An Automated Virtual Reality Cognitive-Behavioural Preventive Intervention for Adults with Agoraphobic Symptoms: A Randomized Controlled Trial of Adapted gameChange in Hong Kong.

INTRODUCTION: Agoraphobic avoidance, fear of situations that seem hard to escape, is common across mental disorders and often remains untreated due to stigma and limited service access. Automated virtual reality (VR) exposure therapy offers a scalable alternative by enabling safe, guided simulations of feared situations. This randomized controlled trial evaluated the efficacy of a culturally adapted version of gameChange VR for reducing agoraphobic avoidance among adults in Hong Kong without psychiatric diagnoses. METHODS: 272 participants were randomly assigned to either a three-session VR intervention (n = 146) or a waitlist control condition (n = 126). Assessments were conducted at baseline, 3-week, and 1-month follow-ups. Compared to the control condition, participants in the VR intervention condition showed significant reductions in the primary outcome of agoraphobic avoidance (Cohen's d = 0.89), and all the secondary outcomes of agoraphobic distress (d = 1.0), social anxiety (d = 0.91), fear of negative evaluation (d = 0.68), generalized anxiety (d = 0.50), depressive symptoms (d = 0.67), and functional impairment (d = 0.85) at 3 weeks. RESULTS: Significant group differences for all outcomes remained at the 1-month follow-up. Higher baseline levels of agoraphobic symptoms were associated with larger improvements in agoraphobic avoidance. CONCLUSION: These findings suggest that the automated VR intervention is effective in reducing agoraphobic symptoms in non-clinical populations and appears to be a scalable treatment in Asia where stigma is strong. Future studies could include longer follow-ups and address pandemic-related confounds on avoidance behaviours.