The i4i Mental Health Challenge Award: Immersive virtual reality to transform the lives of patients with psychosis (gameChange)

The National Institute of Health Research (NIHR) have funded our group to enable state-of-the-art psychological therapy to be delivered via virtual reality (VR) in the NHS, in a project that brings together a team of NHS trusts, universities, a mental health charity, the Royal College of Art, and a University of Oxford spin-out company.

'Our project will see one of the most exciting and powerful new technologies implemented in the NHS for the first time” said the project lead, Professor Daniel Freeman from Oxford University’s Department of Psychiatry.

'Virtual reality treatment can help patients transform their lives. When people put on our headsets, a virtual coach takes them into computer-generated simulations of the situations they find troubling.

'The coach guides the patient through these scenarios, helping them practise techniques to overcome their difficulties. Patients often find it easier to do this work in the virtual world – and they enjoy using our VR applications – but the beauty is that the benefits transfer to the real world,' said Professor Freeman, who is also a clinical psychologist at Oxford Health NHS Foundation Trust.

'Our new treatment is automated – the virtual coach leads the therapy – and it uses inexpensive VR kit, so it has the potential for widespread use in the NHS. We’re inspired by the opportunity VR provides to increase dramatically the number of people who can access the most effective psychological therapies.'

'Realising this ambition will require much work, but our amazing team of patients, NHS staff, researchers, and designers has all the capabilities to achieve it. Over the next three years this major investment should lead to real and positive change in services for patients.'

There are three main stages to the project: a design phase to ensure the VR treatment is simple to use, engaging, and right for patient needs; a large multi-centre clinical trial in NHS trusts across the country, to demonstrate the benefits of the VR treatment; and making a roadmap to roll out the treatment across the NHS.

Please see:

NIHR Blog - Virtual benefits for the real world

GameChange

The Feeling Safe Study

Funded by the NHS National Institute of Health Research (NIHR).

We are evaluating in a randomised controlled trial a new targeted, personalised treatment for severe paranoia.

The Feeling Safe Study is registered with the ISRCTN.

Immersive Virtual Reality Cognitive Treatment (VRCT) for persecutory delusions

Funded by the Medical Research Council.

Many patients have difficulties going into situations with other people present. We are testing whether virtual reality can help individuals with persecutory delusions feel safer. We are using virtual reality environments to help patients practice being with others. The trial is funded by the Medical Research Council.

SleepWell

SleepWell is a feasibility randomised controlled trial (RCT) which aims to find out if treating sleep problems reduces the risk of serious mental health problems in young people, aged 14 - 25 years.

Poor sleep is a casual factor in many mental health problems. Treating sleep problems leads to improvements in mental health. We want to find out if treating sleep problems reduces the risk of developing a serious mental health problem in young people who are having psychotic-like experiences (such as feeling excessive mistrust, or hearing voices).

In an initial case series with 12 young people, the results of our newly developed a psychological intervention for sleep problems were highly promising. Interviews with the people who participated in the case series found that the intervention was engaging and sleep problems were something that young people wanted support with.

The SleepWell trial will now work with forty young people (aged 14-25 years) to test the feasibility of treating sleep problems in young people at high risk of psychosis. The results of this study will determine whether a larger and more conclusive trial of our psychological intervention can take place. Details of how we will carry out the study can be found in our published trial protocol.

The SleepWell trial is funded by the NIHR Research for Patient Benefit (RfPB). We work with the McPin Foundation to involve young people in the design and delivery of the project.

Read the results of our 12-person case series.

Find out what it was like to have the treatment for sleep problems.

The SleepWell trial is registered with the ISRCTN.

If you have any questions about any aspect of this project, please contact the study team at sleepwell@psych.ox.ac.uk.

The Oxford Psychological Investigation of Coronavirus (TOPIC)

This study is being carried out by our team and with colleagues in the Department of Experimental Psychology. The research is funded by the NIHR Oxford Health Biomedical Research Centre. This study has been approved by the University of Oxford Central University Research Ethics Committee (R69638).

The study is open to any adult (18 years or older) who is resident in the UK. The aim of the survey is to understand the psychological factors that may lead to mental health difficulties in the wake of the coronavirus pandemic. This information will be used to provide better psychological treatment.  If we understand the psychological causes then therapy can be better targeted - and therefore more successful.

We will be repeating the survey at three time points (now, and again in approximately three and six months) to understand how responses to the pandemic may change over time.

Approximately 20,000 people are likely to complete the survey.

If you have any questions about any aspect of this project, please contact the study team at TOPIC@psych.ox.ac.uk. We will do our best to answer your query.

See below for the information sheet for this study:

TOPIC Participant Information Sheet

OCEAN

The Oxford Coronavirus Explanations, Attitudes, and Narratives (OCEAN) project is a series of studies focussed on excessive mistrust about the COVID-19 virus, lockdown guidance, and medical interventions. In particular, we aim to understand conspiracy beliefs and vaccine hesitancy and to develop methods to counter misinformation. The results of our first survey are published in the Coronavirus conspiracy beliefs, mistrust, and compliance with government guidelines in England paper.

Oxford Virtual Reality (VR) for Mental Health

For over 15 years we have combined clinical psychological science with the best immersive VR technologies to assess, understand, and treat mental health problems.

Patient and Public Involvement (PPI)

We are committed to significant patient and public involvement in our studies. Therefore we have formed a close collaboration with the McPin Foundation, a charity that exists to transform mental health research by putting the lived experience of people affected by mental health problems at the heart of research methods and the research agenda. We have a Lived Experience Advisory Panel (LEAPS) for the research group, and further LEAPs set up for specific projects. These groups are facilitated by McPin, and advise on study ideas, the conduct of projects, and dissemination. LEAP members have also taken part as researchers on our qualitative studies.

MRC Senior Clinical Fellowship: Understanding and treating persecutory delusions

UNDERSTANDING AND TREATING PERSECUTORY DELUSIONS: AN INTERVENTIONIST-CAUSAL MODEL APPROACH

MEDICAL RESEARCH COUNCIL SENIOR CLINICAL FELLOWSHIP AWARD TO PROF FREEMAN

Paranoia denotes the fear that others intend to cause you harm. Like other psychiatric problems such as fears and phobias, there is a spectrum of severity of paranoia. It occurs most dramatically as delusions of persecution, but is related to suspicious thoughts that occur in 10-20% of the general population. There is a pressing need to develop better treatment. One way to achieve this is to draw upon knowledge of the causes of the problem.  If a potential factor is causal, then by deliberately increasing or decreasing it there will be an effect on paranoia. In a unique programme, a series of studies will be carried out that takes such an approach to paranoia. Interventionist studies provide techniques that can be incorporated into treatments; this has been particularly demonstrated for anxiety disorders and the aim is to emulate this for paranoia. The final study will bring together all Prof Freeman's work in a test of a new treatment package for persecutory delusions. 

NHS NIHR Research Professorship: Overcoming Persecutory Delusions

Persecutory delusions (unfounded beliefs that others intend harm) occur in over 70% of patients with diagnoses of schizophrenia. Examples of such beliefs include: “My neighbours are spreading nasty rumours and tormenting me”, “An evil spirit is out to kill me”. This major psychotic experience is a key treatment target. The delusion has substantial impact for patients (and their families), including isolation, suicidal ideation, and hospital admission. Yet too many patients do not adequately respond to current treatments.

Translating advances in understanding the causes of the delusions into treatment, Professor Freeman has been developing a new targeted psychological intervention. During the NIHR Professorship the new treatment will be evaluated in a randomised controlled trial. The goal at this stage is recovery in persistent persecutory delusions for 50% of patients. Improvements in psychological well-being and activity levels are also predicted.

Work will also be carried out during the award to ready the intervention for implementation in the NHS. The promise is of a major improvement in outcome, using an intervention that patients want and that health professionals have the confidence to use.

Part of the Sleep and Circadian Neuroscience Institute (SCNI) Funded by the Wellcome Trust

Better Sleep Trial (BeST)

Funded by the National Institute for Health Research.

This trial evaluated a Cognitive Behavioural Therapy (CBT) intervention for insomnia for individuals with delusions and/or hallucinations within the context of a diagnosis of psychosis. The trial was funded by the National Institute for Health Research. 

Self Confidence Study

Funded by the Medical Research Council.

This trial evaluated a Cognitive Behavioural Therapy (CBT) intervention for low self-esteem for individuals with persecutory delusions within the context of a diagnosis of psychosis. The trial was funded by the Medical Research Council.

Worry Intervention Trial (WIT)

Funded by the National Institute for Health Research and Medical Research Council’s Efficacy and Mechanism Evaluation programme.

This trial was an evaluation of a Cognitive Behavioural Therapy (CBT) intervention for worry for individuals with persecutory delusions within the context of a diagnosis of psychosis. The trial was funded by the Medical Research Council and the National Institute for Health Research.