Introduction and Significance: Preventive interventions have been shown to reduce the
risk of developing anxiety and depression, making them a critical focus area in mental
health promotion for children and adolescents. Enhancing emotion regulation (ER) skills
in young people is one approach to preventing anxiety and depression, as ER involves
cognitive processes of modifying thoughts and behaviors to manage emotional responses in
different contexts. Executive functions (EF), such as cognitive flexibility, working
memory, and inhibition, play a crucial role in ER development and regulation in children
and adolescents. Recently, immersive virtual reality (IVR) has emerged as a novel tool
for improving cognitive training interventions' accessibility and effectiveness. IVR
allows users to experience immersive, three-dimensional environments, where they can
interact with objects and events in a highly engaging and realistic way. Considering
these developments, this study aims to explore the potential benefits of Enhance VR, a
gamified IVR program designed to improve ER skills and reduce anxiety and depressive
symptoms among children and adolescents.
Methodology: The study will be a longitudinal, parallel, single-blind, randomized
controlled pilot trial involving 80 Spanish - or English-speaking participants aged 10 to
16 years old. Participants will be excluded if they have severe psychiatric or
neurodevelopmental disorders, physical, motor, or sensory impairments, or a risk of
experiencing high cybersickness symptomatology during the VR experience. Participants
will be randomly allocated into two groups: an experimental group receiving E-Emotio VR
and a control group receiving a placebo-based VR relaxation experience. Both VR
interventions will last five weeks, two times a week, for 30 minutes. The experimental
group will engage in six games targeting cognitive flexibility, planning, reappraisal
strategies, working memory, divided and sustained attention, and processing speed. The
control group will be immersed in ten different nature-based VR environments and perform
relaxation exercises. Baseline and post-intervention assessments will be conducted using
age-adapted validated measures of depressive and anxiety symptoms, ER, executive function
(working memory, cognitive flexibility, inhibition, and planning), and attention.
Following the intervention, the assessment battery will be re-administered by a blinded
assessor, and statistical analyses will be conducted for all the primary and secondary
measures assessed before and after the intervention in both groups.
Conclusion: In summary, this study aims to contribute to the development of effective
preventive interventions for emotion regulation and mental health symptoms in children
and adolescents by promoting ER through gamified VR cognitive training. The study's
findings could have significant implications for mental health research, educational and
clinical practice. By exploring the potential benefits of VR cognitive training, this
research has the potential to inform future studies and clinical interventions aimed at
improving young people's mental health and well-being. The gamification of cognitive
training interventions could be a powerful tool for increasing engagement and motivation
among young people, making them more likely to participate in such interventions.