Developing a Virtual Reality-assisted Intervention for Emotion Regulation Difficulties in Psychosis

Background Many people with psychosis report difficulties understanding and managing their emotions (emotion regulation difficulties), yet evidence-based interventions are lacking. Brief interventions that teach emotion regulation skills show promise but service users report wanting additional support to apply what they have learned in therapy to their lives.

Aim: To test the initial feasibility and acceptability of a VR-assisted therapy (called MANaging emOtions in Everyday life Using Virtual REality; MANOEUVRE) for emotion regulation difficulties in psychosis

Methods A mixed methods case series will be undertaken. The study will recruit people with psychosis from NHS community care teams (in England). Assessments will be at baseline, post therapy and 3-month follow up. Feasibility and acceptability of a future trial will be assessed based on uptake/ recruitment, data completeness and qualitative feedback. Feasibility and assessment of the therapy will be assessed based on adherence, acceptability (sessional feedback ratings, qualitative interview feedback, side effect and satisfaction ratings), safety (adverse effects), implementation resources and fidelity.

Participants will complete measures of emotion regulation difficulties, adaptive emotion regulation skill use, psychological distress, personal recovery goal achievement and quality of life. To assess feasibility, individual-level changes will be calculated using the reliable change index to assess whether changes are more likely to reflect measurement error or actual clinical change. Group-level changes will be assessed using means and standard deviations and effect sizes (Cohen's d) with confidence intervals . A post therapy semi-structured interview will explore participants' experience of receiving MANOEUVRE.

Inclusion criteria

• Currently under the care of South London and Maudsley (SLaM) National Health Service (NHS) outpatient services.
• Clinical diagnosis of psychosis (schizophrenia spectrum disorder) (as assessed by their clinical team)
• Willing to have the interview audio recorded (if taking part in post therapy interview)
• Willing and able to provide informed consent to participate in the study (as assessed by their clinical team)

Exclusion criteria

• Clinical presentation (e.g., immediate serious risk to self) (as assessed by their clinical team)
• History of photosensitive epilepsy