Virtual Reality for Visions (VRV): a proof of concept study examining the development of a new treatment for distressing visual hallucinations in people with psychosis.

Research question This study asks if it is feasible to develop and deliver a novel digital treatment combining high impact, visual hallucination (VH) specific, psycho-education with the powerful and engaging experience of Virtual Reality (VR) for VH in people with Psychosis. Background VH are the experience of seeing things that are not there.

Affecting as many as two thirds of people with Psychosis, they are associated with high levels of distress. At present, there are no proven treatments. People with VH find it hard to tell if what they are seeing is real or not which leads to fear and unhelpful coping.

Our work helps people better understand what can lead to VH, and to confidently deal with their VH in a way that improves coping when they need it most (when they see the vision). Aims and objectives To use Programme theory to develop and refine the treatment.

To conduct a proof-of-concept feasibility trial exploring issues around optimal content, delivery, and acceptability of VR to inform a future multisite feasibility trial. To disseminate results from the study and, if appropriate, apply for further funding. Methods Phase one will develop, refine and optimise the new treatment for VH.

This will be led by and involve people with lived experience (PWLE) of psychosis and VH.

Focus groups with PWLE will determine how to assess VH so that a credible representation of the VH can be programmed in VR; to develop bespoke psycho-education materials explaining what leads people to have VH; to develop the VR to be maximally beneficial.

Phase two addresses the feasibility of delivery and uncertainties about the intervention itself by using a case series as a proof-of-concept study.

Participants (n=16) will have 4 sessions of psycho-education, and then 6 sessions of VR enabling people to practice coping skills in the presence of a VR representation of the VH. Assessments will be conducted at baseline, mid (6 weeks) and post treatment (12 weeks) and at follow-up (16 weeks).

This will determine if the intervention is acceptable, engaging, and relevant and whether it reduces distress, and improves quality of life.

Qualitative interviews will be used with participants (~12) to inform the future development and use of the VR intervention.

Phase three: Implementation questions will be considered throughout the phases of intervention development, feasibility testing, process, and outcome evaluation.

Timelines for delivery We will seek to secure approvals after notification of the award, allowing phase one to start in month 3, and phase two (case series) to start in month 7. Recruitment will take 8 months and follow ups will be complete by month 18.

Two further months will allow time for analysing data, preparing publications and developing a proposal for an NIHR RfPB application. Anticipated impact and dissemination This project could provide an effective, accessible treatment within a few years. The trial will be pre-registered and the trial protocol and findings will be published as open access papers.

Findings will be shared with participants, PWLE and staff groups and at conferences.