A safe place to learn: a peer research qualitative investigation of automated virtual reality cognitive therapy (gameChange)

Background Automated virtual reality (VR) therapy has the potential to increase access to evidence-based psychological treatments substantially. The results of a multi-centre randomised controlled trial show 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 the participant experience of gameChange VR therapy. This in-depth experiential exploration of the user experience may inform implementation in clinical services and future VR therapy development. Method Peer-led semi-structured remote interviews were conducted with twenty people with a diagnosis of psychosis who had received gameChange as part of the clinical trial (ISRCTN17308399). Data were analysed using Interpretative Phenomenological Analysis and Template Analysis. A multi-perspectival approach was taken to explore subgroups. Credibility checks were conducted with the study Lived Experience Advisory Panel. Results Participants reported the significant impact before the VR intervention of anxious avoidance on their lives, leaving some 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 to 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 practise and distilling key messages, with support from the delivery staff member. Conclusion 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 presentation of stimuli that induces the original anxious fears yet allows 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 maintenance of the sense of control are likely to facilitate implementation.