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Virtual Reality Therapy for Severe Agoraphobia Approved by NICE

An automated virtual reality therapy for treating severe agoraphobic avoidance has been sanctioned for NHS use in England.

The recommendation was made pending more evidence being collected about the technology's effectiveness, the National Institute for Health and Care Excellence (NICE) stipulated.

In a health technology evaluation on 15 November, NICE said that gameChangeVR can be used to treat severe agoraphobic avoidance in people with psychosis who are 16 years old and over.

Exposure Therapy Through a VR Headset

In the psychological exposure therapy, developed by researchers at the University of Oxford and Oxford Health NHS Foundation Trust, users wear a VR headset to immerse themselves in simulations of everyday situations they might encounter, such as a street, a shop, or a GP's surgery.

NICE said that gameChangeVR had potential benefits for treating the condition but emphasised that it should be used with the support of a mental health professional, and only after a person's safety and suitability had been confirmed.

However, it said the therapy could be delivered and supported by mental health professionals "working in lower pay bands" than staff who were delivering other psychological treatments for psychosis with agoraphobic avoidance. The treatment might also need "less mental health professional time" for delivery and support than other psychological treatments, it noted.

The appraisal committee explained there was high demand for mental health services and variable access to psychological interventions, leaving many patients unable to get the treatment and support they need. Agoraphobia was often "untreated or undertreated", especially when it occurred with other mental health conditions, such as agoraphobic avoidance in people with psychosis. There was, therefore, an "unmet need" for patients with the condition, NICE said.

Experts also expressed concerns that people with agoraphobia could face further barriers to care if they struggle to leave home or use public transport to get to face-to-face appointments.

Use Approved Whilst Further Evidence is Generated

Approval of the technology for NHS use was dependent on the manufacturer generating evidence on its effectiveness, with results submitted to NICE within 3 years. This evidence should include long-term benefits, an assessment of who might benefit most, rates of relapses or worsening of symptoms, and adverse effects. 

The committee will then review the evidence and assess whether the technology could be routinely adopted for the NHS in England.

NICE also assessed the use of other VR technologies — Amelia Virtual Care and XR Therapeutics — to treat agoraphobia, but assessed they could only be used in research. Also, the use of gameChangeVR to treat mild to moderate agoraphobic avoidance in people with psychosis should similarly be restricted to research purposes, it stated.

The regulator pointed out that for all the technologies, evidence gaps were related to the population, intervention, comparators, and outcomes, and that the clinical and cost effectiveness of VR for treating agoraphobia, or agoraphobic avoidance in people with psychosis, was immersed in "uncertainties" due to limited evidence. 

The charity, No Panic, estimated that agoraphobia affects between 0.5% and 1% of people in the UK — around 1.5 million — and in a less severe form, up to 1 in 8 people — about 7 million — might be troubled by some agoraphobic symptoms.

Asked to comment for Medscape News UK, the charity Anxiety UK said that it welcomed any development that provided additional choice to improve the quality of life for people living with anxiety but stressed that such technological advances should be available to everyone.