Virtual reality mindfulness-based cognitive therapy for reducing psychological distress in people with depression and/or anxiety symptoms: two uncontrolled feasibility studies

Group mindfulness-based cognitive therapy (MBCT) is recommended for the treatment of subthreshold-to-mild depressive symptoms. Timely access to MBCT, however, is limited by accessibility issues. Self-help MBCT can overcome these issues, but is associated with poorer engagement. Incorporating virtual reality into self-help MBCT (VR-MBCT) may improve engagement, but relatively little is known about its feasibility and acceptability. Consequently, the aims of this study were to examine the acceptability, feasibility and preliminary signals of efficacy of VR-MBCT for reducing psychological distress in people with depression and/or anxiety symptoms.

In two uncontrolled feasibility studies, participants aged ≥ 18 years with mild-to-moderately severe symptoms of depression and/or anxiety were recruited via self-referral. Participants received five VR-MBCT sessions (totalling approximately two hours in duration) each week for 8 weeks plus usual care. Co-primary outcomes were feasibility (recruitment, retention and data completion) and acceptability (course completion and satisfaction with VR-MBCT) in both studies. Secondary outcomes included measures of depression, anxiety, mental well-being and mindfulness, assessed at pre- and post-intervention.

In Study 1, 35 participants (100% of the target) were recruited, 22 participants (63%) were retained, 20-22 participants (57-63%) completed outcome measures at both timepoints, and 18 participants (51%) completed 4 weeks of VR-MBCT. In Study 2, 48 participants (96% of the target) were recruited, 26 participants (54%) were retained, 23-26 participants (48-54%) completed outcome measures at both timepoints, and 22 participants (46%) completed 4 weeks of VR-MBCT. Satisfaction with VR-MBCT was high in both studies. Data were suggestive of improvements in anxiety, depression, mental well-being and mindfulness from pre- to post-intervention in both studies. Rates of reliable improvement were 77-90% in Study 1 and 62-70% in Study 2.

There was good evidence of the acceptability of VR-MBCT with respect to course satisfaction and feasibility in terms of recruitment. Although consistent with previous studies, findings suggested that further improvements could be made regarding retention/attrition, data completion and initial engagement. Preliminary signals of efficacy suggested that VR-MBCT may reduce psychological distress and improve mental wellbeing and mindfulness in people with depression and/or anxiety symptoms. However, results should be interpreted with caution due to study limitations.