Social anxiety disorder (SAD) is a highly prevalent and impairing disorder. Current best practice is cognitive behavioral therapy (CBT), but there are several challenges associated with performing exposure therapy. Virtual reality exposure (VRE) may improve treatment efficacy of SAD in a group therapy context, because it allows for greater control, flexibility, and individualization of the exposure stimuli. However, to date no study has investigated the use of VRE for SAD in a group context. In the present study, nine patients who had undergone group CBT with VRE for SAD and three therapists responsible for the treatment were interviewed about their experiences. The objective of the study was to investigate the practical and therapeutic challenges of using VRE in a group therapy context. Thematic analysis was used to analyze the data. The results showed that it was difficult for the patients to engage with the VRE in a group therapy context and that there were several practical challenges. However, all participants found the VRE exercises to be meaningful, because it gave them a medium to practice and understand typically avoided social situations. The latter has not previously been described as a treatment mechanism for anxiety through virtual reality. However, the appropriateness of VRE in group therapy remains unclear. Implications are discussed.What is the significance of this article for the general public? Anxiety disorders are increasingly common and represent a growing economic burden in most developed countries. Group therapy that focuses on building skills, facing fears, and changing unhelpful habits is an often used and efficacious treatment. Virtual reality has been used to help people with anxiety face their fears in a safe and flexible environment. However, it has never been investigated if virtual reality can be used in group therapy. The present study is the first to examine the use of virtual reality in group therapy, by interviewing patients and therapists. Several challenges to the treatment format were discovered and recommendations to meet them are proposed. It remains uncertain if virtual reality is a meaningful addition to group therapy.

AimMany individuals with schizophrenia discontinue initially prescribed antipsychotics. Knowledge on reasons for discontinuation among individuals with first‐episode schizophrenia is sparse. We aimed to describe reasons for discontinuation and continuation, differences between individuals discontinuing and continuing, and factors predicting reasons for discontinuation or continuation.MethodsThis was a prospective cohort study with a post hoc design. Individuals with first‐episode schizophrenia were included from early intervention teams in Denmark from 2009–2012. Sociodemographic and clinical variables were collected at baseline and reasons for discontinuation and continuation of antipsychotics were assessed at 3.5‐year follow‐up.ResultsAmong 215 patients, 76 reported reasons for discontinuation and 139 for continuation. The most frequent reasons for discontinuation were “side effects” and “patient believed he/she no longer needed the medication because he/she was now better”. The most frequent reasons for continuation were “benefits for positive symptoms” and “another person told them to”. Individuals who discontinued antipsychotics were at baseline younger, had longer DUP, less negative symptoms, better social function, lower compliance, higher self‐belief of coping, and fewer used antipsychotics compared to those continuing antipsychotics.ConclusionsThe effect of antipsychotics is the main reason to continue, whereas side effects were the main reason to discontinue. Knowledge of reasons to discontinue or continue is helpful in shared decision‐making, identifying individuals with high odds of discontinuation, improving adherence, and helping with safe discontinuation.

Background Discontinuation of antipsychotic medication may be linked to high risk of relapse, hospitalization and mortality. This study investigated the use and discontinuation of antipsychotics in individuals with first-episode schizophrenia in relation to cohabitation, living with children, employment, hospital admission and death. Methods Danish registers were used to establish a nationwide cohort of individuals ⩾18 years with schizophrenia included at the time of diagnosis in1995–2013. Exposure was antipsychotic medication calculated using defined daily dose and redeemed prescriptions year 2–5. Outcomes year 5–6 were analysed using binary logistic, negative binomial and Cox proportional hazard regression. Results Among 21 351, 9.3% took antipsychotics continuously year 2–5, 38.6% took no antipsychotics, 3.4% sustained discontinuation and 48.7% discontinued and resumed treatment. At follow-up year 6, living with children or employment was significantly higher in individuals with sustained discontinuation (OR 1.98, 95% CI 1.53–2.56 and OR 2.60, 95% CI 1.91–3.54), non-sustained discontinuation (OR 1.25, 95% CI 1.05–1.48 and 2.04, 95% CI 1.64–2.53) and no antipsychotics (OR 2.00, 95% CI 1.69–2.38 and 5.64, 95% CI 4.56–6.97) compared to continuous users. Individuals with non-sustained discontinuation had more psychiatric hospital admissions (IRR 1.27, 95% CI 1.10–1.47) and longer admissions (IRR 1.68, 95% CI 1.30–2.16) year 5–6 compared to continuous users. Mortality during year 5–6 did not differ between groups. Conclusion Most individuals with first-episode schizophrenia discontinued or took no antipsychotics the first years after diagnosis and had better functional outcomes. Non-sustained discontinuers had more, and longer admissions compared to continuous users. However, associations found could be either cause or effect.