What we do

Our goal is to enable state-of-the-art virtual reality therapy for mental health issues to be delivered by the NHS

The challenge:

How can we improve outcomes for people with severe mental health difficulties?

Everyday tasks – getting on a bus, doing the shopping, speaking to other people – become very challenging

The issue is an urgent one: all too often, individuals with psychosis find day-to-day life so anxiety-provoking that they simply withdraw. Everyday tasks — getting on a bus, doing the shopping, speaking to other people — become very challenging. Work and home life suffer. And mental and physical health deteriorate.

Psychological therapy can be very beneficial here. But it needs to be the right kind of therapy. What works best is active coaching in the situations that trouble people, helping patients move beyond their fears. However, this is difficult without a skilled therapist who has the time to get out and about with patients. And patients often find the idea frightening. The result is that a potentially powerful treatment is seldom actually delivered.

The solution:

This is why we’re so delighted to be the first winners of the NIHR i4i Mental Health Challenge Award. We believe it will enable us to help transform the lives of many NHS patients with severe mental health problems, dramatically increasing access to the most effective types of psychological intervention. How will we do this? By delivering high quality automated psychological therapy using state-of-the-art immersive virtual reality technology.

In our VR we take people into sophisticated simulations of the real-life scenarios they find troubling. We do it in a graded way, so patients aren’t presented with situations they really can’t cope with at first. And we make it fun. Patients find it easier to do this work in the virtual world – and they enjoy using our VR applications. As one of our pilot study patients commented: “It’s an incredible experience.” But the beauty is that the benefits transfer to the real world.

One of the most innovative features of our VR is our virtual therapist. A friendly computer-generated avatar, voiced by a real person, carefully guides the patient through the therapeutic work, helping them practise techniques to overcome their difficulties. In effect, the treatment is automated, making it a low-cost yet effective complement to existing care.

gameChange:

gameChange comprises three main stages. First is the design and development of the VR treatment, building on the work we’ve done over many years. Completely re-programming our treatment we will produce a six session automated treatment that’s easy to use, engaging, and right for patient needs. Stage two is a large multi-centre clinical trial in NHS trusts across the country to demonstrate the benefits of the VR treatment. The third part of the project will see us develop an implementation package and roadmap to roll out the treatment across the NHS.  Watch our video to find out more. 

Short video:

Transcription 

Intertitle: gameChange is for people with psychosis who get anxious in everyday social situations. This is a common problem.

Person 1: It’s like having like a pain in your chest all the time. It’s a heavy weight on your chest. And you feel like worried to meet somebody or to go to see a GP or to go on the bus. It’s very hard.

Intertitle: the gameChange VR therapy allows a person to practise being in simulations of everyday situations. The gameChange simulations are a café, shop, pub, street, doctor’s surgery, and a bus.

Person 2: Now let’s say you’re in this shop situation and you start having some kind of worry and then, I don’t know, you find a way within the VR to overcome that worry and maybe like when you’re in the real world you have the exact same worry and you’re like, “Now what did I do in the VR? Oh, I did such a thing.” And then you can try in the real world ‘cause you practiced it over and over again in the VR.

Intertitle: People with lived experience of psychosis have helped designed the VR therapy.

Dr Thomas Kabir (McPin Foundation): gameChange has basically been shaped in every aspect by the experiences of people who have psychosis so fundamentally people with lived experience have been involved in every area of this study and have been enormously influential. There is a group which has basically selected each of the different scenarios which are used in gameChange, including the GP surgery, the street, going to a pub, going to have a cup of coffee in a busy shopping centre. Those have all been selected by people with lived experience and indeed what people do in those environments has also been massively influenced by workshops which have been held and meetings which have been held with people with lived experience of psychosis.

Intertitle: The VR therapy is being tested in a clinical trial taking place in Bristol, Manchester, Newcastle, Nottingham, and Oxford.

Prof Daniel Freeman (University of Oxford): We’re very excited about the gameChange VR therapy. It is an easy to use step-by-step program to help people be more confident in everyday situations. But it’s important we test it in a clinical trial to find out whether it works as we hope. 

Full-length video:

Transcription

Intertitle: gameChange is for people with psychosis who get anxious in everyday social situations. This is a common problem.

Person 1: Sometimes people can’t get out of the house to do something, the worry about so much in themselves before they go out, that is, that they feel they can’t do it at all.  So they avoid doing it.

Person 2: It’s like having like a pain in your chest all the time. It’s a heavy weight on your chest. And you feel like worried to meet somebody or to go to see a GP or to go on the bus. It’s very hard.

Person 3: I feel paranoid. I feel scared about leaving the house.

Intertitle: the gameChange VR therapy allows a person to practise being in simulations of everyday situations. The gameChange simulations are a café, shop, pub, street, doctor’s surgery, and a bus.

Person 4: It should be a good way to try out the things that you’re scared of and sort of like learn that it’s not as scary as it actually is.

Person 2: I would say try it and give it a go and you can do it at your own pace and you can change and you can stop when you like.

Person 3: Yeah I’ve never done it before so the first time I tried it so the first time I tried it I was like, “Whoa!  This is really good.’” So, it’s like fun, it’s a fun thing to do. It’s a fun concept. You put on the headset and you can see and you can hear all the different situations so you use the virtual reality to help you with your thoughts and feelings and your confidence. And then when you go back into the real world you might feel a bit better.

Person 4: Now let’s say you’re in this shop situation and you start having some kind of worry and then, I don’t know, you find a way within the VR to overcome that worry and maybe like when you’re in the real world you have the exact same worry and you’re like, “Now what did I do in the VR? Oh, I did such a thing.” And then you can try in the real world ‘cause you practiced it over and over again in the VR.

Intertitle: People with lived experience of psychosis have helped designed the VR therapy.

Dr Thomas Kabir (McPin Foundation): gameChange has basically been shaped in every aspect by the experiences of people who have psychosis so fundamentally people with lived experience have been involved in every area of this study and have been enormously influential. There is a group which has basically selected each of the different scenarios which are used in gameChange, including the GP surgery, the street, going to a pub, going to have a cup of coffee in a busy shopping centre. Those have all been selected by people with lived experience and indeed what people do in those environments has also been massively influenced by workshops which have been held and meetings which have been held with people with lived experience of psychosis. So, I think people with lived experience, I have just been astounded really be how much influence they’ve had and it’s been a pleasure to see just how quickly and how far things have come.

Intertitle: The VR therapy is being tested in a clinical trial taking place in Bristol, Manchester, Newcastle, Nottingham, and Oxford.

Prof Daniel Freeman (University of Oxford): We’re very excited about the gameChange VR therapy. It is an easy to use step-by-step program to help people be more confident in everyday situations. But it’s important we test it in a clinical trial to find out whether it works as we hope. 432 patients across five centres in England will take part in the gameChange trial. Half of the people taking part will receive the VR therapy and half will not. We then see how the people who’ve had the VR therapy get on compared with people who haven’t had the VR therapy. Whether a person has the VR therapy is decided by chance. Everyone in the trial has an assessment in the beginning which is then repeated after six weeks and six months. By the end of the gameChange trial we will know whether we have a powerful new treatment for use with patients across the NHS.

Recent tweets

Department of Psychiatry
University of Oxford
Warneford Hospital
Oxford, OX3 7JX

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