JMIR Publications

ABSTRACT

Background:

Functional recovery in psychosis remains a challenge despite current evidence-based treatment approaches. To address this problem, innovative interventions using virtual reality (VR) have recently been developed. VR technologies have enabled the development of realistic environments wherein individuals with psychosis can receive psychosocial treatment interventions in more ecological settings than traditional clinics. These interventions may therefore increase the transfer of learned psychosocial skills to real-world environments, thereby promoting long-term functional recovery. However, the overall feasibility and efficacy of such interventions within the psychosis population remain to be clarified.

Objective:

The aims of this systematic review were: (1) to investigate whether VR-based psychosocial interventions are feasible and enjoyable for individuals with psychosis; (2) to synthesize the current evidence on the efficacy of VR-based psychosocial interventions for psychosis; and (3) to identify limitations in the current literature to guide future research.

Methods:

This research followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Literature searches were conducted in PubMed and PsycINFO in May 2021. We searched for English peer-reviewed articles that employed a psychosocial intervention with a VR component. Participants in the included studies were diagnosed with schizophrenia, schizoaffective disorder, or another psychotic disorder. The included studies were divided into 4 categories: (1) cognitive remediation interventions; (2) social skills interventions; (3) vocational skills interventions; and (4) auditory verbal hallucinations and paranoia interventions. Risk of bias assessments were performed for each study. The following data were extracted from each article: general study and participant characteristics, study design, number and duration of VR sessions, type of VR system, details on the VR-based psychosocial interventions and exercises, feasibility, measured outcomes, and main efficacy findings.

Results:

Eighteen studies were included in this systematic review. Four used a cognitive remediation intervention, 4 used a social skills intervention, 3 used a vocational skills intervention, and 7 implemented an intervention aimed at improving auditory verbal hallucinations and/or paranoia. A total of 745 individuals with psychosis were included across all studies. All of the studies that evaluated feasibility showed that the VR-based psychosocial interventions were feasible and enjoyable for individuals with psychosis. The preliminary evidence on efficacy included within this review suggests that VR-based psychosocial interventions can improve cognitive, social, and vocational skills in individuals with psychosis. VR-based interventions may also improve symptoms of auditory verbal hallucinations and paranoia. The skills that participants learned through these interventions were durable, transferred into real-world environments, and led to improved functional outcomes such as autonomy, managing housework, and work performance.

Conclusions:

VR-based interventions may represent a novel, efficacious approach to improving psychosocial functioning in psychosis. VR-based psychosocial interventions therefore represent a promising adjunctive therapy to the treatment of psychosis which may be used to improve psychosocial skills, community functioning, and quality of life.