Agoraphobic avoidance in patients with psychosis: Severity and response to automated VR therapy in a secondary analysis of a randomised controlled clinical trial

TY - JOUR

T1 - Agoraphobic avoidance in patients with psychosis

T2 - Severity and response to automated VR therapy in a secondary analysis of a randomised controlled clinical trial

AU - Freeman, Daniel

AU - Lambe, Sinéad

AU - Galal, Ushma

AU - Yu, Ly Mee

AU - Kabir, Thomas

AU - Petit, Ariane

AU - Rosebrock, Laina

AU - Dudley, Robert

AU - Chapman, Kate

AU - Morrison, Anthony

AU - O'Regan, Eileen

AU - Murphy, Elizabeth

AU - Aynsworth, Charlotte

AU - Jones, Julia

AU - Powling, Rosie

AU - Grabey, Jenna

AU - Rovira, Aitor

AU - Freeman, Jason

AU - Clark, David M.

AU - Waite, Felicity

N1 - Funding Information: The work was funded by the National Institute for Health and Care Research ( NIHR ) invention for innovation (i4i) programme (Project II-C7-0117-20001 ). It was also supported by the NIHR Oxford Health Biomedical Research Centre ( BRC-1215-2000 ). DF is an NIHR Senior Investigator. This paper presents independent research funded by the NIHR . The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. FW is funded by a Wellcome Trust Clinical Doctoral Fellowship ( 102176/B/13/Z ). We thank the trial participants and the gameChange Lived Experience Advisory Panel. Publisher Copyright: © 2022 The Authors

PY - 2022/12/1

Y1 - 2022/12/1

N2 - Background: The social withdrawal of many patients with psychosis can be conceptualised as agoraphobic avoidance due to a range of long-standing fears. We hypothesised that greater severity of agoraphobic avoidance is associated with higher levels of psychiatric symptoms and lower levels of quality of life. We also hypothesised that patients with severe agoraphobic avoidance would experience a range of benefits from an automated virtual reality (VR) therapy that allows them to practise everyday anxiety-provoking situations in simulated environments. Methods: 345 patients with psychosis in a randomised controlled trial were categorised into average, moderate, high, and severe avoidance groups using the Oxford Agoraphobic Avoidance Scale. Associations of agoraphobia severity with symptom and functioning variables, and response over six months to brief automated VR therapy (gameChange), were tested. Results: Greater severity of agoraphobic avoidance was associated with higher levels of persecutory ideation, auditory hallucinations, depression, hopelessness, and threat cognitions, and lower levels of meaningful activity, quality of life, and perceptions of recovery. Patients with severe agoraphobia showed the greatest benefits with gameChange VR therapy, with significant improvements at end of treatment in agoraphobic avoidance, agoraphobic distress, ideas of reference, persecutory ideation, paranoia worries, recovering quality of life, and perceived recovery, but no significant improvements in depression, suicidal ideation, or health-related quality of life. Conclusions: Patients with psychosis with severe agoraphobic avoidance, such as being unable to leave the home, have high clinical need. Automated VR therapy can deliver clinical improvement in agoraphobia for these patients, leading to a number of wider benefits.

AB - Background: The social withdrawal of many patients with psychosis can be conceptualised as agoraphobic avoidance due to a range of long-standing fears. We hypothesised that greater severity of agoraphobic avoidance is associated with higher levels of psychiatric symptoms and lower levels of quality of life. We also hypothesised that patients with severe agoraphobic avoidance would experience a range of benefits from an automated virtual reality (VR) therapy that allows them to practise everyday anxiety-provoking situations in simulated environments. Methods: 345 patients with psychosis in a randomised controlled trial were categorised into average, moderate, high, and severe avoidance groups using the Oxford Agoraphobic Avoidance Scale. Associations of agoraphobia severity with symptom and functioning variables, and response over six months to brief automated VR therapy (gameChange), were tested. Results: Greater severity of agoraphobic avoidance was associated with higher levels of persecutory ideation, auditory hallucinations, depression, hopelessness, and threat cognitions, and lower levels of meaningful activity, quality of life, and perceptions of recovery. Patients with severe agoraphobia showed the greatest benefits with gameChange VR therapy, with significant improvements at end of treatment in agoraphobic avoidance, agoraphobic distress, ideas of reference, persecutory ideation, paranoia worries, recovering quality of life, and perceived recovery, but no significant improvements in depression, suicidal ideation, or health-related quality of life. Conclusions: Patients with psychosis with severe agoraphobic avoidance, such as being unable to leave the home, have high clinical need. Automated VR therapy can deliver clinical improvement in agoraphobia for these patients, leading to a number of wider benefits.

KW - Agoraphobia

KW - Hallucinations

KW - Paranoia

KW - Schizophrenia

KW - Therapy

KW - Virtual reality (VR)

UR - http://www.scopus.com/inward/record.url?scp=85141341031&partnerID=8YFLogxK

U2 - 10.1016/j.schres.2022.10.008

DO - 10.1016/j.schres.2022.10.008

M3 - Article

C2 - 36343472

AN - SCOPUS:85141341031

SN - 0920-9964

VL - 250

SP - 50

EP - 59

JO - Schizophrenia Research

JF - Schizophrenia Research

ER -