March 21, 2019
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App-based virtual reality therapy reduces acrophobia symptoms

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A low-cost, self-guided, smartphone app-based cognitive behavioral therapy using virtual reality goggles reduced acrophobia symptoms in nearly 200 participants with fear of heights, according to results of a randomized clinical trial published in JAMA Psychiatry.

Prior study has shown the potential of virtual reality exposure therapy, which may offer a low-cost way to improve accessibility to psychological treatments, Tara Donker, PhD, from the department of clinical, neuro- and developmental psychology, Vrije Universiteit Amsterdam, and colleagues wrote.

“Access to evidence-based psychological treatment for mental health disorders is a global challenge because of high-treatment costs and the limited availability of mental health professionals,” they wrote. “Novel technologies may contribute to accessible and affordable treatment options in important ways.”

In this single-blind randomized clinical trial, the investigators compared the effectiveness of ZeroPhobia, a self-guided app-based virtual reality (VR) CBT using low-cost cardboard virtual reality goggles, with a wait-list control group.

In total, 193 adults from Denmark with acrophobia symptoms received six animated CBT-based modules using animations and a virtual therapist voice-over (which took between 5 and 40 minutes each) over a 3-week period. The app included a gamified immersive VR environment and four 360° videos covering the exposure spectrum as well as psychoeducation and CBT techniques. Participants used gaze control to navigate through the virtual environment, according to the study.

Using the Acrophobia Questionnaire, researchers measured symptoms at baseline, immediately after treatment and at 3-month follow-up.

Ninety-six patients were assigned to the intervention group and 97 to the wait-list control group. Of 74 participants who started using the app, 57 completed the intervention.

Donker and colleagues found that patients who used the VR-CBT app experienced a significant reduction in acrophobia symptoms at 3 months compared with controls (d = 1.14; 95% CI, 0.84-1.44).

Analyses also demonstrated a significant intervention effect compared with the controls in acrophobia symptoms as measured by the Attention to Height Questionnaire (d = 1.091; 95% CI, 0.787-1.393); general anxiety symptoms (d = 0.37; 95% CI, 0.087-656); and greater sense of mastery (d = –0.11; 95% CI, –0.389 to 0.176). The researchers confirmed the findings in sensitivity and robustness analyses.

“The current study adds to the development of innovative and scalable delivery methods of evidence-based treatments and underlines that new technologies have the potential to transform mental health care worldwide,” Donker and colleagues wrote.

The investigators also noted that future research should evaluate the long-term effects of the VR-CBT app, compare its cost-effectiveness with treatment as usual and whether it can also be effective for other mental health disorders. – by Savannah Demko

Disclosures: Donker reports grants from NWO Creative Industrie-KIEM and NOW Toegepaste en Technische Wetenschappen. Donker and another author developed ZeroPhobia in conjunction with Vrije Universiteit; however, they were not involved in data analysis/decisions related to the publication of the findings.