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Bogie BJ, Noël C, Gu F, Nadeau S, Shvetz C, Khan H, Rivard MC, Bouchard S, Lepage M, Guimond S. Using virtual reality to improve verbal episodic memory in schizophrenia: A proof-of-concept trial. Schizophr Res Cogn 2024; 36:100305. [PMID: 38486790 PMCID: PMC10937232 DOI: 10.1016/j.scog.2024.100305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 03/17/2024]
Abstract
Background Schizophrenia is associated with impairments in verbal episodic memory. Strategy for Semantic Association Memory (SESAME) training represents a promising cognitive remediation program to improve verbal episodic memory. Virtual reality (VR) may be a novel tool to increase the ecological validity and transfer of learned skills of traditional cognitive remediation programs. The present proof-of-concept study aimed to assess the feasibility, acceptability, and preliminary efficacy of a VR-based cognitive remediation module inspired by SESAME principles to improve the use of verbal episodic memory strategies in schizophrenia. Methods Thirty individuals with schizophrenia/schizoaffective disorder completed this study. Participants were randomized to either a VR-based verbal episodic memory training condition inspired by SESAME principles (intervention group) or an active control condition (control group). In the training condition, a coach taught semantic encoding strategies (active rehearsal and semantic clustering) to help participants remember restaurant orders in VR. In the active control condition, participants completed visuospatial puzzles in VR. Attrition rate, participant experience ratings, and cybersickness questionnaires were used to assess feasibility and acceptability. Trial 1 of the Hopkins Verbal Learning Test - Revised was administered pre- and post-intervention to assess preliminary efficacy. Results Feasibility was demonstrated by a low attrition rate (5.88 %), and acceptability was demonstrated by limited cybersickness and high levels of enjoyment. Although the increase in the number of semantic clusters used following the module did not reach conventional levels of statistical significance in the intervention group, it demonstrated a notable trend with a medium effect size (t = 1.48, p = 0.15, d = 0.54), in contrast to the control group where it remained stable (t = 0.36, p = 0.72, d = 0.13). These findings were similar for the semantic clustering ratio in the intervention (t = 1.61, p = 0.12, d = 0.59) and control (t = 0.36, p = 0.72, d = 0.13) groups. There was no significant change in the number of recalled words in either group following VR immersion. Discussion This VR intervention was feasible, acceptable, and may be useful for improving the use of semantic encoding strategies. These findings support the use of more ecological approaches for the treatment of cognitive impairments in schizophrenia, such as VR-based cognitive remediation.
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Affiliation(s)
- Bryce J.M. Bogie
- MD/PhD Program, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Royal's Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Chelsea Noël
- Department of Psychology, Lakehead University, Thunder Bay, ON, Canada
| | - Feng Gu
- The Royal's Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Sébastien Nadeau
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Cecelia Shvetz
- The Royal's Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
| | - Hassan Khan
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Marie-Christine Rivard
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Stéphane Bouchard
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
- Centre de recherche, Centre Intégré de Santé et de Services Sociaux de l'Outaouais, Gatineau, QC, Canada
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Martin Lepage
- Douglas Research Centre, Montréal, QC, Canada
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Synthia Guimond
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Royal's Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
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Paul M, Bullock K, Bailenson J, Burns D. Examining the Efficacy of Extended Reality-Enhanced Behavioral Activation for Adults With Major Depressive Disorder: Randomized Controlled Trial. JMIR Ment Health 2024; 11:e52326. [PMID: 38437873 PMCID: PMC11058556 DOI: 10.2196/52326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 02/16/2024] [Accepted: 03/01/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a global concern with increasing prevalence. While many evidence-based psychotherapies (EBPs) have been identified to treat MDD, there are numerous barriers to patients accessing them. Virtual reality (VR) has been used as a treatment enhancement for a variety of mental health disorders, but few studies have examined its clinical use in treating MDD. Behavioral activation (BA) is a simple yet effective and established first-line EBP for MDD that has the potential to be easily enhanced and adapted with VR technology. A previous report by our group explored the feasibility and acceptability of VR-enhanced BA in a small clinical proof-of-concept pilot. This study examines the clinical efficacy of a more immersive extended reality (XR)-enhanced BA (XR-BA) prototype. This is the first clinical efficacy test of an XR-BA protocol. OBJECTIVE This study examined whether XR-BA was feasible and efficacious in treating MDD in an ambulatory telemedicine clinic. METHODS A nonblinded between-subject randomized controlled trial compared XR-BA to traditional BA delivered via telehealth. The study used a previously established, brief 3-week, 4-session BA EBP intervention. The experimental XR-BA participants were directed to use a Meta Quest 2 (Reality Labs) VR headset to engage in simulated pleasant or mastery activities and were compared to a control arm, which used only real-life mastery or pleasant activities as between-session homework. The Patient Health Questionnaire (PHQ)-9 was the primary outcome measure. Independent-sample and paired-sample t tests (2-tailed) were used to determine statistical significance and confirmed using structural equation modeling. RESULTS Overall, 26 participants with MDD were randomized to receive either XR-BA (n=13, 50%) or traditional BA (n=13, 50%). The mean age of the 26 participants (n=6, 23% male; n=19, 73% female; n=1, 4% nonbinary or third gender) was 50.3 (SD 17.3) years. No adverse events were reported in either group, and no substantial differences in dropout rates or homework completion were observed. XR-BA was found to be statistically noninferior to traditional BA (t18.6=-0.28; P=.78). Both the XR-BA (t9=2.5; P=.04) and traditional BA (t10=2.3; P=.04) arms showed a statistically significant decrease in PHQ-9 and clinical severity from the beginning of session 1 to the beginning of session 4. There was a significant decrease in PHQ-8 to PHQ-9 scores between the phone intake and the beginning of session 1 for the XR-BA group (t11=2.6; P=.03) but not the traditional BA group (t11=1.4; P=.20). CONCLUSIONS This study confirmed previous findings that XR-BA may be a feasible, non-inferior, and acceptable enhancement to traditional BA. Additionally, there was evidence that supports the potential of XR to enhance expectation or placebo effects. Further research is needed to examine the potential of XR to improve access, outcomes, and barriers to MDD care. TRIAL REGISTRATION ClinicalTrials.gov NCT05525390; https://clinicaltrials.gov/study/NCT05525390.
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Affiliation(s)
- Margot Paul
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Kim Bullock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Jeremy Bailenson
- Department of Communication, Stanford University, Stanford, CA, United States
| | - David Burns
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
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Smith LC, Mateos AC, Due AS, Bergström J, Nordentoft M, Clemmensen L, Glenthøj LB. Immersive virtual reality in the treatment of auditory hallucinations: A PRISMA scoping review. Psychiatry Res 2024; 334:115834. [PMID: 38452499 DOI: 10.1016/j.psychres.2024.115834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND A large group of psychiatric patients suffer from auditory hallucinations (AH) despite relevant treatment regimens. In mental health populations, AH tend to be verbal (AVH) and the content critical or abusive. Trials employing immersive virtual reality (VR) to treat mental health disorders are emerging. OBJECTIVE The aim of this scoping review is to provide an overview of clinical trials utilizing VR in the treatment of AH and to document knowledge gaps in the literature. METHODS PubMed, Cochrane Library, and Embase were searched for studies reporting on the use of VR to target AH. RESULTS 16 papers were included in this PRISMA scoping review (ScR). In most studies VR therapy (VRT) was employed to ameliorate treatment resistant AVH in schizophrenia spectrum disorders. Only two studies included patients with a diagnosis of affective disorders. The VRT was carried out with the use of an avatar to represent the patient's most dominant voice. DISCUSSION The research field employing VR to treat AH is promising but still in its infancy. Results from larger randomized clinical trials are needed to establish substantial evidence of therapy effectiveness. Additionally, the knowledge base would benefit from more profound qualitative data exploring views of patients and therapists.
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Affiliation(s)
- Lisa Charlotte Smith
- VIRTU Research Group, Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark; Department of Clinical Medicine (DK), University of Copenhagen, Denmark.
| | - Ana Collados Mateos
- VIRTU Research Group, Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark
| | - Anne Sofie Due
- VIRTU Research Group, Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark
| | - Joanna Bergström
- Department of Computer Science (DK), University of Copenhagen, Denmark
| | - Merete Nordentoft
- Department of Clinical Medicine (DK), University of Copenhagen, Denmark; Research Unit (CORE), Capital Region (DK), Mental Health Center Copenhagen, Denmark
| | - Lars Clemmensen
- VIRTU Research Group, Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark
| | - Louise Birkedal Glenthøj
- VIRTU Research Group, Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark; Department of Psychology (DK), University of Copenhagen, Denmark
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Holopainen R, Tiihonen J, Lähteenvuo M. Efficacy of immersive extended reality (XR) interventions on different symptom domains of schizophrenia spectrum disorders. A systematic review. Front Psychiatry 2023; 14:1208287. [PMID: 37599868 PMCID: PMC10436301 DOI: 10.3389/fpsyt.2023.1208287] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Extended reality (XR) is an umbrella term for virtual reality (VR) and augmented reality (AR), both novel vectors for therapeutic intervention modalities. In VR, head-mounted devices (HMD) allow interaction with three-dimensional virtual environments and simulated avatars, while AR overlaps virtual, simulated objects to observe physical reality. Treatment through immersive VR has been studied in psychiatry, including patients suffering from schizophrenia spectrum disorders, while there has not been much attention to AR technologies in psychiatry. Our systematic review aimed to examine the currently available literature regarding the treatment efficacy of immersive VR or AR technologies on different symptom domains of schizophrenia spectrum disorders, screen for potential adverse effects, and gather data on the technological and human resource requirements of such interventions to help guide future research. Methods We conducted a systematic literature review with database searches carried out between 9/2021 and 8/2022 through PubMed, Scopus, EBSCOhost Academic Search Premier, and Web of Science. Results We identified 2,157 records, 214 were assessed further for eligibility and 12 met inclusion criteria. All included articles studied immersive VR and none used AR technology. Included studies were heterogenous in nature, including AVATAR therapy (3) and CBT-based (5) VR interventions, as well as cognitive (2), social (1), and relaxation (1) training through VR. The comparison groups were either passive controls (waitlist and treatment as usual), therapeutic interventions (CBT and Integrated psychological treatment), passive VR environments, or traditional, comparable, non-virtual treatment modalities (social roleplay and progressive muscle relaxation training). Pooled together, the included studies on VR show positive treatment effects in all major symptom domains of schizophrenia spectrum disorders with hardly any adverse effects related to the intervention modalities. Conclusions In this review, we have showcased how different symptom domains can be targeted through VR interventions, highlighting VR as a potential new vector for a diverse range of psychosocial therapeutic modalities that allow for completely new possibilities in the treatment of schizophrenia spectrum disorders. VR technology still requires more research and validation. Our review also shows that there are currently no studies examining AR technology in the treatment of schizophrenia spectrum disorders, indicating a distinctive research gap.
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Affiliation(s)
- Roope Holopainen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
| | - Markku Lähteenvuo
- Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
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Lan L, Sikov J, Lejeune J, Ji C, Brown H, Bullock K, Spencer AE. A Systematic Review of using Virtual and Augmented Reality for the Diagnosis and Treatment of Psychotic Disorders. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2023; 10:1-21. [PMID: 37360960 PMCID: PMC10264872 DOI: 10.1007/s40501-023-00287-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 06/28/2023]
Abstract
Objective Immersive virtual reality (VR) and augmented reality (AR) have the potential to improve the treatment and diagnosis of individuals experiencing psychosis. Although commonly used in creative industries, emerging evidence reveals that VR is a valuable tool to potentially improve clinical outcomes, including medication adherence, motivation, and rehabilitation. However, the efficacy and future directions of this novel intervention require further study. The aim of this review is to search for evidence of efficacy in enhancing existing psychosis treatment and diagnosis with AR/VR. Methods 2069 studies involving AR/VR as a diagnostic and treatment option were reviewed via PRISMA guidelines in five databases: PubMed, PsychInfo, Embase, and CINAHL. Results Of the initial 2069 articles, 23 original articles were eligible for inclusion. One study applied VR to the diagnosis of schizophrenia. Most studies demonstrated that the addition of VR therapies and rehabilitation methods to treatment-as-usual (medication, psychotherapy, social skills training) was more effective than traditional methods alone in treating psychosis disorders. Studies also support the feasibility, safety, and acceptability of VR to patients. No articles using AR as a diagnostic or treatment option were found. Conclusions VR is efficacious in diagnosing and treating individuals experiencing psychosis and is a valuable augmentation of evidence-based treatments. Supplementary Information The online version contains supplementary material available at 10.1007/s40501-023-00287-5.
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Affiliation(s)
- Lucy Lan
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA 94304 USA
| | - Jennifer Sikov
- Department of Psychology, Florida International University, Miami, Fl USA
| | - Julia Lejeune
- Department of Psychology, University of Illinois Chicago, Chicago, IL USA
| | - Chelsea Ji
- Chronic Traumatic Encephalopathy Center, Boston University, Boston, MA USA
| | - Hannah Brown
- Department of Psychiatry, Boston Medical Center, Boston, MA USA
| | - Kim Bullock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA 94304 USA
| | - Andrea E. Spencer
- Department of Psychiatry and Behavioral Health, Northwestern University Feinberg School of Medicine, Chicago, IL USA
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Hudon A, Lammatteo V, Rodrigues-Coutlée S, Dellazizzo L, Giguère S, Phraxayavong K, Potvin S, Dumais A. Exploration of the role of emotional expression of treatment-resistant schizophrenia patients having followed virtual reality therapy: a content analysis. BMC Psychiatry 2023; 23:420. [PMID: 37308864 DOI: 10.1186/s12888-023-04861-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/10/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Emotional responses are an important component of psychotherapeutic processes. Avatar therapy (AT) is a virtual reality-based therapy currently being developed and studied for patients suffering from treatment resistant schizophrenia. Considering the importance of identifying emotions in therapeutical processes and their impact on the therapeutic outcome, an exploration of such emotions is needed. METHODS The aim of this study is to identify the underlying emotions at the core of the patient-Avatar interaction during AT by content analysis of immersive sessions transcripts and audio recordings. A content analysis of AT transcripts and audio recordings using iterative categorization was conducted for 16 patients suffering from TRS who underwent AT between 2017 and 2022 (128 transcripts and 128 audio recordings). An iterative categorization technique was conducted to identify the different emotions expressed by the patient and the Avatar during the immersive sessions. RESULTS The following emotions were identified in this study: Anger, Contempt/ Disgust, Fear, Sadness, Shame/ Embarrassment, Interest, Surprise, Joy and Neutral. Patients expressed mostly neutral, joy and anger emotions whereas the Avatar expressed predominantly interest, disgust/contempt, and neutral emotions. CONCLUSIONS This study portrays a first qualitative insight on the emotions that are expressed in AT and serves as a steppingstone for further investigation in the role of emotions in the therapeutic outcomes of AT.
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Affiliation(s)
- Alexandre Hudon
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | | | | | - Laura Dellazizzo
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Sabrina Giguère
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | | | - Stéphane Potvin
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Alexandre Dumais
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada.
- Services et Recherches Psychiatriques AD, Montreal, QC, Canada.
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
- Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada.
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Pavlidou A, Gorisse G, Banakou D, Walther S. Using virtual reality to assess gesture performance deficits in schizophrenia patients. Front Psychiatry 2023; 14:1191601. [PMID: 37363173 PMCID: PMC10288366 DOI: 10.3389/fpsyt.2023.1191601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Gesture performance deficits are prevalent in schizophrenia patients and are strongly associated with poor social communication skills and community functioning, affecting their overall quality of life. Currently, video-recording technology is widely used in clinical settings to assess gesture production deficits in schizophrenia patients. Nevertheless, the subjective evaluation of video-recordings can encumber task assessment. The present study will aim to use virtual reality to examine its potential use as an alternative tool to objectively measure gesture performance accuracy in schizophrenia patients and healthy controls. Methods Gesture performance in the virtual reality setting will be based on the well-established Test of Upper Limb Apraxia. Participants will be immersed in a virtual environment where they will experience themselves being embodied in a collocated virtual body seen from a first-person perspective. Motion trackers will be placed on participants' hands and elbows to track upper body movements in real-time, and to record gesture movement for later analysis. Participants will see a virtual agent sitting across from them, with a virtual table in between. The agent will perform various types of gestures and the participants' task will be to imitate those gestures as accurately as possible. Measurements from the tracking devices will be stored and analyzed to address gesture performance accuracy across groups. Discussion This study aims to provide objective measurements of gesture performance accuracy in schizophrenia patients. If successful, the results will provide new knowledge to the gesture literature and offer the potential for novel therapeutic interventions using virtual reality technologies. Such interventions can improve gesturing and thus advance social communication skills in schizophrenia patients.
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Affiliation(s)
- Anastasia Pavlidou
- University of Bern, University Hospital of Psychiatry and Psychotherapy, Translation Research Centre, Bern, Switzerland
| | | | - Domna Banakou
- Arts and Humanities Division, New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Sebastian Walther
- University of Bern, University Hospital of Psychiatry and Psychotherapy, Translation Research Centre, Bern, Switzerland
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Hudon A, Beaudoin M, Phraxayavong K, Potvin S, Dumais A. Unsupervised Machine Learning Driven Analysis of Verbatims of Treatment-Resistant Schizophrenia Patients Having Followed Avatar Therapy. J Pers Med 2023; 13:jpm13050801. [PMID: 37240971 DOI: 10.3390/jpm13050801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: The therapeutic mechanisms underlying psychotherapeutic interventions for individuals with treatment-resistant schizophrenia are mostly unknown. One of these treatment techniques is avatar therapy (AT), in which the patient engages in immersive sessions while interacting with an avatar representing their primary persistent auditory verbal hallucination. The aim of this study was to conduct an unsupervised machine-learning analysis of verbatims of treatment-resistant schizophrenia patients that have followed AT. The second aim of the study was to compare the data clusters obtained from the unsupervised machine-learning analysis with previously conducted qualitative analysis. (2) Methods: A k-means algorithm was performed over the immersive-session verbatims of 18 patients suffering from treatment-resistant schizophrenia who followed AT to cluster interactions of the avatar and the patient. Data were pre-processed using vectorization and data reduction. (3): Results: Three clusters of interactions were identified for the avatar's interactions whereas four clusters were identified for the patient's interactions. (4) Conclusion: This study was the first attempt to conduct unsupervised machine learning on AT and provided a quantitative insight into the inner interactions that take place during immersive sessions. The use of unsupervised machine learning could yield a better understanding of the type of interactions that take place in AT and their clinical implications.
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Affiliation(s)
- Alexandre Hudon
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3J4, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Mélissa Beaudoin
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3J4, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3G 2M1, Canada
| | - Kingsada Phraxayavong
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3J4, Canada
- Services et Recherches Psychiatriques AD, Montreal, QC H1C 1H1, Canada
| | - Stéphane Potvin
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3J4, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Alexandre Dumais
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC H1N 3J4, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
- Services et Recherches Psychiatriques AD, Montreal, QC H1C 1H1, Canada
- Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, QC H1C 1H1, Canada
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Giguère S, Potvin S, Beaudoin M, Dellazizzo L, Giguère CÉ, Furtos A, Gilbert K, Phraxayavong K, Dumais A. Avatar Intervention for Cannabis Use Disorder in Individuals with Severe Mental Disorders: A Pilot Study. J Pers Med 2023; 13:jpm13050766. [PMID: 37240936 DOI: 10.3390/jpm13050766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 04/22/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Cannabis use disorder (CUD) is a complex issue, even more so when it is comorbid with a severe mental disorder (SMD). Available interventions are at best slightly effective, and their effects are not maintained over time. Therefore, the integration of virtual reality (VR) may increase efficacy; however, it has not yet been investigated in the treatment of CUD. A novel approach, avatar intervention for CUD, uses existing therapeutic techniques from other recommended therapies (e.g., cognitive behavioral methods, motivational interviewing) and allows participants to practice them in real-time. During immersive sessions, participants are invited to interact with an avatar representing a significant person related to their drug use. This pilot clinical trial aimed to evaluate the short-term efficacity of avatar intervention for CUD on 19 participants with a dual diagnosis of SMD and CUD. Results showed a significant moderate reduction in the quantity of cannabis use (Cohen's d = 0.611, p = 0.004), which was confirmed via urinary quantification of cannabis use. Overall, this unique intervention shows promising results. Longer-term results, as well as comparison with classical interventions in a larger sample, are warranted through a future single-blind randomized controlled trial.
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Affiliation(s)
- Sabrina Giguère
- Department of Psychiatry and Addictology, University of Montreal, Montreal, QC H3T 1J4, Canada
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada
| | - Stéphane Potvin
- Department of Psychiatry and Addictology, University of Montreal, Montreal, QC H3T 1J4, Canada
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada
| | - Mélissa Beaudoin
- Department of Psychiatry and Addictology, University of Montreal, Montreal, QC H3T 1J4, Canada
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3G 2M1, Canada
| | - Laura Dellazizzo
- Department of Psychiatry and Addictology, University of Montreal, Montreal, QC H3T 1J4, Canada
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada
| | - Charles-Édouard Giguère
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada
| | - Alexandra Furtos
- Department of Chemistry, University of Montreal, Montreal, QC H2V 0B3, Canada
| | - Karine Gilbert
- Department of Chemistry, University of Montreal, Montreal, QC H2V 0B3, Canada
| | - Kingsada Phraxayavong
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada
- Services et Recherches Psychiatriques AD, Montreal, QC H1N 3V2, Canada
| | - Alexandre Dumais
- Department of Psychiatry and Addictology, University of Montreal, Montreal, QC H3T 1J4, Canada
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada
- Services et Recherches Psychiatriques AD, Montreal, QC H1N 3V2, Canada
- Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, QC H1C 1H1, Canada
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He Y, Yang L, Qian C, Li T, Su Z, Zhang Q, Hou X. Conversational Agent Interventions for Mental Health Problems: Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Internet Res 2023; 25:e43862. [PMID: 37115595 PMCID: PMC10182468 DOI: 10.2196/43862] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 02/17/2023] [Accepted: 03/10/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Mental health problems are a crucial global public health concern. Owing to their cost-effectiveness and accessibility, conversational agent interventions (CAIs) are promising in the field of mental health care. OBJECTIVE This study aims to present a thorough summary of the traits of CAIs available for a range of mental health problems, find evidence of efficacy, and analyze the statistically significant moderators of efficacy via a meta-analysis of randomized controlled trial. METHODS Web-based databases (Embase, MEDLINE, PsycINFO, CINAHL, Web of Science, and Cochrane) were systematically searched dated from the establishment of the database to October 30, 2021, and updated to May 1, 2022. Randomized controlled trials comparing CAIs with any other type of control condition in improving depressive symptoms, generalized anxiety symptoms, specific anxiety symptoms, quality of life or well-being, general distress, stress, mental disorder symptoms, psychosomatic disease symptoms, and positive and negative affect were considered eligible. This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data were extracted by 2 independent reviewers, checked by a third reviewer, and pooled using both random effect models and fixed effects models. Hedges g was chosen as the effect size. RESULTS Of the 6900 identified records, a total of 32 studies were included, involving 6089 participants. CAIs showed statistically significant short-term effects compared with control conditions in improving depressive symptoms (g=0.29, 95% CI 0.20-0.38), generalized anxiety symptoms (g=0.29, 95% CI 0.21-0.36), specific anxiety symptoms (g=0.47, 95% CI 0.07-0.86), quality of life or well-being (g=0.27, 95% CI 0.16-0.39), general distress (g=0.33, 95% CI 0.20-0.45), stress (g=0.24, 95% CI 0.08-0.41), mental disorder symptoms (g=0.36, 95% CI 0.17-0.54), psychosomatic disease symptoms (g=0.62, 95% CI 0.14-1.11), and negative affect (g=0.28, 95% CI 0.05-0.51). However, the long-term effects of CAIs for the most mental health outcomes were not statistically significant (g=-0.04 to 0.39). Personalization and empathic response were 2 critical facilitators of efficacy. The longer duration of interaction with conversational agents was associated with the larger pooled effect sizes. CONCLUSIONS The findings show that CAIs are research-proven interventions that ought to be implemented more widely in mental health care. CAIs are effective and easily acceptable for those with mental health problems. The clinical application of this novel digital technology will conserve human health resources and optimize the allocation of mental health services. TRIAL REGISTRATION PROSPERO CRD42022350130; https://tinyurl.com/mvhk6w9p.
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Affiliation(s)
- Yuhao He
- Institute of Applied Psychology, College of Education, Tianjin University, Tianjin, China
- Laboratory of Suicidology, Tianjin Municipal Education Commission, Tianjin, China
| | - Li Yang
- Institute of Applied Psychology, College of Education, Tianjin University, Tianjin, China
- Laboratory of Suicidology, Tianjin Municipal Education Commission, Tianjin, China
| | - Chunlian Qian
- Institute of Applied Psychology, College of Education, Tianjin University, Tianjin, China
- Laboratory of Suicidology, Tianjin Municipal Education Commission, Tianjin, China
| | - Tong Li
- Institute of Applied Psychology, College of Education, Tianjin University, Tianjin, China
- Laboratory of Suicidology, Tianjin Municipal Education Commission, Tianjin, China
| | - Zhengyuan Su
- Institute of Applied Psychology, College of Education, Tianjin University, Tianjin, China
- Laboratory of Suicidology, Tianjin Municipal Education Commission, Tianjin, China
| | - Qiang Zhang
- Shenzhen School, Sun Yat-sen University, Shenzhen, China
| | - Xiangqing Hou
- Institute of Applied Psychology, College of Education, Tianjin University, Tianjin, China
- Laboratory of Suicidology, Tianjin Municipal Education Commission, Tianjin, China
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11
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Hudon A, Couture J, Dellazizzo L, Beaudoin M, Phraxayavong K, Potvin S, Dumais A. Dyadic Interactions of Treatment-Resistant Schizophrenia Patients Having Followed Virtual Reality Therapy: A Content Analysis. J Clin Med 2023; 12:jcm12062299. [PMID: 36983300 PMCID: PMC10053204 DOI: 10.3390/jcm12062299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/03/2023] [Accepted: 03/15/2023] [Indexed: 03/18/2023] Open
Abstract
(1) Background: Very little is known about the inner therapeutic processes of psychotherapy interventions for patients suffering from treatment-resistant schizophrenia. Avatar therapy (AT) is one such modalities in which the patient is undergoing immersive sessions in which they interact with an Avatar representing their main persistent auditory verbal hallucination. The aim of this study is to identify the most prevalent dyadic interactions between the patient and the Avatar in AT for patient’s suffering from TRS. (2) Methods: A content analysis of 256 verbatims originating from 32 patients who completed AT between 2017 and 2022 at the Institut universitaire en santé mentale de Montréal was conducted to identify dyadic interactions between the patients and their Avatar. (3) Results: Five key dyads were identified to occur on average more than 10 times for each participant during the immersive sessions across their AT: (Avatar: Reinforcement, Patient: Self-affirmation), (Avatar: Provocation, Patient: Self-affirmation), (Avatar: Coping mechanisms, Patient: Prevention), (Patient: Self-affirmation, Avatar: Reinforcement), and (Patient: Self-appraisal, Avatar: Reinforcement). (4) Conclusion: These dyads offer a first qualitative insight to the interpersonal dynamics and patient-avatar relationships taking place during AT. Future studies on the implication of such dyadic interactions with the therapeutic outcome of AT should be conducted considering the importance of dyadic relationships in psychotherapy.
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Affiliation(s)
- Alexandre Hudon
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3J4, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Jonathan Couture
- Faculty of Medicine, Department of Medicine, Campus Montréal, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Laura Dellazizzo
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3J4, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Mélissa Beaudoin
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3J4, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | | | - Stéphane Potvin
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3J4, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, QC H3T 1J4, Canada
| | - Alexandre Dumais
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montréal, QC H1N 3J4, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, QC H3T 1J4, Canada
- Services et Recherches Psychiatriques AD, Montréal, QC H1C 1H1, Canada
- Institut National de Psychiatrie Légale Philippe-Pinel, Montréal, QC H1C 1H1, Canada
- Correspondence:
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12
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Beaudoin M, Potvin S, Phraxayavong K, Dumais A. Changes in Quality of Life in Treatment-Resistant Schizophrenia Patients Undergoing Avatar Therapy: A Content Analysis. J Pers Med 2023; 13:jpm13030522. [PMID: 36983704 PMCID: PMC10058174 DOI: 10.3390/jpm13030522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 03/15/2023] Open
Abstract
Avatar Therapy has a significant impact on symptoms, beliefs, and quality of life of patients with treatment-resistant schizophrenia. However, little is known about how these changes are implemented into their lives and to which aspects of their lives these improvements relate. Ten consecutive patients enrolled in an ongoing clinical trial were assessed using semi-guided interviews before as well as three months after Avatar Therapy. These encounters have been recorded and transcribed so that the discourse could be thoroughly analyzed, leading to the generation of an extensive theme grid. As the cases were analyzed, the grid was adapted in a back-and-forth manner until data saturation occurred. The content analysis allowed the identification of nine main themes representing different aspects of the patients’ lives, each of which was subdivided into more specific codes. By analyzing the evolution of their frequency, it was observed that, following therapy, patients presented with fewer psychotic symptoms, better self-esteem, more hobbies and projects, and an overall improved lifestyle and mood. Finally, investigating the impact of Avatar Therapy on quality of life allows for a deeper understanding of how people with treatment-resistant schizophrenia can achieve meaningful changes and move towards a certain recovery process.
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Affiliation(s)
- Mélissa Beaudoin
- Department of Psychiatry and Addictology, University of Montreal, Montreal, QC H3T 1J4, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC H3G 2M1, Canada
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada
- Correspondence: (M.B.); (A.D.); Tel.: +1-514-251-4015 (A.D.)
| | - Stephane Potvin
- Department of Psychiatry and Addictology, University of Montreal, Montreal, QC H3T 1J4, Canada
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada
| | - Kingsada Phraxayavong
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada
- Services et Recherches Psychiatriques AD, Montreal, QC H1N 3V2, Canada
| | - Alexandre Dumais
- Department of Psychiatry and Addictology, University of Montreal, Montreal, QC H3T 1J4, Canada
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada
- Services et Recherches Psychiatriques AD, Montreal, QC H1N 3V2, Canada
- Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, QC H1C 1H1, Canada
- Correspondence: (M.B.); (A.D.); Tel.: +1-514-251-4015 (A.D.)
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13
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Application of Immersive Virtual Reality for Assessment and Intervention in Psychosis: A Systematic Review. Brain Sci 2023; 13:brainsci13030471. [PMID: 36979281 PMCID: PMC10046161 DOI: 10.3390/brainsci13030471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/12/2023] Open
Abstract
Virtual reality (VR) has emerged as a safe and non-invasive technology for the assessment of psychotic symptoms, social and cognitive impairments, and psychosocial intervention in improving outcomes in psychosis. This study systematically reviewed the current state of evidence in applying semi- and fully immersive VR for assessing and treating patients with psychosis. A systematic review was conducted adhering to the PRISMA statement and was conducted in Embase, PsycINFO, and PubMed databases for articles published between January 2013 and April 2022, which identified 28 eligible studies, including 12 for assessment and 16 for intervention. In the assessment studies, not all VR tasks could distinguish the differences between patients and healthy controls regarding their physiological responses, paranoid ideation, and certain aspects of cognitive functioning such as memory bias on the object tasks. Comparatively, VR-based interventions are more promising, especially for improving cognitive impairments, social skills, agoraphobic avoidance, negative and positive affective states, auditory verbal hallucination, paranoid ideation and persecutory delusions, and other psychiatric symptoms in patients. We conclude that more rigorous studies are needed to confirm treatment effectiveness and to understand the underlying mechanism of VR-based intervention for psychotic disorders. Future studies should also improve the reliability and validity of VR-based assessments for psychotic disorders.
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Liang N, Li X, Guo X, Liu S, Liu Y, Zhao W, Wen Y, Li Y, Li J, Li F, Wu H, Li J, Li Q, Guo J, Xu Y. P50 sensory gating as a neurophysiological correlate of symptomatic improvement by virtual reality-based computer avatar therapy system in patients with auditory verbal hallucinations: A pilot study. Schizophr Res 2023; 252:296-299. [PMID: 36706474 DOI: 10.1016/j.schres.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/10/2023] [Accepted: 01/15/2023] [Indexed: 01/26/2023]
Affiliation(s)
- Nana Liang
- Department of Psychiatry, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Xinrong Li
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Xianju Guo
- Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
| | - Sha Liu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Yao Liu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Wentao Zhao
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Yujiao Wen
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Yue Li
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Jing Li
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Fangya Li
- School of Humanities and Social Sciences, Shanxi Medical University, Taiyuan, China
| | - Haiyan Wu
- School of Humanities and Social Sciences, Shanxi Medical University, Taiyuan, China
| | - Jianhong Li
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Qiqi Li
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Jianxia Guo
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Yong Xu
- Department of Psychiatry, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China; Department of Mental Health, Shanxi Medical University, Taiyuan, China.
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15
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Tsamitros N, Beck A, Sebold M, Schouler-Ocak M, Bermpohl F, Gutwinski S. [The application of virtual reality in the treatment of mental disorders]. DER NERVENARZT 2023; 94:27-33. [PMID: 36053303 PMCID: PMC9859917 DOI: 10.1007/s00115-022-01378-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Virtual reality (VR) enables immersion in an interactive digital world with realistic experiences, that can be applied for controlled and personalized interventions. This review summarizes the current research on VR in the treatment of mental disorders. METHODS Selective literature search in PubMed and Google Scholar. RESULTS An increasing number of publications report the therapeutic application of VR for the treatment of mental disorders. Most VR applications are based on established therapy approaches, such as exposure therapy. According to meta-analytic data, virtual exposure therapy (VRET) for specific phobia and agoraphobia with panic disorder is as effective as traditional in vivo exposure therapy. VRET for the treatment of social phobia is significantly more effective than waitlist and placebo control groups with, however, currently inconsistent metanalytic results when compared to in vivo exposure therapy. VRET for the treatment of posttraumatic stress disorder (PTSD) is similar in effectiveness compared to active psychotherapy. For psychosis, positive results have been reported for the VR-based treatment of auditory verbal hallucinations. For patients with a substance use disorder, VR can induce craving, with still unverified diagnostic and therapeutic relevance. CONCLUSIONS VRET can broaden the psychotherapy options for anxiety disorders. Encouraging results of VR-based treatments for psychosis and PTSD indicate the need for further research concerning its effectiveness and safety. In the field of substance use disorders, evaluation of clinical-orientated VR applications is needed.
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Affiliation(s)
- N. Tsamitros
- Psychiatrische Universitätsklinik der Charité – Universitätsmedizin Berlin im St. Hedwig-Krankenhaus/Institutsambulanz, Müllerstr. 56–58, 13349 Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - A. Beck
- Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland ,Fakultät Gesundheit, Health and Medical University, Campus Potsdam, Potsdam, Deutschland
| | - M. Sebold
- Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - M. Schouler-Ocak
- Psychiatrische Universitätsklinik der Charité – Universitätsmedizin Berlin im St. Hedwig-Krankenhaus/Institutsambulanz, Müllerstr. 56–58, 13349 Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - F. Bermpohl
- Psychiatrische Universitätsklinik der Charité – Universitätsmedizin Berlin im St. Hedwig-Krankenhaus/Institutsambulanz, Müllerstr. 56–58, 13349 Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - S. Gutwinski
- Psychiatrische Universitätsklinik der Charité – Universitätsmedizin Berlin im St. Hedwig-Krankenhaus/Institutsambulanz, Müllerstr. 56–58, 13349 Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
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16
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Hudon A, Léveillé N, Sanchez-Schicharew K, Dellazizzo L, Phraxayavong K, Dumais A. The impacts of the COVID-19 pandemic on treatment-resistant schizophrenia patients having followed virtual reality therapy or cognitive behavioural therapy: a content analysis. Ann Med 2022; 54:2477-2485. [PMID: 36102593 PMCID: PMC9481136 DOI: 10.1080/07853890.2022.2121852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The COVID-19 pandemic led to exacerbation of mental health symptoms and deterioration in psychological well-being in individuals suffering from schizophrenia. The primary objective of this study is to evaluate the impacts of the COVID-19 pandemic on patients suffering from treatment-resistant schizophrenia (TRS) with auditory verbal hallucinations (AVH) having undergone virtual reality therapy (VRT) or cognitive behavioural therapy (CBT) on their symptomatology. The secondary objective is to identify the differences and similarities in relation to the response to the COVID 19 pandemic between these two groups of patients. METHODS Qualitative analysis of semi-structured interviews was conducted with 42 patients suffering from TRS who had previously followed VRT or CBT. All interviews were recorded, transcribed, and analysed. RESULTS Four themes emerged in this study: Psychotherapeutic Interventions, Impact of COVID-19 and Public health and safety policies, Substance use and Psychiatric follow-up. Participants from both groups reported that their therapy was beneficial in controlling AVH. Patients having followed CBT reported more depressive symptoms whereas patients having followed VRT reported more anxious symptoms. CONCLUSIONS This study offers a first qualitative insight in patients suffering from TRS and the impacts of COVID-19 on them and opens the door to the protective factors of CBT and VRT for this specific population.
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Affiliation(s)
- Alexandre Hudon
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada.,Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Nayla Léveillé
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | | | - Laura Dellazizzo
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada.,Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | | | - Alexandre Dumais
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada.,Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, Canada.,Services et Recherches Psychiatriques AD, Montreal, Canada.,Institut national de Psychiatrie Légale Philippe-Pinel, Montreal, Canada
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17
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Wiebe A, Kannen K, Selaskowski B, Mehren A, Thöne AK, Pramme L, Blumenthal N, Li M, Asché L, Jonas S, Bey K, Schulze M, Steffens M, Pensel MC, Guth M, Rohlfsen F, Ekhlas M, Lügering H, Fileccia H, Pakos J, Lux S, Philipsen A, Braun N. Virtual reality in the diagnostic and therapy for mental disorders: A systematic review. Clin Psychol Rev 2022; 98:102213. [PMID: 36356351 DOI: 10.1016/j.cpr.2022.102213] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 08/21/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Virtual reality (VR) technologies are playing an increasingly important role in the diagnostics and treatment of mental disorders. OBJECTIVE To systematically review the current evidence regarding the use of VR in the diagnostics and treatment of mental disorders. DATA SOURCE Systematic literature searches via PubMed (last literature update: 9th of May 2022) were conducted for the following areas of psychopathology: Specific phobias, panic disorder and agoraphobia, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, dementia disorders, attention-deficit/hyperactivity disorder, depression, autism spectrum disorder, schizophrenia spectrum disorders, and addiction disorders. ELIGIBILITY CRITERIA To be eligible, studies had to be published in English, to be peer-reviewed, to report original research data, to be VR-related, and to deal with one of the above-mentioned areas of psychopathology. STUDY EVALUATION For each study included, various study characteristics (including interventions and conditions, comparators, major outcomes and study designs) were retrieved and a risk of bias score was calculated based on predefined study quality criteria. RESULTS Across all areas of psychopathology, k = 9315 studies were inspected, of which k = 721 studies met the eligibility criteria. From these studies, 43.97% were considered assessment-related, 55.48% therapy-related, and 0.55% were mixed. The highest research activity was found for VR exposure therapy in anxiety disorders, PTSD and addiction disorders, where the most convincing evidence was found, as well as for cognitive trainings in dementia and social skill trainings in autism spectrum disorder. CONCLUSION While VR exposure therapy will likely find its way successively into regular patient care, there are also many other promising approaches, but most are not yet mature enough for clinical application. REVIEW REGISTRATION PROSPERO register CRD42020188436. FUNDING The review was funded by budgets from the University of Bonn. No third party funding was involved.
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Affiliation(s)
- Annika Wiebe
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Kyra Kannen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Benjamin Selaskowski
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Aylin Mehren
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Ann-Kathrin Thöne
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lisa Pramme
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Nike Blumenthal
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Mengtong Li
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Laura Asché
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Stephan Jonas
- Institute for Digital Medicine, University Hospital Bonn, Bonn, Germany
| | - Katharina Bey
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Marcel Schulze
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Maria Steffens
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Max Christian Pensel
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Matthias Guth
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Felicia Rohlfsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Mogda Ekhlas
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Helena Lügering
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Helena Fileccia
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Julian Pakos
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Niclas Braun
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.
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18
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Rammou A, Berry C, Fowler D, Hayward M. Distress factors of voice-hearing in young people and social relating: Exploring a cognitive-interpersonal voice-hearing model. Psychol Psychother 2022; 95:939-957. [PMID: 35773751 PMCID: PMC9795969 DOI: 10.1111/papt.12411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/22/2022] [Accepted: 06/13/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Little is known about the factors that can maintain the distress related to voice-hearing experiences in youth. Building upon understandings developed with adults, this study aimed to explore the associations between negative relating between hearer and voices, persecutory beliefs about voices and voice-related distress in a clinical sample of adolescents. The study also aimed to investigate associations between relating to voices and wider patterns of social relating. DESIGN This was an observational, cross-sectional, survey study. METHODS Thirty-four young people (age 14-18 years) who were hearing voices completed measures about voices (characteristics, relating and beliefs) and relating to social others (negative relating styles, social connectedness and belongingness). Participants were patients of NHS mental health services. Bivariate correlations explored associations between relating to voices and distress, beliefs about voices and distress, and between relating to voices and social relating variables. RESULTS Perceiving the voices as dominant, intrusive, and persecutory and resisting them was significantly associated with distress. Adjusting for loudness and negative content rendered the association between persecutory beliefs and distress non-significant. Fear of separation and of being alone in relation to social others was associated with distancing from voices. Being suspicious, uncommunicative and self-reliant and/or being sadistic and intimidating towards social others was significantly associated with dependence towards the voices. Greater hearer-to-voice dependence was associated with lower perceived social belongingness and connectedness. CONCLUSIONS Beliefs about voices being persecutory, dominant, intrusive and resisting voices seem to be significant contributors of distress in young people. In terms of proximity and power, relating to voices and social others appears to be contrasting.
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Affiliation(s)
- Aikaterini Rammou
- School of PsychologyUniversity of SussexBrightonUK,Research & Development DepartmentSussex Partnership NHS Foundation TrustBrightonUK
| | - Clio Berry
- School of PsychologyUniversity of SussexBrightonUK,Brighton and Sussex Medical SchoolUniversity of SussexBrightonUK
| | - David Fowler
- School of PsychologyUniversity of SussexBrightonUK,Research & Development DepartmentSussex Partnership NHS Foundation TrustBrightonUK
| | - Mark Hayward
- School of PsychologyUniversity of SussexBrightonUK,Research & Development DepartmentSussex Partnership NHS Foundation TrustBrightonUK
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19
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Effect of Virtual Reality on Cognitive Impairment and Clinical Symptoms among Patients with Schizophrenia in the Remission Stage: A Randomized Controlled Trial. Brain Sci 2022; 12:brainsci12111572. [PMID: 36421896 PMCID: PMC9688710 DOI: 10.3390/brainsci12111572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/08/2022] [Accepted: 11/12/2022] [Indexed: 11/22/2022] Open
Abstract
Aims: This intervention study evaluates the effect of a virtual reality cognition training system (VRCTS) on improving cognitive function and clinical symptoms in Han Chinese patients with schizophrenia in the remission stage. Methods: Sixty-eight patients with schizophrenia in the remission stage were recruited for this study and were randomly allocated to either the virtual reality training (VRT) group or the treatment-as-usual (TAU) group. For the VRT group, patients received training with the VRCTS for two weeks and antipsychotic treatment as usual, while the TAU group only received antipsychotic treatment as usual. Cognitive function and clinical symptoms before and after the two-week treatment were assessed by the MATRICS consensus cognitive battery (MCCB), positive and negative syndrome scale (PANSS), and personal and social performance scale (PSP). Results: The results showed that (1) VRCTS could improve MCCB composite scores and scores on 2 out of 7 cognitive domains: visual learning as well as reasoning and problem solving. It was also observed that (2) VRCTS could alleviate general psychopathology symptoms of PANSS, but did not exert effects on positive and negative symptoms among patients with schizophrenia in the remission stage. Conclusions: A therapeutic effect of VRCTS was observed in patients with schizophrenia in the remission stage. This may improve cognitive function and general psychopathological symptoms. Trial registration: China Clinical Trial Registry, ChiVTR1800016121.
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Middleton K, Cooke A, May R. “It allowed us to let our pain out”: perspectives from voice-hearers and their voices on the ‘talking with voices’ approach. PSYCHOSIS 2022. [DOI: 10.1080/17522439.2022.2141840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Kerry Middleton
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Kent, UK
| | - Anne Cooke
- Salomons Institute for Applied Psychology, Canterbury Christ Church University, Kent, UK
| | - Rufus May
- Greater Manchester Mental Health Trust, Greater Manchester, UK
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21
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Collaborative and individual learning of geography in immersive virtual reality: An effectiveness study. PLoS One 2022; 17:e0276267. [PMID: 36256672 PMCID: PMC9578614 DOI: 10.1371/journal.pone.0276267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/04/2022] [Indexed: 11/19/2022] Open
Abstract
Many university-taught courses moved to online form since the outbreak of the global pandemic of coronavirus disease (COVID-19). Distance learning has become broadly used as a result of the widely applied lockdowns, however, many students lack personal contact in the learning process. A classical web-based distance learning does not provide means for natural interpersonal interaction. The technology of immersive virtual reality (iVR) may mitigate this problem. Current research has been aimed mainly at specific instances of collaborative immersive virtual environment (CIVE) applications for learning. The fields utilizing iVR for knowledge construction and skills training with the use of spatial visualizations show promising results. The objective of this study was to assess the effectiveness of collaborative and individual use of iVR for learning geography, specifically training in hypsography. Furthermore, the study's goals were to determine whether collaborative learning would be more effective and to investigate the key elements in which collaborative and individual learning were expected to differ-motivation and use of cognitive resources. The CIVE application developed at Masaryk University was utilized to train 80 participants in inferring conclusions from cartographic visualizations. The collaborative and individual experimental group underwent a research procedure consisting of a pretest, training in iVR, posttest, and questionnaires. A statistical comparison between the geography pretest and posttest for the individual learning showed a significant increase in the score (p = 0.024, ES = 0.128) and speed (p = 0.027, ES = 0.123), while for the collaborative learning, there was a significant increase in the score (p<0.001, ES = 0.333) but not in speed (p = 1.000, ES = 0.000). Thus, iVR as a medium proved to be an effective tool for learning geography. However, comparing the collaborative and individual learning showed no significant difference in the learning gain (p = 0.303, ES = 0.115), speed gain (p = 0.098, ES = 0.185), or performance motivation (p = 0.368, ES = 0.101). Nevertheless, the collaborative learning group had significantly higher use of cognitive resources (p = 0.046, ES = 0.223) than the individual learning group. The results were discussed in relation to the cognitive load theories, and future research directions for iVR learning were proposed.
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22
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Hudon A, Beaudoin M, Phraxayavong K, Dellazizzo L, Potvin S, Dumais A. Implementation of a machine learning algorithm for automated thematic annotations in avatar: A linear support vector classifier approach. Health Informatics J 2022; 28:14604582221142442. [DOI: 10.1177/14604582221142442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Avatar Therapy (AT) is a modern therapeutic alternative for patients with schizophrenia suffering from persistent auditory verbal hallucinations. Its intrinsic therapeutical process is currently qualitatively analyzed via human coders that annotate session transcripts. This process is time and resource demanding. This creates a need to find potential algorithms that can operate on small datasets and perform such annotations. The first objective of this study is to conduct the automated text classification of interactions in AT and the second objective is to assess if this classification is comparable to the classification done by human coders. A Linear Support Vector Classifier was implemented to perform automated theme classifications on Avatar Therapy session transcripts with the use of a limited dataset with an accuracy of 66.02% and substantial classification agreement of 0.647. These results open the door to additional research such as predicting the outcome of a therapy.
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Affiliation(s)
- Alexandre Hudon
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Mélissa Beaudoin
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | | | - Laura Dellazizzo
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Stéphane Potvin
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Alexandre Dumais
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada; Services et Recherches Psychiatriques AD, Montreal, QC, Canada; Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada
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23
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Smith LC, Mariegaard L, Vernal DL, Christensen AG, Albert N, Thomas N, Hjorthøj C, Glenthøj LB, Nordentoft M. The CHALLENGE trial: the effects of a virtual reality-assisted exposure therapy for persistent auditory hallucinations versus supportive counselling in people with psychosis: study protocol for a randomised clinical trial. Trials 2022; 23:773. [PMID: 36100943 PMCID: PMC9468536 DOI: 10.1186/s13063-022-06683-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/24/2022] [Indexed: 11/22/2022] Open
Abstract
Background Many patients suffering from schizophrenia spectrum disorders continue having distressing auditory hallucinations in spite of treatment with antipsychotic medication. The aim of this trial is to examine the effect of a targeted virtual reality therapy for persistent auditory hallucinations in individuals with psychosis. The trial explores whether this type of therapy can decrease the severity, frequency and distress of auditory hallucinations and, additionally, whether it can reduce clinical symptoms and enhance daily functioning in individuals with psychosis. Methods The study is a randomised, assessor-blinded parallel-group superiority clinical trial, allocating a total of 266 patients to either the experimental intervention or supportive counselling. The participants will be randomised to either (1) seven sessions of virtual reality therapy or (2) seven sessions of supportive counselling to be delivered within the first 12 weeks after inclusion in the study. All participants will be assessed at baseline and 12 and 24 weeks post-baseline. Independent assessors blinded to the treatment allocation will evaluate the outcome. The primary outcome is the level of auditory hallucinations measured with the Psychotic Symptoms Rating Scales (PSYRATS-AH) total score at the cessation of treatment at 12 weeks. Secondary outcomes are frequency of auditory hallucinations, the distress caused by auditory hallucinations, perceived voice power, patient acceptance of voices, patients’ ability to respond to voices in an assertive way and social and daily function. Discussion Promising evidence of the efficacy of this immersive virtual reality-based therapy for auditory hallucinations exist, but evidence needs to be established in a large, methodological rigorous trial. If the therapy proves to be beneficial in reducing the severity of refractory auditory hallucinations, a large group of patients with schizophrenia and related disorders could be the target group of this short-term psychotherapeutic intervention.
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Affiliation(s)
- L C Smith
- Research Unit (CORE), Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Capital Region of Denmark, Denmark.
| | - L Mariegaard
- Research Unit (CORE), Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Capital Region of Denmark, Denmark
| | - D L Vernal
- Psychiatry, Aalborg University Hospital, Aalborg, North Denmark Region, Denmark
| | - A G Christensen
- Mental Health Center Esbjerg, Esbjerg, Region of South Denmark, Denmark
| | - N Albert
- Research Unit (CORE), Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Capital Region of Denmark, Denmark
| | - N Thomas
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
| | - C Hjorthøj
- Research Unit (CORE), Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Capital Region of Denmark, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - L B Glenthøj
- Research Unit (CORE), Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Capital Region of Denmark, Denmark.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - M Nordentoft
- Research Unit (CORE), Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Capital Region of Denmark, Denmark
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24
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Manghisi VM, Evangelista A, Semisa D, Latorre V, Uva AE. Evaluating the Acceptance of Cinematic Virtual Reality-Based Applications for Rehabilitative Interventions in Schizophrenia. Games Health J 2022; 11:385-392. [PMID: 36074091 DOI: 10.1089/g4h.2021.0223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: This study aims to evaluate the acceptability of Cinematic VR technology as a novel therapeutic approach supporting Social Skills Training (SST) rehabilitation interventions among patients with schizophrenia. Materials and Methods: We developed an innovative cinematic VR-based platform as a support system for SST rehabilitation of independent living skills and evaluated its acceptance among psychiatric patients in terms of usability, user experience, and use performance. Ten voluntary participants were enrolled in the study. The study inclusion criteria consisted of age 18-65 years, lack of moderate and severe intellectual disability, no substance use disorder, and schizophrenia spectrum disorder pathology according to DSM V. We administered post treatment questionnaires and developed the platform to capture relevant data automatically. Results: Patients rated usability and user experience from good to excellent. We also observed an improvement in the use performance. Conclusions: Cinematic Virtual Reality based applications showed good acceptability among patients with schizophrenia. This result supports further efforts in evaluating its effectiveness as a novel therapeutic approach supporting SST rehabilitation interventions.
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Affiliation(s)
- Vito M Manghisi
- Department of Mechanics, Mathematics, and Management, Polytechnic University of Bari, Bari, Italy
| | - Alessandro Evangelista
- Department of Mechanics, Mathematics, and Management, Polytechnic University of Bari, Bari, Italy
| | - Domenico Semisa
- Department of Mental Health, Azienda Sanitaria Locale Bari, Bari, Italy
| | - Valeria Latorre
- Department of Mental Health, Azienda Sanitaria Locale Bari, Bari, Italy
| | - Antonio E Uva
- Department of Mechanics, Mathematics, and Management, Polytechnic University of Bari, Bari, Italy
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25
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Loizou S, Fowler D, Hayward M. Measuring the longitudinal course of voice hearing under psychological interventions: A systematic review. Clin Psychol Rev 2022; 97:102191. [PMID: 35995024 DOI: 10.1016/j.cpr.2022.102191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 06/10/2022] [Accepted: 08/04/2022] [Indexed: 11/30/2022]
Abstract
Trials of psychological interventions targeting distressing voices have used a range of variables to measure outcomes. This has complicated attempts to compare outcomes across trials and to evaluate the effectiveness of these interventions. Therefore, this review aimed to identify the variables that have been used to measure the longitudinal course and impact of voice hearing under these interventions and to evaluate how these variables change over time. Inclusion and exclusion criteria were applied, resulting in a total of 66 articles. Of these, 60 studies (28 RCTs, 23 uncontrolled, 9 non-randomised) were published in peer-reviewed journals, whilst 6 were recently completed or currently ongoing. The findings of this review suggest that a range of variables that are not directly relevant to psychological interventions have been used (e.g., depression, characteristics of voice hearing experience), whilst those directly impacted by psychological interventions (e.g., voice-related distress), broader concepts of outcome (e.g., functioning) and specific associated processes (e.g., self-schema) have received less attention. Findings also showed that the majority of variables demonstrated improvements, but effect sizes varied considerably across trials. This may be attributed to methodological differences such as statistical power, blinding, control groups and different methods of measurement. Our review highlights the importance of determining a set of outcomes that are directly targeted and should change under psychological interventions. Recommendations include the use of voice-related distress as a primary outcome. This can ultimately facilitate comparisons across studies and inform the development of psychological interventions.
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Affiliation(s)
- Sofia Loizou
- School of Psychology, University of Sussex, Falmer BN1 9QH, UK.
| | - David Fowler
- School of Psychology, University of Sussex, Falmer BN1 9QH, UK
| | - Mark Hayward
- School of Psychology, University of Sussex, Falmer BN1 9QH, UK; Research & Development Department, Sussex Partnership NHS Foundation Trust, Nevill Avenue, Hove BN7 3HZ, UK
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26
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Dellazizzo L, Giguère S, Léveillé N, Potvin S, Dumais A. A systematic review of relational-based therapies for the treatment of auditory hallucinations in patients with psychotic disorders. Psychol Med 2022; 52:2001-2008. [PMID: 35855651 PMCID: PMC9386435 DOI: 10.1017/s003329172200143x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 04/16/2022] [Accepted: 04/27/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Auditory hallucinations in patients with psychotic disorders may be very distressing. Unfortunately, a large proportion of individuals are resistant to pharmacological interventions and the gold-standard cognitive-behavioral therapy for psychosis offers at best modest effects. To improve therapeutic outcomes, several therapies have been created to establish a relationship between voice-hearers and their voices. With increasing literature, we conducted a systematic review of dialogical therapies and examined the evidence behind their efficacy. METHODS A systematic search was performed in PubMed, PsycINFO, Web of Science, and Google Scholar. Articles were included if they discussed the effects of dialogical interventions for patients with psychotic disorders. RESULTS A total of 17 studies were included within this systematic review. Cumulative evidence from various therapies has shown that entering in a dialog with voices is beneficial to patients, even those who are resistant to current pharmacological treatments. Heightened benefits have been mainly observed with Relating Therapy and Avatar Therapy/Virtual Reality assisted Therapy, with evidence generally of moderate quality. Both these interventions have shown large to very large effects on voices and voice-related distress as well as moderate to large magnitude improvements on affective symptoms. Though, cognitive-behavioral therapy for command hallucinations and making sense of voices noted no improvements on voices. CONCLUSIONS Literature on relational-based interventions with a strong emphasis on the relational aspects of voice hearing has shown positive effects. Results suggest that these dialogical therapies might surpass the efficacy of current gold-standard approaches.
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Affiliation(s)
- Laura Dellazizzo
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Sabrina Giguère
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Nayla Léveillé
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Stéphane Potvin
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Alexandre Dumais
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Faculty of Medicine, Université de Montréal, Montreal, Canada
- Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada
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Visual P300 as a neurophysiological correlate of symptomatic improvement by a virtual reality-based computer AT system in patients with auditory verbal hallucinations: A Pilot study. J Psychiatr Res 2022; 151:261-271. [PMID: 35512620 DOI: 10.1016/j.jpsychires.2022.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/09/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022]
Abstract
Previous comparative trials showed that virtual reality (VR) therapies achieved larger effects than gold-standard cognitive-behavioral therapy (CBT) on overall auditory verbal hallucinations (AVHs). However, no trial has examined the corresponding underlying electrophysiological mechanisms. We performed a pilot randomized comparative trial evaluating the efficacy of a virtual reality-based computer AT system (CATS) over CBT for schizophrenia (SCZ) patients with treatment-resistant AVHs and explored these potential electrophysiological changes via the visual P300 component. Patients (CATS, n = 32; CBT, n = 33) completed the clinical assessments pre- and post-interventions and at 12-week follow-up. The visual P300 were measured before and after both therapies. The analysis of changes in psychiatric symptoms used linear mixed-effects models, and the P300 response in temporal and time-frequency domains was analyzed with repeated-measures analysis of variance. There was no interaction effect between change in clinical symptoms and treatment group. However, several statistically significant within-group improvements were found for CATS and CBT over time. AVH improved significantly after both treatments, as measured with the Psychotic Symptom Rating Scales-Auditory Hallucinations (PSYRATS-AH) sub-scores. Especially for the CATS group, omnipotence beliefs, anxiety symptoms, self-esteem, and quality of life also remained improved at the 12-week follow-up. Moreover, P300 amplitude had a significant interaction effect and correlation with AVH response. Overall, our analysis did not demonstrate general clinical superiority of CATS over CBT, but CATS improved refractory AVH in SCZ patients, likely by increasing P300 amplitude. These findings support the continued development of CATS for persistent AVH and suggest further trials to clarify the neurological effects of CATS.
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Rus-Calafell M, Ehrbar N, Ward T, Edwards C, Huckvale M, Walke J, Garety P, Craig T. Participants' experiences of AVATAR therapy for distressing voices: a thematic qualitative evaluation. BMC Psychiatry 2022; 22:356. [PMID: 35610590 PMCID: PMC9129894 DOI: 10.1186/s12888-022-04010-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/11/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AVATAR therapy is an innovative therapy designed to support people with distressing voices. Voice hearers co-create a digital representation of their voice and engage in dialogue with it. Although it has been successfully tested in a powered randomised controlled trial (ISRCTN65314790), the participants' experience of this therapy has not been yet evaluated. We aimed to explore enablers and barriers to engagement with the therapy and potential for real-world impact on distressing voices. METHODS Thirty per cent of those who completed AVATAR therapy (15 people in total) and 5 who dropped out from therapy within the main AVATAR RCT were invited to participate in a semi-structured interview, which was audio-recorded and subsequently transcribed. RESULTS Fourteen therapy completers (28% of the full sample) and one person who dropped out of therapy after 1 active session, were interviewed. Thematic analysis was used to explore the interviews. A total of 1276 references were coded, and five overarching themes identified: AVATAR therapy set-up; voice embodiment and associated emotions; working in a safe space (supported by the therapist); learning new ways of relating to the voices; impact of therapy on everyday life. Overall, the therapy set-up, with its digital components and its distinctive features as compared with common face-to-face talking therapies, was satisfactory. The inclusion of technology was well accepted as both a means to deliver the therapy and a tool to create a digital representation of the person's distressing voice. The co-creation of the avatar and the enactment of the relationship between the person and the voice were perceived as a very helpful process to promote the therapeutical dialogue. Participants reported engaging well with the therapist and feeling supported and identified specific learnt strategies to deal with the voices and how they have had an impact on everyday life. CONCLUSIONS AVATAR therapy is acceptable and provides benefit for participants with psychosis. Our results highlighted the enablers and challenges of working dialogically with distressing voices using a digital representation and dealing with highly demanding emotional, cognitive, and relational processes linked to the experience. Our analysis also identified the core strategies learnt by participants and how these were generalised to their daily life resulting into a positive change in different domains, and in particular broader social relationships.
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Affiliation(s)
- Mar Rus-Calafell
- Mental Health Research and Treatment Centre, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany. .,Department of Health Service and Population Research, Institute of Psychiatry, King's College London, Psychology & Neuroscience, London, UK.
| | - Nils Ehrbar
- grid.5570.70000 0004 0490 981XMental Health Research and Treatment Centre, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Thomas Ward
- grid.13097.3c0000 0001 2322 6764Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,grid.37640.360000 0000 9439 0839South London & Maudsley NHS Foundation Trust, London, UK
| | - Clementine Edwards
- grid.13097.3c0000 0001 2322 6764Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,grid.37640.360000 0000 9439 0839South London & Maudsley NHS Foundation Trust, London, UK
| | - Mark Huckvale
- grid.83440.3b0000000121901201Speech, Hearing and Phonetic Sciences, Division of Psychology and Language Sciences, University College London, London, UK
| | - Jennifer Walke
- grid.13097.3c0000 0001 2322 6764Department of Health Service and Population Research, Institute of Psychiatry, King’s College London, Psychology & Neuroscience, London, UK
| | - Philippa Garety
- grid.13097.3c0000 0001 2322 6764Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK ,grid.37640.360000 0000 9439 0839South London & Maudsley NHS Foundation Trust, London, UK
| | - Tom Craig
- grid.13097.3c0000 0001 2322 6764Department of Health Service and Population Research, Institute of Psychiatry, King’s College London, Psychology & Neuroscience, London, UK ,grid.37640.360000 0000 9439 0839South London & Maudsley NHS Foundation Trust, London, UK
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Paul M, Bullock K, Bailenson J. Virtual Reality Behavioral Activation for Adults With Major Depressive Disorder: Feasibility Randomized Controlled Trial. JMIR Ment Health 2022; 9:e35526. [PMID: 35404830 PMCID: PMC9123544 DOI: 10.2196/35526] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a global crisis with increasing incidence and prevalence. There are many established evidence-based psychotherapies (EBPs) for depression, but numerous barriers still exist; most notably, access and dissemination. Virtual reality (VR) may offer some solutions to existing constraints of EBPs for MDD. OBJECTIVE We aimed to examine the feasibility, acceptability, and tolerability of using VR as a method of delivering behavioral activation (BA) for adults diagnosed with MDD during a global pandemic and to explore for signs of clinical efficacy by comparing VR-enhanced BA (VR BA) to a standard BA treatment and a treatment as usual control group for individuals diagnosed with MDD. METHODS A feasibility trial using a 3-armed, unblinded, randomized controlled pilot design was conducted. The study took place remotely via Zoom telehealth visits between April 8, 2020, and January 15, 2021. This study used a 3-week, 4-session protocol in which VR BA participants used a VR headset to complete their BA homework. Feasibility was measured using dropout rates, serious adverse events, completion of homework, an adapted telepresence scale, the Simulator Sickness Questionnaire, the Brief Agitation Measure, and an adapted Technology Acceptance Model. Efficacy was assessed using the Patient Health Questionnaire-9. RESULTS Of the 35 participants assessed for eligibility, 13 (37%) were randomized into VR BA (n=5, 38%), traditional BA (n=4, 31%), or a treatment as usual control (n=4, 31%). The mean age of the 13 participants (5/13, 38% male; 7/13, 54% female; and 1/13, 8% nonbinary or third gender) was 35.4 (SD 12.3) years. This study demonstrated VR BA feasibility in participants with MDD through documented high levels of acceptability and tolerability while engaging in VR-induced pleasurable activities in conjunction with a brief BA protocol. No adverse events were reported. This study also illustrated that VR BA may have potential clinical utility for treating MDD, as the average VR BA participant's clinical severity decreased by 5.67 points, signifying a clinically meaningful change in severity from a moderate to a mild level of depression as per the Patient Health Questionnaire-9 score. CONCLUSIONS The findings of this study demonstrate that VR BA is safe and feasible to explore for the treatment of MDD. This study documented evidence that VR BA may be efficacious and justifies further examination in an adequately powered randomized controlled trial. This pilot study highlights the potential utility that VR technology may offer patients with MDD, especially those who have difficulty accessing real-world pleasant activities. In addition, for those having difficulty accessing care, VR BA could be adapted as a first step to help people improve their mood and increase their motivation while waiting to connect with a health care professional for other EBPs. TRIAL REGISTRATION ClinicalTrials.gov NCT04268316; https://clinicaltrials.gov/ct2/show/NCT04268316. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/24331.
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Affiliation(s)
- Margot Paul
- PGSP-Stanford PsyD Consortium, Palo Alto University, Palo Alto, CA, United States.,Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, United States
| | - Kim Bullock
- Department of Psychiatry & Behavioral Sciences, Stanford School of Medicine, Stanford, CA, United States
| | - Jeremy Bailenson
- Department of Communication, Stanford University, Stanford, CA, United States
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Ray A, Bhardwaj A, Malik YK, Singh S, Gupta R. Artificial intelligence and Psychiatry: An overview. Asian J Psychiatr 2022; 70:103021. [PMID: 35219978 PMCID: PMC9760544 DOI: 10.1016/j.ajp.2022.103021] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 01/06/2022] [Accepted: 02/11/2022] [Indexed: 12/14/2022]
Abstract
The burden of mental illness both in world and India is increasing at an alarming rate. Adding to it, there has been an increase in mental health challenges during covid-19 pandemic with a rise in suicide, loneliness and substance use. Artificial intelligence can act as a potential solution to address this shortage. The use of artificial intelligence is increasingly being employed in various fields of mental health like affective disorders, psychosis, and geriatric psychiatry. The benefits are various like lower costs, wider reach but at the same time it comes with its own disadvantages. This article reviews the current understanding of artificial intelligence, the types of Artificial intelligence, its current use in various mental health disorders, current status in India, advantages, disadvantages and future potentials. With the passage of time and digitalization of the modern age, there will be an increase in the use of artificial intelligence in psychiatry hence a detailed understanding will be thoughtful. For this, we searched PubMed, Google Scholar, and Science Direct, China national Knowledge Infrastructure (CNKI), Globus Index Medicus search engines by using keywords. Initial searches involved the use of each individual keyword while the later searches involved the use of more than one word in different permutation combinations.
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Affiliation(s)
- Adwitiya Ray
- Department of Psychiatry, Institute of Mental Health, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Akansha Bhardwaj
- Department of Psychiatry, Institute of Mental Health, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Yogender Kumar Malik
- Department of Psychiatry, Institute of Mental Health, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India.
| | - Shipra Singh
- Department of Psychiatry, Institute of Mental Health, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Rajiv Gupta
- Department of Psychiatry, Institute of Mental Health, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
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Schroeder AH, Bogie BJM, Rahman TT, Thérond A, Matheson H, Guimond S. Feasibility and Efficacy of Virtual Reality Interventions to Improve Psychosocial Functioning in Psychosis: Systematic Review. JMIR Ment Health 2022; 9:e28502. [PMID: 35179501 PMCID: PMC8900915 DOI: 10.2196/28502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 08/31/2021] [Accepted: 09/20/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Functional recovery in psychosis remains a challenge despite current evidence-based treatment approaches. To address this problem, innovative interventions using virtual reality (VR) have recently been developed. VR technologies have enabled the development of realistic environments in which individuals with psychosis can receive psychosocial treatment interventions in more ecological settings than traditional clinics. These interventions may therefore increase the transfer of learned psychosocial skills to real-world environments, thereby promoting long-term functional recovery. However, the overall feasibility and efficacy of such interventions within the psychosis population remain unclear. OBJECTIVE This systematic review aims to investigate whether VR-based psychosocial interventions are feasible and enjoyable for individuals with psychosis, synthesize current evidence on the efficacy of VR-based psychosocial interventions for psychosis, and identify the limitations in the current literature to guide future research. METHODS This research followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Literature searches were conducted in PubMed and PsycINFO in May 2021. We searched for peer-reviewed English articles that used a psychosocial intervention with a VR component. Participants in the included studies were diagnosed with schizophrenia, schizoaffective disorder, or another psychotic disorder. The included studies were divided into four categories as follows: cognitive remediation interventions, social skills interventions, vocational skills interventions, and auditory verbal hallucinations and paranoia interventions. The risk of bias assessment was performed for each study. RESULTS A total of 18 studies were included in this systematic review. Of these 18 studies, 4 (22%) studies used a cognitive remediation intervention, 4 (22%) studies used a social skills intervention, 3 (17%) studies used a vocational skills intervention, and 7 (39%) studies implemented an intervention aimed at improving auditory verbal hallucinations or paranoia. A total of 745 individuals with psychosis were included in the study. All the studies that evaluated feasibility showed that VR-based psychosocial interventions were feasible and enjoyable for individuals with psychosis. The preliminary evidence on efficacy included in this review suggests that VR-based psychosocial interventions can improve cognitive, social, and vocational skills in individuals with psychosis. VR-based interventions may also improve the symptoms of auditory verbal hallucinations and paranoia. The skills that participants learned through these interventions were durable, transferred into real-world environments, and led to improved functional outcomes, such as autonomy, managing housework, and work performance. CONCLUSIONS VR-based interventions may represent a novel and efficacious approach for improving psychosocial functioning in psychosis. Therefore, VR-based psychosocial interventions represent a promising adjunctive therapy for the treatment of psychosis, which may be used to improve psychosocial skills, community functioning, and quality of life.
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Affiliation(s)
- Alexandra H Schroeder
- The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada.,Department of Neuroscience, Carleton University, Ottawa, ON, Canada
| | - Bryce J M Bogie
- The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Tabassum T Rahman
- The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Alexandra Thérond
- The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada.,Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Hannah Matheson
- The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada.,Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Synthia Guimond
- The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada.,Department of Neuroscience, Carleton University, Ottawa, ON, Canada.,Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Psychology, Carleton University, Ottawa, ON, Canada.,Department of Psychoeducation and Psychology, University of Quebec in Outaouais, Gatineau, QC, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
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Réalité virtuelle et santé des personnes âgées institutionnalisées. Vers un EHPAD 2.0 ? PRAT PSYCHOL 2022. [DOI: 10.1016/j.prps.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Tan BL, Shi J, Yang S, Loh H, Ng D, Choo C, Medalia A. The use of virtual reality and augmented reality in psychosocial rehabilitation for adults with neurodevelopmental disorders: A systematic review. Front Psychiatry 2022; 13:1055204. [PMID: 36590624 PMCID: PMC9794993 DOI: 10.3389/fpsyt.2022.1055204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Virtual reality and augmented reality have been used in psychosocial rehabilitation for adults with neurodevelopmental disorders in recent years, to provide functional training in a scaffolded and appealing manner. This systematic review attempted to evaluate (1) how virtual reality or augmented reality technology was deployed, when used as an intervention for adults with neurodevelopmental disorders; and (2) how virtual or augmented reality-assisted psychosocial rehabilitation programs impacted on the functional domains of community living, employment and social participation. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was adopted and a search of publications between June 2012 and June 2022 was carried out. The target groups were adults with schizophrenia/schizoaffective disorders, autism spectrum disorder, intellectual disabilities and attention deficit hyperactivity disorder. Interventions that targeted at least one functional domain were included. RESULTS The database search generated 1,267 records and 38 studies met the inclusion criteria. Three studies utilized augmented reality while the rest utilized virtual reality. The virtual scenarios were displayed in various ways, such as head-mounted displays, computer screens, mobile devices and cave rooms. A few studies also used features such as speech recognition, eye tracking and motion-capture device to provide real-time feedback to participants during rehabilitation. Eleven studies reported interventions that addressed community living, 15 studies addressed vocational skills and nine studies trained participants in social skills or social cognition. Three studies sought to improve quality of life using virtual scenarios to expose participants to various situations. Majority of these studies reported preliminary promising results, with improvement in the functional domains addressed. However, several studies had small sample sizes and many single-arm pretest-posttest studies were assessed to be of serious or critical risk of bias. CONCLUSION Virtual reality and augmented reality are deployed in various ways to augment psychosocial rehabilitation for adults with neurodevelopmental disorders. Most interventions target skills training or strategy learning in the areas of community living, work and social participation. Preliminary positive findings of their effects on functional performance were reported. Larger and robust studies using ecologically valid outcome measures will be needed to establish their effects on real-world functional outcomes. SYSTEMATIC REVIEW REGISTRATION identifier: CRD42022335443.
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Affiliation(s)
- Bhing-Leet Tan
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore.,Occupational Therapy Department, Institute of Mental Health, Singapore, Singapore
| | - Jing Shi
- Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore, Singapore
| | - Suyi Yang
- Occupational Therapy Department, Institute of Mental Health, Singapore, Singapore
| | - Hannah Loh
- Occupational Therapy Department, Institute of Mental Health, Singapore, Singapore
| | - Desiree Ng
- Occupational Therapy Department, Institute of Mental Health, Singapore, Singapore
| | - Cherie Choo
- Occupational Therapy Department, Institute of Mental Health, Singapore, Singapore
| | - Alice Medalia
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States
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Faw MH, Buley T, Malinin LH. Being There: Exploring Virtual Symphonic Experience as a Salutogenic Design Intervention for Older Adults. Front Psychol 2021; 12:541656. [PMID: 34925115 PMCID: PMC8674500 DOI: 10.3389/fpsyg.2021.541656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 11/12/2021] [Indexed: 11/13/2022] Open
Abstract
This co-design study examined salutogenic potential of mobile virtual reality (VR) experiences as an alternative to participation in a community-based symphonic engagement program (B Sharp), previously found to benefit people with dementia (PWD) and their informal caregivers. Six focus groups were conducted with sixteen adults aged 76–90; three participants had dementia, and two were informal spousal caregivers. No participants had prior VR experience. The study assessed the feasibility of replicating the community-based-arts program in VR, with the goal of enhancing its salutogenic qualities (e.g., positive distraction, engagement, and social connection). Video-recordings of participants while using a mobile head-mounted display (HMD) were analyzed using qualitative thematic analysis to compare perceptions of different virtual experiences, including replication or enhancement of B Sharp and a campus tour. Findings suggest participants had positive perceptions of enhanced VR experiences with no adverse effects, although PWD were less enthusiastic and HMD usability was complicated by eyewear use and comfort with technology. Participants reacted most favorably to the enhanced symphonic experience, where they were “virtually” onstage during the performance, suggesting unique experiences beyond what is possible in the real world have the greatest potential for deep immersion for older adults. Results suggest VR has strong potential to replicate and enhance salutogenic qualities of community-based programming by enabling greater access to experiences for older adults and by increasing enjoyment and engagement through experiences not otherwise feasible. Furthermore, this study illuminates advantages of a user-centered, co-design approach when developing VR experiences with community partners and older adults.
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Affiliation(s)
- Meara H Faw
- Department of Communication Studies, Colorado State University, Fort Collins, CO, United States
| | - Taylor Buley
- Department of Communication Studies, Colorado State University, Fort Collins, CO, United States
| | - Laura Healey Malinin
- Department of Design and Merchandising, College of Health and Human Sciences, Colorado State University, Fort Collins, CO, United States
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Zanello A, Dugré JR. Preliminary Evidence for Heterogeneity of Beliefs About Auditory Verbal Hallucinations Intent. J Nerv Ment Dis 2021; 209:872-878. [PMID: 34846355 DOI: 10.1097/nmd.0000000000001391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Perceptions of patient's auditory verbal hallucinations (AVHs), commonly termed voices, have important impacts on their everyday lives. Despite research emphasizing the consequences of malevolent voices, preliminary results suggest that beliefs about voices may not be mutually exclusive. As such, we aimed to characterize the heterogeneity of beliefs about AVHs and describe their clinical correlates. We recruited 78 patients referred to a Voices group therapy for refractory and distressing voices. Based on the Revised Beliefs About Voices Questionnaire, clustering analysis yielded four subgroups of patients with distinct pattern of beliefs about AVHs. These subgroups differed significantly in terms of affective disturbances, engagement, and resistance to their voices. Furthermore, no significant changes in beliefs about voices were observed after 6 weeks. Results of the current study suggest that the heterogeneity regarding the beliefs about AVHs should be targeted in treatment to reduce their associated negative outcomes.
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Affiliation(s)
- Adriano Zanello
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
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Liang N, Li X, Liu S, Liu Y, Zhao W, Wen Y, Li Q, Guo J, Xu Y. Effects of virtual reality-based computer avatar therapy system on auditory verbal hallucinations assessed using functional near-infrared spectroscopy: A two-patient case study. Psychiatry Res 2021; 305:114150. [PMID: 34461355 DOI: 10.1016/j.psychres.2021.114150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/30/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Nana Liang
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Jiefang nan road, Taiyuan, 030001, China
| | - Xinrong Li
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Jiefang nan road, Taiyuan, 030001, China; Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorders, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Sha Liu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Jiefang nan road, Taiyuan, 030001, China; Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorders, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yao Liu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Jiefang nan road, Taiyuan, 030001, China
| | - Wentao Zhao
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Jiefang nan road, Taiyuan, 030001, China; Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorders, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yujiao Wen
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Jiefang nan road, Taiyuan, 030001, China
| | - Qiqi Li
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Jiefang nan road, Taiyuan, 030001, China
| | - Jianxia Guo
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Jiefang nan road, Taiyuan, 030001, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Jiefang nan road, Taiyuan, 030001, China; Shanxi Key Laboratory of Artificial Intelligence Assisted Diagnosis and Treatment for Mental Disorders, First Hospital of Shanxi Medical University, Taiyuan, China; Department of Mental Health, Shanxi Medical University, Taiyuan, China.
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Dellazizzo L, Potvin S, Phraxayavong K, Giguère S, Hamidi LN, Dumais A. L’amélioration de la qualité de vie chez les patients atteints d’une schizophrénie réfractaire ayant suivi la Thérapie assistée par la Réalité Virtuelle : une analyse de contenu. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1081514ar] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectifs La schizophrénie, en particulier la schizophrénie résistante aux traitements (SRT), est considérée comme l’un des troubles psychiatriques les plus invalidants en termes d’effets indésirables sur la qualité de vie (QV) des patients. La QV subjective est devenue une cible particulièrement cruciale qui devrait être améliorée avec le traitement, car une QV améliorée peut entraîner le rétablissement chez les patients atteints de schizophrénie. Il existe cependant peu de preuves des effets des interventions psychosociales recommandées sur les mesures non symptomatiques comme la QV. À cet égard, le traitement de la schizophrénie peut être renforcé si, en plus du traitement des symptômes, l’accent thérapeutique est mis sur d’autres sphères importantes pour les patients. Avec les progrès technologiques, la Thérapie assistée par la Réalité Virtuelle (TRV) permet aux entendeurs de voix d’entrer en dialogue direct avec un avatar, animé entièrement par le thérapeute, qui représente leur voix la plus persécutrice. Ceci dans le but de leur permettre d’acquérir un meilleur contrôle sur leurs voix et de travailler sur leur estime de soi. Au-delà de la symptomatologie, les résultats des projets pilotes sur cette thérapie innovante ont montré des résultats significatifs sur la QV.
Méthode Afin de peaufiner les résultats quantitatifs trouvés, cet article a exploré les thèmes émergents d’une analyse de contenu découlant du discours spontané de 10 patients ayant bien répondu à la TRV.
Résultats Quatre thèmes généraux ont émergé : 1) impact de la thérapie sur les voix ; 2) relations interpersonnelles ; 3) bien-être psychologique ; et 4) mode de vie. Cette analyse de contenu a permis d’identifier plusieurs sphères de vie qui sont davantage améliorées chez les patients ayant une SRT à l’aide de la TRV.
Conclusion : La TRV met en évidence l’avenir des approches adaptées aux objectifs des patients qui intègrent plusieurs processus pertinents pour potentiellement améliorer leur QV. La TRV peut avoir des implications potentiellement immenses sur la santé et la qualité de vie des patients. Cette étude fut une première étape vers l’exploration des effets subjectifs de la TRV sur la vie des patients au-delà des symptômes.
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Affiliation(s)
- Laura Dellazizzo
- Centre de recherche de l’Institut Universitaire en Santé mentale de Montréal, Montréal, Canada ; Faculté de Médecine, Université de Montréal, Montréal, Canada
| | - Stéphane Potvin
- Centre de recherche de l’Institut Universitaire en Santé mentale de Montréal, Montréal, Canada ; Faculté de Médecine, Université de Montréal, Montréal, Canada
| | | | - Sabrina Giguère
- Centre de recherche de l’Institut Universitaire en Santé mentale de Montréal, Montréal, Canada ; Faculté de Médecine, Université de Montréal, Montréal, Canada
| | - Lyna-Nour Hamidi
- Centre de recherche de l’Institut Universitaire en Santé mentale de Montréal, Montréal, Canada ; Faculté de Médecine, Université de Montréal, Montréal, Canada
| | - Alexandre Dumais
- Centre de recherche de l’Institut Universitaire en Santé mentale de Montréal, Montréal, Canada ; Faculté de Médecine, Université de Montréal, Montréal, Canada ; Services et Recherches Psychiatriques AD, Montréal, Canada ; Institut national de psychiatrie légale Philippe-Pinel, Montréal, Canada
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Skeva R, Gregg L, Jay C, Pettifer S. Assessment of virtual environments for alcohol Relapse Prevention in a less immersive and cost-effective setup: A qualitative study. COMPUTERS IN HUMAN BEHAVIOR REPORTS 2021. [DOI: 10.1016/j.chbr.2021.100120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Chen J, Xie Z, Or C. Effectiveness of immersive virtual reality-supported interventions for patients with disorders or impairments: a systematic review and meta-analysis. HEALTH AND TECHNOLOGY 2021. [DOI: 10.1007/s12553-021-00561-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Brander M, Egger ST, Hürlimann N, Seifritz E, Sumner RW, Vetter S, Magnenat S. Virtual Reality Human-Human Interface to Deliver Psychotherapy to People Experiencing Auditory Verbal Hallucinations: Development and Usability Study. JMIR Serious Games 2021; 9:e26820. [PMID: 33769295 PMCID: PMC8207250 DOI: 10.2196/26820] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/05/2021] [Accepted: 03/19/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Digital technologies have expanded the options for delivering psychotherapy, permitting for example, the treatment of schizophrenia using Avatar Therapy. Despite its considerable potential, this treatment method has not been widely disseminated. As a result, its operability and functionality remain largely unknown. OBJECTIVE We aimed to study the usability of a therapeutic virtual reality human-human interface, created in a game engine. METHODS Participants were psychiatric hospital staff who were introduced to the therapeutic platform in a hands-on session. The System Usability Scale (SUS) was employed for evaluation purposes. Statistical evaluation was conducted using descriptive statistics, the chi-square test, analysis of variance, and multilevel factor analysis. RESULTS In total, 109 staff members were introduced to the therapeutic tool and completed the SUS. The mean SUS global score was 81.49 (SD 11.1). Psychotherapists (mean 86.44, SD 8.79) scored significantly higher (F2,106=6.136; P=.003) than nursing staff (mean 79.01, SD 13.30) and administrative personnel (mean 77.98, SD 10.72). A multilevel factor analysis demonstrates a different factor structure for each profession. CONCLUSIONS In all professional groups in this study, the usability of a digital psychotherapeutic tool developed using a game engine achieved the benchmark for an excellent system, scoring highest among the professional target group (psychotherapists). The usability of the system seems, to some extent, to be dependent on the professional background of the user. It is possible to create and customize novel psychotherapeutic approaches with gaming technologies and platforms. TRIAL REGISTRATION Clinicaltrials.gov NCT04099940; http://clinicaltrials.gov/ct2/show/NCT04099940.
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Affiliation(s)
- Mischa Brander
- Game Technology Center, Department of Computer Science, Eidgenössische Technische Hochschule Zürich, Zurich, Switzerland
| | - Stephan T Egger
- Psychotherapy and Psychosomatics, Department of Psychiatry, Psychiatric University Hospital of Zurich, University of Zürich, Zurich, Switzerland
- Department of Psychiatry, Faculty of Medicine, University of Oviedo, Oviedo, Spain
| | - Noa Hürlimann
- Psychotherapy and Psychosomatics, Department of Psychiatry, Psychiatric University Hospital of Zurich, University of Zürich, Zurich, Switzerland
| | - Erich Seifritz
- Psychotherapy and Psychosomatics, Department of Psychiatry, Psychiatric University Hospital of Zurich, University of Zürich, Zurich, Switzerland
| | - Robert W Sumner
- Game Technology Center, Department of Computer Science, Eidgenössische Technische Hochschule Zürich, Zurich, Switzerland
| | - Stefan Vetter
- Psychotherapy and Psychosomatics, Department of Psychiatry, Psychiatric University Hospital of Zurich, University of Zürich, Zurich, Switzerland
| | - Stéphane Magnenat
- Game Technology Center, Department of Computer Science, Eidgenössische Technische Hochschule Zürich, Zurich, Switzerland
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Hernández-Serrano O, Ghiţă A, Fernández-Ruiz J, Monràs M, Gual A, Gacto M, Porras-García B, Ferrer-García M, Gutiérrez-Maldonado J. Determinants of Cue-Elicited Alcohol Craving and Perceived Realism in Virtual Reality Environments among Patients with Alcohol Use Disorder. J Clin Med 2021; 10:2241. [PMID: 34064120 PMCID: PMC8196721 DOI: 10.3390/jcm10112241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 12/31/2022] Open
Abstract
The identification of variables that can modulate the efficacy of cue exposure using virtual reality (VR) is crucial. This study aimed to explore determinant variables of cue-elicited alcohol craving and perceived realism (PR) of environments and alcoholic beverages during a VR cue-exposure session among alcohol use disorder (AUD) outpatients. A prospective cohort study was conducted amongst 72 outpatients with AUD from a clinical setting. Alcohol craving experienced during VR exposure and PR of virtual environments and alcoholic drinks were evaluated after a VR session of exposure to alcohol-related contexts and cues. Sociodemographic, psychological and consumption characteristics were examined as possible predicting variables. Multiple linear regression analyses showed that the AUD severity and PR of beverages were predictors of cue-elicited alcohol craving. Educational level, PR of beverages and age were predictors of the PR of VR environments. In relation to the PR of VR beverages, cue-elicited alcohol craving and the PR of environments were predictors. A simple mediational model was also performed to analyze the influence of the PR of beverages on the relationship between the AUD severity and alcohol craving experienced during VR exposure: an indirect or mediational effect was found. PR of alcoholic beverages was (1) a key predictor of the PR of VR environments (and vice versa) and the alcohol craving (and vice versa) experienced during VR cue-exposure sessions using ALCO-VR software among AUD patients and (2) a mediator between AUD severity and cue-elicited alcohol craving.
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Affiliation(s)
- Olga Hernández-Serrano
- Department of Psychology, Catholic University of Saint Anthony, Av. de los Jerónimos, 135, Guadalupe de Maciascoque, 30107 Murcia, Spain;
| | - Alexandra Ghiţă
- Department of Psychology, Health and Technology, University of Twente, Drienerlolaan, 5, 7522 NB Enschede, The Netherlands;
| | - Jolanda Fernández-Ruiz
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de Vall d’Hebron 175, 08035 Barcelona, Spain; (J.F.-R.); (B.P.-G.); (M.F.-G.)
| | - Miquel Monràs
- Addictive Behaviors Unit, Hospital Clinic of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain; (M.M.); (A.G.)
| | - Antoni Gual
- Addictive Behaviors Unit, Hospital Clinic of Barcelona, Carrer de Villarroel, 170, 08036 Barcelona, Spain; (M.M.); (A.G.)
| | - Mariano Gacto
- Department of Physical Therapy, Faculty of Medicine, Campus Espinardo, University of Murcia, 30100 Murcia, Spain;
| | - Bruno Porras-García
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de Vall d’Hebron 175, 08035 Barcelona, Spain; (J.F.-R.); (B.P.-G.); (M.F.-G.)
| | - Marta Ferrer-García
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de Vall d’Hebron 175, 08035 Barcelona, Spain; (J.F.-R.); (B.P.-G.); (M.F.-G.)
| | - José Gutiérrez-Maldonado
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Passeig de Vall d’Hebron 175, 08035 Barcelona, Spain; (J.F.-R.); (B.P.-G.); (M.F.-G.)
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42
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O'Brien C, Rus-Calafell M, Craig TK, Garety P, Ward T, Lister R, Fornells-Ambrojo M. Relating behaviours and therapeutic actions during AVATAR therapy dialogue: An observational study. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 60:443-462. [PMID: 33949726 DOI: 10.1111/bjc.12296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/08/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVES AVATAR therapy is a novel relational approach to working with distressing voices by engaging individuals in direct dialogue with a digital representation of their persecutory voice (the avatar). Critical to this approach is the avatar transition from abusive to conciliatory during the course of therapy. To date, no observational study has examined the moment-to-moment dialogical exchanges of this innovative therapy. We aim to (1) map relating behaviours between participants and their created avatars and (2) examine therapeutic actions delivered within AVATAR dialogue. METHOD Twenty-five of the fifty-three AVATAR therapy completers were randomly selected from a randomized controlled trial (Craig et al. The Lancet Psychiatry, 5, 2018 and 31). Seventy-five audio recordings of active dialogue from sessions 1 and 4 and the last session were transcribed and analysed using a newly developed coding frame. Inter-rater reliability was good to excellent. RESULTS Fine-grained analysis of 4,642 observations revealed nuanced communication around relational power and therapeutic activity. Early assertiveness work, reinforced by the therapist, focussed on increasing power and distancing. Participants' submissive behaviours reduced during therapy, but the shift was gradual. Once the transition to a more conciliatory tone took place, the dialogue primarily involved direct communication between participant and avatar, focussing on sense of self and developmental and relational understanding of voices. CONCLUSIONS AVATAR therapy supports voice-hearers in becoming more assertive towards a digital representation of their abusive voice. Direct dialogue with carefully characterized avatars aims to build the voice-hearers' positive sense of self, supporting the person to make sense of their experiences. PRACTITIONER POINTS AVATAR therapy enables voice-hearers to engage in face-to-face dialogue with a digital representation ('avatar') of their persecutory voice. Fine-grained analyses showed how relating behaviours and therapeutic actions evolve during active AVATAR therapy dialogue. Carefully characterized avatars and direct therapist input help voice-hearers become more assertive over the avatar, enhance positive sense of self, and support individuals to make sense of their experiences.
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Affiliation(s)
- Conan O'Brien
- Research Department of Clinical, Educational and Health Psychology, University College London, UK.,East London NHS Foundation Trust, London, UK
| | - Mar Rus-Calafell
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany.,Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Tom Kj Craig
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,South London & Maudsley NHS Foundation Trust, UK
| | - Thomas Ward
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,South London & Maudsley NHS Foundation Trust, UK
| | - Rachel Lister
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Miriam Fornells-Ambrojo
- Research Department of Clinical, Educational and Health Psychology, University College London, UK.,North East London NHS Foundation Trust, UK
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Zhuo C, Cheng L, Li G, Xu Y, Jing R, Li S, Zhang L, Lin X, Zhou C. COMT-Val158Met polymorphism modulates antipsychotic effects on auditory verbal hallucinations and temporal lobe gray matter volumes in healthy individuals-symptom relief accompanied by worrisome volume reductions. Brain Imaging Behav 2021; 14:1373-1381. [PMID: 30712251 PMCID: PMC7572342 DOI: 10.1007/s11682-019-00043-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Investigation of auditory verbal hallucinations (AVHs) in schizophrenics is complicated by psychiatric symptoms. Investigating healthy individuals with AVHs (H-AVHs) can obviate such confounding factors. The objective of this study was to explore the effects of antipsychotic treatment on AVHs and gray matter volumes (GMVs) in H-AVH subjects and whether such are effects are influenced by COMT-Val158Met genotype. Magnetic resonance imaging (MRI) and genotyping studies were completed for 42 H-AVH subjects and 42 well-matched healthy controls (HCs). COMT-Met/Met homozygotes (158th codon) were identified as COMT-Met genotype; COMT-Met/Val heterozygotes and COMT-Val/Val homozygotes were identified as COMT-Val genotype. Data were compared across groups (H-AVH vs. HC, and between genotypes) with two-sample t-tests. The H-AVH COMT-Met group showed a stronger response to antipsychotic treatment than the H-AVH COMT-Val group (p < 0.001). Both H-AVH genotype groups exhibited temporal lobe GMV reductions after treatment, and relative to their respective genotype-matched HC groups. Antipsychotic treatment effects in H-AVH subjects were influenced by COMT-Val158Met genotype and associated with widespread GMV reductions. These findings provide clues for further exploration of treatment targets for AVHs. Treatment associated GMV reductions, however, raise concerns about use of antipsychotics in H-AVH subjects.
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Affiliation(s)
- Chuanjun Zhuo
- Department of Psychiatric-Neuroimaging-Genetics and Morbidity Laboratory (PNGC-Lab), Tianjin Mental Health Center, Mental Health Teaching Hospital, Nankai University Affiliated Anding Hospital, Tianjin Medical University, Tianjin, 300222, China. .,Department of Psychiatry, Institute of Mental Healthy, Genetic Lab, Jining Medical University, Jining, 272191, China. .,Department of Psychiatry, College of Basic Medical Research, Tianjin Medical University, Tianjin, 300000, China. .,Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, 030001, China. .,Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, 325000, China. .,Department of Psychiatry, Shanxi Medical University, Taiyuan, 030000, China.
| | - Langlang Cheng
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, 325000, China
| | - Gongying Li
- Department of Psychiatry, Institute of Mental Healthy, Genetic Lab, Jining Medical University, Jining, 272191, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, 030001, China.,Department of Psychiatry, Shanxi Medical University, Taiyuan, 030000, China
| | - Rixing Jing
- Department of Pattern Recognition, China National Key Laboratory, Institute of Automation, Chinese Academy of Sciences, Beijing, 100191, China.,Department of Pattern Recognition, University of Chinese Academy of Sciences, Beijing, 100191, China
| | - Shen Li
- Department of Psychiatry, College of Basic Medical Research, Tianjin Medical University, Tianjin, 300000, China
| | - Li Zhang
- GHM Institute of CNS Regeneration, Jinan University, Guangzhou, 510632, Guangdong Province, China
| | - Xiaodong Lin
- Department of Psychiatry, Wenzhou Seventh People's Hospital, Wenzhou, 325000, China.
| | - Chunhua Zhou
- Department of Pharmacy, The First Hospital of Hebei Medical University, Shijiazhuang, 050000, China.
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Abstract
Initially designed for the treatment of phobias, the use of virtual reality in phobic disorders has expanded to other mental health disorders such as posttraumatic stress disorder, substance-related disorders, eating disorders, psychosis, and autism spectrum disorder. The goal of this review is to provide an accessible understanding of why this approach is important for future practice, given its potential to provide clinically relevant information associated with the assessment and treatment of people suffering from mental illness. Most of the evidence is available for the use of virtual reality exposure therapy in anxiety disorders and posttraumatic stress disorder. There is hardly any evidence that virtual reality therapy is effective in generalized anxiety disorder and obsessive-compulsive disorder. There is increasing evidence that cue exposure therapy is effective in addiction and eating disorders. Studies into the use of virtual reality therapy in psychosis, autism spectrum disorder, and attention deficit hyperactivity disorder (ADHD) are promising.
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Affiliation(s)
- Paul M G Emmelkamp
- Department of Clinical Psychology, University of Amsterdam, 1001 NK Amsterdam, The Netherlands;
| | - Katharina Meyerbröker
- Department of Clinical Psychology, Utrecht University, 3584 CS Utrecht, The Netherlands.,Altrecht Academic Anxiety Center, 3524 SH Utrecht, The Netherlands
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45
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Dellazizzo L, Potvin S, Phraxayavong K, Dumais A. One-year randomized trial comparing virtual reality-assisted therapy to cognitive-behavioral therapy for patients with treatment-resistant schizophrenia. NPJ SCHIZOPHRENIA 2021; 7:9. [PMID: 33580033 PMCID: PMC7881089 DOI: 10.1038/s41537-021-00139-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/09/2020] [Indexed: 01/16/2023]
Abstract
The gold-standard cognitive-behavioral therapy (CBT) for psychosis offers at best modest effects. With advances in technology, virtual reality (VR) therapies for auditory verbal hallucinations (AVH), such as AVATAR therapy (AT) and VR-assisted therapy (VRT), are amid a new wave of relational approaches that may heighten effects. Prior trials have shown greater effects of these therapies on AVH up to a 24-week follow-up. However, no trial has compared them to a recommended active treatment with a 1-year follow-up. We performed a pilot randomized comparative trial evaluating the short- and long-term efficacy of VRT over CBT for patients with treatment-resistant schizophrenia. Patients were randomized to VRT (n = 37) or CBT (n = 37). Clinical assessments were administered before and after each intervention and at follow-up periods up to 12 months. Between and within-group changes in psychiatric symptoms were assessed using linear mixed-effects models. Short-term findings showed that both interventions produced significant improvements in AVH severity and depressive symptoms. Although results did not show a statistically significant superiority of VRT over CBT for AVH, VRT did achieve larger effects particularly on overall AVH (d = 1.080 for VRT and d = 0.555 for CBT). Furthermore, results suggested a superiority of VRT over CBT on affective symptoms. VRT also showed significant results on persecutory beliefs and quality of life. Effects were maintained up to the 1-year follow-up. VRT highlights the future of patient-tailored approaches that may show benefits over generic CBT for voices. A fully powered single-blind randomized controlled trial comparing VRT to CBT is underway.
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Affiliation(s)
- Laura Dellazizzo
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and addictology, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Stéphane Potvin
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and addictology, Faculty of Medicine, University of Montreal, Montreal, Canada
| | | | - Alexandre Dumais
- Research center of the Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada.
- Department of Psychiatry and addictology, Faculty of Medicine, University of Montreal, Montreal, Canada.
- Services et Recherches Psychiatriques AD, Montreal, Canada.
- Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada.
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46
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Artistic creation in virtual reality for art therapy: A qualitative study with expert art therapists. ARTS IN PSYCHOTHERAPY 2021. [DOI: 10.1016/j.aip.2020.101745] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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47
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Beaudoin M, Potvin S, Machalani A, Dellazizzo L, Bourguignon L, Phraxayavong K, Dumais A. The therapeutic processes of avatar therapy: A content analysis of the dialogue between treatment-resistant patients with schizophrenia and their avatar. Clin Psychol Psychother 2021; 28:500-518. [PMID: 33484042 DOI: 10.1002/cpp.2556] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/21/2020] [Accepted: 01/05/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Because the therapeutic processes of Avatar Therapy remain equivocal, the current study aims to further extend our previous findings by analysing the evolution of the avatars' and patients' speech and changes in patient responses as sessions progressed. DESIGN Eighteen patients with treatment-resistant schizophrenia were selected from two clinical trials on Avatar Therapy. Three coders analysed both the avatars' and patients' discourse during immersive therapy sessions using content analysis methods. RESULTS Our analyses enabled the categorization of the avatar discourse into confrontational techniques (e.g., provocation) and positive techniques (e.g., reinforcement). Patients responded to these utterances using coping mechanism or by expressing emotions, beliefs, self-perceptions or aspirations. Through identification of mutual changes in the interaction between the patient and their avatar, a shift was observed over the sessions from confrontation to a constructive dialogue. Assertiveness, emotional responses and prevention strategies seemed to be central to the therapeutic process, and these usually occur in response to positive techniques. CONCLUSION Investigating AT's therapeutic process may help to identify components to achieve positive outcomes and can enable the development of more effective treatments. Further studies should explore the association between these themes and therapeutic response to help predict which patients will better respond to Avatar Therapy.
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Affiliation(s)
- Mélissa Beaudoin
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada
- Faculty of Medicine, McGill University, Montreal, Canada
- Research Center, University Institute in Mental Health of Montreal, Montreal, Canada
| | - Stéphane Potvin
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada
- Research Center, University Institute in Mental Health of Montreal, Montreal, Canada
| | - Alexandra Machalani
- Faculty of Medicine, McGill University, Montreal, Canada
- Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Laura Dellazizzo
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada
- Research Center, University Institute in Mental Health of Montreal, Montreal, Canada
| | - Lysandre Bourguignon
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada
- Research Center, University Institute in Mental Health of Montreal, Montreal, Canada
| | | | - Alexandre Dumais
- Department of Psychiatry and Addictology, Université de Montréal, Montreal, Canada
- Research Center, University Institute in Mental Health of Montreal, Montreal, Canada
- Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada
- Services et Recherches Psychiatriques AD, Montreal, Canada
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48
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Pavlidou A, Walther S. Using Virtual Reality as a Tool in the Rehabilitation of Movement Abnormalities in Schizophrenia. Front Psychol 2021; 11:607312. [PMID: 33488466 PMCID: PMC7817610 DOI: 10.3389/fpsyg.2020.607312] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/02/2020] [Indexed: 11/29/2022] Open
Abstract
Movement abnormalities are prevalent across all stages of schizophrenia contributing to poor social functioning and reduced quality of life. To date, treatments are scarce, often involving pharmacological agents, but none have been shown to improve movement abnormalities effectively. Virtual reality (VR) is a tool used to simulate virtual environments where behavioral performance can be quantified safely across different tasks while exerting control over stimulus delivery, feedback and measurement in real time. Sensory information is transmitted via a head mounted display allowing users to directly interact with virtual objects and bodies using gestures and body movements in the real world to perform different actions, permitting a sense of immersion in the simulated virtual environment. Although, VR has been widely used for successful motor rehabilitation in a variety of different neurological domains, none have been exploited for motor rehabilitation in schizophrenia. The objectives of this article are to review movement abnormalities specific to schizophrenia, and how VR can be utilized to restore and improve motor functioning in patients with schizophrenia. Constructing VR-mediated motor-cognitive interventions that can help in retaining and transferring the learned outcomes to real life are also discussed.
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Affiliation(s)
- Anastasia Pavlidou
- Translational Research Center, University Hospital of Psychiatry, Bern, Switzerland
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49
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Sygel K, Wallinius M. Immersive Virtual Reality Simulation in Forensic Psychiatry and Adjacent Clinical Fields: A Review of Current Assessment and Treatment Methods for Practitioners. Front Psychiatry 2021; 12:673089. [PMID: 34122189 PMCID: PMC8193033 DOI: 10.3389/fpsyt.2021.673089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/30/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Research has indicated that interactive, computerized case simulations using immersive virtual reality (VR) technology may be beneficial in the augmentation of conventional methods of assessment and treatment in forensic psychiatry, primarily through providing an engaging and safe environment in which the user can practice and learn skills and behaviors. However, there does not appear to be an overview of current developments available in the field, which may be an obstacle to clinicians considering the use of VR in their clinical practice. Objectives: Current, clinically relevant assessment and treatment methods applying immersive VR in forensic or adjacent clinical settings, were analyzed. Methods: This review surveyed the practical use of immersive VR in forensic psychiatry and relevant adjacent psychiatric and forensic fields from 2016 to 2020 and was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Out of the 1,105 journal articles screened, 14 met criteria for inclusion. Four articles described VR interventions directly addressing forensic psychiatric settings (treatment of general aggression and assessment of sexual offenders against children). The majority of the remaining articles were in the clinical domain of psychosis treatment. Several interventions were designed as part of comprehensive treatment programs, and others were intended as one-off assessments or paired with pre-existing psychological treatment. The degree to which the VR simulations were individualized to the user appeared to be largely dependent upon the extent of provider input. A variety of research methodologies were used in the included articles and the majority had limitations common to small-scale, non-randomized studies. None of the studies reported serious adverse effects. Discussion: There is a lack of large randomized controlled trials of current assessments or treatments using VR simulation in forensic psychiatry, let alone those with long-term follow-up, showing clear advantages of VR over standard practice. The evidence thus far is insufficient to recommend immediate and large-scale implementation of any one VR intervention, however, several have been shown to be feasible and acceptable to the participants and to provide insights and inspiration for future research and development.
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Affiliation(s)
- Kristina Sygel
- Department of Psychiatry and Neurochemistry, Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Forensic Psychiatry, National Board of Forensic Medicine, Stockholm, Sweden
| | - Märta Wallinius
- Department of Psychiatry and Neurochemistry, Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Research and Development Unit, Regional Forensic Psychiatric Clinic, Växjö, Sweden.,Lund Clinical Research on Externalizing and Developmental Psychopathology, Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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50
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Kim H, Kim DJ, Kim S, Chung WH, Park KA, Kim JDK, Kim D, Kim MJ, Kim K, Jeon HJ. Effect of Virtual Reality on Stress Reduction and Change of Physiological Parameters Including Heart Rate Variability in People With High Stress: An Open Randomized Crossover Trial. Front Psychiatry 2021; 12:614539. [PMID: 34447320 PMCID: PMC8384255 DOI: 10.3389/fpsyt.2021.614539] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 07/12/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction: Although, attempts to apply virtual reality (VR) in mental healthcare are rapidly increasing, it is still unclear whether VR relaxation can reduce stress more than conventional biofeedback. Methods: Participants consisted of 83 healthy adult volunteers with high stress, which was defined as a score of 20 or more on the Perceived Stress Scale-10 (PSS-10). This study used an open, randomized, crossover design with baseline, stress, and relaxation phases. During the stress phase, participants experienced an intentionally generated shaking VR and serial-7 subtraction. For the relaxation phase, participants underwent a randomly assigned relaxation session on day 1 among VR relaxation and biofeedack, and the other type of relaxation session was applied on day 2. We compared the State-Trait Anxiety Inventory-X1 (STAI-X1), STAI-X2, the Numeric Rating Scale (NRS), and physiological parameters including heart rate variability (HRV) indexes in the stress and relaxation phases. Results: A total of 74 participants were included in the analyses. The median age of participants was 39 years, STAI-X1 was 47.27 (SD = 9.92), and NRS was 55.51 (SD = 24.48) at baseline. VR and biofeedback significantly decreased STAI-X1 and NRS from the stress phase to the relaxation phase, while the difference of effect between VR and biofeedback was not significant. However, there was a significant difference in electromyography, LF/HF ratio, LF total, and NN50 between VR relaxation and biofeedback. Conclusion: VR relaxation was effective in reducing subjectively reported stress in individuals with high stress.
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Affiliation(s)
- Hyewon Kim
- Department of Psychiatry, Hanyang University Medical Center, Seoul, South Korea
| | - Dong Jun Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Health Sciences and Technology, Department of Medical Device Management and Research, and Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
| | - Seonwoo Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
| | - Won Ho Chung
- Department of Otorhinolaryngology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - James D K Kim
- AR Lab, Samsung Research, Samsung Electronics Co., Ltd, Seoul, South Korea
| | - Dowan Kim
- Advanced Solution Team, Samsung Research, Samsung Electronics Co., Ltd, Seoul, South Korea
| | - Min Ji Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
| | - Kiwon Kim
- Department of Psychiatry, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Health Sciences and Technology, Department of Medical Device Management and Research, and Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
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