the virtual reality (VR) tool gameChange was found to reduce agoraphobia symptoms in people diagnosed with schizophrenia or psychotic symptoms. Results of a randomized controlled trial that assessed this tool were published in Lancet Psychiatry.

VR has been explored as an adjunct to cognitive behavioral therapy, but little is known about how well it delivers automated therapy. To find out, the researchers conducted a clinical trial using 9 National Health Service (NHS) trusts in England. They recruited patients aged 16 and over who were diagnosed with schizophrenia spectrum psychosis or an affective diagnosis with psychotic symptoms. The participants reported difficulties leaving home due to anxiety.

Participants received their usual therapy either with or without the gameChange VR tool. The tool encourages participants to let go of defensive behaviors, and delivers coaching around several social scenarios (eg, visiting a coffee shop, entering a waiting room), among other features. The researchers measured changes in symptoms at 6 and 26 weeks.

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Agoraphobia at baseline was present in between 19 to 32% of the 346 total participants. At 6 weeks, threat cognitions and within-situation defensive behaviors lessened in the VR therapy group. The higher the degree of threat and distress feelings at baseline, the greater the treatment benefits with VR therapy. Of the 12 serious adverse events reported, 10 were found by the data and ethics committee as “definitely” or “probably not” related to treatment.

Although the sample size was relatively small, the researchers conclude VR therapy using gameChange was effective for patients with psychosis who have anxiety around leaving the house for everyday situations. “However, we recommend that it is best used with patients with substantial avoidance of or distress in everyday situations,” they clarify.

The researchers also note the impact an automated tool could have on care access. “With suitable supervision arrangements, the therapy can be supported by peer support workers, assistant psychologists, or cognitive-behavioral therapists,” they stated.

“The increasing availability and affordability of standalone VR headsets means that patients could keep the device at home for some time, thereby substantially increasing the amount of therapy received. Automated therapy delivered in easy-to-use standalone VR headsets, with support possible from a large proportion of the mental health workforce, means that gameChange is a therapy that could be delivered on a large scale in clinical services.”


Freeman D, Lambe S, Kabir T, et al. 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. Lancet Psychiat. 2022;9(5):375-388. doi:10.1016/S2215-0366(22)00060-8

This article originally appeared on Psychiatry Advisor