Feasibility and Efficacy of Virtual Reality Interventions to Improve Psychosocial Functioning in Psychosis: Systematic Review

Abstract

Background: Functional recovery in psychosis remains a challenge despite current evidence-based treatment approaches. To address this problem, innovative interventions using virtual reality (VR) have recently been developed. VR technologies have enabled the development of realistic environments in which individuals with psychosis can receive psychosocial treatment interventions in more ecological settings than traditional clinics. These interventions may therefore increase the transfer of learned psychosocial skills to real-world environments, thereby promoting long-term functional recovery. However, the overall feasibility and efficacy of such interventions within the psychosis population remain unclear.

Objective: This systematic review aims to investigate whether VR-based psychosocial interventions are feasible and enjoyable for individuals with psychosis, synthesize current evidence on the efficacy of VR-based psychosocial interventions for psychosis, and identify the limitations in the current literature to guide future research.

Methods: This research followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Literature searches were conducted in PubMed and PsycINFO in May 2021. We searched for peer-reviewed English articles that used a psychosocial intervention with a VR component. Participants in the included studies were diagnosed with schizophrenia, schizoaffective disorder, or another psychotic disorder. The included studies were divided into four categories as follows: cognitive remediation interventions, social skills interventions, vocational skills interventions, and auditory verbal hallucinations and paranoia interventions. The risk of bias assessment was performed for each study.

Results: A total of 18 studies were included in this systematic review. Of these 18 studies, 4 (22%) studies used a cognitive remediation intervention, 4 (22%) studies used a social skills intervention, 3 (17%) studies used a vocational skills intervention, and 7 (39%) studies implemented an intervention aimed at improving auditory verbal hallucinations or paranoia. A total of 745 individuals with psychosis were included in the study. All the studies that evaluated feasibility showed that VR-based psychosocial interventions were feasible and enjoyable for individuals with psychosis. The preliminary evidence on efficacy included in this review suggests that VR-based psychosocial interventions can improve cognitive, social, and vocational skills in individuals with psychosis. VR-based interventions may also improve the symptoms of auditory verbal hallucinations and paranoia. The skills that participants learned through these interventions were durable, transferred into real-world environments, and led to improved functional outcomes, such as autonomy, managing housework, and work performance.

Conclusions: VR-based interventions may represent a novel and efficacious approach for improving psychosocial functioning in psychosis. Therefore, VR-based psychosocial interventions represent a promising adjunctive therapy for the treatment of psychosis, which may be used to improve psychosocial skills, community functioning, and quality of life.

Keywords: auditory verbal hallucinations; cognitive remediation; functional outcomes; neurocognition; paranoia; psychosis; schizophrenia; social skills; virtual reality (VR); vocational skills.

Conflict of interest statement

Conflicts of Interest: None declared.

©Alexandra H Schroeder, Bryce J M Bogie, Tabassum T Rahman, Alexandra Thérond, Hannah Matheson, Synthia Guimond. Originally published in JMIR Mental Health (https://mental.jmir.org), 18.02.2022.

Figures

Figure 1

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram. VR: virtual reality.

Figure 2

Virtual reality environments developed via the NeuroVr 2.0 software for a cognitive remediation intervention in schizophrenia. The environments include a park (A), valley (B), beach (C), and supermarket (D). Images reproduced with author permission from La Paglia [46].

Figure 3

Virtual reality environment used in the Multimodal Adaptive Social Intervention in virtual reality. (A) The cafeteria environment and (B) the bus stop environment where participants can practice "small talk" and interact with the avatars. (C) The participant chooses what to say to the avatar from a multiple-choice menu. (D) The avatar provides feedback after the exchange with the participant. Reprinted from Psychiatry Research, Adery et al [48], Copyright 2018, with permission from Elsevier.

Figure 4

Virtual reality environment used in the Soskitrain virtual reality integrated program for improving social skills in patients with schizophrenia. Participants can practice social interactions with avatars, such as (A) a bartender and (B) a security guard in a museum. Unpublished images reproduced from the Soskitrain program with author permission from Rus-Calafell [50].