Automated Virtual Reality Cognitive Therapy for People With Psychosis: Protocol for a Qualitative Investigation Using Peer Research Methods (Preprint)

Abstract

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.