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Is Virtual Reality Effective to Motivate and Raise Interest in Phobic Children Toward Therapy? A Clinical Trial Study of In Vivo With In Virtuo Versus In Vivo Only Treatment Exposure

J Clin Psychiatry 2010;71(7):924-931

Objective: The first objective of this study was to assess if a combined treatment with mostly virtual reality–based (in virtuo) exposure increases phobic children’s motivation toward therapy compared to children who only receive in vivo exposure. Another objective was the assessment of motivation as a predictor of treatment outcome.

Method: Thirty-one DSM-IV–diagnosed arachnophobic participants aged from 8 to 15 years were randomly assigned to 1 of 2 treatment conditions: in vivo exposure alone or in virtuo plus in vivo exposure. Measures of motivation were taken at pretest and at the end of each part of the treatment; some other measures were taken at each session. The “Why Are You in Therapy?” questionnaire for children was the target measure of motivation and the main variable in the study. Outcome measures were taken at pretest, at the end of each part of the treatment, and at the 6-month follow-up. This study was conducted between September 2006 and March 2007.

Results: The results showed that children who received in virtuo exposure did not show a higher level of motivation toward their treatment than those who received in vivo exposure, but statistically significant interactions were found for both parts of the treatment. Multiple regression analysis confirmed that motivation was a significant predictor of outcome (P<.01), especially extrinsic integrated motivation. Participants in the combined treatment were significantly more phobic before beginning treatment, but both treatments appeared successful (P<.001).

Conclusions: In this study, the use of virtual reality did not increase motivation toward psychotherapy. At the end of the second part of therapy, all participants were comparably efficient in facing a live tarantula. These results bear important clinical implications concerning how to use virtual reality with children and concerning motivation of children toward therapy in general. They are discussed in the light of how to present in virtuo therapy to children.

Trial Registration: Identifier: ISRCTN87716831

J Clin Psychiatry 2010:71(7):924–931

Submitted: October 26, 2008; accepted August 10, 2009.

Online ahead of print: April 6, 2010 (doi:10.4088/JCP.08m04822blu).

Corresponding author: Stéphane Bouchard, PhD, Université du Québec en Outaouais, Département de Psychoéducation et de psychologie, CP 1250, Succ Hull, Gatineau, Québec J8X 3X7, Canada (