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Summary: A new study demonstrates the potential of virtual reality (VR) in treating major depressive disorder (MDD). Using extended reality-enhanced behavioral activation (XR-BA), researchers found that VR interventions could match the effectiveness of traditional behavioral activation therapies. Participants used VR headsets to engage in various activities, from playing VR board games to dancing, which not only reduced depression symptoms but also made the treatment process more enjoyable. The study highlights VR's potential to make mental health care more accessible and engaging, suggesting a significant advancement in the treatment of depression. Key Facts: Source: JMIR Publications A new study published in JMIR Mental Health sheds light on the promising role of virtual reality (VR) in treating major depressive disorder (MDD). The research, led by Dr Margot Paul and team from Stanford University, unveiled the effectiveness of extended reality (XR)-enhanced behavioral activation (XR-BA) in easing symptoms of depression. MDD affects millions worldwide, and access to evidence-based psychotherapies remains a challenge for many. Traditional treatments often face barriers, prompting researchers to explore innovative solutions. XR, which includes VR, encompasses various immersive technologies involving computer-generated environments that blend physical and digital worlds. Leveraging the immersive power of XR, this study explored XR-BA as a potential game-changer in MDD treatment. Dr Paul and team conducted a randomized controlled trial among 26 outpatients with MDD receiving remote care. Using a VR Meta Quest 2 headset, the participants engaged in simulated pleasant or mastery activities, including playing a magical VR board game, deciphering clues to solve puzzles, dancing to music, and playing mini golf alone or with friends. Though the learning curve for using the headset was high, participants reported that the experience became more enjoyable and useful over time. The results were comparable to traditional behavioral activation delivered via telehealth. Both XR-BA and traditional behavioral activation helped reduce the severity of depression in a significant way, as measured by the Patient Health Questionnaire-9. Moreover, the findings suggest that individuals in the XR-BA group might have experienced a heightened expectancy or placebo response because of the novelty of the technology and implicit beliefs regarding mental health treatment. "These results indicate that XR may help to de-stigmatize mental healthcare and reduce barriers to individuals seeking care. Clinicians could use XR as a treatment tool to help motivate clients to actively participate in their psychotherapy treatment by completing 'homework' that is novel, fun, and accessible," remarked Dr Paul. The study underscores the potential of VR, particularly XR-BA, in revolutionizing depression treatment by offering efficacy akin to traditional therapy. This is a promising avenue for enhancing treatment outcomes and addressing barriers to accessing evidence-based psychotherapies for MDD, potentially expanding care for affected individuals. Additionally, the exploration of XR's capacity to amplify placebo effects hints at the transformative possibilities of technology-assisted mental health therapies. Author: Jane Kelly Original Research: Closed access. Abstract Examining the Efficacy of Extended Reality-Enhanced Behavioral Activation for Adults With Major Depressive Disorder: Randomized Controlled Trial Background: Major depressive disorder (MDD) is a global concern with increasing prevalence. While many evidence-based psychotherapies (EBPs) have been identified to treat MDD, there are numerous barriers to patients accessing them. Virtual reality (VR) has been used as a treatment enhancement for a variety of mental health disorders, but few studies have examined its clinical use in treating MDD. Behavioral activation (BA) is a simple yet effective and established first-line EBP for MDD that has the potential to be easily enhanced and adapted with VR technology. A previous report by our group explored the feasibility and acceptability of VR-enhanced BA in a small clinical proof-of-concept pilot. This study examines the clinical efficacy of a more immersive extended reality (XR)-enhanced BA (XR-BA) prototype. This is the first clinical efficacy test of an XR-BA protocol. Objective: This study examined whether XR-BA was feasible and efficacious in treating MDD in an ambulatory telemedicine clinic. Methods: A nonblinded between-subject randomized controlled trial compared XR-BA to traditional BA delivered via telehealth. The study used a previously established, brief 3-week, 4-session BA EBP intervention. The experimental XR-BA participants were directed to use a Meta Quest 2 (Reality Labs) VR headset to engage in simulated pleasant or mastery activities and were compared to a control arm, which used only real-life mastery or pleasant activities as between-session homework. The Patient Health Questionnaire (PHQ)-9 was the primary outcome measure. Independent-sample and paired-sample t tests (2-tailed) were used to determine statistical significance and confirmed using structural equation modeling. Results: Overall, 26 participants with MDD were randomized to receive either XR-BA (n=13, 50%) or traditional BA (n=13, 50%). The mean age of the 26 participants (n=6, 23% male; n=19, 73% female; n=1, 4% nonbinary or third gender) was 50.3 (SD 17.3) years. No adverse events were reported in either group, and no substantial differences in dropout rates or homework completion were observed. XR-BA was found to be statistically noninferior to traditional BA (t18.6=−0.28; P=.78). Both the XR-BA (t9=2.5; P=.04) and traditional BA (t10=2.3; P=.04) arms showed a statistically significant decrease in PHQ-9 and clinical severity from the beginning of session 1 to the beginning of session 4. There was a significant decrease in PHQ-8 to PHQ-9 scores between the phone intake and the beginning of session 1 for the XR-BA group (t11=2.6; P=.03) but not the traditional BA group (t11=1.4; P=.20). Conclusions: This study confirmed previous findings that XR-BA may be a feasible, non-inferior, and acceptable enhancement to traditional BA. Additionally, there was evidence that supports the potential of XR to enhance expectation or placebo effects. Further research is needed to examine the potential of XR to improve access, outcomes, and barriers to MDD care. Trial Registration: ClinicalTrials.gov NCT05525390; https://clinicaltrials.gov/study/NCT05525390About this depression and virtual reality research news
Source: JMIR Publications
Contact: Jane Kelly - JMIR Publications
Image: The image is credited to Neuroscience News
"Examining the Efficacy of Extended Reality-Enhanced Behavioral Activation for Adults With Major Depressive Disorder: Randomized Controlled Trial" by Margot Paul et al. JMIR Mental Health
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