# The efficacy of home-based virtual reality exposure therapy as an add-on to behavioral therapy for children with selective mutism: Protocol for a single-case experimental design

## TL;DR

This study explores using home-based virtual reality therapy to help children with selective mutism practice speaking in school-like settings, alongside traditional behavioral therapy.

## Contribution

This is the first study to evaluate home-delivered virtual reality exposure therapy as an adjunct to behavioral treatment for selective mutism in children.

## Key findings

- The study will assess the feasibility and preliminary effectiveness of home-based VRET combined with behavioral therapy for children with SM.
- Each behavioral treatment step will be supported by corresponding VRET exercises to enhance skill generalization.
- Qualitative data will be collected to evaluate the usability and acceptability of the home-based VRET protocol.

## Abstract

Selective Mutism (SM) is a rare childhood anxiety disorder characterized by an inability to speak in specific social situations, despite speaking freely in others. School is typically the environment where the disorder manifests itself most clearly. Children with SM often have difficulty generalizing speaking across different social situations. Parents and teachers often struggle to practice speaking with the child outside of therapy due to practical reasons and time constraints. Virtual Reality Exposure Therapy (VRET) at home has potential to enhance the treatment of SM by providing an alternative and engaging method for delivering exercises that support behavioral treatment.

This paper describes the development of the VRET application Speaking at School-VR and the methodology of the single case experimental design (SCED) to evaluate the feasibility and preliminary effects of the behavioral treatment at school, complemented with VRET at home, for children with SM, aged 4–13. A secondary aim is to evaluate the feasibility and adherence of home-based VRET based on qualitative information to capture participants’ experiences. A total of 15 children with SM and their families will be enrolled in the study to examine the potential effectiveness of the combined treatment. The treatment consists of 10 behavioral steps, each accompanied by complementary VRET exercises.

This is the first study to examine the feasibility and the potential effectiveness of home-delivered VRET as an adjunct to behavioral treatment for children with SM. The addition of VRET to behavioral treatment has the potential to enhance the generalization and transfer of skills across different situations in a facilitative and engaging way.

•First study applying home delivered VRET for children with selective mutism.•Immersive VR is used to support gradual exposure at home settings.•Each step of the treatment protocol has corresponding VRET exercises.•Study will assess feasibility, usability, and acceptability of the protocol.

First study applying home delivered VRET for children with selective mutism.

Immersive VR is used to support gradual exposure at home settings.

Each step of the treatment protocol has corresponding VRET exercises.

Study will assess feasibility, usability, and acceptability of the protocol.