A novel virtual reality‐based theory of mind intervention for outpatients with schizophrenia: A proof‐of‐concept pilot study

Abstract

Schizophrenia is a severe and highly disabling mental illness. Although several pharmacological solutions are available to alleviate symptoms of schizophrenia, they do not seem to provide solution for accompanying social dysfunctions. To handle this unmet clinical need, many innovative interventions have been developed recently. Considering the promising results on this field and the development trend, characterized by the growing proportion of included interactive technology, our research team developed a novel virtual reality (VR)-based targeted theory of mind (ToM) intervention (VR-ToMIS) for stable outpatients with schizophrenia. VR-ToMIS is a nine-session long structured and individualized method that uses cognitive and behavioural therapeutic techniques in an immersive VR environment. Our study was a randomized, controlled pilot study.Twenty-one patients have been recruited and randomly allocated to either VR-ToMIS or passive VR condition. Patients assigned to passive VR condition could use the same VR software as the VR-ToMIS group, but without any interventions. Effects on psychiatric symptoms, neurocognitive and social cognitive functions, pragmatic language skills and quality of life were evaluated by using analysis of covariance. According to our results, VR-ToMIS was associated with improvements in negative symptoms, in one neurocognitive field (immediate memory), ToM and pragmatic language skills, but no significant change in quality of life scores was detected. Significant changes in VR-ToMIS group were associated with moderate to large therapeutic effects (η p 2 = .24-.46, φ = .55-.67). On the background of the presented pilot results, VR-ToMIS is concluded to be feasible and tolerable.schizophrenia, theory of mind, virtual reality | INTRODUCTIONSchizophrenia is a severe and disabling mental illness, affecting 1% of the population (Saha, Chant, Welham, & McGrath, 2005). Although effective treatment of this disorder is usually associated with the alleviation of positive and-to a lesser extent-negative symptoms, in most cases, social functioning remains impaired, causing long-lasting difficulties for the patients and their families and resulting in welldefined economic burden for the society as well (Gábor, 2011;Leifker, Bowie, & Harvey, 2009). As pharmacotherapy does not seem to offer

Case Report: Feasibility of a Novel Virtual Reality-Based Intervention for Patients With Schizophrenia

“…When we tried to explore the background of her evaluation Ms. Smith explained that, in the end, nothing changed, as she's still working at the sheltered workshop. Although low internal consistency of Work domain on the scale can also be a possible explanation, in addition to the above there were no other changes detected in Quality-of-Life domains after the intervention at the follow-up assessment (Gaite et al, 2000;Vass et al, 2020). Considering the contradiction between the objective and subjective results at this point, choosing the inappropriate measuring tool to assess the desired changes can be a probable explanation.…”

“…Furthermore, patients found the intervention interesting and tolerated it well. Although the mentioned results show that VR-ToMIS might be beneficial for schizophrenic patients, further study on a larger sample is needed to confirm its short-term and possible long-term effects (Vass et al, 2020).…”

“…Smith participated in a 9 week VR-based intervention (1 h/session/week) in an individual setting led by a licensed clinical psychologist (EV) under the supervision of an experienced psychotherapist (LS). We used the protocol of the ongoing efficacy study/previously published feasibility study of VR-ToMIS (Vass et al, 2020). VR-ToMIS applies an immersive VR software (vTime), with a Samsung GearVR head mounted display built in a Samsung S7 smartphone, and a Simple Controller (www.vTime.net).…”

A Systematic Review of the Current Measures of Theory of Mind in Adults with Schizophrenia

“…ToM impairment in adults with schizophrenia causes them social difficulties even more than their neurocognitive function or symptom severity does [ 15 , 16 , 17 , 18 ]. Fortunately, it has been evidenced that the ToM impairment in people with schizophrenia can be improved by mentalizing-based interventions [ 19 , 20 , 21 ]. Measuring ToM in people with schizophrenia is crucial because ToM has been identified as an important target and outcome measure for psychosocial treatment [ 22 , 23 , 24 ].…”

Multi-Modal Dual-Task Measurement: A New Virtual Reality for Assessment

“…VR can be used in isolation for specific assessments of cognitive functions (Hørlyck et al, 2021), or can be combined with neuroimaging techniques and ancillary methods to offer insight into how target brain regions respond in-vivo to neurorehabilitation and/or cognitive stimulation (Ansado et al, 2020). The specific development of VR-based cognitive assessments and therapeutic interventions in neurological conditions is growing (Schultheis et al, 2002;Bell et al, 2020;Clay et al, 2020;De Luca et al, 2020;Diaz-Orueta et al, 2020;EbrahimiSani et al, 2020;Gamito et al, 2020;Vass et al, 2020). Within clinical practice, cognitive assessments rely on high levels of experimental control, and this is congruent with assessment paradigms in VR, while VR also potentially provides greater ecological validity than clinic-based assessments can provide (Parsons, 2015).…”