Paul M, Bullock K, Bailenson J. Virtual Reality Behavioral Activation for Adults With Major Depressive Disorder: Feasibility Randomized Controlled Trial. JMIR Ment Health 2022;9(5):e35526 DOI: 10.2196/35526

This pilot study tested the feasibility and acceptability of using virtual reality (VR) in behavioral activation (BA) by supporting engagement in pleasant activities for adults diagnosed with major depressive disorder during the COVID-19 pandemic. Participants were recruited via flyers at the Stanford School of Medicine and enrolled if they were 18 or older, English-speaking, and met criteria for major depressive disorder. Using a randomized controlled study design, participants (N=13) were assigned to one of three arms: treatment as usual (n=4), VR BA (n=5), and traditional BA (n=4). Participants assigned to the VR BA and traditional BA groups met with the project director over Zoom four times over three weeks to receive BA therapy. The first session focused on establishing rapport, identifying pleasant activities, and setting activity goals. The traditional BA participants were provided a list of activities and asked to schedule real-life activities, while the VR BA arm were provided a VR headset and asked to choose VR activities. Session two and three included reviewing the activity log and checking in on participants’ goals. During session four, treatment and skills were reviewed, and participants provided feedback. Results demonstrated that the VR BA intervention is feasible and the majority (87%) of participants reported high levels of acceptability. On average, participants in the VR BA and traditional BA arms adhered to the homework assignment of completing at least 4 activities weekly (mean=7.22 activities weekly); however, only 20% of individuals in the VR BA arm completed the questionnaire following each VR activity. Additionally, VR BA participants reported reduced depression severity (mean difference of PHQ-9 = -5.67). The traditional BA arm reported the mean PHQ-9 scores reduced by 3.00 and the control arm did not reduce PHQ-9 scores (mean difference = 0.25). The findings of this study indicate VR BA is feasible for supporting treatment among adults with Major Depressive Disorder who often have difficulty accessing real-life activities. Future research should explore VR BA as Major Depressive Disorder treatment in adequately powered randomized controlled trials.