Virtual reality needs to be explored to show its effects for treatment of schizophrenia

People with schizophrenia often have problems in their processes of thinking and understanding, resulting in poor insight into their illness and poor organisational skills. These factors along with experiencing unpleasant side effects of medication can contribute to people with mental health problems often not taking their medication, unwilling to follow treatment and non-attendance at appointments. This can sometimes lead to a loss of contact with the mental health team and relapse. Virtual reality (VR) is a modern, experimental, computerised and real-time technology that uses visual graphics, sounds and other sensory input which creates an interactive computer world. It includes, for example, the use of sensors attached to the hands and fingers allowing virtual reality users to track their position and movement. Virtual reality creates a computerised environment that simulates real life and everyday activities.This could help people learn in a safe and friendly environment to improve their decisions and attitudes about treatment, so encouraging people to take or comply with their medication.  

So far, virtual reality has been used in the assessment and treatment of a range of psychiatric disorders and social anxieties, some of which include, fear of flying, public speaking anxiety, spider phobia, and post-traumatic stress disorder. There are also a few studies that examine the emotional responses of people with schizophrenia during a computer simulation with characters displaying happy, neutral, and angry emotions. Virtual reality has also been used for people with schizophrenia in social skills training and to improve processes of thinking and understanding. This review investigates the effects of virtual reality in helping support the treatment and taking of medication for people with serious mental illness. 

The most recent search for randomised trials was run in September 2013, only three short studies with a total of 156 people could be included. People with schizophrenia were randomised to a) skills training sessions that used virtual reality to deliver the training or b) sessions of skills training using other methods to deliver the training or c) standard care. All evidence from the trials was low quality and no real effects were found. At present, there is no clear evidence for or against using virtual reality for encouraging people with mental illness to take their medication. If virtual reality is used for people with serious mental illness, it will be of an experimental nature.There is a need to gather more good quality information on the effects of virtual reality for people with mental illness and high quality studies need to be undertaken. At this stage, the effects of virtual reality are experimental, novel and innovative but largely untested.

This summary has been written by a consumer, Ben Gray of RETHINK.

Authors' conclusions: 

There is no clear good quality evidence for or against using virtual reality for treatment compliance among people with serious mental illness. If virtual reality is used, the experimental nature of the intervention should be clearly explained. High-quality studies should be undertaken in this area to explore any effects of this novel intervention and variations of approach.

Read the full abstract...
Background: 

Virtual reality (VR) is computerised real-time technology, which can be used an alternative assessment and treatment tool in the mental health field. Virtual reality may take different forms to simulate real-life activities and support treatment.

Objectives: 

To investigate the effects of virtual reality to support treatment compliance in people with serious mental illness.

Search strategy: 

We searched the Cochrane Schizophrenia Group Trials Register (most recent, 17th September 2013) and relevant reference lists.

Selection criteria: 

All relevant randomised studies comparing virtual reality with standard care for those with serious mental illnesses. We defined virtual reality as a computerised real-time technology using graphics, sound and other sensory input, which creates the interactive computer-mediated world as a therapeutic tool.

Data collection and analysis: 

All review authors independently selected studies and extracted data. For homogeneous dichotomous data the risk difference (RD) and the 95% confidence intervals (CI) were calculated on an intention-to-treat basis. For continuous data, we calculated mean differences (MD). We assessed risk of bias and created a 'Summary of findings' table using the GRADE approach.

Main results: 

We identified three short-term trials (total of 156 participants, duration five to 12 weeks). Outcomes were prone to at least a moderate risk of overestimating positive effects. We found that virtual reality had little effects regarding compliance (3 RCTs, n = 156, RD loss to follow-up 0.02 CI -0.08 to 0.12, low quality evidence), cognitive functioning (1 RCT, n = 27, MD average score on Cognistat 4.67 CI -1.76 to 11.10, low quality evidence), social skills (1 RCT, n = 64, MD average score on social problem solving SPSI-R (Social Problem Solving Inventory - Revised) -2.30 CI -8.13 to 3.53, low quality evidence), or acceptability of intervention (2 RCTs, n = 92, RD 0.05 CI -0.09 to 0.19, low quality evidence). There were no data reported on mental state, insight, behaviour, quality of life, costs, service utilisation, or adverse effects. Satisfaction with treatment - measured using an un-referenced scale - and reported as "interest in training" was better for the virtual reality group (1 RCT, n = 64, MD 6.00 CI 1.39 to 10.61, low quality evidence).

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