Virtual Reality (VR) for Needle Fears

• Research type

  Research Study

• Full title

  Virtual Reality (VR) for Needle Fears: A Cohort Study and a Randomised Controlled Trial of an Automated VR Therapy for the Treatment of Needle Fears (trypanophobia)

• IRAS ID

  334022

• Contact name

  Daniel Freeman

• Contact email

  daniel.freeman@psy.ox.ac.uk

• Sponsor organisation

  University of Oxford Research Governance, Ethics and Assurance Team

• ISRCTN Number

  ISRCTN74002253

• Duration of Study in the UK

  1 years, 3 months, 30 days

• Research summary

  Research Summary:
  Background:
  The hypodermic needle - used to inject substances (e.g. medications, vaccinations) or extract fluids (e.g. blood) in clinical procedures – may be the most important medical device invented. Billions of needles are used worldwide each year. However a significant minority of the population are very fearful of needles. This can make medical procedures unpleasant. It can also lead to avoidance of vaccination, blood donation and tests, and uptake of treatments. Fear of needles is especially high in children and adolescents. Needle fear can be successfully treated using psychological therapy (graded exposure and applied tension) but because of a shortage of therapists very few people are able to access such help.

  Aim:
  Working with adolescents with needle fears, we have automated the delivery of evidence-based psychological therapy for needle fear within virtual reality (VR). A virtual coach guides users through the therapy. As such, the therapy can be supported by a range of professionals, for example, nurses or school pastoral staff. We now wish to assess the effectiveness for young people (ages 12-16 years) of this automated VR therapy for needle fear.

  Methods:
  The project has two elements:
  1. Initial clinical testing. 12 young people with needle fear will receive the VR therapy. They will be assessed before and after completing the intervention. If there is evidence of improvement in the needle fear then we will proceed to the full clinical trial.
  2. Full clinical trial. The VR therapy for needle fear will be tested in a randomised controlled trial. 100 young people reporting significant needle fears will be randomised to receive the VR therapy or the control group. Assessments will be conducted at baseline, end of therapy (two weeks), and at follow-up (six weeks). We will offer the VR therapy to young people in the control group after their participation.

  Summary of Results:
  Virtual Reality Therapy for Needle Fears in Adolescents: Summary of Findings

  The research team at the University of Oxford would like to thank all the young people and families who were involved in this study.

  Why did we do this study?
  Many young people are very scared of needles. Needle fears can make vaccinations, blood tests, and medical treatment very upsetting and difficult. Some young people avoid healthcare because of these fears.
  Needle fear can be successfully treated using gradual exposure to needles, but this psychological therapy can be difficult to access. To overcome this problem, we developed an automated virtual reality (VR) therapy. We did this study to find out if the therapy works.

  Where and when did the study take place?
  The study took place in England between 2024 and 2025. Participants were invited to take part through the Oxfordshire, Berkshire and Buckinghamshire School Aged Immunisation Services and local radio adverts.

  What public involvement was there in the study?
  We set up a Young People’s Advisory Group of adolescents with lived experience of needle fears. They contributed to the design the VR therapy environments, characters, and activities, and tested the programme during development.

  What were the main questions studied?
  We wanted to find out:
  • whether the VR therapy reduces fear of needles in adolescents
  • whether improvements lasted after the treatment finished
  • whether adolescents found the VR programme helpful and easy to use
  • whether the VR therapy was safe

  Who took part in the study?
  A total of 72 adolescents aged 12–15 years old took part across two stages of the study. All participants had significant fears of needles and wanted help with these fears.

  What treatments did participants receive?
  Participants used a VR therapy programme. VR is a computer simulation, like a video game. By putting on a headset, you see, hear, and can move around the computer simulations. There is a virtual coach who guides users through activities designed to gradually build their confidence around needles. The setting is a virtual school. The activities include looking at virtual needles; piercing balloons with needles; injecting penguins with medicine; watching someone being vaccinated; and receiving a vaccination from a nurse into the user’s virtual arm. The activities are designed to be challenging and informative, but also fun and engaging. Some people can feel faint when they see needles, so users also learn applied tension technique within the programme to reduce the chances of fainting.
  On average the therapy took 4.5 hours in total, with around 2.5 hours spent in VR. This was held over approximately three sessions over 2–3 weeks. A member of the research team was always present to support participants.

  Were there any safety concerns during the study?
  There were no serious adverse events (safety concerns) during the study. Most participants did not report any side effects using the VR, but some reported physical discomfort such as headaches. No participants fainted whilst using VR.

  What happened during the study?
  The study happened in two parts.
  In the first part, 11 adolescents completed the VR therapy so researchers could check whether it showed enough promise to continue to a larger study.
  In the second part, 60 adolescents took part in a randomised controlled trial. Half received the VR therapy straight away, while the other half did not. All participants completed questionnaires at the start (before therapy), 3 weeks later (after therapy) and 6 weeks later. Researchers then compared changes in needle fears between the two groups.
  Participants who had not received the therapy were offered it after they had completed the last set of questionnaires.

  What were the results of the study?
  The study found that the VR therapy led to very large reductions in fear of needles. Improvements were still present a few weeks later. Most adolescents said the VR therapy was helpful and easy to use.

  How has this study helped patients and researchers?
  This study is the first randomised controlled trial to test a VR therapy specifically designed to reduce needle fears in adolescents.
  The results suggest that VR therapy may be a promising way to help young people manage fears around medical procedures like vaccinations. As the VR therapy is automated, it could help improve access to psychological therapy.
  Several parents contacted us afterwards to say that their child had successfully had a vaccination or blood test that they had previously been unable to have, however we did not formally assess this in this study. We would like to carry out a larger study to look at whether the VR therapy can help to increase vaccination uptake in adolescents who have refused vaccination due to a needle fear.
  

• REC name

  South Central - Oxford B Research Ethics Committee

• REC reference

  23/SC/0420

• Date of REC Opinion

  15 Dec 2023

• REC opinion

  Favourable Opinion