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Bird M, O'Neill E, Riches S. Digitally Enhanced Psychological Assessment and Treatment of Paranoia: A Systematic Review. Clin Psychol Psychother 2024; 31:e3019. [PMID: 38940680 DOI: 10.1002/cpp.3019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/20/2024] [Accepted: 05/28/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Paranoia is relatively common but can lead to significant distress, impairment and need for care. Digital technologies offer a valuable extension to service provision and are increasingly being integrated into healthcare. This systematic review evaluated feasibility, acceptability, and effectiveness of digitally enhanced psychological assessments and treatments for paranoia across the paranoia continuum (PROSPERO: CRD42023393257). METHODS Databases PsychINFO, EMBASE, MEDLINE and Web of Science were searched until 12 June 2023; the Effective Public Health Practice Project (EPHPP) quality assessment tool evaluated studies; and a narrative synthesis was conducted. RESULTS Twenty-seven studies met inclusion criteria (n = 3457, 23 assessment and 4 treatment, 2005-2023, most in Europe). Technologies included virtual reality (VR, n = 23), experience sampling methodology (ESM, n = 2), an app (n = 1) and a combination of VR and ESM (n = 1). Assessments involved monitoring paranoia under various virtual conditions or in everyday life. Treatments were generally integrated with Cognitive Behaviour Therapy (CBT), which involved using VR to test out threat beliefs and drop safety behaviours or using an app to support slowing down paranoid thinking. EPHPP ratings were strong (n = 8), moderate (n = 12) and weak (n = 7). CONCLUSIONS Digitally enhanced assessments and treatments showed promising acceptability, feasibility and treatment effectiveness. Limitations of studies include small sample sizes, lack of comparison groups and long-term data and limited randomised controlled trials. Results support the potential future integration of VR in the assessment of paranoia and show promise for treatments such as CBT, although further clinical trials are required. Investigation of other technologies is limited.
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Affiliation(s)
- Molly Bird
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Psychology and Psychotherapy, South London and Maudsley NHS Foundation Trust, London, UK
| | - Emma O'Neill
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Psychology and Psychotherapy, South London and Maudsley NHS Foundation Trust, London, UK
| | - Simon Riches
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Psychology and Psychotherapy, South London and Maudsley NHS Foundation Trust, London, UK
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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González Moraga FR, Enebrink P, Perrin S, Sygel K, Veling W, Wallinius M. VR-assisted aggression treatment in forensic psychiatry: a qualitative study in patients with severe mental disorders. Front Psychiatry 2024; 15:1307633. [PMID: 38818023 PMCID: PMC11137625 DOI: 10.3389/fpsyt.2024.1307633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 04/15/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction Improvements in virtual reality (VR) have made it possible to create realistic, virtual settings for behavioral assessment and skills training that cannot otherwise be accessed in a safe way in forensic psychiatric settings. VR interventions are under development but little is known how forensic psychiatric patients with severe mental disorders experience VR-assisted assessments or treatments. Methods The present study aimed to help fill this knowledge gap via qualitative interviews with seven patients with severe mental disorders at a high-security forensic psychiatric clinic who had completed the newly revised Virtual Reality Aggression Prevention Training (VRAPT). All participants were interviewed 12 weeks after the VRAPT intervention, and interview data analyzed with manifest inductive content analysis. Results Six manifest content categories were identified: 1. Therapeutic process, 2. VRAPT method, 3. VR technology, 4. Previous treatment experiences, 5. Challenges to treatment of aggression, and 6. Unexpected experiences. The participants had diverse experiences related to both the VRAPT intervention and forensic psychiatric care. Participants described a mixture of positive experiences in relation to VR-assisted role-plays, and less positive in relation to motivation for aggression-focused treatment and technological limitations. Discussion The present findings suggest further studies are needed on how to best implement VR-assisted treatments for aggression in forensic settings, and potentially further modification of treatment content in interventions like VRAPT.
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Affiliation(s)
- Fernando Renee González Moraga
- Evidence-based Forensic Psychiatry, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Research Department, Regional Forensic Psychiatric Clinic, Växjö, Sweden
- Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Pia Enebrink
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
| | - Kristina Sygel
- Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Forensic Psychiatry, National Board of Forensic Medicine, Stockholm, Sweden
| | - Wim Veling
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Märta Wallinius
- Evidence-based Forensic Psychiatry, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Research Department, Regional Forensic Psychiatric Clinic, Växjö, Sweden
- Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Williams LM, Carpenter WT, Carretta C, Papanastasiou E, Vaidyanathan U. Precision psychiatry and Research Domain Criteria: Implications for clinical trials and future practice. CNS Spectr 2024; 29:26-39. [PMID: 37675453 DOI: 10.1017/s1092852923002420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Psychiatric disorders are associated with significant social and economic burdens, many of which are related to issues with current diagnosis and treatments. The coronavirus (COVID-19) pandemic is estimated to have increased the prevalence and burden of major depressive and anxiety disorders, indicating an urgent need to strengthen mental health systems globally. To date, current approaches adopted in drug discovery and development for psychiatric disorders have been relatively unsuccessful. Precision psychiatry aims to tailor healthcare more closely to the needs of individual patients and, when informed by neuroscience, can offer the opportunity to improve the accuracy of disease classification, treatment decisions, and prevention efforts. In this review, we highlight the growing global interest in precision psychiatry and the potential for the National Institute of Health-devised Research Domain Criteria (RDoC) to facilitate the implementation of transdiagnostic and improved treatment approaches. The need for current psychiatric nosology to evolve with recent scientific advancements and increase awareness in emerging investigators/clinicians of the value of this approach is essential. Finally, we examine current challenges and future opportunities of adopting the RDoC-associated translational and transdiagnostic approaches in clinical studies, acknowledging that the strength of RDoC is that they form a dynamic framework of guiding principles that is intended to evolve continuously with scientific developments into the future. A collaborative approach that recruits expertise from multiple disciplines, while also considering the patient perspective, is needed to pave the way for precision psychiatry that can improve the prognosis and quality of life of psychiatric patients.
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Affiliation(s)
- Leanne M Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Sierra-Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - William T Carpenter
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Evangelos Papanastasiou
- Boehringer Ingelheim Pharma GmbH & Co, Ingelheim am Rhein, Rhineland-Palatinate, Germany
- HMNC Holding GmbH, Wilhelm-Wagenfeld-Strasse 20, 80807Munich, Bavaria, Germany
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Hedström R, Wallinius M, Sygel K, Geraets CNW. Virtual reality-assisted assessment of paranoid ideation in forensic psychiatric inpatients: A mixed-methods pilot study. Front Psychol 2023; 14:1242243. [PMID: 38130966 PMCID: PMC10733482 DOI: 10.3389/fpsyg.2023.1242243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023] Open
Abstract
Background Reliable and valid assessment of paranoia is important in forensic psychiatry for providing adequate care. VR technology may add to current assessment procedures, as it enables observation within realistic (social) situations resembling the complexity of everyday life. VR constitutes a promising tool within forensics, due to the restricted nature of forensic psychiatric hospitals and ethical challenges arising from observing potentially dangerous behaviors in real life. Objective To investigate the feasibility of VR assessment for paranoid ideation in forensic psychiatric inpatients qualitatively by assessing the experiences of patients and a clinician, and to explore how the VR measures relate to established clinical measures. Methods One clinician (experienced psychiatrist) and 10 forensic psychiatric inpatients with a history or suspicion of paranoid ideation were included. Patients participated in two immersive VR scenarios (bus and supermarket) during which paranoia was assessed by the clinician. Qualitative interviews were performed with patients and the clinician performing the assessment to investigate experiences and feasibility. Further, measures of paranoia, social anxiety, and positive symptoms were obtained. Results Nine out of 10 participants with varying levels of paranoid ideation completed the assessment. Manifest inductive content analyses of the interviews revealed general experiences, advantages such as enabling observing participants from a different perspective, and challenges of the VR assessment, such as a lack of objectivity and the laboriousness of the assessment for the clinician. Although more paranoia was experienced during the supermarket scenario, correlates with classical measures were only significant for the bus scenario. Discussion The VR assessment was appreciated by most patients and the clinician. Based on our results short, standardized VR assessment scenarios are feasible, however, they do not appear reliable or objective for assessing paranoia. The clinical usefulness is most likely as a collaborative tool and add-on measure to existing methods.
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Affiliation(s)
- Richard Hedström
- Research and Development Unit, Regional Forensic Psychiatric Clinic, Växjö, Sweden
- Evidence-Based Forensic Psychiatry, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
| | - Märta Wallinius
- Research and Development Unit, Regional Forensic Psychiatric Clinic, Växjö, Sweden
- Evidence-Based Forensic Psychiatry, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Department of Psychiatry and Neurochemistry, Center for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Kristina Sygel
- Research and Development Unit, Regional Forensic Psychiatric Clinic, Växjö, Sweden
- Department of Psychiatry and Neurochemistry, Center for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
- Department of Forensic Psychiatry, National Board of Forensic Medicine, Stockholm, Sweden
| | - Chris N. W. Geraets
- Research and Development Unit, Regional Forensic Psychiatric Clinic, Växjö, Sweden
- Evidence-Based Forensic Psychiatry, Department of Clinical Sciences Lund, Psychiatry, Lund University, Lund, Sweden
- Department of Psychiatry, University Medical Center Groningen, Groningen, Netherlands
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Zeka F, Clemmensen L, Arnfred BT, Nordentoft M, Glenthøj LB. Examination of gaze behaviour in social anxiety disorder using a virtual reality eye-tracking paradigm: protocol for a case -control study. BMJ Open 2023; 13:e071927. [PMID: 37620268 PMCID: PMC10450086 DOI: 10.1136/bmjopen-2023-071927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Social anxiety disorder (SAD) has an early onset, a high lifetime prevalence, and may be a risk factor for developing other mental disorders. Gaze behaviour is considered an aberrant feature of SAD. Eye-tracking, a novel technology device, enables recording eye movements in real time, making it a direct and objective measure of gaze behaviour. Virtual reality (VR) is a promising tool for assessment and diagnostic purposes. Developing an objective screening tool based on examination of gaze behaviour in SAD may potentially aid early detection. The objective of this current study is, therefore to examine gaze behaviour in SAD utilising VR. METHODS AND ANALYSIS A case-control study design is employed in which a clinical sample of 29 individuals with SAD will be compared with a matched healthy control group of 29 individuals. In the VR-based eye-tracking paradigm, participants will be presented to stimuli consisting of high-res 360° 3D stereoscopic videos of three social-evaluative tasks designed to elicit social anxiety. The study will investigate between-group gaze behaviour differences during stimuli presentation. ETHICS AND DISSEMINATION The study has been approved by the National Committee on Health Research Ethics for the Capital Region of Denmark (H-22041443). The study has been preregistered on OSF registries: https://doi.org/10.17605/OSF.IO/XCTAKAll participants will be provided with written and oral information. Informed consent is required for all the participants. Participation is voluntarily, and the participants can at any time terminate their participation without any consequences. Study results; positive, negative or inconclusive will be published in relevant scientific journals.
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Affiliation(s)
- Fatime Zeka
- VIRTU Research Group, Copenhagen Research Centre on Mental Health (CORE), Hellerup, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Lars Clemmensen
- VIRTU Research Group, Copenhagen Research Centre on Mental Health (CORE), Hellerup, Denmark
| | | | - Merete Nordentoft
- Copenhagen Research Centre on Mental Health (CORE), Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Louise Birkedal Glenthøj
- VIRTU Research Group, Copenhagen Research Centre on Mental Health (CORE), Hellerup, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Application of Immersive Virtual Reality for Assessment and Intervention in Psychosis: A Systematic Review. Brain Sci 2023; 13:brainsci13030471. [PMID: 36979281 PMCID: PMC10046161 DOI: 10.3390/brainsci13030471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/12/2023] Open
Abstract
Virtual reality (VR) has emerged as a safe and non-invasive technology for the assessment of psychotic symptoms, social and cognitive impairments, and psychosocial intervention in improving outcomes in psychosis. This study systematically reviewed the current state of evidence in applying semi- and fully immersive VR for assessing and treating patients with psychosis. A systematic review was conducted adhering to the PRISMA statement and was conducted in Embase, PsycINFO, and PubMed databases for articles published between January 2013 and April 2022, which identified 28 eligible studies, including 12 for assessment and 16 for intervention. In the assessment studies, not all VR tasks could distinguish the differences between patients and healthy controls regarding their physiological responses, paranoid ideation, and certain aspects of cognitive functioning such as memory bias on the object tasks. Comparatively, VR-based interventions are more promising, especially for improving cognitive impairments, social skills, agoraphobic avoidance, negative and positive affective states, auditory verbal hallucination, paranoid ideation and persecutory delusions, and other psychiatric symptoms in patients. We conclude that more rigorous studies are needed to confirm treatment effectiveness and to understand the underlying mechanism of VR-based intervention for psychotic disorders. Future studies should also improve the reliability and validity of VR-based assessments for psychotic disorders.
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