scholarly journals Automated virtual reality (VR) cognitive therapy for patients with psychosis: study protocol for a single-blind parallel group randomised controlled trial (gameChange)

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e031606 ◽  
Author(s):  
Daniel Freeman ◽  
Ly-Mee Yu ◽  
Thomas Kabir ◽  
Jen Martin ◽  
Michael Craven ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Psychiatric Symptoms ◽  
Psychological Treatment ◽  
Controlled Trial ◽  
Real Life ◽  
Activity Levels ◽  
Physical And Mental Health ◽  
Social Situations ◽  
Treatment As Usual ◽  
South Central

IntroductionMany patients with psychosis experience everyday social situations as anxiety-provoking. The fears can arise, for example, from paranoia, hallucinations, social anxiety or negative-self beliefs. The fears lead patients to withdraw from activities, and this isolation leads to a cycle of worsening physical and mental health. Breaking this cycle requires highly active treatment directly in the troubling situations so that patients learn that they can safely and confidently enter them. However patients with psychosis seldom receive such life-changing interventions. To solve this problem we have developed an automated psychological treatment delivered in virtual reality (VR). It allows patients to experience computer simulations of the situations that they find anxiety-provoking. A virtual coach guides patients, using cognitive techniques, in how to overcome their fears. Patients are willing to enter VR simulations of anxiety-provoking situations because they know the simulations are not real, but the learning made transfers to the real world.Methods and analysis432 patients with psychosis and anxious avoidance of social situations will be recruited from National Health Service (NHS) secondary care services. In the gameChange trial, they will be randomised (1:1) to the six-session VR cognitive treatment added to treatment as usual or treatment as usual alone. Assessments will be conducted at 0, 6 (post-treatment) and 26 weeks by a researcher blind to allocation. The primary outcome is avoidance and distress in real-life situations, using a behavioural assessment task, at 6 weeks. The secondary outcomes are psychiatric symptoms, activity levels and quality of life. All main analyses will be intention-to-treat. Moderation and mediation will be tested. An economic evaluation will be conducted.Ethics and disseminationThe trial has received ethical approval from the NHS South Central - Oxford B Research Ethics Committee (19/SC/0075). A key output will be a high-quality automated VR treatment for patients to overcome anxious avoidance of social situations.Trial registration numberISRCTN17308399.

scholarly journals New Developments in Virtual Reality-Assisted Treatment of Aggression in Forensic Settings: The Case of VRAPT

2022 ◽  
Vol 2 ◽  
Author(s):  
Fernando Renee González Moraga ◽  
Stéphanie Klein Tuente ◽  
Sean Perrin ◽  
Pia Enebrink ◽  
Kristina Sygel ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Psychological Treatment ◽  
Behavioral Therapy ◽  
Ecological Validity ◽  
Controlled Trial ◽  
Scientific Evidence ◽  
Real Life ◽  
Evidence Base ◽  
Theoretical Background ◽  
Lessons Learned

Aggression is a known problem in individuals being cared for in forensic settings, yet the evidence base for its treatment is scarce. Virtual Reality (VR) has been proposed as a promising addition to interventions in forensic settings, as it may increase the motivation among participants, bridge the gap between real life, therapeutic and laboratory experiences, and increase the ecological validity of psychological research. Recently, a new treatment for aggression using VR as the treatment environment, Virtual Reality Aggression Prevention Training (VRAPT), was developed to provide realistic and safe environments for participants to practice aggression management. In its current revised version, VRAPT is conceptualized as a form of cognitive behavioral therapy with its theoretical background in the General Aggression Model. Its purpose is to increase awareness of, and improve control over, one’s own aggression and that of others through social interactions in individually tailored virtual environments. This manuscript describes how the lessons learned from the first randomized controlled trial of VRAPT have been applied to further develop the method and discusses challenges and future directions for VR-assisted treatment of aggression in forensic settings. VRAPT is a new psychological treatment for aggression and the coming years will provide expanded scientific evidence for further developments and adaptations.

scholarly journals One-year randomized trial comparing virtual reality-assisted therapy to cognitive–behavioral therapy for patients with treatment-resistant schizophrenia

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Laura Dellazizzo ◽  
Stéphane Potvin ◽  
Kingsada Phraxayavong ◽  
Alexandre Dumais
Keyword(s):  
Virtual Reality ◽  
Cognitive Behavioral Therapy ◽  
Psychiatric Symptoms ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Comparative Trial ◽  
Cognitive Behavioral ◽  
Treatment Resistant ◽  
Auditory Verbal Hallucinations

AbstractThe 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.

The impact of an empowerment intervention on people with schizophrenia: Results of a randomized controlled trial

2017 ◽  
Vol 63 (3) ◽  
pp. 212-223 ◽  
Author(s):  
Abdalhadi Hasan ◽  
Mahmoud Musleh
Keyword(s):  
Randomized Controlled Trial ◽  
Psychiatric Symptoms ◽  
Controlled Trial ◽  
Intervention Group ◽  
Post Intervention ◽  
Treatment As Usual ◽  
Randomized Controlled ◽  
Secondary Outcomes ◽  
The Impact

Aims: The aim of the study was to assess what empowerment intervention has on people with schizophrenia. Methods: A randomized controlled trial was carried out between November 2015 and May 2016 involving 112 participants who had been diagnosed with schizophrenia. Patients, who were 18 years and above diagnosed with Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-V) schizophrenia or schizoaffective disorder from the outpatient mental health clinics in Jordan, were randomly assigned to take part in an intervention that consisted of receiving 6 weeks’ worth of information booklets, with face to face discussions, while receiving their usual medication or allocated treatment as usual. The participants were assessed at baseline, immediately after the intervention and at 3-month follow-up. The primary outcome was a change in the helplessness score. Secondary outcomes were psychiatric symptoms, recovery rate, empowerment and quality of life. Results: This study showed that people with schizophrenia in the intervention group showed more improvement in the helplessness score immediately post-intervention ( F = 74.53, p < .001) and at 3-month follow-up ( F = 75.56, p < .001), they reported significant improvements in all secondary outcomes. Conclusion: This study indicated that the empowering intervention was an effective intervention when integrated with treatment as usual.

scholarly journals Outcome Trajectories among Homeless Individuals with Mental Disorders in a Multisite Randomised Controlled Trial of Housing First

2016 ◽  
Vol 62 (1) ◽  
pp. 30-39 ◽  
Author(s):  
Carol E. Adair ◽  
David L. Streiner ◽  
Ryan Barnhart ◽  
Brianna Kopp ◽  
Scott Veldhuizen ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Psychiatric Symptoms ◽  
Controlled Trial ◽  
Growth Mixture Modeling ◽  
Service Planning ◽  
Housing First ◽  
Treatment As Usual ◽  
Housing Stability ◽  
Growth Mixture ◽  
Randomised Controlled

Purpose: Housing First (HF) has been shown to improve housing stability, on average, for formerly homeless adults with mental illness. However, little is known about patterns of change and characteristics that predict different outcome trajectories over time. This article reports on latent trajectories of housing stability among 2140 participants (84% followed 24 months) of a multisite randomised controlled trial of HF. Methods: Data were analyzed using generalised growth mixture modeling for the total cohort. Predictor variables were chosen based on the original program logic model and detailed reviews of other qualitative and quantitative findings. Treatment group assignment and level of need at baseline were included in the model. Results: In total, 73% of HF participants and 43% of treatment-as-usual (TAU) participants were in stable housing after 24 months of follow-up. Six trajectories of housing stability were identified for each of the HF and TAU groups. Variables that distinguished different trajectories included gender, age, prior month income, Aboriginal status, total time homeless, previous hospitalizations, overall health, psychiatric symptoms, and comorbidity, while others such as education, diagnosis, and substance use problems did not. Conclusion: While the observed patterns and their predictors are of interest for further research and general service planning, no set of variables is yet known that can accurately predict the likelihood of particular individuals benefiting from HF programs at the outset.

scholarly journals Effectiveness of a stand-alone, smartphone-based virtual reality exposure app to reduce fear of heights in real-life: a randomized trial

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Dorothée Bentz ◽  
Nan Wang ◽  
Merle K. Ibach ◽  
Nathalie S. Schicktanz ◽  
Anja Zimmer ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Controlled Trial ◽  
Phase 1 ◽  
Real Life ◽  
Phase 2 ◽  
Parallel Group ◽  
Real Life Situation ◽  
Repeated Use ◽  
Virtual Reality Exposure ◽  
Fear Of Heights

AbstractSmartphone-based virtual reality (VR) applications (apps) might help to counter low utilization rates of available treatments for fear of heights. Demonstration of effectiveness in real-life situations of such apps is crucial, but lacking so far. Objective of this study was to develop a stand-alone, smartphone-based VR exposure app—Easy Heights—and to test its effectiveness in a real-life situation. We performed a single-blind, parallel group, randomized controlled trial. We recruited 70 participants with fear of heights, aged 18–60 years. Primary outcome was performance in a real-life Behavioral Avoidance Test (BAT) on a lookout tower after a single 1-h app use (phase 1) and after additional repeated (6 × 30 min) app use at home (phase 2). After phase 2, but not phase 1, participants in the Easy Heights condition showed significantly higher BAT scores compared to participants in the control condition (Cohen’s d = 1.3, p = 0.0001). Repeated use of our stand-alone, smartphone-based VR exposure app reduces avoidance behavior and fear, providing a low-threshold treatment for fear of heights.

scholarly journals Dynamic Interactive Social Cognition Training in Virtual Reality (DiSCoVR) for People With a Psychotic Disorder: Single-Group Feasibility and Acceptability Study (Preprint)

2020 ◽  
Author(s):  
Saskia Anne Nijman ◽  
Wim Veling ◽  
Kirstin Greaves-Lord ◽  
Maarten Vos ◽  
Catharina Elizabeth Regina Zandee ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Social Cognition ◽  
Psychotic Disorder ◽  
Psychiatric Symptoms ◽  
Real Life ◽  
Emotion Perception ◽  
Preliminary Treatment ◽  
Single Group ◽  
Training Environment ◽  
Social Cognition Training

BACKGROUND People with a psychotic disorder commonly experience problems in social cognition and functioning. Social cognition training (SCT) improves social cognition, but may inadequately simulate real-life social interactions. Virtual reality (VR) provides a realistic, interactive, customizable, and controllable training environment, which could facilitate the application of skills in daily life. OBJECTIVE We developed a 16-session immersive VR SCT (Dynamic Interactive Social Cognition Training in Virtual Reality [DiSCoVR]) and conducted a single-group feasibility pilot study. METHODS A total of 22 people with a psychotic disorder and reported problems in social cognition participated. Feasibility and acceptability were assessed using a survey for participants and therapists, and by examining relevant parameters (eg, dropouts). We analyzed preliminary treatment effects on social cognition, neurocognition, and psychiatric symptoms. RESULTS A total of 17 participants completed the study. Participants enjoyed DiSCoVR (mean 7.25, SD 2.05; range 3-10), thought it was useful for daily social activities (mean 7.00, SD 2.05; range 3-10), and enjoyed the combination of VR and a therapist (mean 7.85, SD 2.11; range 3-10). The most frequently mentioned strength of DiSCoVR was the opportunity to practice with personalized social situations (14/20, 70%). A significant improvement of emotion perception was observed (Ekman 60 Faces; t<sub>16</sub>=–4.79, <i>P</i>&lt;.001, <i>d</i>=–0.67), but no significant change was found in other measures of social cognition, neurocognition, psychiatric symptoms, or self-esteem. CONCLUSIONS DiSCoVR was feasible and acceptable to participants and therapists, and may improve emotion perception.

scholarly journals AN-VR-BE. A Randomized Controlled Trial for Reducing Fear of Gaining Weight and Other Eating Disorder Symptoms in Anorexia Nervosa through Virtual Reality-Based Body Exposure

2021 ◽  
Vol 10 (4) ◽  
pp. 682
Author(s):  
Bruno Porras-Garcia ◽  
Marta Ferrer-Garcia ◽  
Eduardo Serrano-Troncoso ◽  
Marta Carulla-Roig ◽  
Pau Soto-Usera ◽  
...  
Keyword(s):  
Body Image ◽  
Virtual Reality ◽  
Anorexia Nervosa ◽  
Exposure Therapy ◽  
Controlled Trial ◽  
Control Group ◽  
Significant Group ◽  
Treatment As Usual ◽  
Experimental Group

In vivo body exposure therapy is considered an effective and suitable intervention to help patients with anorexia nervosa (AN) reduce their body image disturbances (BIDs). However, these interventions have notable limitations and cannot effectively reproduce certain fears usually found in AN, such as the fear of gaining weight (FGW). The latest developments in virtual reality (VR) technology and embodiment-based procedures could overcome these limitations and allow AN patients to confront their FGW and BIDs. This study aimed to provide further evidence of the efficacy of an enhanced (by means of embodiment) VR-based body exposure therapy for the treatment of AN. Thirty-five AN patients (16 in the experimental group, 19 in the control group) participated in the study. FGW, BIDs, and other body-related and ED measures were assessed before and after the intervention and three months later. The experimental group received treatment as usual (TAU) and five additional sessions of VR-based body exposure therapy, while the control group received only TAU. After the intervention, ED symptoms were clearly reduced in both groups, with most of the changes being more noticeable in the experimental group. Specifically, after the intervention and at follow-up, significant group differences were found in the FGW and BIDs, with the experimental group showing significantly lower values than the control group. The current study provides new insights and encouraging findings in the field of exposure-based therapies in AN. VR technology might improve research and clinical practice in AN by providing new tools to help patients confront their core fears (i.e., food- or weight-related cues) and improve their emotional, cognitive, and behavioral responses to their body image.

scholarly journals Virtual Reality Cognitive Training in Individuals with Alcohol Use Disorder Undergoing Residential Treatment: A Pilot Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Pedro Gamito ◽  
Jorge Oliveira ◽  
Marcelo Matias ◽  
Elsa Cunha ◽  
Rodrigo Brito ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Alcohol Use ◽  
Cognitive Training ◽  
Cognitive Flexibility ◽  
Alcohol Use Disorder ◽  
Controlled Trial ◽  
Treatment As Usual ◽  
Randomized Controlled ◽  
Global Cognition ◽  
Pilot Randomized Controlled Trial

BACKGROUND Alcohol use disorder has been associated with diverse physical and mental morbidities. Among the main consequences of chronic and excessive alcohol use are cognitive and executive deficits. Some of these deficits may be reversed in specific cognitive and executive domains with behavioral approaches consisting in cognitive training. The advent of computer-based interventions may leverage these improvements, but RCTs of digital interactive-based interventions are still scarce. OBJECTIVE The aim is to explore whether a cognitive training approach using virtual reality exercises based on activities of daily living is feasible for improving cognitive function of patients with alcohol use disorder undergoing residential treatment, as well as to estimate the effect size for this intervention to power future definitive RCTs. METHODS A two-arm pilot randomized controlled trial with a sample of 36 individuals recovering from alcohol use disorder in a therapeutic community assigned to a therapist-guided virtual reality-based cognitive training combined with treatment-as-usual or a control group with treatment-as-usual without cognitive training. A comprehensive neuropsychological battery of tests was used both at pre and post assessments, including global cognition, executive functions, attention, visual memory and cognitive flexibility. RESULTS In order to control for potential effects of global cognition and executive functions at baseline, these domains were controlled in the statistical analysis for each individual outcome. Results indicate effects (P < .05) of the intervention on attention (in 2 out of 5 outcomes) and cognitive flexibility (in 2 out of 6 outcomes), with effect sizes in significant comparisons being larger for attention than for cognitive flexibility. Patient retention in cognitive training was high, in line with previous studies. CONCLUSIONS Overall data suggest specific contributions of reality-based cognitive training in improving attention ability and cognitive flexibility of patients recovering from alcohol use disorder. CLINICALTRIAL ClinicalTrials.gov NCT04505345; https://clinicaltrials.gov/show/NCT04505345

scholarly journals Virtual reality cognitive-behavioural therapy versus cognitive-behavioural therapy for paranoid delusions: a study protocol for a single-blind multi-Centre randomised controlled superiority trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
M. Berkhof ◽  
E. C. D. van der Stouwe ◽  
B. Lestestuiver ◽  
E. van’t Hag ◽  
R. van Grunsven ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Psychotic Disorder ◽  
Cognitive Behavioural Therapy ◽  
Psychotic Disorders ◽  
Psychological Treatment ◽  
Daily Life ◽  
Time Frame ◽  
Behavioural Therapy ◽  
Social Situations ◽  
Cognitive Behavioural

Abstract Background Seventy per cent of patients with psychotic disorders has paranoid delusions. Paranoid delusions are associated with significant distress, hospital admission and social isolation. Cognitive-behavioural therapy for psychosis (CBTp) is the primary psychological treatment, but the median effect size is only small to medium. Virtual reality (VR) has a great potential to improve the effectiveness of CBTp. In a previous study, we found that VR based CBT (VRcbt) for paranoid delusions is superior to waiting list. As a next step, a direct comparison with CBTp is needed. The present study aims to investigate whether VRcbt is more effective and cost-effective than regular CBTp in treating paranoid delusions and improving daily life social functioning of patients with psychotic disorders. Methods A total of 106 patients with DSM-5 diagnosis of psychotic disorder and at least moderate level of paranoid ideations will be recruited for this multicentre randomized controlled trial (RCT). Patients will be randomized to either VRcbt or standard CBTp for paranoid delusions. VRcbt consists of maximum 16 sessions in virtual social situations that trigger paranoid ideations and distress, delivered in an 8–12 week time frame. Standard CBTp also consists of maximum 16 sessions including exposure and behavioural experiments, delivered in an 8–12 week time frame. The two groups will be compared at baseline, post-treatment and six months follow-up. Primary outcome is the level of paranoid ideations in daily life social situations, measured with ecological momentary assessments (EMA) at semi-random moments ten times a day during seven days, before and after treatment. Every session, participants and therapists will rate the level of paranoid ideation and global clinical impression. Discussion Comparison of VRcbt and CBTp will provide information about the relative (cost-) effectiveness of VRcbt for this population. VRcbt may become a preferred psychological treatment for paranoid delusions and social anxiety in patients with psychotic disorder. Trial registration Netherlands Trial Register, NL7758. Registered on 23 May 2019.

Applying the Science of Habit Formation to Evidence-Based Psychological Treatment: Improving Outcomes for Mental Illness

2020 ◽  
Author(s):  
Allison Harvey ◽  
Catherine A. Callaway ◽  
Garret G. Zieve ◽  
Nicole B. Gumport ◽  
Courtney C. Armstrong
Keyword(s):  
Habit Formation ◽  
Systems Of Care ◽  
Psychological Treatment ◽  
Real Life ◽  
Mental Illnesses ◽  
Future Research ◽  
Evidence Based ◽  
Physical And Mental Health ◽  
Life Habits ◽  
Training And Research

Habits impact nearly every domain of our physical and mental health. While the science of habit formation has long been of interest to psychological scientists across disciplines, we propose that applications to clinical psychological science have been insufficiently explored. More specifically, evidence-based psychological treatments (EBPTs) are the gold standard treatment for many mental illnesses. An implicit goal of EBPTs is to eliminate unwanted habits and develop desired habits. Yet, there has been insufficient attention given to habit formation principles, theory and measures in the development and delivery of EBTPs. Herein we consider if outcomes following the receipt of an EBPT would greatly improve if the basic science of habit formation were more fully leveraged. We distill seven ingredients that are central to habit formation and demonstrate how these are relevant to EBPTs. We highlight practice points and an agenda for future research. Finally, implications for providers, systems of care, training and research are offered. We propose that there is an urgent need for research to guide the application of the science of habit formation and elimination to the complex “real-life” habits that are the essence of EBPTs.

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