Efficacy of a Virtual Reality Biofeedback Game (DEEP) to Reduce Anxiety and Disruptive Classroom Behavior: A Single-Case Study

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A large proportion of adolescents in special education are affected by clinical levels of anxiety in addition to their profound behavioral and psychiatric problems. Anxiety leads to substantial long-term problems and may be the underlying cause of disruptive behaviors in the classroom. Cleary, interventions to address anxiety and diminish disruptive classroom behaviors in special school settings are needed. This study aimed to evaluate feasibility and efficacy of the virtual reality biofeedback game DEEP to reduce daily levels of state-anxiety and disruptive classroom behavior. Eight adolescents in special education, identified as anxious by their teacher, participated in a single-case experimental A-B-A-B design. Selfreported state-anxiety and teacher-reported classroom behavior were assessed over four weeks during which participants completed six DEEP sessions. In addition, exit-interviews were conducted with adolescents, teachers and school clinicians to gain insight in their perceived feasibility of DEEP. Visual analysis and Nonoverlap of all pairs scores indicated that six out of eight participants decreased in anxiety and four participants decreased in disruptive classroom behavior with the introduction of DEEP. The implementation of DEEP was deemed feasible according to adolescents, teachers and school clinicians, indicating its potential as intervention for anxiety and disruptive classroom behavior in a special school setting. Keywords: anxiety, disruptive classroom behavior, single-case experimental design, applied game, special education
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