Unfinished business in virtual reality: Development and preliminary evaluation of an empty chair intervention grounded in emotion-focused therapy

Abstract

The immersive capabilities of virtual reality (VR) make it a promising medium for psychotherapeutic interventions. This randomized controlled trial aimed to develop and evaluate a VR-based adaptation of Emotion-Focused Therapy for Unfinished Business (EFT-UFB). Specifically, we examined its effects on unresolved emotional experiences, self-compassion, self-protection, self-criticism, and perceived stress. Participants (N = 52) were randomly assigned to either the intervention group (n = 26) or a waitlist control group (n = 26), with assessments conducted at pre-test, post-test, and follow-up. The primary between-group analyses revealed no statistically significant differences between the intervention and control groups at post-test (unfinished business: t(50) = −2.00, p = .051, Cohen's d = −0.38, 95 % CI [−0.77, 0.01]) or at follow-up (t(50) = 0.60, p = .551, d = 0.08, 95 % CI [−0.31, 0.47]). Within the intervention group, unfinished business demonstrated a large pre–post reduction that was sustained at follow-up, whereas other effects were small or transient. Effect size estimates suggested small advantages for the intervention arm across several outcomes, including unfinished business (d = −1.01 vs. 0.44 in controls), self-criticism (Inadequate Self d = −0.47), and perceived stress (helplessness d = −0.33; self-efficacy d = 0.37). Other domains, including self-compassion and self-protection, showed negligible or inconsistent differences. While the VR-based EFT-UFB did not outperform the waitlist condition, these pilot findings provide preliminary evidence of feasibility and potential benefits for unfinished business. Importantly, the intervention was effectively delivered by a non-psychotherapist (a trained psychologist), underscoring its potential scalability within digital mental health applications.