Mixed Response Patterns to a Virtual Reality Intervention targeting Trauma-related Shame in Adolescents after Sexual Abuse: A Single-Case Experimental Design

Although trauma-related shame is increasingly recognized as an impactful phenomenon following inter-personal trauma, it appears to be under-addressed in evidence-based trauma treatments in youth. Virtual Reality (VR) technology has potential to act as an adjunct to existing treatments by targeting trauma-related shame. Using a multiple baseline single-case experimental design (SCED), this study aims to test the effectiveness of a novel VR intervention (SHINE-VR) addressing trauma-related shame in adolescents with a history of sexual abuse. The intervention consists of three consecutive modules which include psychoeducation, virtual social sharing and self-compassion tasks. Each module lasts between 15 and 20 min and is followed by a discussion with the administering clinician. Six adolescents (ages 14-17 years) were included. They received SHINE-VR additional to their regular trauma treatment. Direct and indirect shame, self-compassion and post-traumatic stress disorder (PTSD) symptoms were measured daily. Individual-level analyses indicated decreases in direct shame for most, and decreases in indirect shame as well as increases in self-compassion for some adolescents, though magnitude varied. The PTSD symptoms stagnated above a clinically relevant cut-off. Across cases, effects suggested small to modest improvements in direct shame but no consistent changes in indirect shame and self-compassion. Given the small sample and the heterogeneity in treatment responses, findings should be interpreted descriptively. The results suggest that SHINE-VR may be a promising addition to existing trauma treatments to decrease direct shame. Future studies should examine, in larger samples and over the full treatment course, whether more in-depth sessions and longer time periods would increase effectiveness.