Social environments and mental health:Exploring new worlds with virtual reality

With virtual reality (VR) glasses, you can enter a completely different world within seconds. Computer-generated VR simulations of real-like environments can trigger psychological and physical reactions, such as anxiety, sweating or joy, similar to the reactions in real life. This characteristic of VR simulations - feeling real- makes VR a powerful tool for assessment, therapies and research in mental healthcare. With this thesis, we experimentally investigated how people behave in VR environments. We found that people with and without a vulnerability for psychosis maintain similar interpersonal distance to other visitors in a virtual café. Further, we found that emotion recognition in faces of VR simulated people and real people is very similar. This finding supports that virtual emotional stimuli – i.e., emotions on virtual faces - are suitable for research and training of emotion recognition skills.Next, the effects of a novel VR cognitive behavioral therapy (VR-CBT) were investigated in patients with a psychotic disorder and patients with a generalized anxiety disorder. During VR-CBT patients practice within virtual environments which they tend to avoid in the real world. They could practice in a VR bar, streets, bus and supermarket environment. VR environments were personalized by the therapist to fit the specific needs of the patient. The VR-CBT intervention was effective in reducing paranoia as well as social anxiety in everyday life. Currently, several mental health care institutes in the Netherlands are offering VR-CBT as a treatment

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

Improving social cognition in people with a psychotic disorder:preliminary results of a pilot study on Dynamic interactive Social Cognition training in Virtual Reality (DiSCoVR)

Aim: Dysfunctions in emotion recognition, reading others’ mental states and assessing social situations are common in individuals with a psychotic disorder. Social cognitive deficits such as these strongly predict problems in social functioning. Meta-analyses show that social cognition can be improved by social cognition training (SCT); however, it is unclear whether these effects persist over time. The stimuli and techniques that are typically used in SCT may not adequately mimic real-life social interactions. Several key characteristics of real-world interactions are also absent from conventional training materials, particularly interaction. We have therefore developed a SCT which is provided using Virtual Reality (VR). VR is highly realistic and interactive, eliciting genuine psychological responses, and the environment and the virtual people (‘avatars’) in it, react to the actions of the participant. VR also allows for control of several parameters, facilitating structured and individualized training. Methods: A novel form of SCT using VR (called ‘DiSCoVR’) has been developed. DiSCoVR consists of 16 sessions, provided over the course of eight weeks, targeting the following social-cognitive domains: 1) Emotion perception; 2) Social perception and Theory of Mind (i.e., understanding the social context and interdependence of emotions, thoughts and behavior); and 3) Social interaction training (i.e., selecting and practicing adequate responses in social situations). These domains are trained in VR, supplemented by coaching from a therapist and homework assignments. A pilot study of DiSCoVR is currently conducted amongst 25 mental health service clients in the northern Netherlands. In this pilot study, our primary outcome of interest is the acceptability and feasibility of the intervention. Our secondary outcome measure is the efficacy of DiSCoVR on several domains of social cognition: emotion perception, social perception and theory of mind. These domains are measured using conventional tests of social cognition, as well as performance on Virtual Reality tasks. The mental health service client group is compared on these measures to a healthy control group (n=25), to determine ‘normal’ performance on these measures and in VR. Results & Conclusion: We will demonstrate the intervention and provide preliminary results of the ongoing pilot study

Reading the mind of the avatar: demonstration of a new virtual reality social cognition training for people with psychotic disorders

Background: Individuals with psychotic disorders commonly experi- ence deficits in social cognition and limited social functioning. Social Cognition Training (SCT) has been shown to have beneficial effects on proximal social cognition tasks, but generalization to social function- ing is limited and interventions may not have long-term effects. We speculate that this may be due to limited ecological validity of SCT stimuli, and the absence of opportunities for guided practice in realistic, dynamic social interactions. Methods: We propose that this problem could be solved by providing SCT in virtual reality (VR). VR allows for practice of skills in situations mimicking real life, yet is safe and controllable, and facilitates structured training guided by a therapist. The proposed intervention aims to improve social cognition through CRT principles such as errorless learning, scaffolding, and coaching. It builds complex social cognitive skills, such as higher-order Theory of Mind, upon elementary social processes, such as facial affect perception. Results: The virtual reality SCT consists of four modules: 1) facial affect recognition training: encountering avatars showing emotion and identifying their affective expressions; 2) facial affect recognition in social contexts: identifying and understanding expressed emotions using social contextual information; 3) Theory of Mind (ToM) training (progressing from simple, first-order scenarios to complex, higher- order ToM): encountering increasingly complex social situations and inferring virtual characters’ mental states; and 4) integration and practice of FAR and ToM in dynamic interactions with virtual characters, that change according to clients’ choices and psychophy- siological responses in the interactions. Training is delivered using four interactive virtual environments that are common in daily life situations: a shopping street, a super market, a bus and a café. Conclusions: The intervention described above, as well as plans to empirically test its efficacy, are demonstrated and presented in further detail