One-year randomized trial comparing virtual reality-assisted therapy to cognitive\u2013behavioral therapy for patients with treatment-resistant schizophrenia

Laura Dellazizzo,Alexandre Dumais,Stéphane Potvin,Kingsada Phraxayavong

doi:10.1038/s41537-021-00139-2

Abstract

The gold-standard cognitive–behavioral therapy (CBT) for psychosis offers at best modest effects. With advances in technology, virtual reality (VR) therapies for auditory verbal hallucinations (AVH), such as AVATAR therapy (AT) and VR-assisted therapy (VRT), are amid a new wave of relational approaches that may heighten effects. Prior trials have shown greater effects of these therapies on AVH up to a 24-week follow-up. However, no trial has compared them to a recommended active treatment with a 1-year follow-up. We performed a pilot randomized comparative trial evaluating the short- and long-term efficacy of VRT over CBT for patients with treatment-resistant schizophrenia. Patients were randomized to VRT (n = 37) or CBT (n = 37). Clinical assessments were administered before and after each intervention and at follow-up periods up to 12 months. Between and within-group changes in psychiatric symptoms were assessed using linear mixed-effects models. Short-term findings showed that both interventions produced significant improvements in AVH severity and depressive symptoms. Although results did not show a statistically significant superiority of VRT over CBT for AVH, VRT did achieve larger effects particularly on overall AVH (d = 1.080 for VRT and d = 0.555 for CBT). Furthermore, results suggested a superiority of VRT over CBT on affective symptoms. VRT also showed significant results on persecutory beliefs and quality of life. Effects were maintained up to the 1-year follow-up. VRT highlights the future of patient-tailored approaches that may show benefits over generic CBT for voices. A fully powered single-blind randomized controlled trial comparing VRT to CBT is underway.

Highlights

Schizophrenia is among the top medical disorders that produce disability worldwide[1]
138 referrals were provided by clinical teams and the community, 35 individuals refused to partake in the project, thereby leaving 103 participants that were assessed, of whom 74 were eligible
With the rise of virtual reality (VR) in psychotherapy to enhance conventional approaches, this randomized comparative trial aimed to compare the efficacy of an innovative treatment using VR (VRT) to our adapted cognitive–behavioral therapy (CBT) for auditory verbal hallucinations (AVH) in patients with treatment-resistant schizophrenia (TRS)

Summary

Introduction

Schizophrenia is among the top medical disorders that produce disability worldwide[1]. AVH can have a devastating effect on a patient’s life due to high levels of distress[3], feelings of depression[4], impaired social functioning[5], increased suicide risk[6], and delayed recovery[7]. It has been estimated that 20–50% of patients will have treatment-resistant schizophrenia (TRS)[10,11,12,13]. TRS is associated with some of the highest levels of impaired functioning[17], rates of hospitalization[18], and costs to society[19]. Schizophrenia, especially TRS, is a complex, severe, and disabling psychiatric disorder that poses significant therapeutic challenges[20]

Methods

Results

Conclusion