Abstract
BackgroundAddressing specific social cognitive difficulties is an important target in early psychosis and may help address poor functional outcomes. However, structured interventions using standard therapy settings including groups suffer from difficulties in recruitment and retention.AimsTo address these issues, we aimed to modify an existing group social cognitive intervention entitled ‘Social Cognition and Interaction Training' (SCIT) to be delivered through a virtual world environment (Second Life ©).MethodsA single arm nonrandomized proof-of-concept trial of SCIT-VR was conducted. Five groups of three to five individuals per group were recruited over 6 months. Eight sessions of SCIT-VR therapy were delivered through the virtual world platform Second Life© over a 5-week intervention window. Feasibility was examined using recruitment rates and retention. Acceptability was examined using qualitative methods. Secondary outcomes including social cognitive indices, functioning, and anxiety were measured pre- and postintervention.ResultsThe SCIT-VR therapy delivered was feasible (36% consent rate and 73.3% intervention completion rate), acceptable (high overall postsession satisfaction scores) and safe (no serious adverse events), and had high levels of participant satisfaction. Users found the environment immersive. Prepost changes were found in emotion recognition scores and levels of anxiety. There were no signs of clinical deterioration on any of the secondary measures.ConclusionThis proof-of-concept pilot trial suggested that delivering SCIT-VR through a virtual world is feasible and acceptable. There were some changes in prepost outcome measures that suggest the intervention has face validity. There is sufficient evidence to support a larger powered randomized controlled trial.Clinical Trial RegistrationISRCTN, identifier 41443166
Highlights
Novel treatments targeted at functional outcome in early psychosis are important as functional recovery is less common than symptomatic recovery [1], and the two are not always intrinsically linked [2]
social cognition and interactional training (SCIT)-Virtual Reality (VR) Structure SCIT-VR consisted of 10 sessions
The original SCIT [25] was delivered in 20 sessions but our adapted face-to-face version in early psychosis with young people living in Australia was delivered in 10 sessions [11]
Summary
Novel treatments targeted at functional outcome in early psychosis are important as functional recovery is less common than symptomatic recovery [1], and the two are not always intrinsically linked [2]. One treatment approach targeting functional outcomes broadly is social cognition remediation therapy. Global approaches that deliver both social cognition skills training and real-world application of these skills appear to improve functional outcome at least in established psychosis [9]. The thought of attending traditional individual or group therapy provoked considerable anxiety [11]. In this sense, we were aware that our intervention was not reaching a wider group who might benefit from social cognition training, especially as poor social cognition is associated with anxiety and negative symptoms [12]. Addressing specific social cognitive difficulties is an important target in early psychosis and may help address poor functional outcomes. Structured interventions using standard therapy settings including groups suffer from difficulties in recruitment and retention
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