A Review into eHealth Services and Therapies: Potential for Virtual Therapeutic Communities - Supporting People with Severe Personality Disorder

eHealth has expanded hugely over the last fifteen years and continues to evolve, providing greater benefits for patients, health care professionals and providers alike. The technologies that support these systems have become increasingly more sophisticated and have progressed significantly from standard databases, used for patient records, to highly advanced Virtual Reality (VR) systems for the treatment of complex mental health illnesses. The scope of this paper is to initially explore e-Health, particularly in relation to technologies supporting the treatment and management of wellbeing in mental health. It then provides a case study of how technology in e-Health can lend itself to an application that could support and maintain the wellbeing of people with a severe mental illness. The case study uses Borderline Personality Disorder as an example, but could be applicable in many other areas, including depression, anxiety, addiction and PTSD. This type of application demonstrates how e-Health can empower the individuals using it but also potentially reducing the impact upon health care providers and services.Comment: Book chapte

Virtual faces as a tool to study emotion recognition deficits in schizophrenia

Studies investigating emotion recognition in patients with schizophrenia predominantly presented photographs of facial expressions. Better control and higher flexibility of emotion displays could be afforded by virtual reality (VR). VR allows the manipulation of facial expression and can simulate social interactions in a controlled and yet more naturalistic environment. However, to our knowledge, there is no study that systematically investigated whether patients with schizophrenia show the same emotion recognition deficits when emotions are expressed by virtual as compared to natural faces. Twenty schizophrenia patients and 20 controls rated pictures of natural and virtual faces with respect to the basic emotion expressed (happiness, sadness, anger, fear, disgust, and neutrality). Consistent with our hypothesis, the results revealed that emotion recognition impairments also emerged for emotions expressed by virtual characters. As virtual in contrast to natural expressions only contain major emotional features, schizophrenia patients already seem to be impaired in the recognition of basic emotional features. This finding has practical implication as it supports the use of virtual emotional expressions for psychiatric research: the ease of changing facial features, animating avatar faces, and creating therapeutic simulations makes validated artificial expressions perfectly suited to study and treat emotion recognition deficits in schizophrenia

Virtual reality and neuropsychology: a cognitive rehabilitation approach for people with psychiatric disabilities

This pilot-study evaluated the feasibility of a 9 month Cognitive Rehabilitation Program – using Virtual Reality and the Integrated Psychological Therapy (IPT) – to improve cognitive functioning in people with schizophrenia. In order to assess the program it was applied (pre and post) the WCST, WAIS-III sub-tests, Stroop Test, and The Subjective Scale to Investigate Cognition in Schizophrenia. Results identified significant differences (p<0.05) between pre and post tests in the subjective and objective assessed cognitive dimensions. The results point out that virtual reality technology and IPT may be a significant resource and intervention methodology in the cognitive remediation of people with psychiatric disabilities.info:eu-repo/semantics/publishedVersio

Dynamic Interactive Social Cognition Training in Virtual Reality (DiSCoVR) for People With a Psychotic Disorder:Single-Group Feasibility and Acceptability Study

Background: People with a psychotic disorder commonly experience problems in social cognition and functioning. Social cognition training (SCT) improves social cognition, but may inadequately simulate real-life social interactions. Virtual reality (VR) provides a realistic, interactive, customizable, and controllable training environment, which could facilitate the application of skills in daily life. Objective: We developed a 16-session immersive VR SCT (Dynamic Interactive Social Cognition Training in Virtual Reality [DiSCoVR]) and conducted a single-group feasibility pilot study. Methods: A total of 22 people with a psychotic disorder and reported problems in social cognition participated. Feasibility and acceptability were assessed using a survey for participants and therapists, and by examining relevant parameters (eg, dropouts). We analyzed preliminary treatment effects on social cognition, neurocognition, and psychiatric symptoms. Results: A total of 17 participants completed the study. Participants enjoyed DiSCoVR (mean 7.25, SD 2.05; range 3-10), thought it was useful for daily social activities (mean 7.00, SD 2.05; range 3-10), and enjoyed the combination of VR and a therapist (mean 7.85, SD 2.11; range 3-10). The most frequently mentioned strength of DiSCoVR was the opportunity to practice with personalized social situations (14/20, 70%). A significant improvement of emotion perception was observed (Ekman 60 Faces; t(16 )=-4.79, P Conclusions: DiSCoVR was feasible and acceptable to participants and therapists, and may improve emotion perception

Reconhecimento emocional de faces na esquizofrenia: resultados preliminares do programa de realidade virtual para o reconhecimento emocional de faces

BACKGROUND: Significant deficits in emotional recognition and social perception characterize patients with schizophrenia and have direct negative impact both in inter-personal relationships and in social functioning. Virtual reality, as a methodological resource, might have a high potential for assessment and training skills in people suffering from mental illness. OBJECTIVES: To present preliminary results of a facial emotional recognition assessment designed for patients with schizophrenia, using 3D avatars and virtual reality. METHODS: Presentation of 3D avatars which reproduce images developed with the FaceGen® software and integrated in a three-dimensional virtual environment. Each avatar was presented to a group of 12 patients with schizophrenia and a reference group of 12 subjects without psychiatric pathology. RESULTS: The results show that the facial emotions of happiness and anger are better recognized by both groups and that the major difficulties arise in fear and disgust recognition. Frontal alpha electroencephalography variations were found during the presentation of anger and disgust stimuli among patients with schizophrenia. DISCUSSION: The developed program evaluation module can be of surplus value both for patient and therapist, providing the task execution in a non anxiogenic environment, however similar to the actual experience.CONTEXTO: Pessoas diagnosticadas com esquizofrenia apresentam um défice significativo na cognição social com implicações negativas relativamente ao funcionamento interpessoal e social. A realidade virtual apresenta grandes potencialidades para a avaliação e o treino de competências em pessoas com doença mental. OBJETIVOS: Apresentar os resultados preliminares de um programa construído para avaliação do reconhecimento emocional de faces por pessoas com esquizofrenia, utilizando avatares 3D e realidade virtual. MÉTODOS: Apresentação de avatares 3D que reproduzem expressões emocionais, construídas por meio do FaceGen® e integradas num ambiente virtual tridimensional. Apresentou-se cada avatar a 12 doentes com esquizofrenia e a 12 pessoas sem patologia psiquiátrica, avaliando as respostas de reconhecimento e a atividade eletroencefalográfica frontal. RESULTADOS: Os resultados demonstraram que as expressões de alegria e raiva foram as mais bem reconhecidas pelos dois grupos, enquanto de medo e nojo foram as de maior dificuldade. Verificaram-se alterações na atividade alfa frontal para os estímulos raiva e nojo na amostra de doentes com esquizofrenia. CONCLUSÃO: Apesar de algumas expressões emocionais poderem ser melhoradas, o programa desenvolvido pode constituir uma mais-valia para o paciente e para o terapeuta, proporcionando a execução da tarefa em condições não ansiogênicas e aproximadas à experiência real.info:eu-repo/semantics/publishedVersio

Facial emotional recognition in schizophrenia: preliminary results of the virtual reality program for facial emotional recognition

CONTEXTO: Pessoas diagnosticadas com esquizofrenia apresentam um défice significativo na cognição social com implicações negativas relativamente ao funcionamento interpessoal e social. A realidade virtual apresenta grandes potencialidades para a avaliação e o treino de competências em pessoas com doença mental. OBJETIVOS: Apresentar os resultados preliminares de um programa construído para avaliação do reconhecimento emocional de faces por pessoas com esquizofrenia, utilizando avatares 3D e realidade virtual. MÉTODOS: Apresentação de avatares 3D que reproduzem expressões emocionais, construídas por meio do FaceGen® e integradas num ambiente virtual tridimensional. Apresentou-se cada avatar a 12 doentes com esquizofrenia e a 12 pessoas sem patologia psiquiátrica, avaliando as respostas de reconhecimento e a atividade eletroencefalográfica frontal. RESULTADOS: Os resultados demonstraram que as expressões de alegria e raiva foram as mais bem reconhecidas pelos dois grupos, enquanto de medo e nojo foram as de maior dificuldade. Verificaram-se alterações na atividade alfa frontal para os estímulos raiva e nojo na amostra de doentes com esquizofrenia. CONCLUSÃO: Apesar de algumas expressões emocionais poderem ser melhoradas, o programa desenvolvido pode constituir uma mais-valia para o paciente e para o terapeuta, proporcionando a execução da tarefa em condições não ansiogênicas e aproximadas à experiência real.BACKGROUND: Significant deficits in emotional recognition and social perception characterize patients with schizophrenia and have direct negative impact both in inter-personal relationships and in social functioning. Virtual reality, as a methodological resource, might have a high potential for assessment and training skills in people suffering from mental illness. OBJECTIVES: To present preliminary results of a facial emotional recognition assessment designed for patients with schizophrenia, using 3D avatars and virtual reality. METHODS: Presentation of 3D avatars which reproduce images developed with the FaceGen® software and integrated in a three-dimensional virtual environment. Each avatar was presented to a group of 12 patients with schizophrenia and a reference group of 12 subjects without psychiatric pathology. RESULTS: The results show that the facial emotions of happiness and anger are better recognized by both groups and that the major difficulties arise in fear and disgust recognition. Frontal alpha electroencephalography variations were found during the presentation of anger and disgust stimuli among patients with schizophrenia. DISCUSSION: The developed program evaluation module can be of surplus value both for patient and therapist, providing the task execution in a non anxiogenic environment, however similar to the actual experience

Dynamic Interactive Social Cognition Training in Virtual Reality (DiSCoVR) versus Virtual Reality Relaxation (VRelax) for People With a Psychotic Disorder:A Single-Blind Multicenter Randomized Controlled Trial

BACKGROUND AND HYPOTHESIS: Social cognition training (SCT), an intervention for social cognition and social functioning, might be improved by using virtual reality (VR), because VR may offer better opportunities to practice in a potentially more realistic environment. To date, no controlled studies have investigated VR-SCT. This study investigated a VR-SCT, "DiSCoVR". We hypothesized that DiSCoVR would improve social cognition and social functioning. STUDY DESIGN: Participants were randomized to DiSCoVR (n = 41) or VR relaxation ('VRelax', n = 40), an active control condition, and completed 16 twice-weekly sessions. Three assessments (baseline, posttreatment, and 3-month follow-up) were performed by blinded assessors. The primary outcome was social cognition (emotion perception and theory of mind). Secondary outcomes included social functioning (measured with an interview and experience sampling), psychiatric symptoms, information processing, and self-esteem. Data were analyzed using mixed-models regression analysis. Treatment effects were evaluated by the time by condition interaction terms. STUDY RESULTS: No significant time by condition interactions were found for any of the outcome variables, indicating an absence of treatment effects. Between-group effect sizes ranged from negligible to moderate (Cohen's d < |0.53|). Main effects of time were found for several outcomes. CONCLUSIONS: These results suggest that DiSCoVR was not effective, possibly because of inadequate simulation of emotional expressions in VR. This lack of efficacy may indicate that current SCT protocols are relatively unsuitable for improving social functioning. Previous studies showed small to moderate effects on higher order social cognition, but the SCT approach may need critical reevaluation, as it may not sufficiently lead to functional improvement

RC2S: A Cognitive Remediation Program to Improve Social Cognition in Schizophrenia and Related Disorders

In people with psychiatric disorders, particularly those suffering from schizophrenia and related illnesses, pronounced difficulties in social interactions are a key manifestation. These difficulties can be partly explained by impairments in social cognition, defined as the ability to understand oneself and others in the social world, which includes abilities such as emotion recognition, theory of mind (ToM), attributional style, and social perception and knowledge. The impact of several kinds of interventions on social cognition has been studied recently. The best outcomes in the area of social cognition in schizophrenia are those obtained by way of cognitive remediation programs. New strategies and programs in this line are currently being developed, such as RC2S (cognitive remediation of social cognition) in Lyon, France. Considering that the social cognitive deficits experienced by patients with schizophrenia are very diverse, and that the main objective of social cognitive remediation programs is to improve patients’ functioning in their daily social life, RC2S was developed as an individualized and flexible program that allows patients to practice social interaction in a realistic environment through the use of virtual reality techniques. In the RC2S program, the patient’s goal is to assist a character named Tom in various social situations. The underlying idea for the patient is to acquire cognitive strategies for analyzing social context and emotional information in order to understand other characters’ mental states and to help Tom manage his social interactions. In this paper, we begin by presenting some data regarding the social cognitive impairments found in schizophrenia and related disorders, and we describe how these deficits are targeted by social cognitive remediation. Then we present the RC2S program and discuss the advantages of computer-based simulation to improve social cognition and social functioning in people with psychiatric disorders