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

Edit Vass,Lajos Simon,Viktória Simon,Mária Ecseri,Zita Fekete,Laura Lencse,Balázs Kis

doi:10.1002/cpp.2519

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 (ηp 2 =.24-.46, φ=.55-.67). On the background of the presented pilot results, VR-ToMIS is concluded to be feasible and tolerable.

Highlights

Schizophrenia is a severe and disabling mental illness, affecting 1% of the population (Saha, Chant, Welham, & McGrath, 2005)
The ability of inferring mental states to another person was found to be the most relevant field, as it is assumed to influence functionality more directly than other fields of social cognition or neurocognition (e.g., Bell et al supported the role of theory of mind (ToM) as a main predictor of the success of employment) (Bell, Tsang, Greig, & Bryson, 2009; Brüne & Brüne-Cohrs, 2006; Couture, Granholm, & Fish, 2011) Signs of ToM deficit usually precede the onset of the illness and can be detected even in remission, where the impairment cannot be described as a consequence of symptomatology or general cognitive impairment in schizophrenia (Bora, Yucel, & Pantelis, 2009; Harrington, Siegert, & McClure, 2005; Herold, Tényi, Lénárd, & Trixler, 2002)
The current study aims to evaluate the feasibility and tolerability of virtual reality (VR)-ToMIS with a randomized, controlled trial

Summary

Introduction

Schizophrenia is a severe and disabling mental illness, affecting 1% of the population (Saha, Chant, Welham, & McGrath, 2005). Reviews on randomized controlled trials of social cognitive and ToM interventions found that such treatment approaches can successfully modify the ability of attributing mental states, where the overall weighted mean effect size was in the range of small to moderate (d = 0.46, 95% confidence interval [CI]: 0.15–0.78) (Kurtz & Richardson, 2012; Vass et al, 2018).

Results

Conclusion