Exploring the Benefits of Virtual Reality-Assisted Therapy Following Cognitive-Behavioral Therapy for Auditory Hallucinations in Patients with Treatment-Resistant Schizophrenia: A Proof of Concept

Abstract

Background: Combining cognitive behavioral therapy (CBT) for psychosis with another psychosocial intervention comprising virtual reality (VR)-assisted therapy (VRT) may improve targeted outcomes in treatment-resistant schizophrenia patients. Methods: Ten participants having followed CBT were part of our comparative clinical trial comparing VRT to CBT and were selected at the end of the study as they desired to continue to achieve improvements with VRT (CBT + VRT). Clinical assessments were administered before/after treatments and at follow-ups. Changes in outcomes were examined using linear mixed-effects models. To gain a more in depth understanding on CBT + VRT, therapists’ notes, and open interviews on a sub-group of patients were qualitatively analyzed. Results: Findings showed that the sequence of both interventions was appreciated by all patients. Several significant improvements were found throughout time points on auditory verbal hallucinations, beliefs about voices, depressive symptoms, symptoms of schizophrenia and quality of life. Although most of these improvements were in similar range to those observed in our comparative trial, effects of CBT + VRT on depressive symptoms and symptoms of schizophrenia were larger than those found for either intervention alone. Conclusion: This proof of concept is the first to merge gold-standard CBT with VRT for treatment refractory voices and to suggest a certain synergistic effect.

Feasibility and Efficacy of Virtual Reality Interventions to Improve Psychosocial Functioning in Psychosis: Systematic Review

“…Disagreements were resolved through discussion until a consensus was reached. Multimedia Appendix 1 [40,[42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61] provides more information on each tool used to assess the risk of bias in the included studies.…”

“…Table 1 provides a general summary of the included studies. Table S1 in Multimedia Appendix 2 [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61] provides further details of the studies included in this systematic review.…”

“…Within the auditory verbal hallucinations or paranoia category, 3 studies used the same intervention in which participants created avatars that most accurately resembled the entity they believed was the source of their hallucinations [55][56][57]. Participants then engaged in a dialogue with these avatars, which were animated in real time by a therapist.…”

Facial Affect Recognition by Patients with Schizophrenia Using Human Avatars

“…However, these videos have not been validated and have several limitations in terms of length and scene format [16]. As far as computerized interventions are concerned, virtual reality (VR) has gained importance in recent years by providing practically real environments and situations [17][18][19], using dynamic avatars enabling social interaction with the participant which in turn may be manipulated to represent various emotional states [16,20,21]. VR enables the real-time assessment of individuals' emotions, thoughts, behaviors and physiological responses in a built environment that can be controlled unlike a real environment [22].…”

Extended Reality for Enhanced Telehealth During and Beyond COVID-19: Viewpoint

“…Hyperpresence in XR can also enable treatment contexts that in-person care and telehealth cannot. Traditional mental health treatments for internal stimuli (eg, emotional states or auditory hallucinations) rely on guided imagination that can alternatively be visualized and engaged with directly in XR [ 189 , 190 ]. Further, counterfactual hyperpresence can make health care more approachable for the shy or therapies that can be socially awkward.…”