VR-Mediated Cognitive Defusion: A Comparative Study for Managing Negative Thoughts

The growing prevalence of psychological disorders underscores the critical importance of mental health research in today's society. In psychotherapy, particularly Acceptance and Commitment Therapy (ACT), cognitive exercises employing mental imagery are used to manage negative thoughts. However, the challenge of maintaining vivid imagery diminishes their therapeutic effectiveness. Virtual reality (VR) offers untapped potential for increasing engagement and therapeutic efficacy. However, there is still a gap in exploration regarding how to effectively leverage the potential of VR to enhance traditional cognitive exercises with mental imagery. This study investigates the effective HCI design and the comparative efficacy of a VR-mediated exercise for promoting cognitive defusion to address negative thoughts grounded in ACT. Using a co-design approach with clinicians and potential users of postgraduate students, we developed a VR system that materializes negative thoughts into tangible objects. This allows users to visually modify and transpose these objects onto a surface, facilitating mental detachment from negative thoughts. In an evaluation study with 20 non-clinical participants, divided into VR and mental imagery groups, we assessed the impact of the cognitive defusion exercise on their perception of negative thoughts and psychological measures using standardized questionnaires. Results show improvement in both groups, with significant enhancements in negative thought perception and mental detachment from negative thoughts exclusively in the VR group, whereas the mental imagery group did not demonstrate significant changes. Interviews emphasize the VR's capability to present vivid visualizations of negative thoughts effortlessly, highlighting its effectiveness and engagement in psychotherapy to facilitate cognitive exercises.