Title: Treating Depression with Self-Compassion using Virtual Reality
Funder: Department of Health and Social Care

Abstract: Depression is usually maintained by high levels of self-criticism and poor self-compassion but enhancing of self-compassion via conventional face-to-face therapy is time consuming and expensive. Previously we developed a new form of intervention that exploits a property of immersive virtual reality (IVR). Embodiment' visually substitutes a person's real body with a life-sized virtual one and generates an illusion of ownership such that events happening to the virtual body are experienced as happening to the self. We enabled patients to deliver compassion to an avatar and then to experience that interaction from a first-person perspective. In an open trial with 15 patients with depression, three 8-minute IVR experiences brought about a significant decrease in depression and self-criticism over the next month. In Year 1 we will scale up our IVR scenario into a 4-session treatment for depression that takes advantage of technical innovations, responds to patients need for a more flexible and lifelike experience, and incorporates a homework element to ensure generalisability. Over the next 18 months the new treatment will then be tested in a feasibility study that will address issues of recruitment, acceptability, and ease of delivery, will test the proposed mechanism, and will generate an estimate of effect size to power an effectiveness trial. A 2-year effectiveness trial will then be implemented within an existing NHS Improving Access to Psychological Therapies service by psychological wellbeing practitioners and will determine the extent of clinical improvement associated with the new intervention. Together with our commercial partners we will then seek to embed the intervention into other NHS services. We anticipate that the project will pave the way for a new generation of IVR interventions that use embodiment to change the way patients experience themselves and their bodies, and that will be particularly attractive to under-served groups such as adolescents.

Lay abstract: We plan to develop and test a new therapy for depression. Patients with depression are often very self-critical. They lack the ability to use self-compassion to prevent negative thoughts from making them feel worse. Increasing self-compassion via face-to-face therapy is effective but is time consuming and expensive. In previous research we used a feature of virtual reality known as 'embodiment' to improve self-compassion. Embodiment replaces a person's real body with a life-sized virtual body that exactly copies the movements of the real body. This generates an illusion of ownership over the virtual body. We had patients first embody an adult and speak compassionate words to a virtual distressed child. The child responded by becoming less distressed. They then embodied the child and experienced the interaction from the child's perspective. This technique helped patients to feel what it is like to be compassionate to themselves. In our study patients received three 8-minute experiences of compassion in virtual reality. This resulted in a large decrease in both depression and self-criticism, as well as an increase in self-compassion. The first goal of this application is to develop a complete treatment package that is simpler and cheaper than before. We will use portable, consumer-level hardware. Patients will be able to use self-compassion in several situations that have caused them personal distress. We will assess whether virtual bodies made to resemble the patients themselves are more effective or not. The treatment will involve some homework to ensure that patients apply what they have learned to real-life situations. To make this easier they will be able to play back their therapeutic experiences on home-based virtual reality equipment. These developments are based on feedback we have already received from self-critical patients. Advisors with lived experience of depression will give us the patient's perspective during all stages of the research. The second goal is to test how acceptable these procedures are and how easy it is to recruit patients with depression. We will see whether improvements are needed, and how effective the treatment is likely to be. The final goal is to test how effective the procedures are in a larger study when used by NHS staff who are not highly-trained therapists. We will compare results against a comparison group who are depressed but are not receiving any treatment. The methods we are using are cheap to deliver and will reduce treatment time. They are applicable to many other conditions where high self-criticism is common, such as eating disorders. Together with our partners we will plan how they can best be delivered by existing NHS services.

Research activity codes: 6.6 PSYCHOLOGICAL AND BEHAVIOURAL
Health categories: MENTAL HEALTH