Researchers at the University of Oxford have developed a virtual reality (VR) based cognitive therapy (CBT) tool that helps patients recover from agoraphobic psychosis by participating in simulated real-world scenarios.
Image Credit: University of Oxford. (2022) Breakthrough success in provision of automated psychological therapy using virtual reality. [online] Available at: https://www.ox.ac.uk/news/2022-04-05-breakthrough-success-provision-automated-psychological-therapy-using-virtual-reality
The gameChange tool automates the delivery of cognitive-behavioral therapy. Tools such as this, enabled by immersive technologies like virtual reality (VR), promise to significantly increase the availability of effective therapies to patients with psychosis.
Virtual reality psychological therapy has come of age with gameChange. Over the past 25 years VR has been used in a small number of specialist mental healthcare clinics. It has supported in-person therapy delivered by a clinician. However, with gameChange, the therapy is built in, so it can be overseen by a range of staff. And it can be delivered in a variety of settings, including patients’ homes.
Prof. Daniel Freeman, Department of Psychiatry, University of Oxford
An Introduction to Cognitive Behavioral Therapy
Cognitive-behavioral therapy is a method that treats psychoses such as depression and anxiety by targeting distorted thoughts, beliefs and attitudes. It thereby improves associated behaviors and provides sufferers with efficient coping mechanisms.
It is based on the principle that people suffering from psychological disorders can learn ways of coping and functioning better in their daily lives. Role-playing is one of the many effective methods employed in CBT therapy.
It has been shown that many psychotic disorders lead to agoraphobia, a condition whereby sufferers experience intense fear about being outside or encountering everyday social situations. Consequently, they lock themselves in their homes, and avoid normal activities like shopping or catching the bus, which can have a negative effect on their mental and physical wellbeing.
Developing a Virtual Cognitive Therapy
Although CBT has been shown to be effective for treating a wide range of psychological disorders, there remains an acute shortage of qualified therapists. Immersive virtual reality tools offer a potential solution to this challenge. Not only do patients not need a therapist to participate, but they can also participate in anxiety-producing real-life scenarios while being safe in the knowledge these are only simulated.
The gameChange trial is a project that aims to directly address these concerns. It is funded by the UK National Institute for Health Research and developed by a multidisciplinary team from the University of Oxford, Oxford VR, the McPin Foundation, the Royal College of Art, NIHR MindTech, and nine UK health authorities. Professor Daniel Freeman of the University of Oxford’s Department of Psychiatry leads the team.
In gameChange, users simply put on a headset (HTC Vive Pro) and start the program. They do not need any additional cameras, cables or computers.
GameChange: clips of the VR therapy in progress
Video Credit: GameChange: clips of the VR therapy in progress. University of Oxford/Youtube.com
With the increasing affordability and availability of VR headsets, patients could have increased access to therapy while retaining access to qualified clinicians where required; gameChange promises the large-scale delivery of many types of clinical services.
Treating Psychosis with Virtual Cognitive Therapy
The Oxford led trial is the first controlled, randomized trial for automated VR therapy on patients with psychosis. It is also the largest test of any virtual reality therapy applied to a mental health condition.
Eligible patients were selected from a pool of 551 candidates between July 25, 2019, and May 7, 2021 (with a six-month pause in recruitment due to COVID-19) — 346 patients were eventually enrolled. They had to be 16 years old or over, clinically diagnosed with an affective disorder with psychotic symptoms (or schizophrenia spectrum disorder), and had self-reported difficulties with going outside due to anxiety.
Patients were randomly assigned to a usual course of therapy (174 patients) or usual therapy plus gameChange VR therapy (172 patients); gameChange therapy was delivered over six sessions in six weeks. Each session lasted 30 minutes. Mental health workers were present in the room while the therapy was being delivered.
In gameChange, a virtual therapist guides the patient through simulated scenarios designed to lower their defenses. As a first step, patients entered the coach’s virtual office and were given instructions.
They were then given the option to choose between six virtual scenarios — A cafe, a pub, a shop, waiting for the bus, a doctor’s waiting room and opening the front door of their home. Each scenario represented five levels of difficulty — based on the degree of social interaction — and patients worked through them, responding to questions by touching a virtual ball or moving a virtual slider.
The primary outcome of the therapy was the avoidance of everyday situations as assessed by the self-reported Oxford Agoraphobic Avoidance Scale (O-AS). Compared with the usual therapy group, the gameChange VR group displayed significant reductions in agoraphobic avoidance and distress after six weeks.
We are delighted that gameChange has produced excellent results for people with some of the most challenging mental health problems. Individuals who were largely housebound have got back outside. Using today’s affordable and easy-to-use consumer VR equipment, we think gameChange will lead a transformation in the digital provision of evidence-based psychological therapy, with deployment at scale for treatments that really work.
Prof. Daniel Freeman, Department of Psychiatry, University of Oxford
This opens up unique opportunities for the delivery of clinical services in an overstretched workforce.
References and Further Reading
Freeman, D., et al., (2022) Automated virtual reality therapy to treat agoraphobic avoidance and distress in patients with psychosis. The Lancet Psychiatry. [online] Available at: https://www.sciencedirect.com/science/article/pii/S2215036622000608?via%3Dihub
University of Oxford. (2022) Breakthrough success in provision of automated psychological therapy using virtual reality. [online] Available at: https://www.ox.ac.uk/news/2022-04-05-breakthrough-success-provision-automated-psychological-therapy-using-virtual-reality
gameChangeVR. Improving lives through VR therapy. [online] Available at: https://gamechangevr.com
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