Behavioral Activation through Virtual Reality for Depression: A Single Case Experimental Design with Multiple Baselines

Colombo, Desirèe; Suso‐Ribera, Carlos; Ortigosa-Beltrán, Isabel; Fernández‐Álvarez, Javier; García‐Palacios, Azucena; Botella, Cristina

doi:10.3390/jcm11051262

Cited by 10 publications

(11 citation statements)

References 62 publications

(81 reference statements)

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“…This use could also provide some symptom relief for individuals waiting to see a mental health care provider. Furthermore, once an individual is in therapy, the use of VR could provide a sense of novelty, which may encourage individuals struggling with symptoms of depression to engage in the intervention [ 30 ]. Thus, providers could consider incorporating VR as a first step in a hierarchy of activity scheduling to incrementally increase their clients’ behavioral motivation.…”

Section: Discussionmentioning

confidence: 99%

Virtual Reality Behavioral Activation for Adults With Major Depressive Disorder: Feasibility Randomized Controlled Trial

Paul¹,

Bullock²,

Bailenson³

2022

JMIR Ment Health

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Background Major depressive disorder (MDD) is a global crisis with increasing incidence and prevalence. There are many established evidence-based psychotherapies (EBPs) for depression, but numerous barriers still exist; most notably, access and dissemination. Virtual reality (VR) may offer some solutions to existing constraints of EBPs for MDD. Objective We aimed to examine the feasibility, acceptability, and tolerability of using VR as a method of delivering behavioral activation (BA) for adults diagnosed with MDD during a global pandemic and to explore for signs of clinical efficacy by comparing VR-enhanced BA (VR BA) to a standard BA treatment and a treatment as usual control group for individuals diagnosed with MDD. Methods A feasibility trial using a 3-armed, unblinded, randomized controlled pilot design was conducted. The study took place remotely via Zoom telehealth visits between April 8, 2020, and January 15, 2021. This study used a 3-week, 4-session protocol in which VR BA participants used a VR headset to complete their BA homework. Feasibility was measured using dropout rates, serious adverse events, completion of homework, an adapted telepresence scale, the Simulator Sickness Questionnaire, the Brief Agitation Measure, and an adapted Technology Acceptance Model. Efficacy was assessed using the Patient Health Questionnaire–9. Results Of the 35 participants assessed for eligibility, 13 (37%) were randomized into VR BA (n=5, 38%), traditional BA (n=4, 31%), or a treatment as usual control (n=4, 31%). The mean age of the 13 participants (5/13, 38% male; 7/13, 54% female; and 1/13, 8% nonbinary or third gender) was 35.4 (SD 12.3) years. This study demonstrated VR BA feasibility in participants with MDD through documented high levels of acceptability and tolerability while engaging in VR-induced pleasurable activities in conjunction with a brief BA protocol. No adverse events were reported. This study also illustrated that VR BA may have potential clinical utility for treating MDD, as the average VR BA participant’s clinical severity decreased by 5.67 points, signifying a clinically meaningful change in severity from a moderate to a mild level of depression as per the Patient Health Questionnaire–9 score. Conclusions The findings of this study demonstrate that VR BA is safe and feasible to explore for the treatment of MDD. This study documented evidence that VR BA may be efficacious and justifies further examination in an adequately powered randomized controlled trial. This pilot study highlights the potential utility that VR technology may offer patients with MDD, especially those who have difficulty accessing real-world pleasant activities. In addition, for those having difficulty accessing care, VR BA could be adapted as a first step to help people improve their mood and increase their motivation while waiting to connect with a health care professional for other EBPs. Trial Registration ClinicalTrials.gov NCT04268316; https://clinicaltrials.gov/ct2/show/NCT04268316 International Registered Report Identifier (IRRID) RR2-10.2196/24331

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Section: Discussionmentioning

confidence: 99%

Virtual Reality Behavioral Activation for Adults With Major Depressive Disorder: Feasibility Randomized Controlled Trial

Paul¹,

Bullock²,

Bailenson³

2022

JMIR Ment Health

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“…It can be said to be. BA offers a model that can be used in online environments, virtual reality (Colombo et al 2022), and mobile and web-based applications (Wang and Feng 2022) (May et al 2022, Wang andFeng 2022). Therefore, BA is also accepted as a therapy model prone to the development of e-mental health models (Wang and Feng 2022).…”

Section: Discussionmentioning

confidence: 99%

“…BA effectively promotes healthy behaviors in substance use, drug addiction, and occupational and social areas(May et al2022). BA offers a model that can also be used in online environments(May et al 2022, Wang andFeng 2022), virtual reality(Colombo et al 2022), and mobile and web-based applications (Wang and Feng 2022) Therefore, BA is also recognized as a therapy model prone to developing e-mental health models(Wang and Feng 2022). BA is a therapy model that has proven effective in self-help guidelines developed for the elderly and people in care at home (Ekers…”

mentioning

confidence: 99%

Ergen Davranışsal Aktivasyon Programının Uyarlanması ve Etkililiğinin Karma Yöntem ile İncelenmesi

KOŞAN

Seçer

2022

Psikiyatride Güncel Yaklaşımlar

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In this study, the Adolescent Behavioral Activation Program (A-BAP) based on behavioral activation (BA) therapy to reduce depressive symptoms in adolescents was adapted to Turkish culture, and its effectiveness was tested with intervention design, one of the mixed method designs. In this direction, experimental and control groups were formed with 20 students studying in three different high schools in Turkey and with highly elevated depressive symptoms. The study group was determined by nested sampling from mixed-method sampling strategies. The starting point of this study is the absence of any BA-based practice to reduce adolescent depression in Turkey. In this direction, experimental and control groups were formed with 20 students studying in three different high schools in Turkey and with highly elevated depressive symptoms. The adapted A-BAP was applied individually to the students in the experimental group for 12 weeks. Three sessions were also held with the parents of the students in the experimental group. In the quantitative phase of the study, pre-test and post-test control groups paired patterns from semi-experimental designs, and a case study was used in the qualitative stage. The qualitative data of the study were collected from adolescents and their parents through semi-structured interviews and session evaluation forms. It was determined that the adapted BA-based A-BAP was an effective intervention in reducing depressive symptoms in the Turkish adolescent sample and provided a significant decrease in the depression scores of the participants in the experimental group . The qualitative findings show that adolescents perceive the A-BAP process as a factor contributing to making them feel better. Adolescents have reported that A-BAP is effective in reducing avoidance behavior, achieving anger control, and increasing self-esteem and social interaction. Parents consider A-BAP as a developer, educator, and practice that reduces depressive symptoms in their children. In addition, it was determined that the qualitative findings obtained supported the quantitative results. Since the study is the first application of BA therapy in Turkey, it is thought that it will contribute to new studies in Turkey and intercultural studies at the international level.

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“…One possible approach could be to include prospective mental imagery in the process of selecting and scheduling adaptive activities. Following a similar rationale, Colombo et al (2022) report promising results from a single case design study that tested the effectiveness of Virtual Reality to support a brief BA treatment. Studies like this and our results suggest that mental imagery techniques may hold great potential and may be highly relevant for clinical practitioners as guided imagery scripts could enable patients to identify worthwhile, rewarding activities more accurately and, once they have committed to them, increase behavioral motivation and engagement.…”

Section: Implications For Future (Clinical) Researchmentioning

confidence: 96%

Imagine How Good That Feels: The Impact of Anticipated Positive Emotions on Motivation for Reward Activities

et al. 2022

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Background Disease burden and unsatisfactory treatment outcomes call for innovation in treatments of depression. Prospective mental imagery, i.e. future-directed voluntary imagery-based thought, about potentially-rewarding activities may offer a mechanistically-informed intervention that targets deficits in reward processing, a core clinical feature of depression. We propose that the previously described impact of prospective mental imagery on motivation for everyday activities is facilitated by affective forecasting, i.e. predictions about an individual’s emotional response to the imagined activities. Methods Participants (N = 120) self-nominated six activities to engage in over the following week and were randomized to either: (1) an affective forecasting imagery condition (n = 40); (2) a neutral process imagery condition (n = 40); or (3) a no-imagery control condition (n = 40). Results As predicted, increases in motivation ratings from pre to post experimental manipulation were significantly higher following affective forecasting imagery compared to both neutral process imagery (d = 0.62) and no-imagery (d = 0.91). Contrary to predictions, the number of activities participants engaged in did not differ between conditions. Conclusions Results provide initial evidence for a potentially important role of affective forecasting in prospective mental imagery. We discuss how these findings can inform future research aiming to harness prospective mental imagery’s potential for clinical applications.

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Behavioral Activation through Virtual Reality for Depression: A Single Case Experimental Design with Multiple Baselines

Cited by 10 publications

References 62 publications

Virtual Reality Behavioral Activation for Adults With Major Depressive Disorder: Feasibility Randomized Controlled Trial

Virtual Reality Behavioral Activation for Adults With Major Depressive Disorder: Feasibility Randomized Controlled Trial

Ergen Davranışsal Aktivasyon Programının Uyarlanması ve Etkililiğinin Karma Yöntem ile İncelenmesi

Imagine How Good That Feels: The Impact of Anticipated Positive Emotions on Motivation for Reward Activities

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