Virtual reality for psychosocial remediation in schizophrenia: a systematic review

Using Virtual Reality Interventions to Promote Social and Emotional Learning for Children and Adolescents: A Systematic Review and Meta-Analysis

This study provides a comprehensive review of the application of virtual reality (VR) in social and emotional learning (SEL) for children and adolescents over the past decade (January 2013-May 2023), with a specific interest in the relations between their technological and instructional design features. A search in Web of Science resulted in 32 relevant articles that were then manually screened. Coding analysis was conducted from four perspectives: participant characteristics, research design, technological features, and instructional design. The analysis provides insights into the VR literature regarding publication trends, target populations, technological features, instructional scenarios, and tasks. To test the effectiveness of VR interventions for promoting SEL, a meta-analysis was also conducted, which revealed an overall medium effect size and significant moderating effects of SEL disorder type and instructional task. Finally, based on the research results, the practical implications of and future research directions for applying VR in SEL were discussed.

Use of Technologies in the Therapy of Social Cognition Deficits in Neurological and Mental Diseases: A Systematic Review

Objective: This article systematically reviews the effects of technology-based (TB) treatments on impaired social cognition (SC) in neurological and mental disorders. Methods: Strictly adhering to the PRISMA guidelines, a systematic search was carried out in PsycINFO, PubMed, and Web of Science (last search: April 22, 2021) to identify studies that, implementing a control group design, evaluated TB treatments targeting deficits in emotion recognition, Theory of Mind (ToM) and social behavior in adult patients with nondevelopmental and nonprogressive neurological or mental disorders. Risk of bias was assessed using the PEDro Scale, certainty assessment followed the GRADE approach. Results: Sixteen studies involving 857 patients, all focusing on psychotic disorders, were retrieved. The most pronounced effects were observed concerning emotion recognition with all studies revealing overall improvements. Regarding ToM and social behavior, results were mixed. However, the number of studies including outcome measures for these domains, is significantly lower compared to the domain of emotion recognition, limiting the validity of the results. Risk of bias and certainty assessment revealed further limitations of evidence. Conclusion: TB treatment achieves positive effects especially with regard to emotion recognition impairments, at least for patients with schizophrenia. Future research should expand the evaluation of TB training of other SC domains, ought to be carried out in more diverse patient populations, rely on different devices, and include follow-up measurements.

An Integrated Physiotherapeutic Approach With Virtual Reality in Schizophrenic Patients With Ipsilateral Femoral Shaft and Intertrochanteric Fractures: A Case report

Femoral shaft fracture occurs through the diaphyseal region of the femur. The intertrochanteric (IT) fracture is an extracapsular fracture that occurs through the proximal metaphyseal area of the femur. The ipsilateral femoral shaft and IT fractures happen in rare cases following high-energy trauma. These fractures are difficult to manage due to their complexity. They are usually managed surgically and require prompt physiotherapeutic management postoperatively. The postoperative complications involve pain, stiffness, reduced muscle strength, deep vein thrombosis, muscular weakness, and atrophy. These complications occur primarily due to immobilization. In our case, the 30-year-old male patient was a known case of schizophrenia for three years. He met with a road traffic accident (RTA) while driving a car and acquired ipsilateral femoral shaft and IT fractures. He presented with the chief complaints of pain, swelling, deformity over the right thigh, and unable to bear weight over the right lower limb. X-rays revealed a right-side ipsilateral IT fracture and a femoral shaft fracture. The patient underwent an operation that involved open reduction and internal fixation with a proximal femoral nail under spinal epidural anesthesia. We started physical therapy management on postoperative day three. On clinical evaluation, there was a decrease in the range of motion and muscle strength of the right lower limb. This case posed us with a challenge to deliver postoperative physiotherapeutic intervention without elicitation of the symptoms associated with schizophrenia. The physiotherapy protocol involved virtual reality-based (VR-based) interventions in adjunct to conventional therapeutic interventions like strengthening exercises, range of motion exercises, application of electrical modality, balance training, gait training, VR-based relaxation, and aerobic exercises. We used the Lower Extremity Functional Scale, Manual Muscle Testing, Range of Motion, Brief Psychiatric Rating Scale, and the Numerical Pain Rating Scale as outcome measures. The comparison of pre-and post-outcome measure scores demonstrates a significant improvement.

Randomized Controlled Trials of Digital Mental Health Interventions on Patients with Schizophrenia Spectrum Disorder: A Systematic Review

Background: This systematic review aimed to examine the study protocol of Digital Mental Health Interventions (DMHIs) and to review the effect of DMHIs among patients with Schizophrenia Spectrum Disorder (SSD). Methods: This review followed the guideline of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic literature search was performed using PubMed, CINAHL, Embase, and PsycINFO electronic databases to identify randomized clinical trials without any limit on the publication year. Overall, 18 studies were selected and evaluated for the quality assessment utilizing the Risk of Bias 2 tool of Cochranes' Collaboration. In the quality assessment, four studies evaluated as overall high risk of bias were excluded from the selection, and the final 14 studies were chosen. Results: No DMHIs were provided for acute schizophrenia-related symptoms, and there were some studies related to schizophrenia-related symptoms (26.4%). Some studies for improving cognitive function (42.9%) were reported, and there was a significant effect when interventions that were proven to be effective when implemented in a face-to-face manner were delivered using various online devices and sensory stimuli. Nearly half of the studies reported intervention frequency and time (57.1%), and those with unclear reports relied either on a mobile app or telemedicine and were designed to self-pace the frequency and speed of the intervention. Conclusion: Based on our findings, it will be possible to understand the characteristics of DMHIs, without physical contact, for only SSD patients, providing a basis for digital mental health services.

Therapeutic Use of VR Serious Games in the Treatment of Negative Schizophrenia Symptoms: A Systematic Review

Schizophrenia is a chronic brain disorder that affects 1 in every 300 people worldwide. This study intended to perform a systematic review to describe the state-of-the-art of interventions involving patients with negative symptoms of schizophrenia that use Virtual Reality (VR) games as a complement to therapy, and to analyze the key features of such games. Literature research was conducted in three databases, namely, the Institute of Electrical and Electronics Engineers (IEEE), Scopus, and PubMed, to identify relevant publications dated from 2010 to 2021. Of the initial 74 publications found, only 11 satisfied the eligibility requirements and were included in this study. The results were then organized and displayed in a flow diagram. Overall, the results from the studies suggest that the use of VR in therapies enables an increase in social skills and a decrease in anxiety symptoms. The use of such technology in therapy has proven to be effective, although it still lacks features to provide better long-term results.

Virtual reality-based interventions for patients with paranoia: A systematic review

BACKGROUND AND OBJECTIVE

Paranoia is an important psychiatric symptom with a remarkable effect on daily life. Virtual reality (VR)-based treatments are influential and safe for patients with paranoia. This study aimed to evaluate the effectiveness, and define the clinical and technical characteristics of available VR strategies for the treatment of patients with paranoia.

MATERIALS AND METHODS

Studies published up to 25/11/2021 reporting VR-based interventions for the treatment of patients with paranoia were reviewed in five databases, including PubMed, Embase, Web of Science, PsycINFO, and Scopus.

RESULTS

Out of 302 initial search results, eight were included in the present study based on the inclusion criteria. Six studies were randomized clinical trials with the interventions in the experimental group being based on VR, compared to routine interventions as controls. Two were before-after studies. The most commonly used hardware and software were head-mounted display and Unity3D, respectively. Interventions had a range of 1-16 sessions with follow-up durations of 0-6 months. All investigations showed positive results in the main target, including improved social participation, reduced level of anxiety, as well as diminished suspicious ideas and paranoid symptoms.

CONCLUSIONS

Our findings demonstrated that VR-based interventions are effective treatments. Although the use of VR technology is limited for a variety of reasons, such as cost, it improves symptoms in patients with paranoia.

How Interpersonal Distance Between Avatar and Human Influences Facial Affect Recognition in Immersive Virtual Reality

Purpose: The purpose of this study was to determine the optimal interpersonal distance (IPD) between humans and affective avatars in facial affect recognition in immersive virtual reality (IVR). The ideal IPD is the one in which the humans show the highest number of hits and the shortest reaction times in recognizing the emotions displayed by avatars. The results should help design future therapies to remedy facial affect recognition deficits.

Methods: A group of 39 healthy volunteers participated in an experiment in which participants were shown 65 dynamic faces in IVR and had to identify six basic emotions plus neutral expression presented by the avatars. We decided to limit the experiment to five different distances: D1 (35 cm), D2 (55 cm), D3 (75 cm), D4 (95 cm), and D5 (115 cm), all belonging to the intimate and personal interpersonal spaces. Of the total of 65 faces, 13 faces were presented for each of the included distances. The views were shown at different angles: 50% in frontal view, 25% from the right profile, and 25% from the left profile. The order of appearance of the faces presented to each participant was randomized.

Results: The overall success rate in facial emotion identification was 90.33%, being D3 the IPD with the best overall emotional recognition hits, although statistically significant differences could not be found between the IPDs. Consistent with results obtained in previous studies, identification rates for negative emotions were higher with increasing IPD, whereas the recognition task improved for positive emotions when IPD was closer. In addition, the study revealed irregular behavior in the facial detection of the emotion surprise.

Conclusions: IVR allows us to reliably assess facial emotion recognition using dynamic avatars as all the IPDs tested showed to be effective. However, no statistically significant differences in facial emotion recognition were found among the different IPDs.

Psychosocial remediation in depressive disorders: A systematic review

BACKGROUND

Social functioning impairment has been described in several psychiatric illness, including depressive disorders. It is associated with a deterioration in global functioning and quality of life, thus there is a growing interest in psychosocial functioning remediation interventions. This systematic review aims to review all psychotherapeutic, pharmacological and biological social functioning interventions in depressive disorders.

METHODS

A systematic search was conducted on PubMed, PsycINFO and Scopus from the first articles to 2019 following the PRISMA guidelines. 72 original papers were extracted from an initial number of 1827, based on the selected eligibility criteria.

RESULTS

A growing body of research was observed in the last 10 years, with most studies showing a low level of scientific evidence. The main diagnosis found was major depressive disorder and the principal social cognition domains assessed were emotional processing and attributional style. The type of intervention most found was the pharmacological one, followed by psychotherapeutic interventions classified as "non-specific. The efficacy of treatments showed an improvement in depressive symptoms and positive results for emotional processing and attributional style.

LIMITATIONS

Because there is a lack of well-controlled designs and really few interventions focusing on its remediation, and low homogeneity on the assessment of social aspects across, a comparison of results and the extraction of general conclusions is quite difficult.

CONCLUSIONS

Although a promising body of literature has been developed in recent years on the improvement of psychosocial functioning in patients with depressive disorders, more studies are needed to clarify relevant aspects in this area.

Virtual reality-based assessment and treatment of social functioning impairments in psychosis: a systematic review

People with psychosis can experience social functioning impairments. Virtual reality (VR) has been used to assess and treat these difficulties. This systematic review (Prospero CRD42015026288) provides an evaluation of these VR applications. PsycINFO, MEDLINE, Embase, Web of Science, Cochrane Library, and Scopus were searched until May 2020. The Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used to assess studies. Database searching identified 3810 titles. Fifty-eight studies (published 2005-2020; N = 2,853), comprising twenty-six head-mounted display studies (20 assessment, 6 treatment) and thirty-two immersive 2D screen studies (23 assessment, 9 treatment), were included. There were forty-eight observational studies and ten randomised controlled trials, with 1570 participants (of which, 185 were at ultra-high risk of psychosis) in VR test groups. Nearly half the studies were published since 2016. Assessments targeted cognitive and behavioural indicators of social functioning, e.g. paranoia, eye gaze, or interpersonal distance. Treatments promoted cognitive-behavioural social skills or job interview training. Studies indicate feasibility, acceptability, and effectiveness of VR for social functioning impairments in psychosis. Limitations of studies include the narrow scope of social functioning, small sample sizes, and limited randomised controlled trials and standardised interventions. Findings suggest VR has potential to be integrated with existing psychological approaches.

Facial Affect Recognition by Patients with Schizophrenia Using Human Avatars

People with schizophrenia have difficulty recognizing the emotions in the facial expressions of others, which affects their social interaction and functioning in the community. Static stimuli such as photographs have been used traditionally to examine deficiencies in the recognition of emotions in patients with schizophrenia, which has been criticized by some authors for lacking the dynamism that real facial stimuli have. With the aim of overcoming these drawbacks, in recent years, the creation and validation of virtual humans has been developed. This work presents the results of a study that evaluated facial recognition of emotions through a new set of dynamic virtual humans previously designed by the research team, in patients diagnosed of schizophrenia. The study included 56 stable patients, compared with 56 healthy controls. Our results showed that patients with schizophrenia present a deficit in facial affect recognition, compared to healthy controls (average hit rate 71.6% for patients vs 90.0% for controls). Facial expressions with greater dynamism (compared to less dynamic ones), as well as those presented from frontal view (compared to profile view) were better recognized in both groups. Regarding clinical and sociodemographic variables, the number of hospitalizations throughout life did not correlate with recognition rates. There was also no correlation between functioning or quality of life and recognition. A trend showed a reduction in the emotional recognition rate as a result of increases in Positive and Negative Syndrome Scale (PANSS), being statistically significant for negative PANSS. Patients presented a learning effect during the progression of the task, slightly greater in comparison to the control group. This finding is relevant when designing training interventions for people with schizophrenia. Maintaining the attention of patients and getting them to improve in the proposed tasks is a challenge for today’s psychiatry.