VR-SOAP, a modular virtual reality treatment for improving social activities and participation of young people with psychosis:a study protocol for a single-blind multi-centre randomized controlled trial

Background: Young people with a psychotic disorder have the same social goals as their healthy peers, but their social networks are smaller, they participate less often in leisure activities and are less successful in work and education. Causes of these problems are multifaceted, but culminate in difficulties with interacting in daily life social situations. Current treatments have only moderate effects on social functioning and often target one specific domain. Virtual reality (VR) has the potential to improve the treatment of social interaction difficulties. We developed a modular VR treatment for social functioning and participation (VR-SOAP). In this study, the effect of this intervention will be investigated in a randomized controlled trial (RCT). Methods: A total of 116 participants (age 18–40) with a DSM-5 diagnosis of schizophrenia spectrum or other psychotic disorder and problems with social functioning will be recruited from mental healthcare institutes in the Netherlands. Participants will be randomized to the experimental condition (VR-SOAP) or active VR control condition (VRelax). VR-SOAP consists of 14 sessions and 5 modules addressing causes of impaired social functioning: four optional modules (1–4) and one fixed module (5). Vrelax consists of 14 sessions that entail psychoeducation, stress management, relaxation techniques, and the exploration of relaxing environments in VR. Primary outcomes are quantity and quality of social contacts, leisure activities and social participation, measured with the experience sampling method (ESM). Secondary outcomes are psychiatric symptoms, social behaviour, social cognition, self-esteem, self-stigma and paranoid thoughts. Treatment effects will be compared at pre-treatment (baseline), post-treatment and at 6-month follow-up. Discussion: If VR-SOAP proves to be effective, it provides therapists with a much-needed tool to improve social functioning of young adults with a psychotic disorder. Additionally, since the treatment consists of multiple modules targeting different transdiagnostic factors, this trial might provide input for new treatments to improve social functioning in a range of symptoms and disorders, e.g. mood, autism spectrum and anxiety disorders. Trial registration: On the 10th of November 2021, this trial was registered prospectively in the Dutch Trial Register as NL9784.</p

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

Virtually social: research on social cognition and virtual reality in people with a psychotic disorder

Many people who are susceptible to psychosis have problems understanding what is going on in other people’s minds. Problems in these mental skills called ‘social cognition’ have been linked to difficulties in social functioning, such as finding paid work and making new friends. In a network meta-analysis, we found that problems in social cognition can be treated with ‘Social Cognition Training’ (SCT). SCT targeting multiple domains of social cognition was particularly effective. Therefore, we have developed a virtual reality (VR) SCT, ‘DiSCoVR’, because VR makes it possible to practice accessibly in a realistic, interactive environment. DiSCoVR consisted of sixteen sessions, in which participants practiced with emotion recognition, understanding others, and social interaction in VR. These sessions were guided by a psychologist, who helped participants set social goals and determine an appropriate approach for social situations. DiSCoVR was evaluated by comparing it to a VR-relaxation training (‘VRelax’). In VRelax, participants explored relaxing virtual environments. We found no effect of DiSCoVR social cognition or social functioning, neither directly after training, nor three months later. To understand why, we examined data that were logged as participants practiced emotion recognition in VR. This showed that participants did improve their accuracy and speed of emotion recognition in VR, but this did not translate to improvement outside of VR. DiSCoVR might therefore be too abstract, not realistic enough, or too different from real, daily social situations. A solution could be to use more technologically advanced VR programs that are more focused on concrete social problems