Embedding virtual reality social skills training into return-to-work care for depression: A single-arm feasibility pilot with exploratory autistic-trait moderation

Abstract

Aim: To assess the feasibility of embedding virtual reality-based social skills training (SST-VR) into a return-to-work day-care program for major depressive disorder (MDD) and to estimate pre–post change in self-reported social skills, with exploratory moderation by autistic traits. Methods: In this single-arm, add-on pilot at a Japanese psychiatric day-care Re-Work center, 20 adults with MDD (18 men) received six 90-min SST-VR sessions every 2 weeks over approximately 3 months plus the standard Re-Work program. The primary outcome was Kikuchi's Social Skills Scale–18 (KiSS-18); secondary outcomes were social adaptation, social anxiety, and depressive symptoms (self-report). A linear mixed-effects model tested the effects of Time (pre vs post), baseline Autism-Spectrum Quotient (AQ; mean-centered), and their interaction. Feasibility was assessed via attendance and attrition. Results: Attendance was 94.2% with no attrition. KiSS-18 increased from 49.7 ± 10.6 to 53.5 ± 12.4 (p = 0.028; r = 0.56). The model showed significant effects of Time (χ²(1) = 8.11, p = 0.004) and Time × AQ (χ²(1) = 4.46, p = 0.035), suggesting smaller gains at higher AQ (exploratory; restricted AQ range). Emotional processing and stress management subscales improved; secondary outcomes showed no significant change. Bootstrap analyses were consistent with the mixed-model findings. Conclusion: SST-VR was feasible. Because the single-arm add-on design cannot isolate SST-VR–specific effects from concurrent care and nonspecific influences, the KiSS-18 change is hypothesis-generating. Controlled comparisons with Re-Work alone in larger, more diverse samples should test efficacy, include objective behavioral and vocational outcomes, and prospectively evaluate moderation.