A national study, delivered by nine NHS Trusts, including Greater Manchester Mental Health NHS Foundation Trust (GMMH) in Manchester, has found that automated virtual reality (VR) technology can successfully help people recover from mental health problems.
In the largest ever clinical trial of VR for mental health, led by researchers at the University of Oxford and Oxford Health NHS Foundation Trust, and funded by the National Institute for Health Research (NIHR), the automated therapy was shown to work well for patients diagnosed with psychosis. The biggest benefits were experienced by those with the most challenging psychological problems.
In a landmark development, psychological therapy has been automated in virtual reality. With the user guided by a virtual coach, there is no need for a real-life therapist, meaning the treatment can reach many more patients.
The gameChange VR program targets a problem that is common in people diagnosed with psychosis: intense fears about being outside in everyday situations. For many patients, these fears develop into a severe agoraphobia that means they avoid leaving the home, severely disrupting relationships with family and friends, their education, and careers.
gameChange is designed to treat this agoraphobia and help patients re-engage with day-to-day activities. It takes them from a housebound existence to life back in the world outside. With the user guided by a virtual coach, there is no need for a real-life therapist, meaning the treatment can reach many more patients.
Professor Daniel Freeman, lead researcher, Department of Psychiatry, University of Oxford and NIHR Senior Investigator, said:
“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.
“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.”
GMMH joined the gameChange trial in July 2019, and throughout the trial period, worked with 58 service users to deliver and evaluate the therapy in Greater Manchester.
Dr Elizabeth Murphy, gameChange Trial Coordinator and Research Clinical Psychologist, said:
“GMMH agreed to join the gameChange trial to embrace the technological innovation in psychosis treatment, as there is a high prevalence of psychosis in Manchester and the North West. Many people with psychosis experience disabling levels of agoraphobia, and gameChange virtual reality therapy offers high quality, engaging and effective psychological intervention for agoraphobia in psychosis.
“The trial at GMMH recruited service users from seven localities across Greater Manchester, including Bury, Bolton, Salford, Trafford, Manchester, Tameside and Salford, showing a commitment from Greater Manchester to contribute to research and innovation in psychosis treatment.
“Looking to the future, we hope to implement gameChange virtual reality therapy into routine clinical services. This will involve a piloting phase to test the feasibility of implementing the program into a sample of community teams, who are currently treating people with psychosis.”
gameChange led to significant reductions in the avoidance of everyday situations and in distress. However, the patients who benefitted most significantly were those who found it hardest to leave the house, and those with most psychiatric symptoms, such as severe anxiety, depression, delusions, and hallucinations. These patients experienced large benefits – for example, being able to undertake activities they had previously found unthinkable. These benefits were maintained at the six-month follow-up.
Patient feedback showed that the treatment was very popular, with very high up-take rates. It was found that patients are keen to try psychological interventions, but seldom receive them. Automated VR, with an in-built virtual coach, offers an innovative and effective way out of this impasse.
Leo, Service User Co-Producer of the gameChange trial at GMMH, said:
“When I first found out about using virtual reality in recovery work, I questioned how this would all work. After working with a team and trying out their VR software, I gave therapy a go. When I took off the headset, I felt more confident with speaking to people and using eye contact in social situations. I felt as if it had conquered a fear. I know in my heart, for a fact, that if I had found gameChange earlier, my recovery process would have taken half the time it did. It truly showed me the possibilities of using virtual reality for therapy.
“I think gameChange is an important research project that could revolutionise the way therapy is delivered, through the use of virtual reality.”
This research is funded by a multimillion-pound award from the UK Department of Health: the inaugural National Institute for Health Research (NIHR) i4i (Invention for Innovation) Mental Health Challenge Award. It was also supported by the NIHR Oxford Health Biomedical Research Centre.
Professor Mike Lewis, NIHR i4i Programme Director, said:
“This impressive research exemplifies what NIHR aims to achieve through its i4i funding scheme – truly transformational technology that can change people’s lives for the better. We’re really excited about the potential for gameChange to bring the benefits of psychological therapy to many more people in their own homes through the medium of virtual reality.”