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Virtual-reality assisted CBT for social difficulties: a feasibility study in early intervention for psychosis services

Student thesis: Doctoral ThesisDoctor of Clinical Psychology

Background: People with psychosis often experience social difficulties associated with key psychological processes, such as social anxiety, paranoia, interpersonal sensitivity and fear of negative evaluation. Virtual reality presents a unique opportunity to bring social environments into the therapy room. This study presents a development case-series of virtual-reality assisted cognitive behavioural therapy (VR-CBT) for people with first episode psychosis (FEP) who are experiencing social difficulties.

Methods: Participants were recruited from two South London Early Intervention mental health teams for people experiencing a FEP. Participants received a course of 10 sessions of individual formulation-driven VR-CBT with a focus on improving social functioning. A novel VR environment and therapy package were piloted for the use of the assessment, formulation and treatment of social difficulties. The VR environment was used to conduct exposures, behavioural experiments and to practice coping strategies, which were then translated into the individuals’ real-life environments (e.g. at work, on public transport, in the gym etc). A psychometric assessment was conducted with each participant pre- and post-therapy. A feasibility assessment was conducted, regarding the process of recruitment and retention, required resources and barriers to implementation. To examine acceptability participants also provided qualitative feedback during and after their experiences, and completed an ‘unwanted effects’ questionnaire.

Results: 11 participants were recruited to the study, which was above the target of 6-10. There was a 64% conversion rate from those who were approached to those who consented to participation. There was an 82% retention rate; although several participants therapy was somewhat affected by the Covid-19 pandemic and adjustments had to be made to their participation in the study. An assessment of study resources was completed and identified potential challenges for future implementation. Comparison of the pre- and post-therapy psychometric assessment scores revealed a reliable change on some of the assessed domains for all participants. Participants reported few or no unwanted effects and provided positive feedback about the inclusion of VR in the therapy.

Conclusions: This study presents promising findings from an innovative VR-CBT package for people with FEP who are experiencing social difficulties. It appears to be feasible and acceptable to participants, and potential benefits were derived. However, a number of challenges to implementation were identified that should be carefully considered before further piloting or trailing is attempted. Therapist reflections on using the VR environment in therapy are also presented. The clinical implications and possible future directions for research are considered.

KEYWORDS: Virtual-reality; VR-CBT; psychosis; early intervention; social difficulties; paranoia; social anxiety
Original languageEnglish
Awarding Institution
Award date1 Oct 2020

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