How Virtual Reality Therapy Can Improve Psychosis Treatment
VR is a promising treatment option for many different conditions — including agoraphobia in psychosis patients.
Virtual reality (VR) is most well-known for its gaming applications. Yet, this technology has the potential to revolutionize a large number of different industries, including healthcare.
Many patients with psychosis also experience agoraphobia. New research has found that virtual reality therapy can improve agoraphobia in psychosis patients.
What is Psychosis?
“Psychosis” describes mental conditions that alter the perception of reality¹. For those that have symptoms of psychosis, it can be hard to tell what is real and what is not.
Some notable symptoms of psychosis include:
- A sudden drop in job performance or school grades
- Confused or disturbed thoughts
- Delusion
- Difficulty communicating
- Hallucinations
- Paranoia or suspiciousness of others
- Withdrawing socially
Psychosis disorders can be classified as ‘affective’ or ‘non-affective.’²
Affective psychosis: psychosis symptoms typical of mood disorders. Examples of these are bipolar disorders and major depressive disorder.
Non-affective psychosis: schizophrenic spectrum disorders including schizophrenia, brief psychotic disorder, and delusional disorder.
What is Virtual Reality?
Virtual reality is an interactive, computer-generated, three-dimensional world that gives you the feeling you are actually experiencing what you are seeing. A virtual reality headset is a head-mounted device (HMD) that looks kind of like large goggles.
VR is most commonly known for its gaming applications. However, it can be applied in many other situations, including:
- Workplace training
- Healthcare and patient treatment
- Education
- Journalism
- Sports
How Could VR Help Psychosis?
A survey in the UK found that 64.5% of patients with non-affective psychosis (such as schizophrenia) have agoraphobia³. Agoraphobia is the fear of being in situations in which escape may be difficult or help may not be available if things were to go wrong⁴. Examples of this include a fear of:
- Leaving home
- Shopping
- Taking the bus
- Walking down the street
People with agoraphobia tend to become distressed in these situations or avoid them entirely. To cope with these situations, they often display defense behaviors. These behaviors include:
- Avoiding eye contact
- Being on constant alert for danger
- Rushing to leave early
These defense behaviors are reinforced as patients believe that the absence of harm is due to these behaviors.
Active ‘real-world’ learning (practicing going into anxiety-inducing situations with a trained therapist) is crucial for the clinical improvement of agoraphobia. However, there are a few problems with the current treatment.
Patient adherence is a significant problem as active treatment can be scary and difficult for the patient. Additionally, therapists often cannot provide sufficient real-world treatment. This is due to time constraints and an inadequate amount of competent therapists⁵.
To address both of these issues, researchers set out to examine the benefit of VR as a therapy for agoraphobia in psychosis patients⁵.
gameChange VR Cognitive Therapy
Participants had either a diagnosis of schizophrenia spectrum disorder or an affective psychosis diagnosis and avoided going out due to anxiety.
The VR cognitive therapy, called gameChange, simulated different environments for the participants to practice leaving home. The environments included:
- Cafes
- Doctors offices
- Getting on a bus
- Pubs
- Shops
Participants in the treatment group had 6 sessions of gameChange therapy as well as their regular treatment. The sessions were about 30 minutes long and spaced over 6 weeks. Those in the control group simply continued with regular treatment. The trial assessors did not know which group each patient was in to avoid bias.
So, Did gameChange Improve Agoraphobia?
gameChange VR therapy significantly reduced agoraphobic avoidance and distress in patients with psychosis. These benefits were even more profound in patients who initially reported severe avoidance and distress behaviors⁵.
Patients who displayed severe avoidance and distress behaviors before VR therapy had moderate-to-large improvements for 6 months following treatment. On average, patients with severe agoraphobia could do at least two of the activities (such as leaving the house or going to the shops) at the 26-week follow-up after treatment had ended⁵.
Additionally, those with severe agoraphobia also found that VR therapy improved paranoia symptoms and aided in the recovery of quality of life⁵.
How VR Therapy Could Benefit Clinical Psychosis Care
The VR cognitive therapy worked by reducing the anxious thoughts and defense behaviors associated with the different environments. Even though the participants knew that the therapy was a simulation, the VR reduced a range of threat cognitions, which is a key element in anxiety.
This essentially trained the participant’s brains to not set off the avoidance and distress behaviors in these situations.
VR cognition therapy has the potential to benefit agoraphobia treatment in a number of ways.
Improved patient adherence. Virtual reality therapy would help improve patient adherence to treatment as it is much less daunting than ‘real-world’ treatment. Patients are aware that it is a simulation and can take the headset off whenever necessary. Additionally, as this therapy is delivered via a stand-alone headset, it has the potential to be done from the comfort of the patient’s home.
No longer reliant on trained therapists. By automating this VR treatment, the reliance on trained professionals is removed. Peer-support workers, assistant psychologists, or cognitive behavioral therapists will also be able to provide this treatment.
Active treatment available from home. As mentioned before, being able to have this therapy at home is likely to improve patient adherence. But, being able to access treatment from home is an especially important benefit in light of the COVID-19 pandemic. Not only were patients unable to have real-world active treatment during the pandemic, but their avoidance and distress behaviors were being reinforced by the subsequent lockdowns.
By introducing VR therapy from home, patients would be able to continue with treatment throughout a pandemic. This would improve their agoraphobia and help negate the worsening effects of the pandemic.
Easing the transition from psychiatric hospitals to the ‘real world’. Transitioning from a psychiatric hospital back into the ‘real world’ can be very difficult for patients. VR cognitive therapy has the potential to make this easier. Patients could utilize this VR therapy before leaving the psychiatric hospital, relieving some anxiety and giving them a better chance at positively and confidently transferring back into ‘real world’ activities.
Conclusion
VR cognitive therapy is a promising development for the treatment of agoraphobia in psychosis patients. Patients with severe avoidance and distress behaviors tend to receive the most benefit from this treatment.
References
- Understanding Psychosis. National Institute of Mental Health. Accessed January 4, 2023. https://www.nimh.nih.gov/health/publications/understanding-psychosis
- Bello I, Dixon L. Treating Affective Psychosis and Substance Use Disorders Within Coordinated Specialty Care. National Association of State Mental Health Program Directors. Accessed January 4, 2023. https://www.nasmhpd.org/sites/default/files/DH-TreatingAffectivePsychosis_v2_0.pdf
- Freeman D, Taylor KM, Molodynski A, Waite F. Treatable clinical intervention targets for patients with schizophrenia. Schizophr Res. 2019;211:44–50. doi:10.1016/j.schres.2019.07.016
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 2013. Accessed January 4, 2023.
- Freeman D, Lambe S, Kabir T, et al. Automated virtual reality therapy to treat agoraphobic avoidance and distress in patients with psychosis (gameChange): a multicentre, parallel-group, single-blind, randomised, controlled trial in England with mediation and moderation analyses. Lancet Psychiatry. 2022;9(5):375–388. doi:10.1016/S2215–0366(22)00060–8
