Breakthrough success in provision of automated psychological therapy using virtual reality (VR)

5 April 2022

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.

In the largest ever clinical trial of VR for mental health, published today in The Lancet Psychiatry, 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.

The gameChange VR program was developed by a multi-partner team of university, health and industry experts including Oxford University spin-out: OxfordVR, creators of immersive technology for mental health. It is led by researchers at the University of Oxford and Oxford Health NHS Foundation Trust, and 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.

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.’

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.

Access to effective psychological therapies has been hampered by a shortage of clinicians. The problem is especially acute for people with severe mental health difficulties, such as psychosis. 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.

Dr Felicity Waite, clinical psychologist in the Department of Psychiatry, University of Oxford, said:
‘The gameChange program provides an engaging, active therapy. In a safe place, patients learn by doing, practising real-life activities such as buying a coffee or getting on a bus, which helps them develop the confidence to take on real-world challenges. Feedback from participants shows that people of all ages really enjoy the gameChange experience. They find it easy to use. And they are often amazed at the progress it has helped them to make.’

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.’

Participants in the gameChange trial commented:
‘gameChange therapy changed my life. I’m more confident in myself. I’m more confident around other people. I see gameChange helping everyone. I think everyone’s going to be using it.’
‘If anyone has the opportunity to do the virtual reality treatment, I really would recommend it because it’s made a lot of difference to me. After seven years of illness, I do feel so much better. I’ve been able to make eye contact with people more, without feeling really anxious, I’ve been able to walk down a street without worrying about anyone walking towards me. I’m now able to go into a café. I feel much more confident about going on a bus. I just feel so much more confident than I was.’

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.

Notes to editor:

Press Office contact details: Chris McIntyre, Communications Manager (Research & Innovation), University of Oxford.
Direct tel: 01865 270046 News Office tel: 01865 280528 Email: [email protected]

The new study, “Automated virtual reality therapy to treat agoraphobic avoidance and distress in patients with psychosis (gameChange): a multicentre, parallel-group, single-blind, randomised, controlled trial in England with mediation and moderation analyses” https://doi.org/10.1016/S2215-0366(22)00060-8
Images, videos, and other materials for media use from the gameChange project can be found here: https://www.flickr.com/photos/182007125@N02/albums/with/72157709079518647
gameChange was designed in collaboration with people with lived experience of psychosis, with over five hundred hours of patient feedback, facilitated by the McPin

Foundation, a mental health research charity that champions lived experience in research, and the Helen Hamlyn Centre for Design at the Royal College of Art. Over six sessions comprising three hours in VR, users practise being in simulations of everyday situations: a café, shop, pub, street, doctor’s surgery, and a bus. Treatment is personalised: patients can choose what they work on and when, and find the “sweet spot” of safety and challenge in order to overcome their fear. https://gamechangevr.com/

gameChange was trialled with 346 patients with psychosis in nine NHS Trusts across five English regions - Bristol, Manchester, Newcastle, Nottingham, and Oxford:

* Oxford Health NHS Foundation Trust
* Cumbria, Northumberland, Tyne, and Wear NHS Foundation Trust
* Avon and Wiltshire Mental Health Partnership (AWP) NHS Trust
* Greater Manchester Mental Health NHS Foundation Trust
* Nottinghamshire Healthcare NHS Foundation Trust
* Berkshire Healthcare NHS Foundation Trust
* Northamptonshire Healthcare NHS Foundation Trust
* Central and North West London NHS Foundation Trust (Milton Keynes)
* Pennine Care NHS Foundation Trust.

OxfordVR is a digital therapeutics company that develops evidence-based immersive treatments using virtual reality for serious mental illness. A spin out of Oxford University, our treatments are built on more than 25 years of research from Professor Daniel Freeman of Oxford University. The company has amassed a strong foundation of clinical validation through multiple clinical trials and real-world deployments since its inception in 2017. OxfordVR is dedicated to improving world class access to mental health using immersive technology to automate gold-standard treatments like cognitive behavioural therapy (CBT) without the need to rely on increasingly scarce and expensive clinical resources. www.ovrhealth.com
The University Department of Psychiatry’s mission is to conduct world-class research, teach psychiatry to medical students, develop future researchers in a graduate programme, teach doctors in training, promote excellence in clinical practice, and develop and provide innovative clinical services. It supports research in four key areas: neurobiology, psychological treatments, developmental psychiatry and social psychiatry. The Department is committed to the translation of scientific discovery into benefits for patients. www.psych.ox.ac.uk
Oxford University has been placed number 1 in the Times Higher Education World University Rankings for the sixth year running, and 2 in the QS World Rankings 2022. At the heart of this success is our ground-breaking research and innovation.
Oxford is world-famous for research excellence and home to some of the most talented people from across the globe. Our work helps the lives of millions, solving real-world problems through a huge network of partnerships and collaborations. The breadth and interdisciplinary nature of our research sparks imaginative and inventive insights and solutions.
Through its research commercialisation arm, Oxford University Innovation, Oxford is the highest university patent filer in the UK and is ranked first in the UK for university spinouts, having created more than 200 new companies since 1988. Over a third of these companies have been created in the past three years. The university is a catalyst for prosperity in Oxfordshire and the United Kingdom, contributing £15.7 billion to the UK economy in 2018/19, and supports more than 28,000 full time jobs.

Oxford Health NHS Foundation Trust (OHFT) provides physical, mental health and social care for people of all ages across Oxfordshire, Buckinghamshire, Swindon, Wiltshire, Bath and North East Somerset. Our services are delivered at community bases, hospitals, clinics and people’s homes. We focus on delivering care as close to home as possible.
As a leading teaching, training and research trust, we have close links to Oxford and Oxford Brookes, Buckinghamshire, Reading and Bath universities. We are part of the Oxford Academic Health Science Centre, working closely with our university colleagues to translate their findings into clinical care as quickly as possible, enabling people using our services to benefit from the latest advances in healthcare. We host the NIHR Oxford Health Biomedical Research Centre with Oxford University, and aim to bring the best science to the complex problems of mental disorders and dementia. We also host the NIHR Applied Research Collaboration Oxford and Thames Valley; a partnership between universities, healthcare, charities and industry, that aims, through applied health research, to co-produce better, more equitable, appropriate and sustainable health and care across the region. www.oxfordhealth.nhs.uk

National Institute for Health Research (NIHR)
The mission of the National Institute for Health Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:
Funding high quality, timely research that benefits the NHS, public health and social care;
Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.

NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK Aid from the UK government.

The NIHR Oxford Health Biomedical Research Centre is a partnership between Oxford Health NHS Foundation Trust and the University of Oxford.
The mission of the National Institute for Health Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:
Funding high quality, timely research that benefits the NHS, public health and social care;
Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.

NIHR is funded by the Department of Health and Social Care. Its work in low and middle income countries is principally funded through UK Aid from the UK government.