Supplementary Material for: An Automated Virtual Reality Cognitive-Behavioural Preventive Intervention for Adults with Agoraphobic Symptoms: A Randomised Controlled Trial of adapted gameChange in Hong Kong

Automated Virtual Reality (VR) has emerged as a promising way to deliver exposure intervention by offering immersive yet controlled exposure to simulations of feared situations. In this study, the efficacy of an automated VR intervention (gameChange) for reducing agoraphobic avoidance in adults without a formal psychiatric diagnosis was evaluated in Hong Kong. 272 participants were randomly assigned to either a three-session VR intervention (n=146) or a waitlist control condition (n=126). Assessments were conducted at baseline, 3-week, and 1-month follow-ups. Compared to the control condition, participants in the VR intervention condition showed significant reductions in the primary outcome of agoraphobic avoidance (Cohen’s d=0.89), and all the secondary outcomes of agoraphobic distress (d=1.0), social anxiety (d=0.91), fear of negative evaluation (d=0.68), generalized anxiety (d=0.50), depressive symptoms (d=0.67) and functional impairment (d=0.85) at 3 weeks. Significant group differences for all outcomes remained at the 1-month follow-up. Higher baseline levels of agoraphobic symptoms were associated with larger improvements in agoraphobic avoidance. These findings suggest that the automated VR intervention is effective in reducing agoraphobic symptoms in non-clinical populations and appears to be a scalable treatment in Asia where stigma is strong. Future studies could include longer follow-ups and address pandemic-related confounds on avoidance behaviors.