Abstract
BackgroundRecently, the efficacy of a novel virtual reality based cognitive behavior therapy (VR-CBT) for paranoia was demonstrated. Cognitive biases, cognitive limitations, negative schematic beliefs and safety behavior have been associated with paranoid ideations and delusions. It is unknown whether VR-CBT affects these associated factors, and how changes in these factors relate to changes in paranoid ideation.MethodsIn this multi-center randomized controlled trial patients with a psychotic disorder and paranoia were randomized to VR-CBT (n = 58) or treatment as usual (TAU; n = 58). VR-CBT consisted of maximally sixteen 60-minute individual therapy sessions. Paranoia, safety behavior, schematic beliefs, cognitive biases and limitations were assessed at baseline, post-treatment (at three months) and follow-up (at six months). Mixed model analyses were conducted to study treatment effects. Mediation analyses were performed to explore putative working mechanisms by which VR-CBT reduced paranoia.ResultsVR-CBT, but not TAU, led to reductions in jumping to conclusions, attention for threat bias and social cognition problems. Schematic beliefs remained unaffected. The effect of VR-CBT on paranoia was mediated by reductions in safety behavior and social cognition problems.DiscussionVR-CBT affects multiple mechanisms that are associated with paranoid ideation. Although maintaining factors of paranoia are likely to influence each other, targeting safety behavior and social cognitive problems seems effective in breaking the vicious circle of paranoia.
Highlights
Cognitive impairment is a core feature of schizophrenia, which limits functions of individuals with schizophrenia and negatively influences their quality of life (Green, 1993; Green et al, 2000; Heaton et al, 2001; Heinrichs, 1998)
While pharmacological treatment is known to have a limited effect on impaired cognition in schizophrenia (Marder, 2006; Rund and Borg, 1999; Elie et al, 2010), a majority of literature has concluded that cognitive remediation(CR) produces small to moderate improvements (McGurk et al, 2007; Wykes et al, 2011)
While CR only group participated in usual CR with Q&A sessions, experimental group participated CR sessions integrated with motivational intervention
Summary
Cognitive impairment is the most important feature of schizophrenia that leads to severe social and functional disability. In the current study we investigated the effect of raloxifine as a selective estrogen modulator and isradipine as a voltage gated L type calcium channel blocker on the enhancement of schizophrenic patients’ cognitive deficits. The first group received isradipine 5 mg, the second raloxifine 60 mg and the third placebo for 6 consequent weeks, in the same shape capsules, 2 times a day, alongside treatment with the conventional antipsychotics. The initial and final lab tests, ECG, as well as cognitive tests in specific domains such as attention, processing speed, executive function and verbal memory were carried out. Results: Our findings, revealed a remarkable association between adjunctive treatment of raloxifine in verbal memory deficits. Isradipine treatment indicated significant improvement relative to placebo in verbal memory as well as attention dysfunction in some variables of the Stroop test. Discussion: The study provides the first evidence to our knowledge, which isradipine as a novel therapy was associated with improvement in verbal
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