Needle fears are extremely common among children and teenagers, affecting an estimated 20–50% of adolescents. Yet the teenage years are exactly when several key vaccinations are given, including protection against tetanus, diphtheria, polio, meningitis, and HPV. The NHS aims to vaccinate 90–95% of adolescents but currently reaches only 70–75%, with fear of needles responsible for an estimated 10–20% of the shortfall. Exposure therapy is effective, but a shortage of therapists means few young people can access it.
Researchers at Oxford's Department of Experimental Psychology have developed a solution: a fully automated VR therapy needing no therapist input. In the first clinical trial of its kind, published today in The Lancet: eClinical Medicine, the treatment, which takes only 2.5 hours, produced substantial reductions in needle fears among 12-15-year-olds. It was co-designed with young people who themselves experience needle fears.
Set in a virtual high school and guided by a virtual coach, Farah, users progress through five levels of exposure: looking at needles, picking them up, using them, observing needle procedures, and finally receiving one — from piercing balloons and injecting a virtual penguin, to a final scene in which a virtual nurse vaccinates the user's own virtual arm.
Professor Daniel Freeman, study lead and Psychological Treatments Theme Lead for the NIHR Oxford Health Biomedical Research Centre, said: "Needle fear can be successfully treated using gradual exposure, but because of a shortage of therapists very few people are able to access such help. Virtual reality offers an exciting way to get therapy that works for the people who need it. Our programme runs on inexpensive consumer VR headsets, with a virtual therapist so treatment is fully automated. People find it easier to approach the objects they fear in VR because they know they're not real, yet the learning still transfers to the real world."
Virtual reality offers an exciting way to get therapy that works for the people who need it.
- Professor Daniel Freeman
Dr Eve Twivy, the trial's clinical psychologist, explained: "VR has previously been used as a distraction from anxiety during needle procedures. Instead, we targeted the fear that makes people avoid these procedures in the first place. Facing fears is challenging, but young people in our trial were motivated to complete the programme and found it helpful."
The research was funded by the Beryl Alexander Charity and the NIHR Oxford Health and Oxford Biomedical Research Centres.
Find the full paper in the The Lancet “Automated virtual reality therapy to treat needle fears (trypanophobia) in adolescents in England: a proof-of-concept cohort study and a Phase II randomised controlled trial”.