Currently submitted to: JMIR Mental Health
Date Submitted: Nov 7, 2026
Open Peer Review Period: Nov 9, 2026 - Jan 4, 2027
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Virtual Reality as a Tool to Reduce Pre-Procedure Anxiety Prior ECT via Enhancing Patient Education (PERFECT-VR): Randomized Controlled Trial
ABSTRACT
Background:
Electroconvulsive therapy (ECT) is a safe and effective treatment for a wide variety of psychiatric disorders, however data suggests that it is underutilized due to ongoing stigma and misconceptions about this treatment. In other medical procedures, it has been shown that immersive virtual reality (VR) can reduce anxiety by improving patient education. It is unknown if VR provided pre-ECT can change anxiety, attitude and knowledge regarding this treatment.
Objective:
In this study, we compared a VR intervention to standard of care (SOC) pre-ECT education to see whether an immersive VR video can enhance knowledge and reduce anxiety in patients about to undergo this treatment.
Methods:
72 participants were randomized 1:1 to receive either a 9-minute immersive 360° VR video or standard of care (SOC) pre-ECT psychoeducation. These interventions were provided 1 to 3 days before their scheduled ECT treatment. Baseline, post-VR intervention and post-treatment measures in both the VR (n=32) and SOC (n=34) groups included the ECT Attitude and Knowledge Questionnaire, anxiety severity (VAS), depression severity (QIDS-SR), cognitive function (MoCA) and hemodynamic measures (HR and BP).
Results:
Immediately after watching the VR video, participants demonstrated a significant reduction in their anxiety (VAS; mean difference=0.12, 95% CI 0.06-0.18, P <.001) and an increase in positive attitudes towards ECT (the ECT Attitude and Knowledge Questionnaire; mean difference=2.4, 95% CI 1.6-3.4, P <.001). However, the anxiety scores in the VR group returned to pre-intervention levels immediately before the ECT treatment (t26=0.43, P=.674; Figure 2A). Heart rate was significantly lower in the VR treatment group as compared to the SOC group both pre-ECT (mean difference=6.7, 95% CI 0.3-12.3, P=.04) and post-ECT (mean difference=9.9, 95% CI 2.6-17.2, P=.01).
Conclusions:
This study is the first RCT evaluating the use of an immersive 360° VR intervention to pre-ECT to address anxiety and improve attitudes and knowledge about this treatment. The brief VR intervention was well-tolerated by participants and resulted in improvements in anxiety and attitudes towards ECT after VR, as well as an associated reduction in heart rate pre-procedure. These results suggest that VR technology is a promising low-cost tool to help prepare patients for ECT and can potentially address some barriers to this treatment, resulting in an increase in its acceptability. Clinical Trial: ClinicalTrials.gov NCT04291196; https://clinicaltrials.gov/study/NCT04291196
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