Background Many people with psychosis experience difficulties in everyday social situations. Anxiety can make life challenging, leading to withdrawal. Cognitive therapy, using active in vivo learning, enables people to overcome fears. These treatments are not readily available to people with psychosis. Automated virtual reality (VR) therapy is a potential route to increase accessibility. The gameChange automated VR cognitive therapy is designed to help people overcome anxious avoidance and build confidence in everyday social situations. A virtual coach guides the person through the treatment. Understanding user experience is key to facilitating future implementation. Peer research methods, in which people with lived experience of the issues being studied are involved in collecting and analyzing data, may be useful in developing this understanding. This encourages researchers to draw on their lived experience to explore participant perspectives and co-create knowledge. Objective The primary objective is to use a peer research approach to explore the participant experience of a novel automated VR therapy for anxious social avoidance. This includes understanding (1) the experience of anxious social avoidance in people with psychosis, (2) the experience of the gameChange automated VR cognitive therapy, and (3) any potential impact of the therapy in people’s lives. This will inform future implementation strategies. The secondary objective is to explore how peer research can be used to co-create knowledge. Methods Semistructured interviews will be conducted with approximately 25 people with psychosis participating in the gameChange trial (ISRCTN17308399). Participants will be recruited from the five trial centers based in National Health Service mental health trusts across England. Interviews will be conducted by two researchers. One is a peer researcher with similar lived experience to the trial participants. The other has lived experiences of mental health issues that do not directly overlap with those of the trial participants. Interview questions will focus on an individual’s experience of anxious social avoidance, experiences of participating in the gameChange VR therapy, and any changes or impact following therapy. The interview schedule was developed in collaboration with the gameChange Lived Experience Advisory Panel (LEAP), comprising 10 project advisors with lived experience of psychosis. Interpretative phenomenological analysis and template analysis will be used to explore individual accounts. The LEAP will contribute to the analysis. Results Data collection will be conducted from April to September 2021, and analysis will be conducted from June to October 2021. As of September 28, 2021, 20 participants had been interviewed, and coding is underway. Conclusions The study, employing a peer research approach, may provide a unique insight into the experiences of anxious social avoidance in people with psychosis and its treatment using automated VR therapy. This will inform potential future implementation of VR automated therapies in mental health services. International Registered Report Identifier (IRRID) DERR1-10.2196/31742

Background: The Feeling Safe Programme is a cognitive therapy developed to improve outcomes for individuals with persecutory delusions. It is theoretically driven, modular and personalised, with differences in therapeutic style and content compared with first-generation cognitive behavioural therapy for psychosis. Objectives: We set out to understand the participant experience of the Feeling Safe Programme. Design: A qualitative study employing interpretative phenomenological analysis. Methods: Using a peer research approach, semi-structured face-to-face interviews were conducted with six people who had received the Feeling Safe Programme as part of the outcome clinical trial. Results: Participants spoke of feeling 'unsafe' in their daily lives before the intervention. Openness to the intervention, facilitated by identification with the programme name, and willingness to take an active role were considered important participant attributes for successful outcomes. The therapist was viewed as a professional friend who cared about the individual, which enabled trust to form and the opportunity How to cite this article:

BACKGROUND Many people with psychosis struggle in everyday social situations. Anxiety can make life challenging, leading to withdrawal. Cognitive therapy, using active in-vivo learning, enables people to overcome fears. Yet these treatments are not readily available to people with psychosis. Automated virtual reality (VR) therapy may be one route to increase accessibility. The gameChange automated VR cognitive therapy is designed to help people overcome anxious avoidance and build confidence in everyday social situations (such as visiting a café or taking a bus). A virtual coach guides the person through the treatment. Understanding user experience will be key to facilitating future implementation. Peer-research methods, where people with lived experience of issues being studied are involved in collecting and analysing the data, may be useful in developing this understanding. This approach encourages researchers to draw on their lived experience to explore participant perspectives and co-create knowledge. OBJECTIVE The primary objective of this study is to use a peer-research approach to explore the participant experience of a novel automated VR therapy for anxious social avoidance. This includes understanding 1) the experience of anxious social avoidance in people with psychosis, 2) the experience of the gameChange automated VR cognitive therapy, and 3) any potential impact of the therapy in peoples’ lives. This will inform future implementation strategies. The secondary objective is to explore how peer research can be used to co-create knowledge. METHODS Semi-structured interviews will be conducted with approximately 25 people with psychosis who are participating in the gameChange trial (ISRCTN17308399). Participants will be recruited from the five trial centres based in NHS mental health Trusts across England. Interviews will be conducted by two researchers. One is a peer-researcher with similar lived experience of mental health to the trial participants. The other has lived experience of mental health issues that do not directly overlap with those of the trial participants. Interview questions will focus on an individual’s experience of anxious social avoidance, the experience of participating in the gameChange VR therapy, and any changes or impact following the therapy. The interview schedule was developed in collaboration with the gameChange Lived Experience Advisory Panel (LEAP); a group of ten project advisors with lived experience of psychosis. Interpretative Phenomenological Analysis and Template Analysis will be used to explore individual accounts as well as convergence and divergence across the sample. The LEAP will contribute to the analysis. RESULTS Data collection will be conducted April - August 2021, analysis conducted June – October 2021. CONCLUSIONS The study, employing a peer-research approach, may provide a unique insight into experiences of anxious social avoidance in people with psychosis and its treatment using automated VR therapy. This will inform potential future implementation of VR automated therapies in mental health services.

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