The acceptability and feasibility of a novel virtual reality based social skills training game for schizophrenia: Preliminary findings

Abstract

Social impairment is a core feature of schizophrenia that presents a major barrier toward recovery. Some of the psychotic symptoms are partly ameliorated by medication but the route to recovery is hampered by social impairments. Since existing social skills interventions tend to suffer from lack of availability, high-burden and low adherence, there is a dire need for an effective, alternative strategy. The present study examined the feasibility and acceptability of Multimodal Adaptive Social Intervention in Virtual Reality (MASI-VR) for improving social functioning and clinical outcomes in schizophrenia. Out of eighteen patients with schizophrenia who enrolled, seventeen participants completed the pre-treatment assessment and 10 sessions of MASI-VR, but one patient did not complete the post-treatment assessments. Therefore, the complete training plus pre- and post-treatment assessment data are available from sixteen participants. Clinical ratings of symptom severity were obtained at pre- and post-training. Retention rates were very high and training was rated as extremely satisfactory for the majority of participants. Participants exhibited a significant reduction in overall clinical symptoms, especially negative symptoms following 10 sessions of MASI-VR. These preliminary results support the feasibility and acceptability of a novel virtual reality social skills training program for individuals with schizophrenia.

Keywords: Computerized training; Negative symptoms; Psychosocial intervention; Schizophrenia; Social attention; Social cognition; Social skills training; Virtual reality.

Conflict of interest statement

Declaration of Conflict of Interest: No conflict of interest.

Copyright © 2018 Elsevier B.V. All rights reserved.

Figures

Figure 1.

Study procedure

Figure 2.. Sample scenes from MASI-VR

All environments display the number of completed missions (in green), failed missions (in red), and mission target (red text below mission count) on the upper left side of the screen. (A) Participants explore the virtual environment (shown, cafeteria). (B) Participants must select avatars to approach and interact with (shown, bus stop) (C) Once an avatar is selected, participants must fixate on the avatar prior to initiating a conversation (shown, grocery store). (D) The participant receives feedback after selecting a conversation topic and exchanging with the avatar (shown, grocery store).

Figure 3.

Flow chart of participant recruitment and retention

Figure 4.. Symptom change from PRE-to-POST training

SAPS: Schedule for the Assessment of Positive Symptoms; SANS: Schedule for the Assessment of Negative Symptoms; BPRS: Brief Psychiatric Rating Scale. *Significant change from PRE-to- POST, p < 0.05.