Virtual Reality Experiments Linking Social Environment and Psychosis: A Pilot Study

Abstract

Initial studies with healthy subjects and individuals with high risk for psychosis have suggested that virtual reality (VR) environments may be used to investigate social and psychological mechanisms of psychosis. One small study reported that VR can safely be used in individuals with current persecutory delusions. The present pilot study investigated the feasibility and potential negative side effects of exposure to different virtual social risk environments in patients with first episode psychosis and in healthy controls. Seventeen patients with first episode psychosis (FEP) and 24 healthy control subjects (HC) participated in four virtual experiments during which they walked for 3.5-4 minutes in a virtual café, looking for avatars with digits on their clothing. The level of paranoid thoughts, as well as psychological, physiological, and behavioral correlates of paranoid thoughts, were measured in different virtual social risk environments, manipulating two factors: population density and ethnicity of avatars. FEP and HC frequently had paranoid thoughts about avatars. Paranoia in the real world correlated strongly with paranoid thoughts about avatars in virtual environments (Spearman's ρ=0.67 and 0.54 in FEP and HC respectively, p<0.01). FEP kept a smaller distance to avatars than HC. In FEP, but not in HC, galvanic skin response was significantly stronger in virtual environments with avatars of other ethnicity than in the own ethnicity condition. These results suggest that VR is an acceptable and sufficiently realistic method to use in patients with first episode psychosis. VR research may help to increase our understanding of the social and psychological mechanisms of psychosis and to develop new treatment applications.

Social defeat predicts paranoid appraisals in people at high risk for psychosis

“…Moreover, lower perceived social rank has been found to be associated with paranoid ideation in healthy controls (Freeman et al, 2005;Gilbert et al, 2005) and in people with early psychosis (Allison et al, 2013), and paranoia in real life has been found to be associated with VR related paranoid ideation in VR in people with psychosis (Veling et al, 2014).…”

“…However, research using virtual reality to study in vivo and in situ reactions to social situations allows the measurement of real-time physiological activation and the assessment of thoughts, mood and symptoms as they occur(e.g. (Fornells-Ambrojo et al, 2013;Freeman et al, 2005;Freeman et al, 2003;Stinson et al, 2010;Valmaggia et al, 2007;Veling et al, 2014)). …”

Bullying victimisation and paranoid ideation in people at ultra high risk for psychosis

“…Psychotic symptoms can be evaluated in a more standardised way by using a Virtual Reality (VR) environment, which provides an ecologically valid and controlled setting that can elicit paranoid experiences (Freeman et al, 2005. VR environments such as a busy train carriage have been shown to induce paranoid ideation in healthy participants (Freeman et al, 2003, Green et al, 2011, people at UHR for psychosis , and individuals with persecutory delusions (Fornells-Ambrojo et al, 2008, Veling et al, 2014. The environmental stimulus is identical in all participants, and their response can be evaluated as soon as they exit the environment, maximising the likelihood of obtaining an accurate assessment of their experiences.…”

Using virtual reality to investigate psychological processes and mechanisms associated with the onset and maintenance of psychosis: a systematic review

“…Galvanic skin response, heart rate and behavioural response (distance kept from the avatars) was found to be triggered by changes in population density and ethnic density in a VR bar environment [ 69 ]. The same environment was used to investigate galvanic skin response in a sample of individuals with psychosis [ 65 ]. Distance kept from the avatar was also measured in a study which manipulated the contingency behaviour of avatars while participants were exploring a VR student flat [ 60 ].…”