any indication of adolescent suicidal ideation during the laboratory session, risk assessments will be conducted by trained study personnel. In the event that a participant is in imminent danger to themselves or others, their accompanying parent will be informed. Study personnel will meet with the family to establish a safety plan. In the event of reported, active suicidal ideation or plan, the family will be accompanied to the Psychiatric Emergency Program at the nearby University Hospital.

Participant Incentives

Upon completing the 2-hour laboratory-based session, participating families will receive one US $30 Amazon gift card, for a rate of US $15 per hour, the standard rate approved by the University IRB and consistent with minimum wage in New York State. When each participating adolescent and parent complete the 3-month follow-up questionnaire, the family will receive a US $10 Amazon gift card, again based on a US $15 per hour rate. Similarly, when the adolescent and parent both complete the 9-month follow-up questionnaire, the family will receive a final US $10 Amazon gift card. Thus, total compensation for participating in this study is US $50.

Follow-Up Assessments

To enable evaluation of the interventions’ effects on depressive symptoms and secondary study outcomes over time, each adolescent and parent will be invited to complete Qualtrics-based questionnaire batteries, including the same questionnaires as those they completed at their initial laboratory session. Links to Qualtrics surveys will be sent to families at 3- and 9-month follow-up points. Surveys may be conducted via phone at the family’s request. Families who do not complete the follow-up questionnaires within 3 days of receipt will receive up to 3 reminder messages from the research team to encourage survey completion.

Notably, logistical constraints necessitated our limiting the number of follow-up assessments in this study to 2 per family (at 3- and 9-month postintervention), and analyses were planned accordingly (see below for a more thorough description). We elected a final follow-up assessment at the 9-month mark to maintain consistency with previous trials of GMI [13,14].

After the study is complete, an aggregate results summary will be emailed to families. Condition assignment will be revealed at this time, and all youths will receive access to both Web-based interventions. Youths who did not receive the VR program will be invited to complete the intervention at Stony Brook University.


Table 2 displays a timeline of all study procedures, including points at which each questionnaire will be administered to parents and/or youths. All questionnaires are detailed below.

Family and Treatment History Questionnaire

Parents will report demographic, family, and other background information (eg, age, sex, race, childhood adversity exposure, and mental health treatment history). Parents will also complete the 4-item Pubertal Development Scale [30] with regard to their adolescent, given the well-documented effects of puberty on depression onset.

Children’s Depression Inventory-2

Adolescent depressive symptom severity will be assessed using the CDI-2 [31] child form (youth-report) and parent forms (parent-report). The CDI-2 is a reliable, valid measure of youth depression severity, normed for youth age and sex and yielding raw and T scores. Changes in youth-report CDI-2 scores from baseline to each of the follow-up assessments (3-month and 9-month) will serve as the primary index of intervention effects. Changes in parent-report CDI-2 scores from baseline to each of the follow-up assessments (3-month and 9-month) will serve as a secondary index of intervention effects. The CDI-2 will not be administered to youths or to parents immediately postintervention, as we do not expect depressive symptom change to occur within the span of 1 study session. Changes in scores on other assessments will serve as secondary outcomes.

Screen for Child Anxiety and Related Disorders

Given high comorbidity between depression and anxiety [32], anxiety symptoms will be assessed at baseline and all follow-ups (except postintervention) using the Screen for Child Anxiety and Related Disorders-Child and -Parent versions (SCARED-C/SCARED-P): a 41-item self-report measure [33,34]. Youths and parents, respectively, rate (0 to 2) the degree to which statements describing anxiety symptoms are true about them or their adolescent. Higher summed SCARED-C and SCARED-P total scores indicate greater adolescent anxiety severity.

Primary Control Scale for Children

The primary control scale for children (PCSC) [35] is a 24-item scale measuring youths’ perceived ability to influence or alter objective events or conditions through personal effort. Youth rate agreement with statements about their ability to exert primary control (eg, “I can do well on tests if I study hard” and “I can get other kids to like me if I try”). The PCSC has shown acceptable internal consistency, 6-month test-retest reliability, and inverse relations to adolescent depression severity.

Secondary Control Scale for Children

The secondary control scale for children (SCSC) [19] is a 20-item scale measuring youths’ perceived ability to shape the personal impact of objective conditions on oneself by adjusting oneself to fit those conditions. Youth rate agreement with items reflecting various kinds of secondary control such as adjusting cognition (“When something bad happens, I can find a way to think about it that makes me feel better”). The SCSC has shown acceptable reliability and validity in a large youth sample.

Implicit Personality Theory Questionnaire

The Implicit Personality Theory Questionnaire [36] asks the youth to rate the extent of their agreement with 3 statements linked to the malleability of personality, using a 1 to 7 Likert scale (eg, “Your personality is something about you that you can't change very much”). Higher mean scores on these 3 items indicate a stronger fixed personality mindset, a lower score indicates a stronger growth personality mindset. Both youths and parents will report their mindsets of personality in this study.

University of California Los Angeles Loneliness Scale

The UCLA Loneliness Scale [37] is a widely used self-report scale of loneliness in adolescents. The 20-item version will be used in this study. Adolescents rate how often they experience loneliness in various contexts (eg, “How often do you feel part of a group of friends?” and “How often do you feel there is no one you can turn to?”). Higher scores indicate higher levels of loneliness.

Beck Hopelessness Scale—Short Version

The Beck Hopelessness Scale (BHS)-4 [38] is a shortened version of the 20-item BHS [39] designed for brief psychological screening purposes. The 4 items on this measure are “My future seems dark to me”; “Things just won’t work out the way I want them to”; “There is no use in really trying to get something I want because I probably won’t get it”; and “I feel that the future is hopeless and that things cannot improve.” On each item, participants rate their agreement from 0 to 3, resulting in a maximum of 12 points in total (higher scores indicate higher levels of hopelessness). The short version of the BHS has high internal consistency (alpha=.85) and correlates highly with measures of depressive symptoms, as well as the full-length BHS, in large studies of clinical and community samples [40].

see original article for Table "Schedule of enrollment, interventions, and assessments"

Brief Symptom Inventory 18

The Brief Symptom Inventory (BSI)-18 [41] is a valid, reliable screening tool for adult (here, parental) psychological distress. Adult respondents rate endorsement of 18 physical and emotional complaints on a 0 to 4 Likert scale. The BSI-18 includes 3 subscales for somatic, anxiety, and depressive symptoms. The total sum score yields an additional total distress score.

Attitudes Toward Therapy

Attitudes toward psychotherapy [42] will be assessed using a single item for youth and parents: “Lots of kids deal with difficult emotions at one time or another. On a scale from 1 (not at all helpful) to 10 (extremely helpful), how helpful do you think therapy or counseling would be for you (your child) in coping with these kinds of problems?”

Program Feedback Scale (Designed for This Study)

To assess the acceptability of each intervention program, youths will be asked to complete questions regarding their experience with the intervention to which they were assigned. Questions inquire about how much they enjoyed the program; whether they understood the program; whether they would recommend the program to a friend; and whether they found the program easy to use. The Program Feedback Scale was developed specifically for this study; several items from the Scale were drawn from previous research [13,14] but others are new to this study and have not been used previously. All items are included in Textbox 1.

Timeline for Data Collection and Results Reporting

Data collection began in March 2019 and is projected to be complete by December 2021. Thus, we intend to report results by Spring of 2022. Upon completion of data collection and publication of results, deidentified participant-level data will be made publicly accessible.


Aim 1: Attempt to Replicate Past Research

We will use mixed-effects linear models to test the hypothesis that interventions teaching GM (either VR or Web-based) predict reductions in adolescent depressive symptom severity (primary study outcome), per both adolescent and parent reports, relative to Web-based ST. Our study design, including 3 assessment points is structured to allow for detection of linear intervention effects. We will run additional mixed-effects linear models to assess whether interventions teaching GM predict larger improvements in secondary study outcomes (perceived primary and secondary control, hopelessness, loneliness, attitudes toward psychotherapy, and parent psychopathology) versus Web-based ST. Intervention condition will be a binary predictor variable in these models, with the VR GMI and Web-based GMI groups collapsed into a single GM intervention group. Potential covariates will include family income, age, sex, and time (baseline, postintervention where applicable, and 3-month and 9-month follow-up); each possible covariate will be included in analyses if it shows a significant association with a model outcome at baseline or any follow-up point (such associations are unlikely to occur, given randomization procedures, but remain possible). Models will include a random intercept and slope, an autoregressive error structure, and use full information maximum likelihood (FIML) estimation to address missing data. We will create 2 orthogonal planned contrasts for testing intervention effects. One planned contrast will examine whether the 2 active GM conditions differ from the ST control condition, whereas the other planned contrast will examine whether the VR-based intervention outperforms the Web-based intervention. A significant (P<.05) interaction between the first contrast and time would indicate that interventions teaching GM predicted significantly different 9-month change in an outcome relative to the control ST condition. We will also replicate these analyses for the most central symptoms of adolescent depression identified in previous analyses (sadnessself-hatred, and loneliness) and use Holm-Bonferroni corrections for multiple comparisons.

Aim 2: Evaluate New, Single-Session, Virtual Reality Growth Mindset Intervention

As for Aim 1, we will use mixed-effects linear models to test the hypothesis that VR-GMI predicts greater reductions in adolescent and parent-reported depressive symptom severity (primary study outcomes), as well as perceived primary and secondary control, hopelessness, loneliness, attitudes toward psychotherapy, and parent psychopathology (secondary outcomes), relative to (1) the Web-based GM program, (2) the control program, and (3) either program, when combined into a single, non-VR intervention group. Models will be structured as described in Aim 1. A significant (P<.05) interaction between the second orthogonal contrast mentioned in Aim 1 and time would indicate that interventions teaching GM predicted significantly different 9-month change in an outcome relative to the control ST condition. We will also replicate these analyses for the most central symptoms of adolescent depression identified in previous analyses (sadnessself-hatred, and loneliness [43]) and use Holm-Bonferroni corrections for multiple comparisons.

Aim 3: Test Mediation Through Perceived Control

To test whether the VR intervention and the Web-based GM intervention reduces youth-reported depressive symptoms through proximal increases in perceived control, we will conduct multiple mediation analyses which involve simultaneous indirect effects by multiple variables [44]. This approach allows for both an analysis of the total indirect effect (the aggregate indirect effect of all the candidate mediators under investigation) and analyses of specific indirect effects (ie, of each mediator under investigation). For mediation models assessing perceived control, we will use postintervention data to assess candidate mediators and 9-month follow-up data to assess depressive symptoms. In each model, the predictor variable will be intervention condition (in Model 1, VR versus Web-based GM intervention; in Model 2, VR versus Web-based ST; and in Model 3, Web-based GM versus Web-based ST); the simultaneous mediator variables will be postintervention perceived behavioral control and postintervention perceived emotional control. We will use bias-corrected bootstrapping to test the significance of specific and total indirect effects within the mediation model. Bootstrapping has the advantage of high statistical power without assuming multivariate normality in sampling distributions, enabling parsimonious analysis of one or several candidate mediators [44,45]. The Iavaan package version 0.5-16 in R version 2.15.1, which is capable of testing both multiple and single mediator models using FIML estimation, will be used for mediation tests [46]. To test for indirect effects of candidate mediators, parameter estimates of total and specific indirect effects are generated, along with their CI, using 1000 to 20,000 random bootstrapped samples. We will specify 5000 resamples in this study per Preacher and Hayes’ [32] recommendations. If the 95% bias-corrected CI for a total indirect parameter estimate does not contain 0, then that indirect effect can be considered statistically significant, demonstrating mediation [44,45]. Using this approach, this study will be sufficiently powered to detect significant indirect effects in each model (bias-corrected CIs for a 2-mediator model show .80 power for samples of 50 and over .90 for samples of 100 [46,47]).

Aim 4: Gauge Acceptability of the Virtual Reality Intervention

A series of between-group ANOVAs will be used to evaluate differences by intervention condition assignment in adolescent-reported intervention acceptability. Specifically, we will examine group-level differences in adolescents’ mean ratings on each continuously rated item from the Program Feedback Scale. Specific contrasts comparing groups will be examined, should significant overall mean differences emerge on any item.


The objective of this 3-arm randomized trial is to evaluate whether a single-session, immersive VR intervention teaching GM —the belief that personal traits and attributes are malleable as opposed to fixed—can reduce depressive symptoms in high-risk adolescents compared with a Web-based GMI and an active Web-based control. Secondary aims are to evaluate the VR program’s effects on other types of adolescent symptoms and functioning, including anxiety, perceived control, and hopelessness; to evaluate a possible mechanism through which the VR might reduce depression symptoms (ie, by increasing adolescents’ sense of perceived control); and to assess the VR program’s acceptability relative to the Web-based interventions. Results will gauge the promise of the VR Personality Project as a brief, highly engaging, and mechanism-targeted intervention for reducing adolescent depressive symptoms. Given the increasing levels of adolescent depressive symptoms in recent years [2] and variable efficacy and accessibility of existing interventions [3,8], results of this trial may suggest a promising new approach, using immersive VR technology, to reducing depression in youth.


 Direct costs for the aforementioned clinical trial will be funded by Limbix; however, no Limbix staff are involved in clinical research procedures.

Conflicts of Interest

None declared.


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If you haven’t yet heard about Oculus Rift, chances are you soon will. Virtual reality (VR) headset technology – in the form of the Oculus and its main competitor the HTC Vive, both of which have just been launched on the consumer market – is about to make the leap into the mainstream. For the gaming industry, big bucks are in the offing. Facebook paid more than $2 billion to acquire Oculus Rift; the returns, one imagines, could swiftly dwarf that figure.


VR may be about to transform gaming, but the technology dates back to the late 1960s and the so-called Sword of Damocles. Bulky and relatively unsophisticated though it was, the main elements of VR were all present in the Sword. A computer generated an image, a display system presented the sensory information and a tracker fed back the user’s position and orientation in order to update the image. For the user, sensory data from the natural world was superseded by information about an imaginary world that changed in response to their actions. The result was what you’d experience with Oculus Rift or the Vive today: a “sense of presence” in an interactive, three-dimensional virtual world.


It’s difficult to appreciate just how remarkable VR is until you’ve tried it. Although you know what you’re seeing isn’t real, your mind and body behave as if it were. It’s an extraordinary experience. But VR’s ability to “con” our brain means that it isn’t simply the next big thing in gaming: it may prove to be an extremely effective device for psychological therapy.


In fact, it already is. Fear of heights (acrophobia) is typically – and successfully – treated by exposure therapy. The person is helped to face progressively more challenging situations, discovering as they do so that the danger they fear doesn’t materialise: they are safe. What’s remarkable is that exposure therapy using VR isjust as effective as taking people into real situations. That’s because if you take someone with acrophobia in a virtual glass-fronted lift up a skyscraper, for example, their reactions (heart racing, stomach churning, panicky thoughts) will be the same as if they were truly zooming to the top of One WTC. Ask anyone – phobia or no phobia – to step off a virtual ledge and they’re very rarely able to do so (even though the “edge” is simply a space on our lab floor).


It’s not just fear of heights that VR seems so well suited to tackling: it works for a wide range of anxiety disorders. A recent meta-analysis of fourteen clinical trials, for example, found that VR treatment is effective for tackling spider and flying phobias. Evidence is also growing for VR’s potential in treating Post Traumatic Stress Disorder. So what, we wondered, could it do for patients experiencing another kind of condition marked by fear of imminent danger: persecutory delusions?

Persecutory delusions – unfounded, strongly held beliefs that other people intend to harm us – have traditionally been regarded as a key symptom of psychiatric diagnoses such as schizophrenia. They are better conceived as the severe end of a paranoia spectrum in the general population, with paranoid thoughts much more common than previously thought. Delusions are notoriously difficult to treat, so there’s a pressing need for new ways of tackling the problem – which is where VR comes in. In a UK Medical Research Council (MRC) funded study at the University of Oxford we’ve just completed the first experiment in using VR to treat persecutory delusions. We wanted to tackle the fundamental fear that we believe underlies paranoia: the sense of danger from other people. The most effective way to do that is to help the individual learn from experience that the situations they dread are actually safe. As the feeling of safety increases, so the delusion diminishes.


Understandably, it can be very difficult for patients with severe paranoia to face feared situations. But it’s easier with VR. Knowing that the scenario isn’t real helps with confidence, and it’s simple for us to present the least difficult situations first. VR offers other practical advantages. The fact that patients can try the same situation as many times as they like, and be instantly transported from one challenging situation (a shop) to another (a train), means that progress may well be much faster than it would be if they were facing real-life scenarios. Moreover, patients in psychiatric wards often have very limited access to real-world situations.


Our experiment involved 30 mental health patients from Oxford Health NHS Foundation Trust, all of whom were experiencing persecutory delusions (even after treatments such as antipsychotic medication). They held beliefs like: “someone intends to attack me”; “people know what I’m thinking and will kill me”; “others do things to belittle me”; “people are deliberately trying to upset me”.


We began by assessing the severity of their delusions. Each patient then spent five minutes in a situation that they found difficult (for example, a visit to a local shop) so that we could assess how they coped. Next was one session in our VR lab, during which they experienced a total of seven simulated journeys in an underground train carriage and a lift, with the number of virtual passengers increasing in each scenario. The participants spent a total of thirty minutes in VR, and then tried the real-life situation for a second time. Finally, we reassessed the strength of their persecutory delusions.

In an added twist, we compared two different VR therapies. Patients were randomly allocated to the VR treatments, with half the patients undergoing exposure therapy (VRET) and the other participants undergoing virtual reality cognitive therapy (VRCT). The VRCT group, like the VRET patients, took a virtual train or lift ride. But they were helped to do so without using defensive or safety-seeking behaviours, such as avoiding eye contact or looking for escape routes. This kind of behaviour makes us feel safer in the short term, but it fuels our fears by preventing us from learning that we aren’t really in danger. In VRCT we didn’t merely ask people to abandon their safety behaviours: we encouraged the participants to try things they would never contemplate in real life – boldly approaching the VR characters, for example, or staring at them.

The results of the experiment have now been published in the British Journal of Psychiatry. They paint a very striking picture of the power of cognitive VR in particular. Immediately after the VR therapy session, eight of the 15 patients who had VRCT no longer had persecutory delusions (that is, they had greater doubt than certainty in the threat beliefs). There were benefits for those who’d had VRET too, with three out of fifteen patients no longer meeting formal criteria for delusions at the end of the testing day. But VR cognitive therapy very clearly outperformed VR exposure therapy in all the statistical testing.


When we asked patients to rate how strongly they believed their paranoid thoughts on a scale of 0-100%, VRCT patients averaged 80% at the beginning of the testing session but 47% at the end. For the VRET group, the reduction was much more modest: from 79% to 68%. Importantly, we saw real-world benefits too, with the VRCT group showing a drop by half in their self-reported distress in their second trip into a feared situation compared to the VRET group.

These gains were produced, remember, with just thirty minutes in VR. Imagine what could be achieved with more time. We don’t know how long the benefits gained in the initial experiment will last, though the success of VR in treating anxiety disorders suggests that they may well endure for longer than one might imagine. We’re therefore developing an extended VRCT, using the latest consumer equipment, and plan to test it in a full clinical trial. Virtual reality isn’t merely here to stay in the gaming world. We believe it’s likely to play a central role in assessment and treatment in the mental health centres of the future.


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