gameChange
Virtual Reality for Severe Agoraphobic Avoidance*
*gameChange is only available in the UK
gameChange focuses on the overwhelming fear of being in public places that prevents people from participating in everyday activities.
These fears can severely disrupt relationships with family and friends, education, career life, and even lead people to avoid leaving their home altogether.
Designed in collaboration with people with lived experience.
gameChange is a virtual reality therapy, where over the course of six sessions, users practice being in simulations of everyday situations: a café, shop, pub, street, doctor's office, and a bus. Users can freely choose what they work on and when.
gameChange was developed by a multi-partner team led by researchers at the University of Oxford and Oxford Health NHS Foundation Trust, including staff from the University of Oxford spinout company Oxford VR – now part of RealizedCare; the McPin Foundation, a charity dedicated to ensuring the participation of people with relevant personal experience in mental health research; the Royal College of Art, NIHR MindTech, specialists in the development and adoption of new digital technologies in mental health; and nine NHS Trusts across England.
gameChange was tested in the largest ever randomized controlled trial of VR mental health and is now in use in selected NHS mental health services. The results are available in The Lancet Psychiatry.
Clinical Trial
In the largest ever clinical trial of VR for mental health, gameChange was trialed with 346 patients with psychosis in nine NHS Trusts across five English regions: Bristol, Manchester, Newcastle, Nottingham, and Oxford.
The results were published in The Lancet Psychiatry in April 2022. The article is available to read online "Automated virtual reality therapy to treat agoraphobic avoidance and distress in patients with psychosis (gameChange): a multicentre, parallel-group, single-blind, randomized, controlled trial in England with mediation and moderation analyses."
The trial showed that gameChange led to significant reductions in the agoraphobic avoidance of everyday situations and in related distress. The patients who benefited most were those who found it hardest to leave the house and those with the most psychiatric symptoms, such as severe anxiety, depression, delusions, and hallucinations. These patients experienced large benefits, often being able to undertake activities they had previously found unthinkable. These benefits were maintained at the six-month follow-up. Patient feedback showed that the treatment was extremely popular, with very high up-take rates.
Supporting Evidence
Clinical 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.
See Article
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.
See Article