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Virtual Reality Behavioral Activation as an Intervention for Major Depressive Disorder: Case Report

Margot Paul · Kim D. Bullock · Jeremy N. Bailenson

39 citations0/0 files storedJMIR Mental Health

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Digital Mental Health Interventions Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Virtual Reality Applications and Impacts

Abstract

BACKGROUND: Major depressive disorder (MDD) is a global problem with an increasing incidence and prevalence. There has additionally been an increase in depression due to the COVID-19 pandemic. Behavioral activation is considered an evidence-based treatment for MDD. However, there are many barriers that could hinder one's ability to engage in behavioral activation, with COVID-19 "shelter-in-place" and social distancing orders being current and large impediments. Virtual reality (VR) has been successfully used to help treat a variety of mental health conditions, but it has not yet been used as a method of administering behavioral activation to a clinical population. Using VR to engage in behavioral activation could eliminate barriers that pandemic precautions place and help decrease symptoms of depression that are especially exacerbated in these times. OBJECTIVE: The following case report examines the feasibility, acceptability, and tolerability of VR behavioral activation for an adult with MDD during a global pandemic. This participant was part of a larger pilot study, and the case serves as a description of the VR intervention. METHODS: The participant engaged in a weekly 50-minute psychotherapy Zoom session for 4 weeks, in which a modified behavioral activation protocol was administered using a VR headset to simulate activities. Data on mood ratings, homework compliance, and headset use were obtained from the headset. Acceptability, tolerability, and depression symptoms were obtained using self-report rating scales. RESULTS: The intervention was feasible, acceptable, and tolerable, as reported by this participant. The participant's depressive symptoms decreased by five-points on the Patient Health Questionnaire-9 over a month, with a beginning score of 10 (moderate depression) and a final score of 5 (mild depression). CONCLUSIONS: The implications of these findings for future research are discussed. TRIAL REGISTRATION: ClinicalTrials.gov NCT04268316; http://clinicaltrials.gov/ct2/show/NCT04268316.

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References

2013Diagnostic and Statistical Manual of Mental Disorders 2001The PHQ-9 2020The psychological impact of quarantine and how to reduce it: rapid review of the evidence 2013Burden of Depressive Disorders by Country, Sex, Age, and Year: Findings from the Global Burden of Disease Study 2010 2005Twelve-Month Use of Mental Health Services in the United States 2013The State of US Health, 1990-2010 1997The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability 2004SARS Control and Psychological Effects of Quarantine, Toronto, Canada

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2021Using virtual reality to target positive autobiographical memory in individuals with moderate-to-moderately severe depressive symptoms: A single case experimental design 2022Behavioral Activation through Virtual Reality for Depression: A Single Case Experimental Design with Multiple Baselines 2024Examining the Efficacy of Extended Reality–Enhanced Behavioral Activation for Adults With Major Depressive Disorder: Randomized Controlled Trial 2023Acceptability, feasibility, and user satisfaction of a virtual reality relaxation intervention in a psychiatric outpatient setting during the COVID-19 pandemic

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