NHS approves virtual reality treatment for severe agoraphobia

The National Institute for Health and Care Excellence (NICE) has approved the gameChange virtual reality therapy programme for use in the NHS, to treat severe agoraphobia in patients with psychosis.

The treatment enables patients whose agoraphobia has rendered them largely housebound to practise re-entering everyday situations, gently taking them from a housebound existence to life back in the world outside. It aims to help individuals continue with education, relationships, working life and socialising.

The gameChange VR programme was developed by a multi-partner team of university, health and industry experts including researchers from Oxford Health Biomedical Research Centre (OH BRC).

Agoraphobia is common in people diagnosed with psychosis, who may experience intense fear about being outside in everyday situations.

Trial showed gameChange worked well in patients with psychosis

The decision to recommend gameChange in the NHS was made after a large-scale randomised controlled trial of the technology, led by Professor Daniel Freeman of the University of Oxford, showed that it worked well for patients with psychosis. The trial, published in the Lancet Psychiatry, investigated the benefits of gameChange VR with 346 patients with psychosis in nine NHS trusts.

Patients who took part in the trial were aged 16 years or older, with a clinical diagnosis of a schizophrenia spectrum disorder or an affective diagnosis with psychotic symptoms, and had self-reported difficulties going outside due to anxiety. Patients were randomly assigned to either gameChange VR therapy plus usual care or usual care alone.

The use of gameChange led to significant reductions in the avoidance of everyday situations and in distress. The patients who benefited most 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 were able to undertake activities they had previously found unthinkable – and the benefit was maintained at six-month follow-up.

The researchers wrote that the VR therapy “led to significant reductions in anxious avoidance of, and distress in, everyday situations compared with usual care alone.” They added: “The mediation analysis indicated that the VR therapy worked in accordance with the cognitive model by reducing anxious thoughts and associated protective behaviours…gameChange VR therapy has the potential to increase the provision of effective psychological therapy for psychosis, particularly for patients who find it difficult to leave their home, visit local amenities, or use public transport.”

High-quality therapy for more people

One trial participant said: “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.”

Commenting on the NHS’s decision, Freeman said: “gameChange has been designed in collaboration with people with lived experience and can help patients who are largely housebound get back to everyday activities. gameChange was tested in the largest ever clinical trial of virtual reality for a mental health condition – this trial has led to it becoming the first VR therapy recommended for use in the NHS.

“gameChange can be a way of getting high quality psychological therapy to many more of the people who need it.”

The gameChange research was 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.