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  • Status:: Closed

Many patients with psychosis experience everyday social situations as anxiety-provoking. The fears can arise, for example, from paranoia, hallucinations, social anxiety, or negative self-beliefs. The fears lead patients to withdraw from activities, and this isolation leads to a cycle of worsening physical and mental health. Breaking this cycle requires highly active treatment directly in troubling situations so that patients learn that they can safely and confidently enter them. However, patients with psychosis seldom receive such life-changing interventions.

To solve this problem researchers have developed an automated psychological treatment delivered in Virtual Reality (VR). It allows patients to experience computer simulations of the situations that they find anxiety-provoking (e.g. a street, a shop, a café, a GP surgery). A virtual coach guides patients, using cognitive techniques, in how to overcome their fears. Patients are willing to enter VR simulations of anxiety-provoking situations because they know the simulations are not real, but the learning made still transfers to the real world. The aim of the study is to test whether the automated VR therapy works (i.e. reduces anxiety and avoidance of social situations).

Participants are randomly allocated to the automated VR cognitive treatment added to treatment as usual, or treatment as usual. The VR treatment comprises about six 30-minute (half an hour) sessions. Assessments are conducted at the start of the study and after 6 and 26 weeks to measure avoidance and distress in real-life situations, psychiatric symptoms, activity levels, and quality of life.


Study design Randomisation to automated virtual reality cognitive therapy (in addition to treatment as usual) or to treatment as usual
Sponsor Clinical Trials Research Governance
Ethical approval 19/SC/0075
Chief Investigator Prof Daniel Freeman, Department of Psychiatry
Main point-of-contact Ariane Petit, Department of Psychiatry

Study website:

Study protocol: DOI: 10.1136/bmjopen-2019-031606

Main trial results: DOI: 10.1016/S2215-0366(22)00060-8