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gameChange: improving lives through VR therapy

gameChange is a landmark virtual reality treatment. It targets the intense anxiety that keeps many people with psychosis from participating in everyday activities. These fears can develop into a severe agoraphobia that means people avoid leaving the home, severely disrupting relationships with family and friends, their education, and working lives.

gameChange is automated: a virtual therapist guides the patient though the program. So, the therapy can be supported by a range of staff: peer support workers, assistant psychologists, or CBT therapists. And it can be delivered in a variety of settings, including patients’ homes.

Funded by the inaugural National Institute for Health and Care Research i4i (Invention for Innovation) Mental Health Challenge Award, the results of 346-person randomised controlled trial have now been published in the Lancet Psychiatry.

The trial results show that gameChange led to significant reductions in the avoidance of everyday situations and in distress. The patients who benefitted most were those with severe agoraphobia and those with the most psychiatric symptoms, such as severe anxiety, depression, delusions, and hallucinations. These patients experienced large benefits – for example, being able to undertake activities they had previously found unthinkable. The benefits were maintained at the six-month follow-up.

gameChange is now available to mental health services through Oxford VR. To find out more: 

gameChange publications

The trial

Freeman, D., Lambe, S., Kabir, T., Petit, A., Rosebrock, L., Yu, L-M., Dudley, R., Chapman, K., Morrison, A., O’Regan, E., Aynsworth, C., Jones, J., Murphy, E., Powling, R., Galal, U., Grabey, J., Rovira, A., Martin, J., Hollis, C., Clark, D.M., Waite, F., & gameChange Trial Group (2022). 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 Psychiatry, 9, 375–388.

Freeman, D., Yu, L-M., Kabir, T., Martin, J., Craven, M., Leal, J., Lambe, S., Brown, S., Morrison, A., Chapman, K., Dudley, R., O’Regan, E., Rovira, A., Goodsell, A., Rosebrock, L., Bergin, A., Cryer, T., Robotham, D., Andleeb, H., Geddes, J., Hollis, C., Clark, D., & Waite, F. (2019). Automated virtual reality (VR) cognitive therapy for patients with psychosis: study protocol for a single-blind parallel group randomised controlled trial (gameChange). BMJ Open, 9:e031606. doi: 10.1136/bmjopen-2019-031606

Agoraphobia in psychosis

Rosebrock, L., Lambe, S., Mulhall, S., Petit, A., Loe, B.S., Saidel, S., Mitchell, J., Aynsworth, C., Murphy, E., Jones, J., Powling, R., Chapman, K., Dudley, R., Morrison, A., O’Regan, E., Clark, D.M., Waite, F., & Freeman, D. (2022). Understanding Agoraphobic Avoidance Across Mental Health Disorders: The Development of the Oxford Cognitions and Defences Questionnaire (O-CDQ). Behavioural and Cognitive Psychotherapy.

Lambe, S., Bird, J., Loe, B., Rosebrock, L., Kabir, T., Petit, A., Mulhall, S., Jenner, L., Aynsworth, C., Murphy, E., Jones, J., Powling, R., Chapman, K., Dudley, R., Morrison, A., O’Regan, E., Yu, L-M., Clark, D., Waite, F., & Freeman, D. (2021). The Oxford Agoraphobic Avoidance Scale. Psychological Medicine, DOI:

Freeman, D., Taylor, K., Molodynski, A., & Waite, F. (2019). Treatable clinical intervention targets for patients with schizophrenia. Schizophrenia Research, 21, 44-50.          

The design of the VR therapy

Knight, I., West, J., Matthews, E., Kabir, T., Lambe, S., Waite, F., & Freeman, D. (2021). Participatory design to create a VR therapy for psychosis. Design for Health, 5, 98-119.

Lambe, S., Knight, I., Kabir, T., West, J., Patel, R., Lister R., Rosebrock, L., Rovira, A., Garnish, B., Freeman, J., Clark, D., Waite, F., & Freeman, D. (2020). Developing an automated VR cognitive treatment for psychosis: gameChange VR therapy. Journal of Behavioural and Cognitive Therapy, 30, 33-40.

The experience of the VR therapy

Brown, P., Waite, F., Lambe, S., Jones, J., Jenner, L., Diamond, D., & Freeman, D. (2022). Automated virtual reality cognitive therapy (gameChange) in inpatient psychiatric wards: qualitative study of staff and patient views using an implementation framework. JMIR Formative Research, 6, e34225

Freeman, D., Rosebrock, L., Waite, F., Loe, B.S., Kabir, T., Petit, A., Dudley, R., Chapman, K., Morrison, A., O’Regan, E., Aynsworth, C., Jones, J., Murphy, E., Powling, R., Peel, H., Walker, H., Bryne, R., Freeman, J., Rovira, A., Galal, U., Yu, L-M., Clark, D.M., & Lambe, S. (2022). Virtual reality (VR) therapy for patients with psychosis: satisfaction and side effects. Psychological Medicine. 

Bond, J., Robotham, D., Kenny, A., Pinfold, V., Kabir, T., Andleeb, H., Larkin, M., Martin, J., Brown, S., Bergin, A., Petit, A., Rosebrock, L., Lambe, S., Freeman, D., & Waite, F. (2021). Automated virtual reality cognitive therapy for people with psychosis: protocol for a qualitative investigation using peer research methods. JMIR Research Protocols, 10(10):e31742.

Brown, P., Waite, F., Lambe, S., Rosebrock, L., & Freeman, D. (2020). Virtual Reality Cognitive Therapy in Inpatient Psychiatric Wards: Protocol for a Qualitative Investigation of Staff and Patient Views Across Multiple National Health Service Sites. JMIR Research Protocols, 9(8), e20300.