(SSCP1-8) SSCP Submission: Virtual Reality-reward Training for Anhedonia: Preliminary Results from a Randomized Controlled Trial

Background: Anhedonia, the loss of interest or pleasure in usual activities, is a transdiagnostic symptom characteristic of depression and some forms of anxiety. Although anhedonia is a predictor of poorer prognosis as well as suicidal ideation and behavior, traditional interventions insufficiently improve anhedonia. In recent years, several reward-focused interventions have been designed to target the deficits in reward functioning posited to underlie anhedonia. These nascent approaches show preliminary promise in improving symptoms. One such program, Virtual Reality-Reward Training (VR-RT), leverages VR immersion and imaginal recounting to enhance savoring and reward functioning. A pilot trial demonstrated preliminary support for VR-RT’s potential to improve symptoms and increase activation in neural regions involved in reward processing. The present randomized controlled trial compares the effects of VR-RT with an active control condition, Virtual Reality-Memory Training (VR-MT) on anhedonia, depression, reward functioning, and impairment. We present preliminary findings from this RCT. Method: Preliminary data were analyzed from an RCT at UCLA. Treatment-seeking individuals with low positive affect, depressive symptoms, and impairment were randomly assigned to 7 sessions of either VR-RT (n = 29) or VR-MT (n = 21). Each VR-RT session involved immersion in positive VR scenes and subsequent imaginal recounting of both the experienced scene as well as a positive autobiographical memory. VR-MT sessions involved immersion in neutral VR scenes and subsequent imaginal recounting of both the experienced scene and a neutral autobiographical memory. Anhedonia, depression, and reward processing were assessed using the anhedonic depression scale from the Mood and Anxiety Symptoms Questionnaire (MASQ-AD), the depression scale of the Depression Anxiety Stress Scale-21 (DASS-21), and the Positive Valence Systems Scale (PVSS-21) respectively. Multilevel modeling tested for group-by-time interactions and within-group symptom improvements. Results: Consistent with our pilot trial, individuals undergoing VR-RT demonstrated significant improvements in anhedonia (p=.01), reward functioning (p=.01), impairment (p=.01) from pre-treatment to follow-up. Depression improved but this change was nonsignificant. Contrary to what we predicted, our MLM revealed no group-by-time interactions for any of our outcome measures (all ps≥.18). VR-MT yielded significant reductions in depression and impairment (ps< .001) but not in anhedonia or reward functioning. Discussion: Our preliminary findings indicated no significant difference in symptom improvements between VR-RT and an active control condition. Instead, significant improvements were observed across both interventions. It is possible that the active control condition, VR-MT, was in and of itself an effective intervention as it resembles memory specificity training which has shown efficacy in prior studies. Alternatively, results across conditions might be due to regression to the mean or other nonspecific therapeutic factors. Ongoing data collection and future analyses may further clarify VR-RT’s efficacy as well as mechanisms of change.