Yes I Can: A Trial of Immersive Virtual Reality to Treat Social Avoidance

OUTCOME REPORT SUMMARY

Waiting times to see a psychologist in Hong Kong’s public health system are long, and private consultations are expensive. New work from a joint initiative between the Chinese University of Hong Kong, AXA Hong Kong, and Oxford VR, supported by the AXA Research Fund, has revealed that virtual reality (VR) therapy could overcome this accessibility issue while also alleviating social avoidance, depression, and anxiety. Prof. Winnie Mak from the Chinese University of Hong Kong, Dr. Amy Chan, and AXA Hong Kong’s Dr. Yi Mien Koh report on their Yes I Can randomized control trial in people with social avoidance. As well as reducing the stigma of mental health issues in Asia, this work shows that autonomous self-treatment in the novel and fun setting of a VR headset could be an effective standalone intervention for people with social avoidance.

Technology and mental health

Prior to the Yes I Can trial, Prof. Mak’s Diversity & Well-Being Laboratory had already shown that online mindfulness-based and cognitive behavioral interventions and apps can reduce depression and anxiety symptoms and elevate well-being. VR tools have also already been used to treat people with schizophrenia in work led by Professor Daniel Freedman of Oxford VR. Inspired by his pioneering work, Prof. Koh formed a joint research initiative with Oxford VR and Prof. Mak, supported by the AXA Research Fund, to bring this commercialized technology to Hong Kong. Their Yes I Can trial investigated how VR can be used to help people feel safer and more confident in social situations.

Randomized controlled trial (RCT) results

The Yes I Can trial included 273 socially avoidant participants who were allocated to a VR therapy group or waitlist control group. Interventions comprised three VR sessions of 45 minutes each, during which users confronted virtual scenarios that would typically cause them anxiety, such as a shop, café, and medical clinic. The VR therapy group showed a clear and persistent reduction in social avoidance, and had less social anxiety, depression, and fear of negative evaluation after the program. The waitlist control group remained socially avoidant, anxious, and depressed.

Localizing VR scenarios

For VR therapy to be successful, it needs to resonate with the user—one challenge of the Yes I Can trial was ensuring that the scenarios were culturally relevant. Dr. Chan was heavily involved in localizing Oxford VR’s program to make it seem more like Hong Kong, one of the busiest places in the world. She found ways to simulate hordes of people without crashing the system, such as including more noise and more clutter, making avatars appear more Asian, and, as a finer detail, using the city’s trash can colors.

De-stigmatizing mental health issues

The stigma of mental health issues is ever-present in Asia, and VR might go some way to overcome this. The Yes I Can trial attracted more male participants than usually seen in psychology studies—around a third of participants were men, versus the usual 25%. Its association with gaming, as well as being lighthearted and unconnected with serious, face-to-face talk therapy, means that VR could help normalize the conversation on mental health.

A hybrid future?

As with telehealth services and online interventions, VR technology could become a recognized tool to relieve common mental health issues. VR therapy is inexpensive, convenient, and effective, and so could be complement existing in-person services in an optimized “hybrid” model of healthcare to improve treatment access, not only in Hong Kong but worldwide.

 August 2022