Feasibility and impact of virtual reality exposure therapy on epilepsy-specific anxiety: Phase 3 of the AnxEpiVR pilot clinical trial

People with epilepsy (PwE) commonly experience interictal anxiety related to their epilepsy and seizures. However, therapeutic interventions have received minimal investigation. This study was the third phase of the "AnxEpiVR" pilot that examined the feasibility and effectiveness of a novel virtual reality exposure therapy (VR-ET) program to treat epilepsy-specific (ES) interictal anxiety in PwE. Participants (N = 5) completed the Epilepsy Anxiety Survey Instrument (EASI), Perceived Stress Scale, Igroup Presence Questionnaire, System Usability Scale, and an adapted version of the diagnostic protocol that Hingray et al. (2019) proposed. They also participated in a semi-structured interview. Participants were assigned to a personally relevant VR-ET scenario (dinner party, shopping mall, or a subway station/train). Over 12 to 14 days within a 14-day period, participants engaged in the VR-ET intervention, progressing through an individualized hierarchy of exposures. Preliminary findings suggest promising feasibility of VR-ET and high tolerability, achieving a 100% completion rate. The EASI scores showed that two of the four participants who scored above the cut-off for a probable anxiety disorder before VR-ET (brief EASI ≥ 7) scored below the cut-off after VR-ET (brief EASI < 7). Subjective reports of the VR-ET's impact supported the intervention's potential for reducing ES-interictal anxiety. This trial represents the inaugural use of VR-ET as a potential remote intervention for ES-interictal anxiety. Moreover, these findings support the feasibility of conducting larger clinical trials to further evaluate and to validate VR-ET as a therapeutic tool for managing interictal anxiety in PwE.