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Augustin E, Beaudoin M, Giguère S, Ziady H, Phraxayavong K, Dumais A. The Relationship between Sense of Presence, Emotional Response, and Clinical Outcomes in Virtual Reality-Based Therapy for Treatment-Resistant Schizophrenia: An Exploratory Correlational Study. J Pers Med 2024; 14:614. [PMID: 38929835 PMCID: PMC11204393 DOI: 10.3390/jpm14060614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
Avatar therapy (AT) is a novel virtual reality-based psychotherapy that has been developed to treat auditory verbal hallucinations (AVH) in treatment-resistant schizophrenia. Various psychotherapeutic components, such as emotions and sense of presence, could contribute to clinical outcomes. However, the interplay between sense of presence, emotions, and clinical response has seldom been investigated. This study aimed to explore the relations between sense of presence, emotions, and clinical outcomes in AT. To conduct this investigation, data from previous and ongoing AT trials were used. Sense of presence and emotions were assessed using standardized questionnaires. AVH were evaluated using the Psychotic Symptom Rating Scales. While sense of presence was positively associated with positive emotions such as control and serenity, no significant associations were found for negative emotions. Moreover, a higher level of sense of presence was associated with a bigger decrease in AVH. Overall, positive emotions seem to be associated with sense of presence in AT. Sense of presence also seems to be involved in the therapeutic outcome, thereby suggesting that this could be an important component related to clinical response. More studies are needed to confirm these trends, which could be generalized to other virtual reality-based psychotherapies.
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Affiliation(s)
- Elischa Augustin
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada; (E.A.); (M.B.); (S.G.); (H.Z.)
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
| | - Mélissa Beaudoin
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada; (E.A.); (M.B.); (S.G.); (H.Z.)
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
| | - Sabrina Giguère
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada; (E.A.); (M.B.); (S.G.); (H.Z.)
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
- School of Social Work, Faculty of Arts and Sciences, University of Montreal, Montreal, QC H3T 1J4, Canada
| | - Hind Ziady
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada; (E.A.); (M.B.); (S.G.); (H.Z.)
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
| | | | - Alexandre Dumais
- Research Center of the University Institute in Mental Health of Montreal, Montreal, QC H1N 3V2, Canada; (E.A.); (M.B.); (S.G.); (H.Z.)
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
- Services et Recherches Psychiatriques AD, Montreal, QC H1N 3V2, Canada;
- Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, QC H1C 1H1, Canada
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Döllinger L, Letellier I, Högman L, Laukka P, Fischer H, Hau S. Trainee psychotherapists' emotion recognition accuracy during 1.5 years of psychotherapy education compared to a control group: no improvement after psychotherapy training. PeerJ 2023; 11:e16235. [PMID: 38099307 PMCID: PMC10720477 DOI: 10.7717/peerj.16235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/14/2023] [Indexed: 12/17/2023] Open
Abstract
The ability to recognize and work with patients' emotions is considered an important part of most psychotherapy approaches. Surprisingly, there is little systematic research on psychotherapists' ability to recognize other people's emotional expressions. In this study, we compared trainee psychotherapists' nonverbal emotion recognition accuracy to a control group of undergraduate students at two time points: at the beginning and at the end of one and a half years of theoretical and practical psychotherapy training. Emotion recognition accuracy (ERA) was assessed using two standardized computer tasks, one for recognition of dynamic multimodal (facial, bodily, vocal) expressions and one for recognition of facial micro expressions. Initially, 154 participants enrolled in the study, 72 also took part in the follow-up. The trainee psychotherapists were moderately better at recognizing multimodal expressions, and slightly better at recognizing facial micro expressions, than the control group at the first test occasion. However, mixed multilevel modeling indicated that the ERA change trajectories for the two groups differed significantly. While the control group improved in their ability to recognize multimodal emotional expressions from pretest to follow-up, the trainee psychotherapists did not. Both groups improved their micro expression recognition accuracy, but the slope for the control group was significantly steeper than the trainee psychotherapists'. These results suggest that psychotherapy education and clinical training do not always contribute to improved emotion recognition accuracy beyond what could be expected due to time or other factors. Possible reasons for that finding as well as implications for the psychotherapy education are discussed.
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Affiliation(s)
| | - Isabelle Letellier
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Department of Child and Youth Studies, Stockholm University, Stockholm, Sweden
| | - Lennart Högman
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Petri Laukka
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Håkan Fischer
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Stephan Hau
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Döllinger L, Högman LB, Laukka P, Bänziger T, Makower I, Fischer H, Hau S. Trainee psychotherapists' emotion recognition accuracy improves after training: emotion recognition training as a tool for psychotherapy education. Front Psychol 2023; 14:1188634. [PMID: 37546436 PMCID: PMC10402901 DOI: 10.3389/fpsyg.2023.1188634] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/26/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Psychotherapists' emotional and empathic competencies have a positive influence on psychotherapy outcome and alliance. However, it is doubtful whether psychotherapy education in itself leads to improvements in trainee psychotherapists' emotion recognition accuracy (ERA), which is an essential part of these competencies. Methods In a randomized, controlled, double-blind study (N = 68), we trained trainee psychotherapists (57% psychodynamic therapy and 43% cognitive behavioral therapy) to detect non-verbal emotional expressions in others using standardized computerized trainings - one for multimodal emotion recognition accuracy and one for micro expression recognition accuracy - and compared their results to an active control group one week after the training (n = 60) and at the one-year follow up (n = 55). The participants trained once weekly during a three-week period. As outcome measures, we used a multimodal emotion recognition accuracy task, a micro expression recognition accuracy task and an emotion recognition accuracy task for verbal and non-verbal (combined) emotional expressions in medical settings. Results The results of mixed multilevel analyses suggest that the multimodal emotion recognition accuracy training led to significantly steeper increases than the other two conditions from pretest to the posttest one week after the last training session. When comparing the pretest to follow-up differences in slopes, the superiority of the multimodal training group was still detectable in the unimodal audio modality and the unimodal video modality (in comparison to the control training group), but not when considering the multimodal audio-video modality or the total score of the multimodal emotion recognition accuracy measure. The micro expression training group showed a significantly steeper change trajectory from pretest to posttest compared to the control training group, but not compared to the multimodal training group. However, the effect vanished again until the one-year follow-up. There were no differences in change trajectories for the outcome measure about emotion recognition accuracy in medical settings. Discussion We conclude that trainee psychotherapists' emotion recognition accuracy can be effectively trained, especially multimodal emotion recognition accuracy, and suggest that the changes in unimodal emotion recognition accuracy (audio-only and video-only) are long-lasting. Implications of these findings for the psychotherapy education are discussed.
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Affiliation(s)
| | | | - Petri Laukka
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Tanja Bänziger
- Department of Psychology and Social Work, Mid Sweden University, Östersund, Sweden
| | - Irena Makower
- Evidens University College, Göteborg, Västergötland, Sweden
| | - Håkan Fischer
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Stephan Hau
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Hudon A, Lammatteo V, Rodrigues-Coutlée S, Dellazizzo L, Giguère S, Phraxayavong K, Potvin S, Dumais A. Exploration of the role of emotional expression of treatment-resistant schizophrenia patients having followed virtual reality therapy: a content analysis. BMC Psychiatry 2023; 23:420. [PMID: 37308864 DOI: 10.1186/s12888-023-04861-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 05/10/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Emotional responses are an important component of psychotherapeutic processes. Avatar therapy (AT) is a virtual reality-based therapy currently being developed and studied for patients suffering from treatment resistant schizophrenia. Considering the importance of identifying emotions in therapeutical processes and their impact on the therapeutic outcome, an exploration of such emotions is needed. METHODS The aim of this study is to identify the underlying emotions at the core of the patient-Avatar interaction during AT by content analysis of immersive sessions transcripts and audio recordings. A content analysis of AT transcripts and audio recordings using iterative categorization was conducted for 16 patients suffering from TRS who underwent AT between 2017 and 2022 (128 transcripts and 128 audio recordings). An iterative categorization technique was conducted to identify the different emotions expressed by the patient and the Avatar during the immersive sessions. RESULTS The following emotions were identified in this study: Anger, Contempt/ Disgust, Fear, Sadness, Shame/ Embarrassment, Interest, Surprise, Joy and Neutral. Patients expressed mostly neutral, joy and anger emotions whereas the Avatar expressed predominantly interest, disgust/contempt, and neutral emotions. CONCLUSIONS This study portrays a first qualitative insight on the emotions that are expressed in AT and serves as a steppingstone for further investigation in the role of emotions in the therapeutic outcomes of AT.
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Affiliation(s)
- Alexandre Hudon
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | | | | | - Laura Dellazizzo
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Sabrina Giguère
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | | | - Stéphane Potvin
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Alexandre Dumais
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, Canada.
- Services et Recherches Psychiatriques AD, Montreal, QC, Canada.
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
- Institut national de psychiatrie légale Philippe-Pinel, Montreal, Canada.
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