Immersive Virtual Reality Applications in Schizophrenia Spectrum Therapy: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Eligibility Criteria
- (1)
- Participants: patients with schizophrenia spectrum disorders.
- (2)
- Intervention: any kind of VR-based intervention performed through immersive virtual reality (VR), carried out with HMD (head-mounted display).
- (3)
- Comparison: therapy as usual (TAU), not VR based, or other types of VR interventions.
- (4)
- Outcomes: We considered the outcomes social skills and cognition, cognitive deficit, persecutory delusions and paranoia, and auditory verbal hallucinations (AVH).
- (5)
- Study design: clinical trials.
2.3. Data Extraction
2.4. Risk of Bias Assessment
3. Results
3.1. Characteristics of the Included Studies
3.1.1. Delusions and Paranoia
3.1.2. Auditory Verbal Hallucinations
3.1.3. Cognitive Deficits
3.1.4. Social Skills
4. Discussions
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Authors | Year | Title | Target | Country | Study Design | Total Sample | Patient’s Diagnosis | DSM | Type of VR-Therapy | Number of Sessions | Duration of Each Session | Duration of Treatment | Principal Outcome Assessment | Principal Findings |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
du Sert, O. P.; Potvin, S.; Lipp, O.; Dellazizzo, L.; Laurelli, M.; Breton, R.; Lalonde, P.; Phraxayavong, K.; O’Connor, K.; Pelletier, J.-F.; Boukhalfi, T.; Renaud, P.; Dumais, A. | 2018 | Virtual reality therapy for refractory auditory verbal hallucinations in schizophrenia: A pilot clinical trial | Auditory verbal hallucinations | Canada | randomised controlled trial | 15 | schizophrenia or schizoaffective disorder | DSM-5 | AVATAR therapy | 1 avatar creation session + 6 sessions | 45 min | 7 weeks | PSYRATS BAVQ-R PANSS QLESQ-SF | VRT produced significant improvements in auditory verbal hallucinations severity, depressive symptoms and quality of life that remained table at the 3-month follow-up period. |
Freeman, D.; Bradley, J.; Antley, A.; Bourke, E.; DeWeever, N.; Evans, N.; Černis, E.; Sheaves, B.; Waite, F.; Dunn, G.; Slater, M.; Clark, D. M. | 2016 | Virtual reality in the treatment of persecutory delusions: Randomised controlled experimental study testing how to reduce delusional conviction | Delusions and paranoia | UK | randomized controlled trial | 30 | psycosis with persecutory delusions | not specified | VR-CBT and VR-exposure | 1 | 30 min | 1 day | PANSS PSYRATS BDI BAI SBQ-PB | Cognitive therapy using virtual reality could prove highly effective in treating delusions. In comparison with exposure, virtual reality cognitive therapy led to large reductions in delusional conviction (reduction 22.0%, and real-world distress (reduction 19.6%,). |
La Paglia F.; La Cascia C.; Rizzo R.; Sanna M.; Cangialosi F.; Sideli L.; Francomano A.; Riva G.; La Barbera D. | 2016 | Virtual reality environments to rehabilitation attention deficits in schizophrenic patients | Cognitive deficits | Italy | clinical trial | 15 | schizophrenia | DSM-5 | VR-training | 10 | 90 min | 10 weeks | MMSE FAB TMT-A, TMT-B, TMT B-A ToL Memory Battery WCST | Both VR training and IPT were associated with improved performance. VR training was additionally related with better cognitive functioning (MMSE), and with improved planning (TOL), and sustained attention (TMT-A). |
La Paglia, F.; La Cascia, C.; Rizzo, R.; Sideli, L.; Francomano, A.; La Barbera, D. | 2013 | Cognitive Rehabilitation of Schizophrenia Through Neurovr Training. | Cognitive deficits | Italy | clinical trial | 12 | schizophrenia | DSM IV-TR | VR-training | 10 | 90 min | 10 weeks | MMSE ToL FAB TMT-B execution time, error number | VR may improve cognitive functioning in psycotic patients. |
Park, K.-M.; Ku, J.; Choi, S.-H.; Jang, H.-J.; Park, J.-Y.; Kim, S. I.; Kim, J.-J. | 2011 | A virtual reality application in role-plays of social A randomized, controlled trial | Social skills | Korea | randomized controlled trial | 91 | schizophrenia | DSM-IV | SST-VR | 10 | 90 min | 5 weeks | SBS | SST-VR group improved more in conversational skills and assertiveness. |
Pot-Kolder, Roos M. C. A.; Geraets, Chris N. W.; Veling, Wim; van Beilen, Marije; Staring, Anton B. P.; Gijsman, Harm J.; Delespaul, Philippe A. E. G.; van der Gaag, Mark; | 2018 | Virtual-reality-based cognitive behavioural therapy versus waiting list control for paranoid ideation and social avoidance in patients with psychotic disorders: A single-blind randomised controlled trial | Delusions and paranoia | Holland | randomised controlled trial | 116 | psychotic disorder and paranoid ideation | DSM-IV | VR-CBT | 16 | 60 min | 8-12 weeks | ESM (structured diary) via PsyMate electronic device | A large reduction was noted in momentary paranoia in the VR-CBT group, whereas a slight increase was noted in the control group; A significantly larger decrease in momentary anxiety was noted in the VR-CBT group than in the control These result remained significant at follow-up. Treatment effects on paranoid ideation were significant: at the post-treatment and follow-up assessments, levels of ideas of persecution and social reference were lower in the VR-CBT group than in the ontrol group. The VR-CBT group had improvements in self-stigmatisation and social functioning at follow-up whereas the control group did not. |
Type of VR Intervention | Description |
---|---|
VR training | Training consisting of a series of 3D-VR scenarios reproducing daily life and related challenges, to training and improve cognitive skills of schizophrenic subjects. |
VR SST | Virtual reality social skill training (VR SST), consist of a VR version of classic SST intervention, thought conversation training and role-plays focused on interpersonal communication. It aimed at enhancing verbal, non-verbal skills and social cognition, detecting and correcting the errors committed by the patient on multiple communication levels. |
VR Avatar therapy | The therapy involves a three-way conversation between therapist, patient and a VR digital simulation (avatar) of one of his hallucinated voices, made by patients himself as a representation of the entity to which he attributes his auditory hallucinations. The therapist’s voice is transformed through speech transformation software to coincide with the vocal characteristics attributed by the patient to the entity. |
VR CBT (cognitive behavior therapy) | Use of techniques of cognitive behavioral psychotherapy (CBT) for the treatment of delusional disorders and paranoia, taking advantage of the immersive environment offered by VR, that allows a controlled exposure to social situation. |
VR exposure | Therapy based on controlled exposure in a virtual reality environment to a situation or a stimulus that usually causes anxiety and fear in the subject, in order to induce a progressive desensitization towards it. |
Randomization process | Deviations from intended interventions | Missing outcome data | Measurement of the outcome | Selection of the reported result | Overall | ||||
Du Sert et al. (2018) | |||||||||
Freeman et al. (2016) | |||||||||
La Paglia et al. (2013) | Legend: | ||||||||
La Paglia et al. (2016) | Low risk | ||||||||
Park et al. (2011) | Some concerns | ||||||||
Pot-Kolder et al. (2018) | High risk |
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Bisso, E.; Signorelli, M.S.; Milazzo, M.; Maglia, M.; Polosa, R.; Aguglia, E.; Caponnetto, P. Immersive Virtual Reality Applications in Schizophrenia Spectrum Therapy: A Systematic Review. Int. J. Environ. Res. Public Health 2020, 17, 6111. https://doi.org/10.3390/ijerph17176111
Bisso E, Signorelli MS, Milazzo M, Maglia M, Polosa R, Aguglia E, Caponnetto P. Immersive Virtual Reality Applications in Schizophrenia Spectrum Therapy: A Systematic Review. International Journal of Environmental Research and Public Health. 2020; 17(17):6111. https://doi.org/10.3390/ijerph17176111
Chicago/Turabian StyleBisso, Emanuele, Maria Salvina Signorelli, Michele Milazzo, Marilena Maglia, Riccardo Polosa, Eugenio Aguglia, and Pasquale Caponnetto. 2020. "Immersive Virtual Reality Applications in Schizophrenia Spectrum Therapy: A Systematic Review" International Journal of Environmental Research and Public Health 17, no. 17: 6111. https://doi.org/10.3390/ijerph17176111