Feasibility of a self-compassion-based virtual avatar therapy for patients with major depressive disorder: a pilot study

Background Major depressive disorder (MDD) is highly burdensome. Self-compassion interventions can alleviate symptoms, but traditional training often involves imagery-based exercises, which may be challenging for some patients. Virtual avatar technology may help by concretizing self-compassion experiences. Objective This pilot study aimed to evaluate the feasibility and tolerability of a self-compassion-based virtual avatar therapy for MDD and to describe preliminary changes in clinical outcomes. Methods In a prospective single-arm feasibility pilot study, 12 MDD patients (DSM-5) received a 6-week (once weekly, 60 min) stepped virtual avatar therapy. Four core training sessions used a self-developed computer avatar therapy system (CATS). Outcomes (BDI-II, SCS, DEQ-I) were assessed at baseline, post-treatment, and 3-month follow-up. VR experience and tolerability were assessed after each session using the Virtual Reality Experience Questionnaire and Simulator Sickness Questionnaire, respectively. Results Eleven of the 12 enrolled participants (91.7%) completed the 6-week intervention and post-treatment assessment, and 10 participants (83.3%) completed the 3-month follow-up assessment. Exploratory analyses suggested increases in several dimensions of presence, embodiment, and perceived comfort across sessions, with some pairwise comparisons reaching statistical significance. Most discomfort was mild (16/19; fatigue most common). No VR-related serious adverse events or treatment discontinuations due to VR intolerance were observed. Following the intervention, mean BDI-II scores decreased from 26.60 (SD 6.04) to 12.70 (SD 6.33), while SCS scores increased and DEQ-I scores decreased. These within-participant changes were observed at post-treatment and remained at a similar level at the 3-month follow-up. Owing to the uncontrolled pilot design, these findings should be interpreted as preliminary descriptive changes rather than evidence of treatment efficacy. Conclusion Self-compassion-based virtual avatar therapy demonstrated preliminary feasibility and tolerability in patients with MDD. Observed changes in depressive symptoms, self-compassion, and self-criticism require confirmation in larger randomized controlled trials.