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

Article


Freeman, D., Haselton, P., Freeman, J., Spanlang, B., Kishore, S., Albery, E., Denne, M., Brown, P., Slater, M. and Nickless, A. 2018. Automated psychological therapy using immersive virtual reality for treatment of fear of heights: A single-blind, parallel-group, randomised controlled trial. The Lancet Psychiatry. 5 (8), pp. 625-632. https://doi.org/10.1016/S2215-0366(18)30226-8
TypeArticle
TitleAutomated psychological therapy using immersive virtual reality for treatment of fear of heights: A single-blind, parallel-group, randomised controlled trial
AuthorsFreeman, D., Haselton, P., Freeman, J., Spanlang, B., Kishore, S., Albery, E., Denne, M., Brown, P., Slater, M. and Nickless, A.
Abstract

Background
Engaging, 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.
Methods
We 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.
Findings
Between 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.
Interpretation
Psychological 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.

Sustainable Development Goals3 Good health and well-being
Middlesex University ThemeHealth & Wellbeing
PublisherElsevier
JournalThe Lancet Psychiatry
ISSN2215-0366
Electronic2215-0374
Publication dates
Online11 Jul 2018
PrintAug 2018
Publication process dates
Accepted11 Jul 2018
Deposited30 Oct 2023
Output statusPublished
Publisher's version
License
Digital Object Identifier (DOI)https://doi.org/10.1016/S2215-0366(18)30226-8
PubMed ID14511458
Scopus EID2-s2.0-85053826918
Web of Science identifierWOS:000440070600021
LanguageEnglish
Permalink -

https://repository.mdx.ac.uk/item/w39wy

Download files


Publisher's version
  • 74
    total views
  • 18
    total downloads
  • 0
    views this month
  • 0
    downloads this month

Export as

Related outputs

Evaluating student evaluations: evidence of gender bias against women in higher education based on perceived learning and instructor personality
Khokhlova, O., Lamba, N. and Kishore, S. 2023. Evaluating student evaluations: evidence of gender bias against women in higher education based on perceived learning and instructor personality. Frontiers in Education. 8. https://doi.org/10.3389/feduc.2023.1158132
Who is more ‘human-like’? Exploring gender and race in perception of avatars in an online classroom
Lamba, N., Kishore, S. and Khokhlova, O. 2023. Who is more ‘human-like’? Exploring gender and race in perception of avatars in an online classroom. 11th European Conference on Education (ECE2023). London, UK, and Online 13 - 17 Jul 2023
Developing an object detection and gripping mechanism algorithm using machine learning
Mohammad, H., Kishore, S. and Prasetyo, J. 2023. Developing an object detection and gripping mechanism algorithm using machine learning. Journal of Applied Science and Advanced Engineering. 1 (2), pp. 47-54. https://doi.org/10.59097/jasae.v1i2.15
Interactive multimodal learning: towards using pedagogical agents for inclusive education
Al Omoush, M., Salih, S., Kishore, S. and Mehigan, T. 2023. Interactive multimodal learning: towards using pedagogical agents for inclusive education. 2023 IEEE International Humanitarian Technology Conference. Santa Marta, Colombia 01 - 03 Nov 2023 IEEE. https://doi.org/10.1109/IHTC58960.2023.10508848
PhD Work with Robothespian on display at Centre of Contemporary Culture Barcelona
Kishore, S. 2022. PhD Work with Robothespian on display at Centre of Contemporary Culture Barcelona. Centre of Contemporary Culture Barcelona (CCCB) 27 Jul - 11 Dec 2022
Using virtual avatars to explore the impact of instructors' gender, race, and qualification on perceived learning in an online classroom
Lamba, N., Kishore, S. and Khokhlova, O. 2022. Using virtual avatars to explore the impact of instructors' gender, race, and qualification on perceived learning in an online classroom. The 10th European Conference on Education. London, UK 14 - 17 Jul 2022
When your robot avatar misbehaves you are likely to apologize: an exploration of guilt during robot embodiment
Aymerich-Franch, L., Kishore, S. and Slater, M. 2020. When your robot avatar misbehaves you are likely to apologize: an exploration of guilt during robot embodiment. International Journal of Social Robotics. 12 (1), pp. 217-226. https://doi.org/10.1007/s12369-019-00556-5
A virtual reality embodiment technique to enhance helping behavior of police toward a victim of police racial aggression
Kishore, S., Spanlang, B., Iruretagoyena, G., Halan, S., Szostak, D. and Slater, M. 2019. A virtual reality embodiment technique to enhance helping behavior of police toward a victim of police racial aggression. PRESENCE: Virtual and Augmented Reality. 28, pp. 5-27. https://doi.org/10.1162/pres_a_00339
Virtually being Einstein results in an improvement in cognitive task performance and a decrease in age bias
Banakou, D., Kishore, S. and Slater, M. 2018. Virtually being Einstein results in an improvement in cognitive task performance and a decrease in age bias. Frontiers in Psychology. 9. https://doi.org/10.3389/fpsyg.2018.00917
Beaming into the news: a system for and case study of tele-immersive journalism
Kishore, S., Navarro, X., Dominguez, E., De La Peña, N. and Slater, M. 2018. Beaming into the news: a system for and case study of tele-immersive journalism. IEEE Computer Graphics and Applications. 38 (2), pp. 89-101. https://doi.org/10.1109/mcg.2017.2801407
Examining sense of responsibility in an experience of robot avatar embodiment
Aymerich-Franch, L., Kishore, S. and Slater, M. 2018. Examining sense of responsibility in an experience of robot avatar embodiment. 68th Annual Conference of the International Communication Association (ICA). Prague, Czech Republic 24 - 28 May 2018
Multi-destination beaming: apparently being in three places at once through robotic and virtual embodiment
Kishore, S., Muncunill, X.N., Bourdin, P., Or-Berkers, K., Friedman, D. and Slater, M. 2016. Multi-destination beaming: apparently being in three places at once through robotic and virtual embodiment. Frontiers in Robotics and AI. 3. https://doi.org/10.3389/frobt.2016.00065
Comparison of SSVEP BCI and eye tracking for controlling a humanoid robot in a social environment
Kishore, S., González-Franco, M., Hintemüller, C., Kapeller, C., Guger, C., Slater, M. and Blom, K.J. 2014. Comparison of SSVEP BCI and eye tracking for controlling a humanoid robot in a social environment. PRESENCE: Virtual and Augmented Reality. 23 (3), p. 242–252. https://doi.org/10.1162/pres_a_00192
Real time whole body motion mapping for avatars and robots
Spanlang, B., Navarro, X., Normand, J.-M., Kishore, S., Pizarro, R. and Slater, M. 2013. Real time whole body motion mapping for avatars and robots. 19th ACM Symposium on Virtual Reality Software and Technology. Singapore 06 - 09 Oct 2013 Association for Computing Machinery (ACM). https://doi.org/10.1145/2503713.2503747