The Evidence Portal

IVRE + ER: Immersive Virtual Reality Environments (IVREs) paired with a Brief Emotion Regulation and Risk Reduction Intervention (ER)

About the program

IVRE + ER is a two-part intervention comprising Emotional Regulation (ER) content and subsequent role-play conducted in Immersive Virtual Reality Environments (IVREs) using virtual reality headsets.

The ER (emotional regulation) component of the intervention aims to enhance ER skills to reduce poor decision-making that can lead to unplanned sex or other health risk behaviours, such as substance use.

Role play activities are then conducted in the virtual reality space to practice emotional regulation skills learned in the ‘ER’ component of the program. In the pilot study for the program, four IVREs (adolescent party, condom purchasing, sexual negotiation, and HIV/STD testing) were developed and tested over several years with 130 youths.

Who does it work for?

IVRE + ER is designed for students aged 12-15 years old. IVRE + ER has only been tested in the USA. A randomized control trial (Hadley et al. 2019) was conducted with 85 participants (44 in the intervention group and 40 in the control group). Study participants were an average of 13 years old and just over half were female (54%). Most participants were Hispanic / Latino (42%) and over two thirds of participants identified as heterosexual. Most participants reported having never had sex and 22% reported ever having used alcohol. Very few participants reported to ever having used marijuana.

IVRE + ER has not been evaluated in Australia or with Aboriginal Australians.

What outcomes does it contribute to?

Positive outcomes:

  • IVRE + ER participants had less difficulty accessing emotion strategies
  • IVRE + ER participants had increased self-efficacy for engaging in sexual risk prevention behaviours

No effect:

  • The program had no effect on measures of participants’ difficulty in emotional awareness
  • The program had no effect on measures of participants’ emotional self-efficacy
  • The program had no effect on measures of participants’ affect dysregulation
  • The program had no effect on measures of participants’ condom use self-efficacy

How effective is it?

Overall, IVRE + ER had mixed effects on client outcomes.

How strong is the evidence?

Mixed research evidence (with no adverse effects):

  • At least one high-quality randomised controlled trial (RCT)/quasi-experimental design (QED) study reports statistically significant positive effects for at least one outcome, AND
  • An equal number or more RCT/QED studies of similar size and quality show no observed effects than show statistically significant positive effects, AND
  • No RCT/QED studies show statistically significant adverse effects

How is it implemented?

IVRE + ER is delivered in classroom settings in groups of 4-8 single gender groups. The program is delivered over 4 weeks and led by two facilitators (one male, one female).

Program activities included didactics and games which are reinforced in the IVRE component. The first two sessions of the program presented the relationship between emotions and behaviours as well as emotion education, such as identifying emotional arousal in oneself through somatic cues, labelling these feelings, and recognizing their sources (“triggers”). The last two sessions of the program taught developmentally appropriate strategies for regulating emotions during moments of decision-making. The program presented connections between ER and peer relationships, and risk behaviours.

Before beginning each IVRE, adolescents were instructed to complete an objective (e.g., purchasing condoms at the pharmacy, asking the physician for an HIV/STD test). The IVRES contained both passive and interactive environmental elements. Passive environmental elements included those events happening in the background that did not directly address the participant (e.g., laughter from a group of teens in the condom purchasing environment) but were designed to contribute to the emotional experience. Interactive elements included events in which an avatar directly approached the participant and attempted to elicit a response from the participant. For example, within the condom purchasing scene, the cashier at the pharmacy asked the participant about whether they liked a particular brand of condoms.

How much does it cost?

The costs for IVRE + ER were not reported in the study.

What else should I consider?

Participants using virtual reality headsets must not be susceptible to virtual reality sickness (a type of virtual motion sickness).

Where does the evidence come from?

1 RCT conducted in the USA with a sample of 84 people (Hadley et al., 2019).

Further resources

Hadley, W, Houck, C, Brown, LK, Spitalnick, JS, Ferrer, M, & Barker, D 2019, ‘Moving beyond role-play: evaluating the use of virtual reality to teach emotion regulation for the prevention of adolescent risk behavior within a randomized pilot trial’, Journal of Pediatric Psychology, vol. 44, pp. 425-435,

Last updated:

09 Dec 2022

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