VR (Virtual Reality) is the experience of a sense of presence in an interactive 3D world where virtual world changes according to the participant’s movements and actions. VR elicits psychological and physiological responses remarkably similar to those in the real world. Are we entering an era where VR based interventions would form one of the main means of delivering mental health interventions?
Opriş D et al 2012 ( meta analysis ) showed that VR exposure therapy is as effective as conventional therapies for anxiety disorders. VR is now being developed for assessment and intervention in psychosis. Wim Veling et al review this emerging field in this review.
VR experiments/studies has shown that paranoid ideas about avatars correlates with levels of anxiety, interpersonal sensitivity, perceptual abnormalities and paranoia in real life. Individuals provide several types of ‘evidence’ supporting their paranoid beliefs.Patients more often use their own mood/affect and pre-existing beliefs about threat in daily interactions as evidence. It has also been shown that paranoia, social anxiety, and correlates of psychosis like cognitive biases were associated with paranoid thoughts about avatars, with correlation coefficients up to 0.7
It has also been used to study cognitive functioning in schizophrenia ( e.g. maze task) and found that individuals with schizophrenia are less flexible in changing strategies for finding the best bus route, were slower and less successful in a shopping task and had poorer medication management skills in a virtual apartment. They also are less able to read others emotions, and tend to keep less eye contact etc. None of these will surprise clinicians working with such individuals.All these suggest the huge potential VR is offering to assess /study various domains and abilities in controlled settings which otherwise would have been either impossible or hugely expensive.Only side effect of VR assessments so far noted was cyber sickness ( nausea).
Avatar Treatment examples
Positive symptoms: Error feedback on reading others emotions in paranoid individuals has lead to decrease in paranoid beliefs. Avatar therapy for auditory hallucinations where patients create an avatar of the entity they believe is talking to them. Then they have short dialogs with these avatars. These interventions lead to reduce the impact of hallucinations in their life.
Negative symptoms: Social skills training using VR helped patients to improve conversational skills and assertiveness and reduce negative symptoms
Cognitive intervention: Virtual shop was used for training schizophrenia patients being a salesperson, aiming at training of executive functions, problem solving, categorization, memory, and attention
VR treatments are conceivable for most dimensions of psychotic disorders. Possibilities of VR are only beginning to be explored. It definitely has great potential for increasing our understanding of psychosis and expanding the therapeutic toolbox.