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Two case studies from a virtual reality intervention for delusions: feasibility and preliminary evidence

Published online by Cambridge University Press:  01 August 2018

Mona Dietrichkeit ,
Kristina Flint ,
Eva Krieger ,
Karsten Grzella ,
Matthias Nagel  and
Steffen Moritz
Mona Dietrichkeit*
Affiliation:
Department of Psychiatry and Psychotherapy, Asklepios Clinic North, Hamburg, Germany
Kristina Flint
Affiliation:
Department of Psychiatry and Psychotherapy, Asklepios Clinic North, Hamburg, Germany
Eva Krieger
Affiliation:
Department of Psychiatry and Psychotherapy, Asklepios Clinic North, Hamburg, Germany
Karsten Grzella
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Matthias Nagel
Affiliation:
Department of Psychiatry and Psychotherapy, Asklepios Clinic North, Hamburg, Germany
Steffen Moritz
Affiliation:
Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
*
*Author for correspondence: Mona Dietrichkeit, Asklepios Klinik Nord – Wandsbek, Jüthornstraße 71, 22043 Hamburg, Germany (email: m.dietrichkeit@uke.de).
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Abstract

The use of virtual reality (VR) interventions for psychosis is on the rise. As information-processing biases such as overconfidence in memory are likely to be involved in the formation and maintenance of delusions, VR could also be used to correct cognitive distortions and in turn ameliorate delusions. The present study illustrates two case studies in which a VR intervention was employed to reduce delusions by means of correcting experiences. Participants navigated four virtual environments via a head-mounted display (HMD) and computer and were asked to recollect previously seen faces and objects and to rate their response confidence. The scenarios were created to elicit false memories. Immediately after each response, they received feedback to correct possible overconfidence in false memories. We present two case studies to illustrate individual differences. Both participants benefited from the intervention: delusions were reduced from pre- to post-assessment (after 3 weeks) as measured with the Positive and Negative Syndrome Scale and Psychotic Symptom Scale. This was corroborated by results on the Paranoia Checklist and the Community Assessment of Psychic Experiences collected immediately after the session. Immediate effects also showed a reduction in delusion conviction rate. The present study provides preliminary evidence that delusions may be ameliorated by a VR paradigm designed to correct memory overconfidence. Cybersickness emerged as a problem in one of the patients.

Keywords

psychosisdelusionsvirtual realitycognitive biasoverconfidence in memory
Type
Case Study
Information
the Cognitive Behaviour Therapist , Volume 11 , 2018 , e10
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2018 

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References

Recommended follow-up reading

Valmaggia, LR, Latif, L, Kempton, MJ, Rus-Calafell, M (2016). Virtual reality in the psychological treatment for mental health problems: a systematic review of recent evidence. Psychiatry Research 236, 189–195. https://doi.org/10.1016/j.psychres.2016.01.015Google Scholar
Veling, W, Moritz, S, van Der Gaag, M (2014). Brave new worlds – review and update on virtual reality assessment and treatment in psychosis. Schizophrenia Bulletin 40, 1194–1197. https://doi.org/10.1093/schbul/sbu125Google Scholar

References

Balzan, RP (2016). Overconfidence in psychosis: the foundation of delusional conviction? Cogent Psychology 3, 1135855. https://doi.org/10.1080/23311908.2015.1135855Google Scholar
Coltheart, M, Langdon, R, McKay, R (2011). Delusional belief. Annual Review of Psychology 62, 271–298. https://doi.org/10.1146/annurev.psych.121208.131622Google Scholar
Davis, S, Nesbitt, K, Nalivaiko, E (2015). Comparing the onset of cybersickness using the Oculus Rift and two virtual roller coasters. 11th Australasian Conference on Interactive Entertainment (IE 2015) (January), 27–30. https://doi.org/10.17973/MMSJ.2015Google Scholar
Dudley, R, Taylor, P, Wickham, S, Hutton, P (2016). Psychosis, delusions and the ‘jumping to conclusions’ reasoning bias: a systematic review and meta-analysis. Schizophrenia Bulletin 42, 652–665. https://doi.org/10.1093/schbul/sbv150Google Scholar
Eisenacher, S, Rausch, F, Ainser, F, Mier, D, Veckenstedt, R, Schirmbeck, F et al. (2015). Investigation of metamemory functioning in the at-risk mental state for psychosis. Psychological Medicine 45, 3320–3340. https://doi.org/10.1017/S0033291715001373Google Scholar
Eisenacher, S, Zink, M (2017). The importance of metamemory functioning to the pathogenesis of psychosis. Frontiers in Psychology 8. https://doi.org/10.3389/fpsyg.2017.00304Google Scholar
Fornells-Ambrojo, M, Barker, C, Swapp, D, Slater, M, Antley, A, Freeman, D (2008). Virtual reality and persecutory delusions: safety and feasibility. Schizophrenia Research 104, 228–236. https://doi.org/10.1016/j.schres.2008.05.013Google Scholar
Freeman, D (2007). Suspicious minds: the psychology of persecutory delusions. Clinical Psychology Review 27, 425–457. https://doi.org/10.1016/j.cpr.2006.10.004Google Scholar
Freeman, D (2008). Studying and treating schizophrenia using virtual reality: a new paradigm. Schizophrenia Bulletin 34, 605–610. https://doi.org/10.1093/schbul/sbn020Google Scholar
Freeman, D, Bradley, J, Antley, A, Bourke, E, DeWeever, N, Evans, N et al. (2016). Virtual reality in the treatment of persecutory delusions: randomised controlled experimental study testing how to reduce delusional conviction. British Journal of Psychiatry 209, 62–67. https://doi.org/10.1192/bjp.bp.115.176438Google Scholar
Freeman, D, Garety, PA, Bebbington, PE, Smith, B, Rollinson, R, Fowler, D, Kuipers, E (2005). Psychological investigation of the structure of paranoia in a non-clinical population. British Journal of Psychiatry 186, 427–435. https://doi.org/10.1192/bjp.186.5.427Google Scholar
Freeman, D, Pugh, K, Vorontsova, N, Antley, A, Slater, M (2010). Testing the continuum of delusional beliefs: an experimental study using virtual reality. Journal of Abnormal Psychology 119, 83–92. https://doi.org/10.1037/a0017514Google Scholar
Freeman, D, Reeve, S, Robinson, A, Ehlers, A, Clark, D, Spanlang, B, Slater, M (2017). Virtual reality in the assessment, understanding, and treatment of mental health disorders. Psychological Medicine 47, 2393–2400. https://doi.org/10.1017/S003329171700040XGoogle Scholar
Garety, PA, Freeman, D (2013). The past and future of delusions research: from the inexplicable to the treatable. British Journal of Psychiatry 203, 327–333. https://doi.org/10.1192/bjp.bp.113.126953Google Scholar
Gavgani, AM, Nesbitt, KV, Blackmore, KL, Nalivaiko, E (2017). Profiling subjective symptoms and autonomic changes associated with cybersickness. Autonomic Neuroscience: Basic and Clinical 203, 41–50. https://doi.org/10.1016/j.autneu.2016.12.004Google Scholar
Gregg, L, Tarrier, N (2007). Virtual reality in mental health. A review of the literature. Social Psychiatry and Psychiatric Epidemiology 42, 343–354. https://doi.org/10.1007/s00127-007-0173-4Google Scholar
Haddock, G, McCarron, J, Tarrier, N, Faragher, EB (1999). Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psychological Medicine 29, 879–889.Google Scholar
Hesse, K, Schroeder, PA, Scheeff, J, Klingberg, S, Plewnia, C (2017). Experimental variation of social stress in virtual reality – feasibility and first results in patients with psychotic disorders. https://doi.org/10.1016/j.jbtep.2016.11.006Google Scholar
Kay, SR, Opler, LA, Lindenmayer, JP (1988). Reliability and validity of the positive and negative syndrome scale for schizophrenics. Psychiatry Research 23, 99–110. https://doi.org/10.1016/0165-1781(88)90038-8Google Scholar
Kay, SR, Opler, LA, Lindenmayer, JP (1989). The Positive and Negative Syndrome Scale (PANSS): rationale and standardisation. British Journal of Psychiatry suppl, 59–67.Google Scholar
Kennedy, RS, Lane, NE, Berbaum, KS, Lilienthal, MG (1993). Simulator Sickness Questionnaire: an enhanced method for quantifying simulator sickness. International Journal of Aviation Psychology 3, 203–220.Google Scholar
Lecrubier, Y, Sheehan, DV, Weiller, E, Amorim, P, Bonora, I, Sheehan, KH et al. (1997). The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. European Psychiatry 12, 224–231. https://doi.org/10.1016/S0924-9338(97)83296-8Google Scholar
Lincoln, TM, Ziegler, M, Lüllmann, E, Müller, MJ, , Rief W (2010). Can delusions be self-assessed? Concordance between self- and observer-rated delusions in schizophrenia. Psychiatry Research 178, 249–254. https://doi.org/10.1016/j.psychres.2009.04.019Google Scholar
Lombard, M, Ditton, T (2006). At the heart of it all: the concept of presence. Journal of Computer-Mediated Communication 3 (2). https://doi.org/10.1111/j.1083-6101.1997.tb00072.xGoogle Scholar
McLean, BF, Mattiske, JK, Balzan, RP (2016). Association of the jumping to conclusions and evidence integration biases with delusions in psychosis: a detailed meta-analytic approach. Schizophrenia Bulletin 43, 344–354. https://doi.org/10.1093/schbul/sbw056Google Scholar
Miller, MB, Gazzaniga, MS (1998). Creating false memories for visual scenes. Neuropsychologia 36, 513–520. https://doi.org/10.1016/S0028-3932(97)00148-6Google Scholar
Moritz, S, Andreou, C, Schneider, BC, Wittekind, CE, Menon, M, Balzan, RP, Woodward, TS (2014a). Sowing the seeds of doubt: a narrative review on metacognitive training in schizophrenia. Clinical Psychology Review 34, 358–366. https://doi.org/10.1016/j.cpr.2014.04.004Google Scholar
Moritz, S, Pfuhl, G, Lüdtke, T, Menon, M, Andreou, C (2016). A two-stage cognitive theory of the positive symptoms of psychosis. Highlighting the role of lowered decision thresholds. Journal of Behavior Therapy and Experimental Psychiatry 56, 12–20. https://doi.org/10.1016/j.jbtep.2016.07.004Google Scholar
Moritz, S, Rietschel, L, Veckenstedt, R, Bohn, F, Schneider, BC, Lincoln, TM, Karow, A (2015). The other side of ‘madness’: frequencies of positive and ambivalent attitudes towards prominent positive symptoms in psychosis. Psychosis 7, 14–24. https://doi.org/10.1080/17522439.2013.865137Google Scholar
Moritz, S, Voigt, M, Köther, U, Leighton, L, Kjahili, B, Babur, Z et al. (2014b). Can virtual reality reduce reality distortion? Impact of performance feedback on symptom change in schizophrenia patients. Journal of Behavior Therapy and Experimental Psychiatry 45, 267–271. https://doi.org/10.1016/j.jbtep.2013.11.005Google Scholar
Moritz, S, Woodward, TS (2002). Memory confidence and false memories in schizophrenia. Journal of Nervous and Mental Disease 190, 641–643.Google Scholar
Moritz, S, Woodward, TS (2006). Metacognitive control over false memories: a key determinant of delusional thinking. Current Psychiatry Reports 8, 184–190. https://doi.org/10.1007/s11920-006-0022-2Google Scholar
Moritz, S, Woodward, TS, Rodriguez-Raecke, R (2006). Patients with schizophrenia do not produce more false memories than controls but are more confident in them. Psychological Medicine 36, 659–667. https://doi.org/10.1017/S0033291706007252Google Scholar
Palmisano, S, Mursic, R, Kim, J (2017). Vection and cybersickness generated by head-and-display motion in the Oculus Rift. Displays 46, 1–8. https://doi.org/10.1016/j.displa.2016.11.001Google Scholar
Pannu, JK, Kaszniak, AW (2005). Metamemory experiments in neurological populations: a review. Neuropsychology Review 15, 105–130. https://doi.org/10.1007/s11065-005-7091-6Google Scholar
Parsons, TD (2011). Neuropsychological assessment using virtual environments: enhanced assessment technology for improved ecological validity. Advanced Computational Intelligence Paradigms in Healthcare 6. Virtual Reality in Psychotherapy, Rehabilitation, and Assessment, 271–289. https://doi.org/10.1007/978-3-642-17824-5_13Google Scholar
Roberts, DL, Penn, DL, Combs, DR (2015). Social Cognition and Interaction Training (SCIT). New York: Oxford University Press.Google Scholar
Roediger, HL, McDermott, KB (1995). Creating false memories: remembering words not presented in lists. Journal of Experimental Psychology: Learning, Memory and Cognition 21, 803–814.Google Scholar
Ross, K, Freeman, D, Dunn, G, Garety, PA (2011). A randomized experimental investigation of reasoning training for people with delusions. Schizophrenia Bulletin 37, 324–333. https://doi.org/10.1093/schbul/sbn165Google Scholar
Schlier, B, Jaya, ES, Moritz, S, Lincoln, TM (2015). The Community Assessment of Psychic Experiences measures nine clusters of psychosis-like experiences: a validation of the German version of the CAPE. Schizophrenia Research 169, 274–279.Google Scholar
Schneider, SD, Jelinek, L, Lincoln, TM, Moritz, S (2011). What happened to the voices? A fine-grained analysis of how hallucinations and delusions change under psychiatric treatment. Psychiatry Research 188, 13–17. https://doi.org/10.1016/j.psychres.2010.12.013Google Scholar
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E et al. (1998). The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59, 22–33. https://doi.org/10.1016/S0924-9338(99)80239-9Google Scholar
Stefanis, NC, Hanssen, M, Smirnis, NK, Avramopoulos, DA, Evdokimidis, IK, Stefanis, CN et al. (2002). Evidence that three dimensions of psychosis have a distribution in the general population. Psychological Medicine 32, 347–358. https://doi.org/10.1017/S0033291701005141Google Scholar
Suenderhauf, C, Walter, A, Lenz, C, Lang, UE, Borgwardt, S (2016). Counter striking psychosis: Commercial video games as potential treatment in schizophrenia? A systematic review of neuroimaging studies. Neuroscience and Biobehavioral Reviews 68, 20–36. https://doi.org/10.1016/j.neubiorev.2016.03.018Google Scholar
Turner, WA, Casey, LM (2014). Outcomes associated with virtual reality in psychological interventions: where are we now? Clinical Psychology Review 34, 634–644. https://doi.org/10.1016/j.cpr.2014.10.003Google Scholar
van der Gaag, M, Hoffman, T, Remijsen, M, Hijman, R, de Haan, L.van Meijel, B et al. (2006). The five-factor model of the Positive and Negative Syndrome Scale II: a ten-fold cross-validation of a revised model. Schizophrenia Research 85, 290–287. https://doi.org/10.1016/j.schres.2006.03.021Google Scholar
Veling, W, Brinkman, W-P, Dorrestijn, E, van der Gaag, M (2014a). Virtual reality experiments linking social environment and psychosis: a pilot study. Cyberpsychology, Behavior and Social Networking 17, 191–195. https://doi.org/10.1089/cyber.2012.0497Google Scholar
Veling, W, Moritz, S, van Der Gaag, M (2014b). Brave new worlds – review and update on virtual reality assessment and treatment in psychosis. Schizophrenia Bulletin 40, 1194–1197. https://doi.org/10.1093/schbul/sbu125Google Scholar
Weibel, D, Wissmath, B (2011). Immersion in computer games: the role of spatial presence and flow. International Journal of Computer Games Technology. https://doi.org/10.1155/2011/282345Google Scholar
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