Automated psychological therapy using immersive virtual reality for treatment of fear of heights: a single-blind, parallel-group, randomised controlled trial

Abstract

SummaryBackgroundEngaging, interactive, and automated virtual reality (VR) treatments might help solve the unmet needs of individuals with mental health disorders. We tested the efficacy of an automated cognitive intervention for fear of heights guided by an avatar virtual coach (animated using motion and voice capture of an actor) in VR and delivered with the latest consumer equipment.MethodsWe did a randomised trial of automated VR versus usual care. We recruited adults aged older than 18 years with a fear of heights by radio advertisements in Oxfordshire, UK. We diagnosed fear of heights if participants scored more than 29 on the Heights Interpretation Questionnaire (HIQ). We randomly allocated participants by computer in a 1:1 ratio to either automated VR delivered in roughly six 30-min sessions administered about two to three times a week over a 2-week period (intervention group) or to usual care (control group). Randomisation was stratified by severity of fear of heights. The research team, who were unaware of the random allocation, administered three fear-of-height assessments, at baseline (0 weeks), at the end of treatment (2 weeks), and at follow-up (4 weeks). The primary outcome measure was HIQ score (range 16–80, with higher scores indicating greater severity). This trial is registered with the ISRCTN registry, number ISRCTN11898283.FindingsBetween Nov 25, 2017, and Feb 27, 2018, 100 individuals were enrolled and underwent randomisation, of whom 49 were assigned to the VR treatment group and 51 to the control group. All participants completed the 4-week follow-up. The mean total treatment time in VR was 124·43 min (SD 34·23). Compared with participants in the control group, the VR treatment reduced fear of heights at the end of treatment (mean change score −24·5 [SD 13·1] in the VR group vs −1·2 [7·3] in the control group; adjusted difference −24·0, 95% CI −27·7 to −20·3; Cohen's d=2·0; p<0·0001). The benefit was maintained at follow-up (mean change score −25·1 [SD 13·9] in the VR group vs −1·5 [7·8] in the control group; adjusted difference −24·3, 95% CI −27·9 to −20·6; Cohen's d=2·0; p<0·0001). The number needed to treat to at least halve the fear of heights was 1·3. No adverse events were reported.InterpretationPsychological therapy delivered automatically by a VR coach can produce large clinical benefits. Evidence-based VR treatments have the potential to greatly increase treatment provision for mental health disorders.FundingOxford VR, and the National Institute of Health Research Oxford Health Biomedical Research Centre.

Gamified, Automated Virtual Reality Exposure Therapy for Fear of Spiders: A Single-Subject Trial Under Simulated Real-World Conditions

“…Virtual Reality exposure therapy has well-established efficacy, and several recent studies show that this applies also to automated interventions (15,16,18). Effectiveness studies examining the effects of automated VRET interventions under real-world conditions are thus the next research step along the translational pipeline before dissemination and implementation into clinical and non-clinical settings can be recommended.…”

“…To assess the stability of scores within each phase before running the mixed models, paired ttests were conducted; none were significant (all p > . 15), suggesting stabile phases and appropriateness of a phase-based time variable in the mixed models. Clinically significant change was defined as a change exceeding two standard deviations (32).…”

“…To our knowledge, at least three automated VRET applications have been developed and evaluated in high-quality trials: two for fear of heights (15,16), and one for fear of spiders (17,18). In the latter study, we evaluated a novel, automated VRET application with gamified exposure tasks and level design, against gold-standard in-vivo exposure therapy using a randomized non-inferiority design, with behavioral avoidance of a real spider serving as the primary outcome measure.…”

Recent developments in the intervention of specific phobia among adults: A rapid review.

“…Seven of the studies fit the criteria: six used a VR platform and one examined the effectiveness of augmented reality (AR). In VRET, an individual with phobia experiences the fear situation in a fully artificial setting simulated by a computer program through a headset 28 . Conversely, AR creates an immersive environment where the target feared stimulus is digitally enhanced and combined with other aspects in the real-life environment 27 .…”

The Need for Artificial Intelligence in Digital Therapeutics

“…This gap in healthcare provides even more motivation for new technologies to be researched and developed for the automation of treating patients with precision medicine approaches. However, some potential therapeutic areas which could advance the machine learning capabilities include virtual reality systems to treat psychological disorders [13,14], artificially intelligent inhalers to treat asthma or chronic obstructive pulmonary disease [15], or humanoid robots to help manage chronic diseases and medication adherence [16]. Advancing the computer intelligence of these systems would enable more efficient and practical use for patients on a regular basis.…”