Virtual reality in the treatment of persecutory delusions: Randomised controlled experimental study testing how to reduce delusional conviction

Abstract

BackgroundPersecutory delusions may be unfounded threat beliefs maintained by safety-seeking behaviours that prevent disconfirmatory evidence being successfully processed. Use of virtual reality could facilitate new learning.AimsTo test the hypothesis that enabling patients to test the threat predictions of persecutory delusions in virtual reality social environments with the dropping of safety-seeking behaviours (virtual reality cognitive therapy) would lead to greater delusion reduction than exposure alone (virtual reality exposure).MethodConviction in delusions and distress in a real-world situation were assessed in 30 patients with persecutory delusions. Patients were then randomised to virtual reality cognitive therapy or virtual reality exposure, both with 30 min in graded virtual reality social environments. Delusion conviction and real-world distress were then reassessed.ResultsIn comparison with exposure, virtual reality cognitive therapy led to large reductions in delusional conviction (reduction 22.0%, P = 0.024, Cohen's d = 1.3) and real-world distress (reduction 19.6%, P = 0.020, Cohen's d = 0.8).ConclusionCognitive therapy using virtual reality could prove highly effective in treating delusions.

Clinical Virtual Reality tools to advance the prevention, assessment, and treatment of PTSD

“…This recognition of the potential impact of VR technology has led to the emergence of a significant, albeit still maturing, research literature that documents the many clinical and research targets where VR can add value relative to traditional assessment and intervention methods. A short list of the areas where Clinical VR has been usefully applied includes fear reduction in persons with specific phobias (Morina et al, 2015; Opris et al, 2012; Parsons & Rizzo, 2008; Powers & Emmelkamp, 2008), treatment for posttraumatic stress disorder (Beidel, Frueh, Neer, & Lejuez, 2017; Botella et al, 2015; Difede & Hoffman, 2002; Difede et al, 2007, 2014; Maples-Keller et al, 2017; McLay et al, 2011; Rizzo et al, 2010, 2013, 2017; Rothbaum, Hodges, Ready, Graap, & Alarcon, 2001; Rothbaum et al, 2014), cue-exposure for addiction and relapse prevention (Hone-Blanchet, Wensing, & Fecteau, 2014; Yoon et al, 2014), depression (Falconer et al, 2016), paranoid delusions (Freeman et al, 2016), discomfort reduction in cancer patients undergoing chemotherapy (Schneider, Kisby, & Flint, 2010), acute pain reduction during wound care and physical therapy with burn patients (Hoffman et al, 2011), other painful procedures (Gold et al, 2006; Mosadeghi, Reid, Martinez, Rosen, & Spiegel, 2016), body image disturbances in patients with eating disorders (Riva, 2011), navigation and spatial training in children and adults with motor impairments (John, Pop, Day, Ritsos, & Headleand, 2017), functional skill training and motor rehabilitation in patients with central nervous system dysfunction (e.g. stroke, traumatic brain injury, spinal cord injury, cerebral palsy, multiple sclerosis, etc.)…”

The Use of Virtual Reality to Facilitate Mindfulness Skills Training in Dialectical Behavioral Therapy for Borderline Personality Disorder: A Case Study

“…Cognitive Behavioral Therapy involving VR exposure is effective for treating more severe psychological disorders such as Post-Traumatic Stress Disorder (Rothbaum et al, 2001; Difede and Hoffman, 2002; Freedman et al, 2010; Rizzo et al, 2010; Difede et al, 2014). VR has also been used to treat eating disorders (Manzoni et al, 2016; Wiederhold et al, 2016) and may help treat delusions (Freeman et al, 2016), self-criticism (Falconer et al, 2014); and patients with chronic pain (Botella et al, 2013; Garcia-Palacios et al, 2015). To our knowledge; no studies have tested VR as an intervention to facilitate mindfulness skills training for DBT®, nor are there any studies using VR to treat BPD, an unusually severe mental disorder.…”

Behandlungen kognitiver Verzerrungen bei Psychose: Ein Überblick der aktuellen Befunde

“…Virtuelle Realität (VR) bietet die Möglichkeit, lebensnahe Szenarien zu schaffen, die auch in der Behandlung von Psychose genutzt werden können [Suenderhauf et al, 2016;Veling et al, 2014]; VR-Interventionen weisen eine hohe ökologische Validität auf, da VRErfahrungen und reale Symptomatik korrelieren [Veling et al, 2014] und die Präsentation der wahrgenommenen Stimuli genauestens kontrolliert werden kann [Parsons, 2011]. Die aktuelle Studienlage zeigt, dass VR bei Psychose sowohl zu diagnostischen Zwecken [Freeman et al, 2014] als auch für therapeutische Interventionen [Freeman et al, 2016;Moritz et al, 2014c] eingesetzt werden kann.…”