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Who Can Benefit from Virtual Reality CBT?

Posted on April 17, 2018

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I have previously written about the possible benefits of using virtual reality (VR) in the treatment of obsessive-compulsive disorder (OCD). Now it seems that virtual-reality based cognitive-behavioral therapy (CBT) has more wide-reaching benefits and can help reduce momentary paranoia and anxiety, as well as improve social cognition in individuals with psychotic disorders.

In a February 2018 study published in The Lancet (Psychiatry), researchers conducted a randomized controlled trial of personalized virtual-reality based cognitive-behavioral therapy in 116 patients with a DSM IV-diagnosed psychotic disorder and paranoid ideation.

Patients were randomized to 16 virtual-reality therapy sessions, each an hour-long, which resulted in a significant reduction in self reports of momentary paranoia immediately after treatment as well as at a six-month follow-up. In contrast, the control group — who received typical care including antipsychotic medication, regular psychiatric consultations, and social and community functioning — showed a slight increase in momentary paranoia. The group that received virtual-reality therapy also showed statistically significant decreases in momentary anxiety, compared with those in the control group. Those decreases also remained significant at follow-up.

Additionally, researchers observed a significant drop in safety behaviors, such as lack of eye contact, in the group who received the virtual-reality therapy. At follow-up, this group showed less paranoid ideation in the form of lower levels of ideas of persecution and social reference. The treatment also was associated with a small increase in time spent with others at the 6-month follow-up; a decrease was seen in the control group. Patients who underwent virtual-reality therapy also showed improvements in self-stigmatization and social functioning.

The study authors noted that the benefits for social functioning might take some time to emerge after therapy, as patients in symptomatic remission do not immediately start spending more time with other people. They said:

“When patients increasingly feel more comfortable in social situations and learn that other people are less threatening than anticipated, they might try and succeed to make and maintain social contacts and find hobbies and jobs.”

It is interesting to note that no significant differences were found between the two groups in terms of depression and anxiety, or in quality of life measurements posttreatment and at follow-up.

One of the benefits of virtual-reality based CBT is that it can be used to circumvent some of the limitations of exposure-based therapeutic exercises for paranoid ideation. In virtual-reality settings, the environment and characters can be completely controlled by the therapist, and the therapy is in real-time rather than retrospective and therefore not as vulnerable to patient bias.

The therapy used took place in four virtual social environments — a street, bus, café, and supermarket. The therapist was able to control the characteristics and responses of up to 40 human avatars, enabling personalized treatment exercises for each patient.

Said the authors:

“Patients and therapists communicated during virtual reality sessions to explore and challenge suspicious thoughts during social situations, drop safety behaviors during social situations (such as avoiding eye contact with, keeping distance from, and refraining from communication with avatars), and test harm expectancies.”

Several limitations of the study were cited. For one, because follow-up was restricted to 6 months, the long-term effects of virtual reality-based CBT were not measured. Also, some of the patients opted not to participate in the study because traveling to the therapy location proved too frightening. Because of this the patient sample have been somewhat biased, because some of the most paranoid and avoidant patients did not participate.

While more research is needed, it appears that the benefits of virtual-reality based therapy go beyond helping those with OCD. Those with psychotic disorders and paranoid ideation can be helped as well.

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Author: Janet Singer

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