Automated VR therapy for improving positive self-beliefs and psychological well-being in young patients with psychosis: a proof of concept evaluation of Phoenix VR self-confidence therapy

Positive self-beliefs mediate the association between body appreciation and positive mental health

Previous work has supported direct, positive associations between body appreciation and positive mental health, but has largely neglected to examine possible indirect mechanistic pathways. Here, we propose one relevant mediational pathway, wherein body appreciation is associated with positive mental health via positive self-beliefs (i.e., cognitions that lead individuals to view themselves, their lives, and/or their futures under a positive outlook). To test this hypothesis, we asked an online sample of 496 adults (249 women, 247 men) from the United Kingdom to complete measures of body appreciation, positive self-beliefs, and positive mental health. Participants also completed measures of self-efficacy and resilience, and provided their demographic information. Correlational analysis revealed significant, positive, and strong associations between body appreciation and facets of positive self-beliefs and positive mental health, respectively. Structural equation modelling showed that positive self-beliefs mediated the association between body appreciation and positive mental health after controlling for self-efficacy and resilience. This model was robust across women and men separately, and the mediational effects remained intact in sensitivity and robustness analyses. We discuss ways in which greater body appreciation may help individuals develop and maintain positive self-beliefs, which in turn shape mental health outcomes.

Randomised controlled trial of automated VR therapy to improve positive self-beliefs and psychological well-being in young people diagnosed with psychosis: a study protocol for the Phoenix VR self-confidence therapy trial

INTRODUCTION

The confidence of young people diagnosed with psychosis is often low. Positive self-beliefs may be few and negative self-beliefs many. A sense of defeat and failure is common. Young people often withdraw from many aspects of everyday life. Psychological well-being is lowered. Psychological techniques can improve self-confidence, but a shortage of therapists means that very few patients ever receive such help. Virtual reality (VR) offers a potential route out of this impasse. By including a virtual coach, treatment can be automated. As such, delivery of effective therapy is no longer reliant on the availability of therapists. With young people with lived experience, we have developed a staff-assisted automated VR therapy to improve positive self-beliefs (Phoenix). The treatment is based on established cognitive behavioural therapy and positive psychology techniques. A case series indicates that this approach may lead to large improvements in positive self-beliefs and psychological well-being. We now aim to conduct the first randomised controlled evaluation of Phoenix VR.

METHODS AND ANALYSIS

80 patients with psychosis, aged between 16 and 30 years old and with low levels of positive self-beliefs, will be recruited from National Health Service (NHS) secondary care services. They will be randomised (1:1) to the Phoenix VR self-confidence therapy added to treatment as usual or treatment as usual. Assessments will be conducted at 0, 6 (post-treatment) and 12 weeks by a researcher blind to allocation. The primary outcome is positive self-beliefs at 6 weeks rated with the Oxford Positive Self Scale. The secondary outcomes are psychiatric symptoms, activity levels and quality of life. All main analyses will be intention to treat.

ETHICS AND DISSEMINATION

The trial has received ethical approval from the NHS Health Research Authority (22/LO/0273). A key output will be a high-quality VR treatment for patients to improve self-confidence and psychological well-being.

TRIAL REGISTRATION NUMBER

ISRCTN10250113.