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Breakthrough success in delivering automated psychotherapy using virtual reality (VR)

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In a breakthrough development, psychotherapy has been automated in virtual reality. Users are led by virtual coaches, so they can reach more patients without the need for physical therapists.

The largest-ever clinical trial of VR for mental health, published in The Lancet Psychiatry, has shown that automated treatments work well for patients diagnosed with psychosis. Those with the most difficult psychological problems experienced the greatest benefits.

The gameChange VR program was developed by a multi-partner team of university, health and industry experts, including OxfordVR, a spin-out of the University of Oxford, creator of immersive technology for mental health. Led by researchers at Oxford Health BRC, it targets a common problem among people diagnosed with psychosis: the intense fear of being outside in everyday situations. For many patients, these fears develop into severe agoraphobia. This means avoiding leaving home and severely disrupting family and friend relationships, education, and careers. gameChange is designed to treat this agoraphobia and allow patients to re-engage in their daily lives. It takes them from a homebound existence back to life in the outside world.

Professor Daniel Freeman, principal investigator and consultant psychiatrist at Oxford Health, said:

“Virtual reality psychotherapy has matured with gameChange. Over the past 25 years, VR has been used in a small number of specialized psychiatric clinics. It supports face-to-face therapy by clinicians. It’s built in so it can be monitored by different staff, and it can be delivered in different settings, such as a patient’s home. People who were largely stuck at home have moved out, and with today’s affordable and easy-to-use consumer VR gear, gameChange can provide treatments that actually work. By deploying the law at scale, we believe we will lead the transformation of the digital delivery of evidence-based psychotherapy.”

gameChange led to avoidance of everyday situations and a significant reduction in distress. However, the patients who benefited the most were those who found it most difficult to leave the house and those who had the most psychiatric symptoms such as severe anxiety, depression, delusions and hallucinations. These patients experienced significant benefits, including being able to perform previously unthinkable activities. These benefits were maintained at 6 months follow-up. Patient feedback has shown that this treatment is very popular and has a very high utilization rate.

Access to effective psychotherapy has been hampered by a shortage of clinicians. This problem is especially acute for those with serious mental health problems such as psychosis. Patients are eager to try psychological interventions but rarely receive them. Automated VR with a built-in virtual coach offers an innovative and effective way to get out of this impasse.

Researcher and clinical psychologist Dr. Felicity Waite said:

“The gameChange program offers an engaging and proactive approach to therapy. In a safe setting, patients learn by doing real-life activities such as buying coffee or riding a bus, and are challenged with real-world challenges.” It helps build confidence to work in. Feedback from participants shows that people of all ages really enjoy the gameChange experience, they find it easy to use, and they are often surprised that it has helped them progress.

NIHR i4i Program Director Professor Mike Lewis said:

“This impressive study demonstrates what the NIHR seeks to achieve through its i4i funding scheme: truly transformative technology that can change people’s lives for the better. We are really excited about the potential to bring the benefits of psychotherapy to more people at home through virtual reality.”

A participant in the gameChange trial commented:

“GameChange therapy has changed my life. I am more confident in myself. I am more confident around other people. I see gameChange helping everyone. I think everyone uses it.

“If anyone has the chance to get virtual reality therapy, I really recommend it because it has made a huge difference to me. After seven years of being ill, I feel so much better.” I was able to make eye contact with people and felt less anxious, walking down the street without having to worry about someone approaching me. I feel more confident on the bus, I feel much more confident than I used to.

The research is funded by a multi-million pound award from the UK Department of Health. This is the National Institutes of Health (NIHR) i4i (Invention for Innovation) Mental Health Challenge Award. It was also supported by the NIHR Oxford Health Biomedical Research Center.