Training Reward Responsiveness Through Virtual Reality

Anhedonia, or loss of interest and pleasure in usual activities, has been relatively resistant to pharmacological and psychological treatments in the context of anxiety and depression. Newer treatments that focus upon positivity or reward sensitivity have shown promising results.

The purpose of the current randomized controlled trial is to compare the effects of Virtual Reality-Reward Training (VR-RT) with an active control condition, Virtual Reality-Memory Training (VR-MT), on positive affect and other clinical symptoms. Virtual Reality-Reward Training is designed to augment reward sensitivity in individuals with depression and low positive affect. Targets include reward anticipation and initial response to reward. Specificity of target engagement is assessed by comparison with Virtual Reality-Memory Training, designed to improve memory.

Targets and clinical outcomes are assessed at Week 0 Assessment (Week 0) and either weekly or at mid-treatment (Week 7), post-treatment (1 week after Session 14), and follow-up (Week 12). Statistical models evaluate whether change in outcomes and change in target measures are greater as a result of Virtual Reality-Reward Training compared to Virtual-Reality-Memory Training and whether changes in target measures correlate with changes in outcome measures.

Target enrollment is 80 participants with low positive affect, depression, and impaired functioning, who are at least 18 years old, who will be randomized to Virtual Reality-Reward Training or Virtual-Reality Memory Training, each comprising 13 individual virtual reality training sessions over the course of 7 weeks.

Participants will complete laboratory tests and self-report questionnaires as part of the study. Total length of participation is around 3 months.

• Depression, Anxiety, and Stress Scales (DASS-21) [Time frame: Change from Week 0 assessment to Post-Assessment (Week 8). Change from Week 0 assessment to Follow-Up (Week 12).]
• Positive and Negative Affective Schedule (PANAS) [Time frame: Change from Week 0 assessment to Post-Assessment (Week 8). Change from Week 0 assessment to Follow-Up (Week 12).]
• Positive and Negative Affective Schedule (PANAS-X) [Time frame: Change from Week 0 assessment to Post-Assessment (Week 8). Change from Week 0 assessment to Follow-Up (Week 12).]
• Responses to Positive Affect Questionnaire (RPA) [Time frame: Change from Week 0 assessment to Post-Assessment (Week 8). Change from Week 0 assessment to Follow-Up (Week 12).]
• Work and Social Adjustment Scale (WSAS) [Time frame: Change from Week 0 assessment to Post-Assessment (Week 8). Change from Week 0 assessment to Follow-Up (Week 12).]
• igroup Presence Questionnaire (IPQ) [Time frame: Change from Week 0 assessment to Post-Assessment (Week 8).]
• Memory Retrieval Task [Time frame: Change from Week 0 assessment to Post-Assessment (Week 8). Change from Week 0 assessment to Follow-Up (Week 12).]
• Heart Rate Variability [Time frame: Change from VR Session 1 (Week 1) to VR Session 13 (Week 7).]
• State Affect [Time frame: Change from VR Session 1 (Week 1) to VR Session 13 (Week 7).]
• Change in reward-relevant neural activity [Time frame: Change from Week 0 Assessment to Post Assessment (Week 8)]
• Blood-Based Biomarkers [Time frame: Change from Week 0 assessment to Post-Assessment (Week 8). Change from Week 0 assessment to Follow-Up (Week 12).]
• Depressive Symptoms Composite Score [Time frame: Change from Week 0 assessment to Post-Assessment (Week 8). Change from Week 0 assessment to Follow-Up (Week 12).]