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Trial registered on ANZCTR
Registration number
ACTRN12624000136505
Ethics application status
Approved
Date submitted
11/01/2024
Date registered
14/02/2024
Date last updated
14/02/2024
Date data sharing statement initially provided
14/02/2024
Type of registration
Prospectively registered
Titles & IDs
Public title
A trial of a virtual reality treatment to improve social functioning in young people experiencing hallucinations
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Scientific title
Virtual reality based cognitive behavioural therapy for young people experiencing
hallucinations: LINK feasibility and acceptability trial
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Secondary ID [1]
311298
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None
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Universal Trial Number (UTN)
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Trial acronym
LINK
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Early psychosis
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Schizophrenia
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Condition category
Condition code
Mental Health
329228
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0
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Schizophrenia
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
The Revive – Hallucinations virtual reality (VR) treatment has been adapted from an existing
evidence based protocol for cognitive behavioural therapy for hallucinations (see Turner et al., 2020). This protocol involves a core focus on learning to cope with hallucinations in social situations in such a way that they no longer interfere with social functioning. The primary treatment activities involve addressing avoidance of social situations in which hallucinations are likely to be triggered, excessive attention to the hallucinations within social situations, and trying to suppress the hallucinations to the detriment of social participation. The treatment will be delivered one-on-one by a psychologist and involve using a VR headset within sessions. Within the VR, the participant will be immersed in a virtual environment that contains relevant social scenarios, such as a cafe, public transport or a lecture theatre. These environments were designed based on feedback from young people who have experiences of hallucinations and social anxiety who suggested they were the most relevant to their social difficulties. Session 1 will involve an orientation and explanation of the treatment process, and basic training in how to use the VR headset, and setting a personal social goal. Sessions 2 through 9 will involve working with the young person to map which of their current strategies to manage hallucinations in social situations to identify strategies which are counterproductive, and then replacing these with more effective coping strategies within the virtual environments. The therapist will guide young people through personally relevant social VR scenarios in order to identify, understand and address counter-productive strategies. Session 10 will involve a review of treatment progress and a focus on maintenance of gains following the end of the treatment. During VR scenarios, participants will be immersed into a personally selected VR environment that is relevant to their own social concerns (e.g. a cafe, university, bus). The participant can move around the environment and 'play out' social interactions by talking to an avatar. The avatar will play a roll in the situation, such as ordering a coffee from a barista or buying a ticket from a bus driver, and will be voiced by the therapist. The therapist can switch between speaking as themselves or the avatar.
The young person will be offered 10 sessions to complete over 10 weeks (1 x 1 hour session per week for 10 weeks). A post session log book will be kept by the therapist.
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Intervention code [1]
327743
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Behaviour
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Intervention code [2]
327983
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Treatment: Devices
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Comparator / control treatment
No control group
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Control group
Uncontrolled
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Outcomes
Primary outcome [1]
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Feasibility - recruitment and consent rates
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Assessment method [1]
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Via audit of study enrolment and consent logs
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Timepoint [1]
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12 weeks post intervention commencement
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Primary outcome [2]
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Acceptability - intervention endorsement
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Assessment method [2]
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Proportion of respondents who state they would recommend the intervention to other young people, measured using a purpose built self-report acceptability questionnaire
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Timepoint [2]
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12 weeks post intervention commencement
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Primary outcome [3]
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Safety - adverse events
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Assessment method [3]
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The number of adverse events and serious adverse events specifically related to the intervention or trial (e.g. nausea during VR) via post session log book
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Timepoint [3]
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Continuously throughout the trial and at 12 weeks post intervention
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Secondary outcome [1]
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Feasibility - attendance rates of assessments and sessions
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Assessment method [1]
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Via audit of attendance logs
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Timepoint [1]
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12 weeks post intervention commencement
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Secondary outcome [2]
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Feasibility - Drop out rates
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Assessment method [2]
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Via audit of attendance logs
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Timepoint [2]
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12 weeks post intervention commencement
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Secondary outcome [3]
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Acceptability - satisfaction
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Assessment method [3]
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Purpose built self-report acceptability and usability questionnaire (reported descriptively for each item) which will be combined to form a composite outcome measure to indicate overall acceptability
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Timepoint [3]
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12 weeks post intervention commencement
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Secondary outcome [4]
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Cybersickness
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Assessment method [4]
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Simulator Sickness Questionnaire (SSQ) reported as the total score at each timepoint
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Timepoint [4]
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At the end of sessions 4 and 8
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Secondary outcome [5]
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Presence (a sense of ‘being there’ or ‘realness’)
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Assessment method [5]
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Igroup Presence Questionnaire (IPQ)
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Timepoint [5]
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At the end of sessions 4 and 8
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Secondary outcome [6]
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Auditory hallucinations - severity
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Assessment method [6]
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Psychotic Symptom Rating Scales – Auditory Hallucinations (PSYRATS-AH) total score
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Timepoint [6]
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Baseline and 12 weeks post intervention commencement
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Secondary outcome [7]
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Auditory hallucinations - beliefs
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Assessment method [7]
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Beliefs about Voices Questionnaire (BAVQ-R) total score for each subscale
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Timepoint [7]
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Baseline and 12 weeks post intervention commencement
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Secondary outcome [8]
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Social functioning - Reaching a personal formulated Specific Measurable Achievable Realistic Time-bound (SMART) social goal
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Assessment method [8]
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Scale rating from 0%-100% of goal achievement as formulated in session 1
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Timepoint [8]
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Session 1 and 12 weeks post intervention commencement
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Secondary outcome [9]
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Social functioning - confidence and enjoyment
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Assessment method [9]
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Two Likert scales measuring subjective social functioning (1 - strongly disagree to 7 – strongly agree) completed following each therapy session: ‘I can handle social situations’ and ‘I can enjoy social situations'
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Timepoint [9]
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Baseline and 12 weeks post intervention commencement
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Secondary outcome [10]
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Social functioning - overall
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Assessment method [10]
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Social and occupational functioning scale (SOFAS) total score
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Timepoint [10]
430546
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Baseline and 12 weeks post intervention commencement
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Secondary outcome [11]
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Psychological needs
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Assessment method [11]
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Basic Psychological Need Satisfaction in General scale (BPNSG) total score
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Timepoint [11]
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Baseline and 12 weeks post intervention commencement
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Secondary outcome [12]
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Social functioning in daily life
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Assessment method [12]
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Ecological momentary assessment involving a brief 10 item questionnaire, completed 10 times per day over 6 days. Individual item scores will be analysed.
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Timepoint [12]
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Two identical EMA phases – in the week immediate following the baseline assessment session and in the week immediate following the post assessment
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Eligibility
Key inclusion criteria
1) Any service users aged 16-25 within an early psychosis or ultra-high risk for psychosis service who are experiencing current hallucinations, defined by the occurrence of sensory experience in the absence of external stimuli, occurring at least once in the past month
2) The hallucinations are interfering with social functioning, as reported by the young person and/or clinician
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Minimum age
16
Years
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Maximum age
25
Years
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1) Inability to communicate via English language
2) Recent change in mental health treatment, including new medication or initiation of psychological therapy within last 8 weeks
3) Moderate or severe intellectual disability as determined by the treating clinician
4) Moderate or severe audio or visual condition precluding engagement with the VR equipment
5) Current risk of harm to self or others, as judged by treating clinician
6) Current inpatient of a psychiatric hospital
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Non-randomised trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Single group
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Other design features
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Phase
Not Applicable
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Type of endpoint/s
Safety
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Statistical methods / analysis
The primary outcomes of this study will be reported descriptively as summary statistics, including means and standard deviations (or equivalent) of feasibility and acceptability measures for each group. Pre - post changes in mental health measures will be conducted within each group using paired samples t-tests with associated p-values and effect sizes with confidence intervals for mean group differences (Cohen's d effect sizes). Specifically Cohen’s d effect sizes will be measured to determine the difference in pre-post scores.
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Recruitment
Recruitment status
Not yet recruiting
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Date of first participant enrolment
Anticipated
25/03/2024
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Actual
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Date of last participant enrolment
Anticipated
3/02/2025
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Actual
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Date of last data collection
Anticipated
28/04/2025
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Actual
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Sample size
Target
20
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
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Orygen Youth Health - Parkville - Parkville
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Recruitment hospital [2]
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Orygen Youth Health - Sunshine - Sunshine
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Recruitment postcode(s) [1]
41845
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3052 - Parkville
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Recruitment postcode(s) [2]
41846
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3020 - Sunshine
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Funding & Sponsors
Funding source category [1]
315552
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Charities/Societies/Foundations
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Name [1]
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Brain and Behaviour Research Fund (BBRF)
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Address [1]
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747 Third Avenue, 33rd Floor New York, NY 10017
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Country [1]
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United States of America
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Primary sponsor type
Hospital
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Name
The Royal Melbourne Hospital
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Address
RMH City Campus, Level 2 South West 300 Grattan Street, Parkville Victoria 3050
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Country
Australia
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Secondary sponsor category [1]
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None
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Name [1]
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Address [1]
317640
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Country [1]
317640
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Ethics approval
Ethics application status
Approved
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Ethics committee name [1]
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Royal Melbourne Hospital Human Research Ethics Committee (HREC)
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Ethics committee address [1]
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Office for Research The Royal Melbourne Hospital Level 2 South West 300 Grattan Street, Parkville , 3050 , Australia
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Ethics committee country [1]
314451
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Australia
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Date submitted for ethics approval [1]
314451
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26/04/2023
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Approval date [1]
314451
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17/08/2023
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Ethics approval number [1]
314451
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HREC/92768/MH-2023
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Summary
Brief summary
Psychotic illness tends to emerge during adolescence, which is a stage of critical social development. One of the earliest signs of psychotic illness is social difficulties, which can cause young people to become withdrawn from everyday life. Psychotic symptoms like paranoia and hallucinations (hearing or seeing things that aren’t there) can make it hard for young people to function around others. These symptoms are usually triggered in social situations, which can make young people want to avoid them, ultimately making the problem worse and causing them to become more withdrawn. Psychological treatments like cognitive behavioural therapy can be effective for helping young people feel comfortable in social situations. However, these treatments are delivered in clinics, removed from the social situations where they need the most help, and are therefore have limited effectiveness. Virtual reality (VR) is a technology that involves wearing a headset which projects 3D images of real world environments onto a screen so the user feels like they are immersed in that environment. Users can interact with the virtual environment using hand controllers, and virtual characters (‘avatars’) are often present to simulate social interactions. Research has found that VR can be used to support treatment of social difficulties by guiding people to learn and practice social skills in virtual environments. This technology therefore has potential to help young people who experience symptoms of psychosis, which is yet to be explored. This research aims to evaluate a new VR treatment based on cognitive behavioural therapy for young people experiencing hallucinations (a common and distressing symptom of psychosis) to understand whether it is feasible and safe to deliver, and whether it has potential to improve social functioning.
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Trial website
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Trial related presentations / publications
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Public notes
Turner, David & Burger, Simone & Smit, Filip & Valmaggia, Lucia & Gaag, Mark. (2020). What Constitutes Sufficient Evidence for Case Formulation-Driven CBT for Psychosis? Cumulative Meta-analysis of the Effect on Hallucinations and Delusions. Schizophrenia Bulletin. 46. 10.1093/schbul/sbaa045.
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Contacts
Principal investigator
Name
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Dr Roos Pot-Kolder
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Address
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Orygen Youth Health, 35 Poplar Rd, Parkville VIC 3052
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Country
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Australia
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Phone
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+61467670731
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Fax
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Email
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[email protected]
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Contact person for public queries
Name
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Roos Pot-Kolder
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Address
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Orygen Youth Health, 35 Poplar Rd, Parkville VIC 3052
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Country
131631
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Australia
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Phone
131631
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+61467670731
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Fax
131631
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Email
131631
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[email protected]
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Contact person for scientific queries
Name
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Roos Pot-Kolder
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Address
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Orygen Youth Health, 35 Poplar Rd, Parkville VIC 3052
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Country
131632
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Australia
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Phone
131632
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+61467670731
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Fax
131632
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Email
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[email protected]
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Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
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What data in particular will be shared?
At the discretion the principle investigator, all of the individual participant data collected during the trial will be shared.
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When will data be available (start and end dates)?
Once the study is completed (post May 2025) and will be available indefinitely
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Available to whom?
At the discretion the principle investigator
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Available for what types of analyses?
At the discretion the principle investigator, all of the de-identified individual participant data collected during the trial will be shared
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How or where can data be obtained?
On request via email to
[email protected]
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
Documents added manually
No documents have been uploaded by study researchers.
Documents added automatically
No additional documents have been identified.
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