The development and pilot testing of VR-SOAP, a modular virtual reality treatment for improving social activities and participation in early psychosis

Abstract Background: Young adults with a psychotic disorder often experience difficulties in social functioning. We developed a modular virtual reality treatment to improve social activities and participation by targeting common causes of social functioning difficulties in patients with a psychotic disorder (VR-SOAP). This paper details the development of this intervention, encompassing a piloting phase. Method: Using an iterative Scrum method with software engineers, clinicians, researchers, and individuals with lived experience of psychosis, we developed a treatment protocol along with a software prototype. Subsequently five patients with a psychotic disorder, aged 18–40, and three therapists, piloted VR-SOAP. Feasibility was assessed by means of interviews and session forms. Acceptability was evaluated along the seven domains of the Theoretical Framework of Acceptability (i.e. affective attitude, burden, ethicality, intervention coherence, opportunity costs, self-efficacy, and perceived effectiveness). Results: The final protocol consisted of the following modules and targets: 1. Motivation and Pleasure (negative symptoms); 2. Understanding Others (social cognition); 3. Safety and Trust (paranoid ideations and social anxiety); 4. Self-Image (self-esteem and self-stigma); 5. Communication (communication and interaction skills). Modules were piloted by the participating patients and therapists. The modules proved feasible and showed a high degree of acceptability on all seven domains of the acceptability framework. Conclusion: The modular VR-SOAP treatment protocol and prototype was acceptable and feasible for therapists and patients. The primary recommendation for enhancement underscores the need for flexibility regarding the number of sessions and the content. Key learning aims (1) Understanding the development and structure of a novel modular CBT treatment in VR. (2) Learning to use specific VR modules to target negative symptoms, social cognition, paranoid ideations, social anxiety, self-esteem, and communication skills. (3) Gaining insights into the feasibility and acceptability assessments of a novel modular CBT treatment in VR.