Virtual Reality-Assisted Therapy (VRT) for Distressing Voices in Psychotic Disorders and Eating Disorders:Exploring User and Therapist Experiences

Virtual reality assisted therapy (VRT) for distressing voices is an adaptation of avatar therapy within the emerging field of relational therapies. VRT targets patterns of interaction and relational dynamics, aiming for therapeutic change through an experiential dialogue with the identity associated with the voice.<br/><br/>Originally developed to voices linked to psychotic disorders, the VRT approach has been adapted to other conditions where internal voices play a critical role, such as eating disorders. This symposium presents qualitative findings from studies exploring the experiences of both service users and therapists engaged in VRT.<br/><br/>Through in-depth accounts, we will examine the personal meanings ascribed, the professional observations made, and the perceived therapeutic potential of VR-assisted dialogue with distressing voices. By highlighting both the shared and unique features of VRT for distressing voices in psychosis and eating disorders, this symposium aims to advance our understanding of its broader applicability and potential for clinical implementation.<br/><br/>#1 Presentation: Virtual Reality-Assisted Therapy (VRT) for Distressing Voices in Psychotic Disorders and Eating Disorders: Exploring User and Therapist Experiences<br/><br/>Introduction<br/>Hearing voices, or auditory verbal hallucinations, can manifest as a non-clinical phenomenon, across various disorders, and is particularly common and often distressing within the psychosis spectrum. Virtual reality-assisted therapy (VRT), used in the Challenge randomized controlled trial (RCT), enables immersive dialogue between individuals and an avatar representing their most distressing voice. While VRT and its UK counterpart, avatar therapy, demonstrate efficacy, qualitative research on participant and therapist experiences remains limited. This study examines these experiences to enhance VRT understanding and guide clinical implementation.<br/><br/>Methods<br/>A topic guide, based on focus group discussions with service-users and clinicians, was used in the conductance of ten semi-structured interviews with VRT participants and interviews with eight VRT therapists from Challenge RCT. Selection criteria included recruitment site and voice-hearing duration to align with the RCT’s sample distribution. All interviews were recorded, transcribed, analyzed by thematic analysis, and discussed in relation to implementation outcomes.<br/><br/>Results<br/>A total of 2093 (participants: 1086, therapists: 1007) references were coded. Preliminary analysis suggests four themes: 1) A different approach to voices and treatment; 2) Using technology to meet the voice; 3) Limitations, obstacles, and adaptations; and 4) Changes, mechanisms, and prerequisites.<br/><br/>Discussion<br/>Preliminary results indicate that VRT is generally acceptable, appropriate, and feasible. Most users found avatar interactions meaningful and beneficial. All participants reported positive but variable and not always quantifiable outcomes. Users struggled with anxiety and negative voice reactions, impacting their overall comfort. Feasibility challenges include access to therapist training and supervision, given the novelty of the approach, as well as technical support, since technological issues were common and distressing.