VR therapy for psychosis (gameChange)

Domain IX · Biomedical, neuro & digital · Daniel Freeman · 2022 · Oxford

What it is

gameChange is an automated, immersive virtual reality (VR) therapy for people with psychosis who avoid everyday places mainly because of anxiety (agoraphobic avoidance). It was developed by Daniel Freeman's team at the University of Oxford with people with lived experience of psychosis, clinical…

Format

• Phase A: Referral and assessment (before session 1).
• Trial eligibility: aged 16 or over; schizophrenia-spectrum diagnosis (ICD-10 F20–F29) or an affective disorder with psychotic symptoms; self-reported difficulty going outside mainly because of anxiety; able to consent. Exclusions included photosensitive epilepsy; substantial visual, auditory or…

Who practises it, and how they are trained or regulated

• Who delivers and status. The coach is software; the human role is a supporting mental health professional. In the trial, supporters needed no prior cognitive therapy experience; they had half a day of training, a written manual and weekly supervision. NICE notes one NHS trust trained band 3 to band 5 staff in about half a day with supervision inside clinical teams. A psychotherapist may take the supporter role, or…
• Regulatory and NICE status (as of October 2026 per NICE): NICE early value assessment HTE15, published 15 November 2023 and now listed as HTG701, says gameChangeVR can be used in the NHS while more evidence is generated, for severe agoraphobic avoidance in people with psychosis aged 16 and over, with support from a mental health professional. For mild to moderate agoraphobic avoidance in psychosis it is recommended…

Evidence status, as the guide reports it

• Format: about six sessions with roughly 30 minutes in VR each, usually weekly; three sessions was the minimum adherent dose in the trial; people progress at their own pace. A clinical expert told NICE sessions last about 20 minutes. The current evidence-generation trial describes practice over…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Does it use a device, heat, cold, water or a physical procedure? Has a medical professional checked that it is safe for you?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• duplicate or conflicting tasks between services; the person feeling handed over to a machine.
• abrupt loss of support at course end, especially if the supporter was the main reason the person went out.
• difficulty with controls (common in people unused to gaming), headset discomfort, panic when vision is covered.
• drift into extra unscripted interventions; supporters pushing progression; burnout or over-identification in peer workers.
• frustration with technical glitches being read as personal failure; self-consciousness about speaking aloud with the supporter present.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.