Standard CBT versus integrative and multimodal CBT assisted by virtual-reality for generalized anxiety disorder

Abstract

IntroductionGeneralized Anxiety Disorder (GAD) is a prevalent emotional disorder associated with increased dysfunctionality, which has a lasting impact on the individual’s quality of life. Besides medication, Cognitive-Behavioral Therapy (CBT) represents the golden standard psychotherapeutic approach for GAD, integrating multilevel techniques and various delivery formats that enable the development of tailored treatment protocols. The objective of this study was to compare the efficiency of a standard CBT protocol targeting worries, dysfunctional beliefs, and intolerance of uncertainty with an integrative and multimodal CBT intervention augmented with Virtual Reality (VR).Materials and methodsThis study included 66 participants (Mage = 22.53 years; SD = 2.21) with moderate GAD symptoms that were randomized to the standard CBT group (CBTs; N = 32) and the Integrative and Multimodal CBT augmented with VR (IM-VRCBT; N = 34) group. The interventions comprised 10 weekly sessions conducted by trained CBT therapists, including cognitive restructuring, problem-solving, behavioral exposure, and relaxation techniques. Baseline and post-assessments were conducted with both groups. Primary outcome measures included the Hamilton Anxiety Rating Scale (HARS) and Penn-State Worry Questionnaire (PSWQ) to evaluate the severity of GAD symptoms and worries, respectively. Secondary outcomes involved the administration of Automatic Thoughts Questionnaire (ATQ), Dysfunctional Attitudes Scale (DAS) and Unconditional Self-Acceptance Questionnaire (USAQ).ResultsBoth interventions determined statistically significant effects on both primary and secondary outcomes (ps < 0.001) in the expected direction. However, CBTs was associated with higher effect sizes for anxiety (Cohen’s d = 2.76) and worries (Cohen’s d = 1.85), in contrast to IM-VRCBT. Also, secondary analyses revealed positive correlations between changes in anxiety and worries level and the reduction of dysfunctional cognitive processes.ConclusionThis research emphasized the effectiveness of CBT interventions for treating adults with moderate GAD symptomatology. Specifically, both interventions were efficient for reducing anxiety symptomatology present at individuals with GAD. However, regarding cognitive dysfunctions like worries, the standard CBT protocol performed better, as compared to the IM-VRCBT. In addition, we conclude that VR could be integrated within CBT interventions in a single protocol for GAD treatment.

A systematic review on the efficacy of virtual reality and gamification interventions for managing anxiety and depression

“…The results show that the most commonly used frequency in implementing VR interventions was once per week, with 7 out of 15 studies implementing the intervention at this frequency (9, 10, 13,21,24,42,43). The second highest frequency was twice weekly, used in 5 studies (11,12,20,41,44).…”

“…VR-CBT is an innovative therapeutic approach that combines VR technology with CBT techniques to address various mental health conditions. Specifically, VRET is a type of VR-CBT that utilizes computer-generated virtual environments to simulate real-life situations, providing individuals with a controlled and safe space to confront and work through their fears, anxieties, or phobias (24,32).…”

“…Regarding control groups, the results showed that two of the studies incorporated some VR into the control group (10, 13). In seven studies, the control group received treatment as usual, such as CBT or PCT (9,11,20,24,42,44). Seven studies had a waitlist or no intervention or a control group (7,8,10,12,32,41,44), and one study offered health controls to the control group (21).…”

“…Three studies had less than 4 sessions (11,21,43). The duration per session was reported in 13 studies, with 3 studies offering 10 min or less (9, 10, 32), 4 studies between 15 and 30 min (7,8,12,41,43), 4 studies between 45 and 60 min ( (11,20,24,44)), and 2 studies did 90 min or more per session (21, 42).…”

“…By exploring the multifaceted nature of VR and integrating gamification, this review establishes the foundation for comprehending how VR, with its diverse modalities, can be leveraged to optimize remote work settings. Such optimization can enhance overall productivity, increase patient convenience and employee wellbeing, and promote a more seamless and effective integration of remote work into daily routines and can be scaled and distributed to a wide range of users without significant increases in provisions and maintenance costs (12,16,19,24).…”