The research and co-design resulted in a VR intervention which uses the psychology principle of discouraging the use of defence behaviours. This is the first large scale intervention to do this. Building on prior VR research by psychologists at Oxford University, this research is a flagship NIHR project, and one of first VR treatments developed for psychosis.

The aim is to scale the therapy, improving access at low cost, with the use of an automated VR coach. This raised important usability questions, and extensive inclusive design methods were used in order to address them, including mixed methods of participatory research and co-design with people with lived experience of psychosis.

With the aim of integration into NHS mental health services, usability is central to adoption. People need to understand, interact with and navigate through the VR quickly and intuitively.

This is the first VR treatment to be co-designed with a Lived Experience Advisory Panel (LEAP), plus a smaller working group comprised of people with lived experience of psychosis, psychologist, designers and commercial developers. This group met regularly for rapid co-design, and larger workshops were held at five NHS sites across England with further stakeholders to develop VR prototypes, task flows, scripting and design specifications for the developers to build the final intervention for trial. Over the course of the 6 month co-design phase, the researchers hosted 8 LEAP panels, 12 participatory design workshops, 5 implementation workshops, 7 working group meetings and 17 user testing sessions. Remote feedback was also sought via email questionnaires.

Prior to the clinical trial, two rounds of user testing were carried out; the outputs achieved the benchmark of 90% agreement with the success criteria.

The VR intervention is now subject to a clinical trial with 432 people with psychosis, taking place in five NHS trusts in England.