A Safe Place to Learn: Peer Research Qualitative Investigation of gameChange Virtual Reality Therapy

Abstract

Background Automated virtual reality (VR) therapy has the potential to substantially increase access to evidence-based psychological treatments. The results of a multicenter randomized controlled trial showed that gameChange VR cognitive therapy reduces the agoraphobic avoidance of people diagnosed with psychosis, especially for those with severe avoidance. Objective We set out to use a peer research approach to explore participants’ experiences with gameChange VR therapy. This in-depth experiential exploration of user experience may inform the implementation in clinical services and future VR therapy development. Methods Peer-led semistructured remote interviews were conducted with 20 people with a diagnosis of psychosis who had received gameChange as part of the clinical trial (ISRCTN17308399). Data were analyzed using interpretative phenomenological analysis and template analyses. A multiperspectival approach was taken to explore subgroups. Credibility checks were conducted with the study Lived Experience Advisory Panel. Results Participants reported the substantial impact of anxious avoidance on their lives before the VR intervention, leaving some of them housebound and isolated. Those who were struggling the most with agoraphobic avoidance expressed the most appreciation for, and gains from, the gameChange therapy. The VR scenarios provided “a place to practise.” Immersion within the VR scenarios triggered anxiety, yet participants were able to observe this and respond in different ways than usual. The “security of knowing the VR scenarios are not real” created a safe place to learn about fears. The “balance of safety and anxiety” could be calibrated to the individual. The new learning made in VR was “taken into the real world” through practice and distilling key messages with support from the delivery staff member. Conclusions Automated VR can provide a therapeutic simulation that allows people diagnosed with psychosis to learn and embed new ways of responding to the situations that challenge them. An important process in anxiety reduction is enabling the presentation of stimuli that induce the original anxious fears yet allow for learning of safety. In gameChange, the interaction of anxiety and safety could be calibrated to provide a safe place to learn about fears and build confidence. This navigation of therapeutic learning can be successfully managed by patients themselves in an automated therapy, with staff support, that provides users with personalized control. The clinical improvements for people with severe anxious avoidance, the positive experience of VR, and the maintenance of a sense of control are likely to facilitate implementation.

Agoraphobic avoidance in patients with psychosis: Severity and response to automated VR therapy in a secondary analysis of a randomised controlled clinical trial

“…A peer-led qualitative evaluation of gameChange with 20 participants, analysed without knowledge of the trial results, also found that those individuals who were struggling the most with agoraphobic avoidance gained the most benefits from gameChange ( Bond et al, in press ). The interviews captured how individuals who were housebound and low in mood were often able to do activities subsequently that they had not imagined possible at the start of the VR therapy.…”

“…Patients can overcome anxieties and return to everyday situations, even with a very brief therapy. As a patient in a qualitative study of gameChange described ( Bond et al, in press ): “The everyday situations that I found difficult, the more I practised them in the VR, the more I could get confident and be more confident in day-to-day life. I think because I was learning about it in the VR and practising and practising and practising, I could then take that and build up more confidence and do it in the everyday real world.” This provides great optimism for clinical services providing care to patients with severe difficulties.…”

Application of Immersive VR Serious Games in the Treatment of Schizophrenia Negative Symptoms

“…While VR serious games are gaining popularity for treating various psychological issues, for instance the treatment of anxiety in studies [16,17], our research exclusively centers on addressing the negative symptoms of schizophrenia. By focusing our work in this particular area, we want to have a significant impact on people dealing with the difficult challenges associated with schizophrenia.…”