By Olivia Trani
A mental health intervention that uses virtual reality to teach social-emotional learning skills to youth has been shown to reduce conduct problems, aggression and other antisocial behavior, according to a new study published in Research on Child and Adolescent Psychopathology.
The program, called Impact VR, was developed by Nicholas Thomson, Ph.D., a psychologist in Virginia Commonwealth University’s School of Medicine and the director of research for the Injury and Violence Prevention Program at VCU Health. He says it’s the first virtual reality program designed for youth with conduct disorder and callous-unemotional traits.
“Conduct disorder is one of the most common childhood disorders, yet few treatments work — especially for youth with limited access to intensive care. This study shows that utilizing virtual reality technology could help change that,” Thomson said. “For a brief and low-cost treatment, this is a major breakthrough in youth mental health.”
Conduct disorder is a mental health disorder diagnosed in children and adolescents with consistent patterns of aggressive and rule-breaking behaviors. Some youth with this condition also exhibit callous-unemotional traits, characterized by having callousness and lack of remorse and empathy. While typically diagnosed in children, conduct disorder can persist into adulthood and increase the risk of other long-term consequences, including criminality, substance use, social difficulties, and chronic mental and physical health issues.
Cognitive behavioral therapy and parent training are effective for some youth, however, these treatments often fall short for those with higher levels of callous-unemotional traits. Access is another barrier, as intensive therapy requires time, money, trained staff and consistent engagement, which is often out of reach for schools, mental health providers and caregivers.
To address this treatment gap, Thomson developed Impact VR with his company, Arche XR, which has also built a suite of virtual reality programs grounded in cognitive-behavioral therapy to address youth mental health and social-emotional learning. Arche XR collaborated with VCU TechTransfer and Ventures, which helps bring university innovations to market. Because the program runs on commercially available headsets without specialized staff or IT infrastructure, it can be used in schools, clinics and juvenile justice systems.
Impact VR uses a new approach to treat conduct disorder
While traditional treatments focus on managing behaviors associated with conduct disorder, like aggression or disobedience, Impact VR takes a different approach. The program is designed to address the underlying factors driving these behaviors, such as difficulty understanding emotional cues, interpreting social situations and building empathy. These are mechanisms that underlie other childhood disorders like autism and ADHD.
The virtual reality program guides participants through different games and scenarios to help them build social-emotional skills. (ArcheXR)
Using virtual reality (VR) headsets, youth are guided through a series of gamified tasks that involve recognizing facial expressions, identifying emotional triggers and developing strategies to tackle challenging social situations. The program also places youth as problem solvers in interactive stories that simulate real-world social situations.
“We’re retraining how the brain responds to emotion and social cues,” Thomson said. “By directly targeting the systems that drive empathy and emotional learning, we can shift conduct patterns in ways traditional therapy has struggled to achieve.”
To ensure the program would be engaging for its target audience, Thomson collaborated with an advisory group of youth with conduct disorder and callous-unemotional traits to help shape the experience in a meaningful way.
“We wanted an intervention that felt real to young people,” Thomson said. “By letting them shape the stories and dialogue, we turned therapy into something they could see themselves in, and that’s when it starts to work.”
After using Impact VR, teens and caregivers saw behavioral changes
To test the Impact VR’s effectiveness, a team of researchers led by Thomson conducted a study at VCU Health involving 110 participants, aged 10-17, with a diagnosis of conduct disorder. Youth were randomly assigned to either complete a single 25-minute emotion recognition training session or participate in the Impact VR program over four weekly 25-minute sessions.
As part of the study, participants completed surveys and clinical interviews about their conduct problems, aggression and callous-unemotional traits. Their caregivers also completed similar questionnaires and clinical interviews. These assessments were completed three times: at the beginning of the study, immediately after completing the 4-week intervention and then three months later.
The results showed that caregivers of youth who completed the Impact VR program saw immediate reductions in their child’s conduct problems, callous-unemotional traits and reactive aggression. These improvements were still observed by caregivers three months following treatment. Youth who received the Impact VR program also self-reported reductions in their conduct disorder-related behaviors.
The findings show that emotional and behavioral change is possible through brief, engaging interventions like Impact VR, even among youth who have long been considered resistant to treatment. The results also suggest that therapies focused on targeting the root causes of conduct disorder rather than just the symptoms may be a more effective treatment option.
“With virtual reality, we can meet youth where they are and make emotional learning engaging and effective, and sustainable,” Thomson said. “Many of the youth with conduct disorder in our study also had autism, ADHD, or social anxiety—conditions that often make traditional therapy difficult to sustain. By combining creativity with science, we’re opening new doors for mental health support that feels relevant, accessible, and built for real-world challenges.”
This research was supported by funding from the National Institute of Mental Health of the National Institutes of Health.
The Injury and Violence Prevention Program at VCU Health aims to reduce and prevent injuries through ongoing education, research and community outreach. Learn more about the program’s work throughout Central Virginia.
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