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Augmented Reality-Supported Cognitive Behavioral Therapy for Children With Cancer: A Multicenter, Three-Arm
Tuba Mutluer1,2,3, Aslıhan Özcan Morey4, Pelin Karaturhan5
1Department of Child and Adolescent Psychiatry, Akdeniz University School of Medicine, Antalya, Türkiye.
Background:
Children undergoing cancer treatment experience high anxiety, procedural distress, and impaired quality of life (QoL), yet scalable psychosocial interventions remain scarce. We tested whether an augmented reality (AR)-supported, manualized cognitive behavioral therapy program (AR-CBT; the "My Hospital Buddy Ida" application plus a workbook) improves psychosocial outcomes more than standard CBT or usual care.
Procedure:
In a multicenter, three-arm, assessor-blinded randomized controlled trial at six recruiting sites in Türkiye, 114 children aged 6-12 years within the first 4 months of chemotherapy were randomized to AR-CBT, standard CBT (workbook only), or usual care; both active arms received nine clinician-delivered sessions. The primary outcome was the child-reported Pediatric Quality of Life Inventory (PedsQL) Cancer Module total score. Pre-specified secondary outcomes included resilience, parent-reported behavior problems, state anxiety, parent-proxy QoL, and anticipatory fatigue, nausea, and distress. Analyses adjusted for baseline and age.
Results:
Ninety-three children completed the trial (AR-CBT n = 36; standard CBT n = 28; usual care n = 29). AR-CBT yielded higher post-treatment PedsQL total scores than both comparators (F[2,88] = 12.98, p < 0.001, partial η2 = 0.23), with parallel gains across most subscales. Resilience was higher after AR-CBT (p < 0.001), parent-reported anxiety problems decreased (F = 5.75, p = 0.004), and anticipatory fatigue, nausea, and distress all declined (p ≤ 0.014). Acceptability was high in all arms (97.2% in AR-CBT; between-arm differences nonsignificant).
Conclusions:
AR-supported CBT was feasible, acceptable, and superior to standard CBT and usual care for QoL, resilience, and symptom-related distress, supporting AR-CBT as a scalable vehicle for evidence-based psychotherapy in pediatric oncology.
Trial Registration:
ClinicalTrials.gov: NCT07742059 (first submitted July 21, 2026, first posted August 3, 2026). Enrollment began in April 2024, so registration was retrospective. The study design and primary outcome were pre-specified in the Institutional Review Board (IRB)-approved protocol (2023.128.IRB1.040, approved April 12, 2023) before enrollment began.
