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

Abstract

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.

• Authors: Daniel Freeman, Sinéad Lambe, Ushma Galal, Ly-Mee Yu, Thomas Kabir, Ariane Petit, Laina Rosebrock, Robert Dudley, Kate Chapman, Anthony Morrison, Eileen O'Regan, Elizabeth Murphy, Charlotte Aynsworth, Julia Jones, Rosie Powling, Jenna Grabey, Aitor Rovira, Jason Freeman, David M Clark, Felicity Waite
• Journal: Schizophrenia research (Schizophr Res) Vol. 250 Pg. 50-59 (Dec 2022) ISSN: 1573-2509 [Electronic] Netherlands
• PMID: 36343472 (Publication Type: Randomized Controlled Trial, Journal Article)
• Copyright: Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.

Topics

• Humans
• Virtual Reality Exposure Therapy
• Quality of Life
• Cognitive Behavioral Therapy
• Agoraphobia (complications, therapy, psychology)
• Psychotic Disorders (complications, therapy, psychology)