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

Abstract

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.

Keywords:

• Virtual reality
• psychosis
• schizophrenia
• social functioning
• systematic review

Disclosure statement

The authors have carried out virtual reality research and have published some of the studies included in this review. Dr Riches has received a grant from the Health Innovation Network for virtual reality research. Professor Garety and Dr Rus-Calafell have received a grant from the Wellcome Trust for Avatar Therapy. Dr Valmaggia is the Head of the VR Lab at the Institute of Psychiatry, Psychology and Neuroscience and she has received grants from the following funding bodies for her VR work: Medical Research Council, Economic and Social Research Council, Psychiatry Research Trust, National Institute for Health Research, NARSAD, and Wellcome Trust.

Additional information

Funding

The authors acknowledge financial support from the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College London (PI: LV, PG). Dr Rus-Calafell is supported by the Sofja Kovalevskaja Award (Alexander von Humbold Foundation and Ministry of Education and Research, Germany).