Investigating the acceptability and validity of a novel VR paradigm that simulates auditory hallucinations

There is a growing use of Virtual Reality (VR) technologies in psychosis research and intervention. Validated VR simulations of psychotic-like experience have the potential to allow controlled manipulation of stimuli, reproducibility, and to isolate mechanisms of change in an ethical research framework. Although initial developments appear to be safe, qualitative reporting of participants' experiences of VR simulated psychotic-like experiences is lacking. This paper proposes and demonstrates an ethically grounded framework for evaluating the acceptability and validity of an immersive VR experience that simulates auditory hallucinations (VR-sAH) based upon the prototypical content of auditory hallucinations described by people with lived experience. Sixty-eight non-clinical participants undertook an experimental trial involving VR-sAH. Validity of the VR-sAH was assessed by combined assessment of qualitative reports and psychophysiological responses. Non-acceptability was operationalised as drop-outs, indications of distress during the experiment, and self-reported Subjective Units of Distress post-experiment. Following the experiment, a subset of participants (n = 29) undertook semi-structured interviews guided by the Theoretical Framework of Acceptability. Results indicated that the VR-sAH produced a believable and affectively salient analogue of auditory hallucinatory experiences. Statistically significant reductions in heart rate variability validated participants' self-reported embodied immersion in the VR-sAH. Semi-structured interviews and quantitative acceptability criteria indicated that the VR-sAH was an acceptable research tool. However, this sentiment was subject to important caveats to consider: including participants with psychosis and other mental health issues, and the importance of integrity and transparency on the part of the researcher team. Although VR-sAHs do not replicate the full phenomenology of clinical auditory hallucinations, they may provide ethically manageable and experimentally controllable analogues of perceptual and cognitive processes relevant to psychosis research, particularly during early-stage development in non-clinical populations.