Virtual reality technologies for treating agoraphobia or agoraphobic avoidance: early value assessment

In people aged 18 and over, agoraphobia without complex or severe mental health conditions is usually treated in primary care or in NHS Talking Therapies for anxiety and depression services. NICE's guideline on common mental health problems recommends a stepped-care approach for treating common mental health disorders in adults, such as panic disorder with or without agoraphobia. The first step is identification and assessment, including identifying any comorbidities. This is used to develop a treatment plan, which may involve lifestyle changes and guided self-help based on CBT that is delivered with the support of a practitioner or therapist. If needed or preferred, more intensive treatments should be offered. NICE's guideline on generalised anxiety disorder and panic disorder in adults recommends that adults with moderate to severe panic disorder with or without agoraphobia should be considered for referral for CBT or an antidepressant. Antidepressants may be considered if the disorder is long-standing or if the person has not benefited from or has declined psychological intervention. The NHS Talking Therapies for anxiety and depression programme offers evidence-based psychological therapies for adults, including CBT, guided self-help and counselling. Agoraphobia with co-occurring complex or severe mental health conditions would not be treated in primary care or NHS Talking Therapies for anxiety and depression services, but most likely in community mental health services or inpatient services. There is no NICE guideline on treating agoraphobia in young people aged under 18. Young people with symptoms of anxiety may be assessed and treated in a range of settings, including school mental health teams, single point of access teams, voluntary sector teams and children and young people's mental health services (CYPMHS).

Treatment and care for psychosis in adults is usually managed in community mental health services including early intervention in psychosis services and community mental health teams. NICE's guideline on psychosis and schizophrenia in adults recommends that adults with a first episode or first presentation of psychosis should have an assessment and treatment in early intervention in psychosis services. Longer-term treatment and care are usually then provided by community mental health teams. NICE's guideline on psychosis and schizophrenia in children and young people recommends that young people with a first presentation of sustained psychotic symptoms should be urgently referred to child and adolescent mental health services or an early intervention in psychosis service. Longer-term treatment and care may then be provided in primary care or secondary care, including early intervention in psychosis services. The clinical experts advised that there is no established care pathway for agoraphobic avoidance within psychosis services. Treatment for agoraphobic avoidance in psychosis would be integrated within standard care treatment for psychosis. People with psychosis should be offered oral antipsychotic medicine and psychological interventions including CBT and family intervention. The clinical and patient experts advised that access to CBT for psychosis varies and is limited for some people. Most adults with psychosis who are having treatment outside of early intervention in psychosis services do not have the psychological treatment recommended by NICE's guideline on psychosis and schizophrenia. They are more likely to be offered antipsychotic medicine and monitoring from their mental health service.

Agoraphobia and agoraphobic avoidance may further affect a person's ability to access mental health services and support. The clinical and patient experts advised that agoraphobia is often untreated or undertreated especially when its symptoms occur with other mental health conditions, such as agoraphobic avoidance in people with psychosis. Some people may also stop treatment because they have difficulty tolerating treatments such as exposure therapy. VR technologies may increase access to care by offering another treatment option for agoraphobia, or agoraphobic avoidance in people with psychosis. It would be used as an alternative or in addition to standard care. It is not intended to replace treatment for co-occurring mental health conditions.