JMIR Publications

ABSTRACT

Background:

Virtual reality-assisted therapy (VRT) for distressing voices in psychosis is a variant of AVATAR therapy (AT) that uniquely incorporates immersive virtual reality (VR) to facilitate dialogue with a digital representation of a voice, unlike original AT which does not use VR. While previous research from the AVATAR trial has explored participants' experiences with AT, no qualitative studies have investigated therapists’ perspectives or focused specifically on VRT.

Objective:

The present study aimed to explore both participants´ experiences of receiving VRT and therapists´ experiences of delivering VRT within the Challenge trial.

Methods:

This qualitative study conducted semi-structured interviews with 10 trial participants and 8 therapists from the Challenge trial. Selection criteria of VRT trial participants included recruitment site and voice-hearing duration. Interviews were audio-recorded, transcribed, and subjected to thematic analysis. Reporting follows SRQR (i.e. Standards of Reporting Qualitative Research).

Results:

Analysis led to five overarching themes: (1) Using technology to meet the voice, (2) A different approach to voice-hearing and treatment, (3) Limitations, obstacles, and adaptations, (4) Changes, mechanisms and prerequisites, and (5) A price to pay. VRT was generally perceived as acceptable, appropriate, and feasible. However, some areas required attention, including trial participant anxiety, negative voice reactions, optimization of immersion, technical malfunctions, time restraints, and availability of organizational resources. Notably, therapists’ extra efforts helped overcome these barriers to effective VRT delivery.

Conclusions:

The results highlight VRT’s potential for positive outcomes in alleviating distressing voices. However, challenges such as trial participant anxiety, negative voice reactions, and therapists' struggles with technology issues must be addressed in future research, trials, or in implementation efforts.