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Ramsey KA, Essoe JKY, Boyle N, Patrick AK, McGuire JF. Immersive Virtual Reality Exposures for the Treatment of Childhood Anxiety. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01628-4. [PMID: 37985621 DOI: 10.1007/s10578-023-01628-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 11/22/2023]
Abstract
Exposure-based cognitive behavior therapy (CBT) has demonstrated efficacy and is recommended as a front-line treatment for childhood anxiety. Unfortunately, challenges exist that impact the effective implementation of exposure-based CBT in clinical practice. One of the primary challenges is the accessibility and availability of exposure stimuli (e.g., spiders, storms, heights) in CBT sessions. Immersive virtual reality (VR) has shown promise as a scalable and sustainable solution to address this clinical need, but remains largely untested in youth with anxiety disorders. Here, we examine the use of VR exposures in the treatment of youth with an anxiety disorder (i.e., specific phobias). We aimed to investigate: (1) the feasibility and clinical benefit of VR exposures; (2) whether VR exposures elicit changes in physiological arousal and/or subjective distress; and (3) whether habituation serves as a mechanism across physiological and subjective outcomes for VR exposures. Three youth and their parents completed a clinical evaluation, which was followed by a one session treatment (OST) with VR exposures. Afterward, youth and parents completed clinical assessments one-week and 1-month after treatment. Immersive VR exposures were found to be feasible and demonstrated clinical benefit for reducing anxiety severity. Additionally, VR exposures elicited changes in both physiological and subjective outcomes. Finally, physiological habituation to VR exposures was observed among participants who exhibited treatment response at follow-up. Collectively, these findings demonstrate preliminary evidence that VR exposures are feasible, tolerable, and show some therapeutic benefit for treating youth with anxiety.
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Affiliation(s)
- Kesley A Ramsey
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 550 N Broadway, Suite 206, Baltimore, MD, 21205, USA.
| | - Joey Ka-Yee Essoe
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Psychology, University of Maine at Farmington, Farmington, ME, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 550 N Broadway, Suite 206, Baltimore, MD, 21205, USA
| | - Nathan Boyle
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- University of Maryland College Park, College Park, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 550 N Broadway, Suite 206, Baltimore, MD, 21205, USA
| | - Ainsley K Patrick
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Psychology, University of Kansas, Lawrence, KS, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 550 N Broadway, Suite 206, Baltimore, MD, 21205, USA
| | - Joseph F McGuire
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, 550 N Broadway, Suite 206, Baltimore, MD, 21205, USA
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Hipolito G, Pagnamenta E, Stacey H, Wright E, Joffe V, Murayama K, Creswell C. A systematic review and meta-analysis of nonpharmacological interventions for children and adolescents with selective mutism. JCPP ADVANCES 2023; 3:e12166. [PMID: 37720585 PMCID: PMC10501694 DOI: 10.1002/jcv2.12166] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/28/2023] [Indexed: 09/19/2023] Open
Abstract
Background Selective mutism (SM) is an anxiety disorder that often starts in early years with serious and lasting consequences. Nonpharmacological interventions are commonly seen as the preferred first treatment. This systematic review identifies outcome measures used and outcomes achieved for nonpharmacological interventions for children and adolescents with SM. Methods Systematic searches were conducted using 13 electronic databases and hand searches, including peer-reviewed and grey literature since 1992. Results Twenty-five studies were identified. While specific measures varied, all studies reported an outcome measure for speaking behaviour and 18 used a measure of anxiety. Few studies reported measures of SM remission (k = 6), well-being (k = 6), academic impact (k = 2), or quality of life (k = 1). Within subject outcomes for nonpharmacological interventions were variable for improvements in speaking behaviours (very small to large positive effects) and reduction in anxiety symptoms (very small negative to large positive effects). Only five randomised controlled trials (RCTs) were included in the meta-analysis. Three studies compared a combined systems/behavioural approach with waitlist controls indicating a significant and large effect (Hedges g = 1.06, p < .0001, 95% CI: 0.57-1.56) on improved speaking behaviour. Two of these RCTs showed a large effect for SM remission favouring the intervention (Risk Ratio = 4.25, p = .1774, 95% CI: 0.52-34.84) but this did not reach statistical significance. Non-significant outcomes for two RCTs with active controls (Hedges g = 0.55, p < .2885, 95% CI: -0.47 to 1.57) showed considerable heterogeneity in approach and outcomes, one with large and one with negligible effects. Conclusion Despite the considerable impairment caused by SM, there has been little systematic evaluation of non-pharmacological interventions. Although combined systems/behavioural interventions are promising, further systematic evaluations are urgently needed to inform treatment approaches. Cross-study measurement harmonisation is required to promote learning from all studies, including wider clinical and economic outcomes. Clinical Trial Registration Not applicable.
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Affiliation(s)
- Gino Hipolito
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
- Paediatric Speech and Language Therapy DepartmentSt George's University Hospitals NHS Foundation TrustLondonUK
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
| | - Emma Pagnamenta
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | - Helen Stacey
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | - Emily Wright
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | - Victoria Joffe
- School of Health and Social CareUniversity of EssexColchesterUK
| | - Kou Murayama
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
- Hector Research Institute of Education Sciences and PsychologyUniversity of TübingenTübingenGermany
| | - Cathy Creswell
- Department of Experimental PsychologyUniversity of OxfordOxfordUK
- Department of PsychiatryUniversity of OxfordOxfordUK
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Aruta JJBR. Treatment of selective mutism during the COVID-19 pandemic: Insights from practice. Int J Soc Psychiatry 2022; 68:1153-1154. [PMID: 35652421 DOI: 10.1177/00207640221102728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- John Jamir Benzon R Aruta
- Department of Psychology, School of Medical and Life Sciences, Sunway University, Selangor, Malaysia
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