Virtual Reality Relaxation for Reducing Perceived Stress of Intensive Care Nurses During the COVID-19 Pandemic

During the COVID-19 pandemic ICU nurses endure high levels of stress. VR relaxation (VRelax, containing 360° immersive environments) provides an easy-to-use and effective means to induce positive affect and reduce perceived stress. We investigated feasibility and immediate effect on perceived stress of VRelax use by ICU nurses during work shifts. ICU nurses working with COVID-19 patients in an academic hospital could use VRelax as a 10-min break during their shift. Primary outcome was the difference between perceived stress immediately before and after VRelax use measured by a single-question VAS-stress scale. Statistically significant difference of the mean VAS-stress before and after use was determined using the paired t student test. A socio-demographic questionnaire, a questionnaire on perceived stress and stress resilience and VRelax user experiences were sent by email. Eighty-six (26%) nurses used VRelax at least once; 77% (N=66) of these filled out the VAS-stress scale before and after use of VRelax. Mean perceived stress lowered with 39.9% after use of VRelax (mean difference=14.0, SD=13.3, p<0.005). Mean score on the perceived stress scale-10 was 11.4 (SD=6.50), mean score on the Connor-Davidson Resilience Scale-10 was 29.0 (SD=5.51). Sixty-two percentage of the ICU nurses thought VRelax was helpful to reduce stress. Main barrier for use was a high workload. It is feasible for nurses to use VRelax in an ICU context. VRelax is an effective intervention to reduce immediate perceived stress and is of added value in stressful situations as during the COVID-19 pandemic, inducing a positive affective state and lowering perceived stress

Mapping aggressive behavior of forensic psychiatric inpatients with self-report and structured staff-monitoring

Structured assessment of aggressive behavior in forensic psychiatry is needed. This study investigated staffobserved and self-reported measures to map prevalence and characteristics of aggressive behavior in forensic inpatients and aimed to identify early signs of aggressive outbursts. In this longitudinal study, 120 forensic psychiatric inpatients with a history of aggression were included. Staff monitored aggressive behavior for 30 weeks using the Social Dysfunction and Aggression Scale (SDAS). Patients completed baseline self-report measures on aggression, anger, and impulsivity. Staff monitoring showed that most inpatients displayed moderate (86%) or severe (65%) aggressive behavior at least once, and 37.5% showed physical aggression. Inpatients with a least one physical aggression incident differed from others in self-reported anger, (reactive) aggression, nonplanning impulsivity, and sociodemographic and clinical characteristics (e.g., higher prevalence of cluster B personality disorders, and lower intelligence). Two-thirds of the physical aggression incidents were preceded by observations of increased non-physical aggression (SDAS). In forensic psychiatric inpatients with a history of aggression, more than a third of the patients demonstrated at least one occasion of physical aggression during 30 weeks of observation

Trajectories of Emotion Recognition Training in Virtual Reality and Predictors of Improvement for People with a Psychotic Disorder

Meta-analyses have found that social cognition training (SCT) has large effects on the emotion recognition ability of people with a psychotic disorder. Virtual reality (VR) could be a promising tool for delivering SCT. Presently, it is unknown how improvements in emotion recognition develop during (VR-)SCT, which factors impact improvement, and how improvements in VR relate to improvement outside VR. Data were extracted from task logs from a pilot study and randomized controlled trials on VR-SCT (n = 55). Using mixed-effects generalized linear models, we examined the: (a) effect of treatment session (1-5) on VR accuracy and VR response time for correct answers; (b) main effects and moderation of participant and treatment characteristics on VR accuracy; and (c) the association between baseline performance on the Ekman 60 Faces task and accuracy in VR, and the interaction of Ekman 60 Faces change scores (i.e., post-treatment - baseline) with treatment session. Accounting for the task difficulty level and the type of presented emotion, participants became more accurate at the VR task (b = 0.20, p &lt; 0.001) and faster (b = -0.10, p &lt; 0.001) at providing correct answers as treatment sessions progressed. Overall emotion recognition accuracy in VR decreased with age (b = -0.34, p = 0.009); however, no significant interactions between any of the moderator variables and treatment session were found. An association between baseline Ekman 60 Faces and VR accuracy was found (b = 0.04, p = 0.006), but no significant interaction between difference scores and treatment session. Emotion recognition accuracy improved during VR-SCT, but improvements in VR may not generalize to non-VR tasks and daily life.</p

Anxiety Partially Mediates Cybersickness Symptoms in Immersive Virtual Reality Environments

The use of virtual reality (VR) in psychological treatment is expected to increase. Cybersickness (CS) is a negative side effect of VR exposure and is associated with treatment dropout. This study aimed to investigate the following: (a) if gender differences in CS can be replicated, (b) if differences in anxiety and CS symptoms between patients and controls can be replicated, and (c) whether the relationship between exposure to VR and CS symptoms is mediated by anxiety. A sample (N = 170) of participants with different levels of psychosis liability was exposed to VR environments. CS and anxiety were assessed with self-report measures before and after the VR experiment. This study replicated gender differences in CS symptoms, most of which were present before exposure to VR. It also replicated findings that a significant correlation between anxiety and CS can be found in healthy individuals, but not in patients. In a VR environment, anxiety partially mediated CS symptoms, specifically nausea and disorientation. A partial explanation for the differences found between patients and controls may lie in a ceiling effect for the symptoms of CS. A second explanation may be the partial overlap between CS symptoms and physiological anxiety responses. CS symptoms reported at baseline cannot be explained by exposure to VR, but are related to anxiety. Caution is required when interpreting studies on both CS and anxiety, until the specificity in measurements has been improved. Since anxiety mediated the CS symptoms, CS is expected to decline during treatment together with the reduction of anxiety

Cognitive behavioral group treatment for low self-esteem in psychosis: a proof of concept study

Abstract Background Patients with a psychotic disorder often suffer from low self-esteem, which has been related to higher suicidal risk, poor quality of life and, the maintenance of psychotic and depression symptoms. However, intervention studies are scarce and reported interventions concern individual therapies provided by highly educated psychologists. Both the individual setting and the required qualifications of the therapist may contribute to a low level of availability of an intervention. Therefore we aimed to investigate the efficacy of an easily accessible psychological group treatment targeting self-esteem in patients with a psychotic disorder. Methods Thirty patients with a psychotic disorder were included in this pilot study. All participants received nine weekly group sessions of 90 min. The therapy was offered in groups of six to eight patients and was provided by a psychiatry nurse and a graduate psychologist. To assess self-esteem the Rosenberg Self-esteem Scale and the Self-Esteem Rating Scale were used, to measure depression symptoms the Beck Depression Inventory-II was administered. Questionnaires were completed at baseline and post-treatment. Results Twenty-seven patients (90%) completed treatment. At post-treatment, self-esteem was significantly increased and depression symptoms were significantly decreased compared to baseline. Discussion This pilot study demonstrates the feasibility and treatment potential of a self-esteem group treatment provided by a psychiatry nurse and graduate psychologist in a patient population that receives little psychological treatment. Results suggest that this easily accessible intervention may be effective in improving self-esteem and reducing depression symptoms

Victims of Bullying:Emotion Recognition and Understanding

Introduction: Victims of bullying often show interpersonal problems, such as having less high-quality interpersonal relationships compared to non-involved individuals. Research suggests that interpersonal struggles are associated with diminished emotional intelligence and competence and can lead to mental health problems such as depression. Therefore, we examined emotion recognition abilities, empathic accuracy, and behavioral responses to emotions in bullying victims and non-involved individuals. Based on previous research, we expected victims to show diminished skills in all three domains. Methods: Adolescents (M(age)=17years; 67% female; no “other” gender participants) with (N=24) and without (N=21) a self-reported history of bullying victimization in high school completed a Virtual Reality facial emotion recognition task (ERT-VR), an empathic accuracy task (EAT) using videos of people recounting real-life autobiographical events, and a computer task in which they indicated their likely behavioral responses to facial emotions. Results: The two groups only significantly differed in recognizing emotions when taking their depression symptoms into account. Across emotions, victims had lower recognition accuracy than non-involved individuals. When examining emotion-specific differences, victims showed lower accuracy for neutral faces which they mainly mistook for angry faces. Conclusion: In contrast to expectations, adolescents with a high-school history of bullying victimization mostly showed similar emotional intelligence and competence skills as non-involved individuals. Nonetheless, we found some subtle differences regarding emotion recognition. Victims misjudged neutral as angry faces. This suggests a hostile attribution bias which might help explain victims’ interpersonal problems as well as their increased risk for mental health problems

Traditional and faith-based healthcare in the management of psychotic disorders in Africa:in search for synergy

PURPOSE OF REVIEW: This review summarizes the current literature on the role of traditional and faith-based healthcare in the management of psychotic disorders in Africa.RECENT FINDINGS: In contemporary Africa, individuals with psychosis and traditional and faith healers (TFH) are pluralistic towards their understanding of psychosis and their help-seeking behaviour. Traditional healing is perceived to be helpful to patients with psychotic disorders and their family members and may have a positive influence on the course of psychosis in some selected individuals. Studies show that potentially harmful practices are commonly used by African TFH, but that these are associated with a lack of resources and are susceptible to training. Although various TFH and biomedical practitioners are open to collaboration, the many identified obstacles hinder actual partnerships. However, the few studies that have been conducted on collaborative care for patients with psychotic disorders on the continent, show positive outcomes.SUMMARY: Rather than harmonizing the two healing paradigms, synergistic collaboration between traditional/faith-based and biomedical mental healthcare in the management of individuals with psychosis seems to be possible within certain limits. Synergistic collaboration is more culturally syntonic and may actually contribute to bridging the treatment gap for mental disorders in present-day Africa.</p

Effect of virtual reality exposure therapy on social participation in people with a psychotic disorder (VRETp):study protocol for a randomized controlled trial

Background: Many patients with a psychotic disorder participate poorly in society. When psychotic disorders are in partial remission, feelings of paranoia, delusions of reference, social anxiety and self-stigmatization often remain at diminished severity and may lead to avoidance of places and people. Virtual reality exposure therapy (VRET) is an evidence-based treatment for several anxiety disorders. For patients with a psychotic disorder, the VRETp was developed to help them experience exposure to feared social situations. The present study aims to investigate the effects of VRETp on social participation in real life among patients with a psychotic disorder. Methods/design: The study is a single-blind randomized controlled trial with two conditions: the active condition, in which participants receive the virtual reality treatment together with treatment as usual (TAU), and the waiting list condition, in which participants receive TAU only. The two groups are compared at baseline, at 3 months posttreatment and at 6 months follow-up. All participants on the waiting list are also offered the virtual reality treatment after the follow-up measurements are completed. The primary outcome is social participation. Secondary outcomes are quality of life, interaction anxiety, depression and social functioning in general. Moderator and mediator analyses are conducted with stigma, cognitive schemata, cognitive biases, medication adherence, simulator sickness and presence in virtual reality. If effective, a cost-effectiveness analysis will be conducted. Discussion: Results from the posttreatment measurement can be considered strong empirical indicators of the effectiveness of VRETp. The 6-month follow-up data may provide reliable documentation of the long-term effects of the treatment on the outcome variables. Data from pre-treatment and mid-treatment can be used to reveal possible pathways of change

Social Cognition Training for People With a Psychotic Disorder:A Network Meta-analysis

Deficits in social cognition are common in people with psychotic disorders and negatively impact functioning. Social Cognition Training (SCT) has been found to improve social cognition and functioning, but it is unknown which interventions are most effective, how characteristics of treatments and participants moderate efficacy, and whether improvements are durable. This meta-analysis included 46 randomized studies. SCTs were categorized according to their focus (targeted/broad-based) and inclusion of cognitive remediation therapy (CRT). Network meta-analysis was conducted, using both direct (original) and indirect (inferred from the network of comparisons) evidence. All SCT types were compared to treatment as usual (TAU; the chosen reference group). Moderators of outcome were investigated with meta-regression and long-term efficacy with multivariate meta-analysis. Compared to TAU, emotion perception was improved by targeted SCT without CRT (d = 0.68) and broad-based SCT without CRT (d = 0.46). Individual treatments worked better for emotion perception. All treatments significantly improved social perception (active control, d = 0.98, targeted SCT with and without CRT, d = 1.38 and d = 1.36, broad-based SCT with and without CRT, d = 1.45 and d = 1.35). Only broad-based SCT (d = 0.42) improved ToM. Broad-based SCT (d = 0.82 without and d = 0.41 with CRT) improved functioning; group treatments worked significantly better. Male gender was negatively related to effects on social functioning and psychiatric symptoms. At follow-up, a moderate effect on social functioning (d = 0.66) was found. No effect was found on attribution, social cognition (miscellaneous), and psychiatric symptoms. While targeted SCT is the most effective for emotion perception and social perception, broad-based SCT produces the best overall outcomes. CRT did not enhance SCT effects