Impact VR: A Socioemotional Intervention for Reducing CU Traits, Conduct Problems, and Aggression in Youth with Conduct Disorder.

Conduct Disorder (CD) and callous-unemotional (CU) traits are associated with persistent antisocial behavior, emotional processing deficits, and poor treatment response. CU traits designate a subgroup of youth with CD who are at greater risk of violence and long-term mental health challenges. It is well-established that CU traits, CD, and aggression are tied to deficits in emotion recognition, social information processing, and interpersonal functioning, yet few interventions directly target these mechanisms. This randomized controlled trial tested the effects of Impact VR, a brief virtual reality program designed to improve emotion recognition and build social-emotional skills in youth with CD. One hundred and ten youth diagnosed with CD were randomly assigned to either Impact VR or a treatment control group. Youth and caregivers completed assessments at baseline, post-intervention, and 3-month follow-up. Youth in the Impact VR group had lower levels of self-reported and caregiver-reported CU traits at follow-up. Caregiver ratings also indicated that youth who received Impact VR had significantly lower conduct problems at both follow-up time points. Youth reported immediate reductions in reactive aggression, which was sustained until the 3-month follow-up. However, the intervention groups did not significantly differ on proactive aggression. These findings suggest that CU traits may be modifiable through brief, engaging interventions like Impact VR.