A new study published in JMIR Mental Health highlights the potential of virtual reality in the treatment of major depressive disorder. The study found that virtual reality can be an effective tool in reducing depressive symptoms, performing comparably to traditional methods of behavioral activation therapy.
Major depressive disorder is a growing global concern, with significant impacts on health and economic burdens. Traditional therapies for depression, such as behavioral activation, are effective but often inaccessible due to various barriers, including financial constraints, physical limitations, and a lack of trained providers.
Behavioral activation is based on the idea that depression is linked to a cycle of avoidance and withdrawal from pleasurable or meaningful activities. By intentionally scheduling and engaging in activities that promote enjoyment or a sense of accomplishment, individuals can break this cycle, improve their mood, and reduce depressive symptoms.
Virtual reality offers a potential solution to the accessibility issues associated with this form of therapy. By immersing patients in engaging and controlled virtual environments, it can provide therapeutic experiences that might otherwise be unattainable in real life.
“I was originally interested in this topic given that depression is such a common and debilitating mental health issue with many barriers to treatment,” said study author Margot Paul, a clinical assistant professor at the Stanford Medicine Department of Psychiatry and Behavioral Sciences.
“Dr. Kim Bullock and I recognized that while extended reality (XR) has been used to treat a variety of mental health disorders (i.e. anxiety and PTSD), very few studies had considered its use in the treatment of depression. We recognized that in using XR to treat depression, this could eliminate some of the barriers to care.”
The study aimed to test the safety, feasibility, and efficacy of an extended reality-enhanced behavioral activation protocol (XR-BA) compared to traditional behavioral activation (BA). Participants were recruited through various channels, including flyers, online listings, and external websites. The inclusion criteria ensured participants were adults diagnosed with major depressive disorder, while excluding those with certain other psychiatric conditions or recent substance use disorders.
Participants were randomly assigned to one of two groups: XR-BA or traditional BA. Both groups received four weekly sessions of behavioral activation therapy via Zoom, each lasting 30 to 50 minutes.
In the XR-BA group, participants were provided with a Meta Quest 2 virtual reality headset, which they used to engage in personalized pleasant and mastery activities from a diverse list. This list included gaming, fitness, social, educational, and immersive 360-degree video experiences, allowing users to select activities such as puzzle-solving, virtual workouts, social events, and exploring iconic sites.
By offering a wide range of engaging options, the XR-BA protocol aimed to enhance the therapeutic impact through enjoyable and tailored experiences. The traditional BA group engaged in real-life activities chosen from a similar list.
Throughout the study, participants were asked to complete a minimum of four activities per week and submit a weekly post-activity questionnaire assessing their experiences, including spatial presence, simulator sickness, and technology acceptability. Depression symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9) at the beginning of each session. The researchers also monitored dropout rates, adverse events, and the overall number of times the headset was used in the XR-BA group.
The study demonstrated that the XR-BA protocol was both feasible and safe. The completion rates were high in both groups, with 77% in the XR-BA group and 85% in the traditional BA group. No serious adverse events were reported. Participants in the XR-BA group used the headset slightly less than recommended, averaging around 11 uses instead of the suggested 12. However, they reported a strong sense of presence in the virtual environment, with the average presence rating being 71% among those who completed the protocol.
In terms of acceptability, participants in the XR-BA group generally found the virtual reality experience to be engaging and useful, although there were some complaints about the weight and comfort of the headset. The learning curve for using the VR device was noted as a challenge, with some participants experiencing “decision paralysis” due to the wide range of activity options available. Despite these challenges, participants who completed the protocol indicated progressively higher levels of presence and acceptability over time, suggesting that familiarity with the device improved their overall experience.
The efficacy results were promising. Both the XR-BA and traditional BA groups showed significant reductions in depressive symptoms over the course of the study. Participants in the XR-BA group experienced an average decrease of 4.4 points in their PHQ-9 scores, while those in the traditional BA group saw a 3.7-point reduction. These results indicate that XR-BA is not inferior to traditional BA in reducing depressive symptoms.
Additionally, participants in the XR-BA group showed a statistically significant decrease in symptoms even before the treatment began, likely due to the novelty and high expectations associated with the virtual reality technology.
The findings provide evidence that “using XR as a method of engaging in pleasant activities within an evidence-based protocol may be just as efficacious in treating symptoms of depression as engaging in these activities in real life,” Paul told PsyPost.
Despite the promising results, the study had some limitations. The small sample size and short duration of the trial may limit the generalizability and long-term applicability of the findings. Additionally, the learning curve associated with using the VR headset and the initial excitement about the new technology might have affected the participants’ engagement and outcomes. Future studies should aim for larger sample sizes and longer follow-up periods to confirm these findings.
“My long-term goal is to translate this research into practical use so that clinicians can start utilizing XR as a treatment tool for depression when indicated and appropriate,” Paul explained.
The study, “Examining the Efficacy of Extended Reality–Enhanced Behavioral Activation for Adults With Major Depressive Disorder: Randomized Controlled Trial,” was authored by Margot Paul, Kim Bullock, Jeremy Bailenson, and David Burns.
