Developing an Automated Virtual Reality Therapy forImproving Positive Self-Beliefs and Psychological Well-Being(Phoenix VR Self-Confidence Therapy): Tutorial

Virtual reality (VR) is an immersive technology in which delivery of psychological therapy techniques can be automated.Techniques can be implemented similarly to real-world delivery or in ways that are not possible in the real world to enhanceefficacy. The potential is for greater access for patients to effective therapy. Despite an increase in the use of VR for mentalhealth, there are few descriptions of how to build and design automated VR therapies. We describe the development of PhoenixVR Self-Confidence Therapy, designed to increase positive self-beliefs in young patients diagnosed with psychosis in order toimprove psychological well-being. A double-diamond, user-centered design process conducted over the course of 18 monthswas used, involving stakeholders from multiple areas: individuals with lived experience of psychosis, clinical psychologists,treatment designers, and VR software developers. Thirteen meetings were held with young patients diagnosed with psychosisto increase the understanding and improve the assessment of positive self-beliefs, help design the scenarios for implementingtherapeutic techniques, and conduct user testing. The resulting Phoenix therapy is a class I United Kingdom ConformityAssessed (UKCA)-certified medical device designed to be used on the standalone Meta Quest 2 (Meta Platforms) headset.Phoenix aims to build up 3 types of positive self-beliefs that are connected to psychological well-being. In a community farmarea, tasks are designed to increase a sense of mastery and achievement ("I can make a difference"); in a TV studio, userscomplete an activity with graded levels of difficulty to promote success in the face of a challenge ("I can do this"); and ina forest by a lake, activities are designed to encourage feelings of pleasure and enjoyment ("I can enjoy things"). Phoenix isdelivered over the course of approximately 6 weekly sessions supported by a mental health provider. Patients can take theheadsets home to use in between sessions. Usability testing with individuals with lived experience of psychosis, as well aspatients in the National Health Service (aged 16-26 years), demonstrated that Phoenix is engaging, easy to use, and has highlevels of satisfaction