None listed
Conditions
Brief summary
Psychotic illness tends to emerge during adolescence, which is a stage of critical social development. One of the earliest signs of psychotic illness is social difficulties, which can cause young people to become withdrawn from everyday life. Psychotic symptoms like paranoia and hallucinations (hearing or seeing things that aren’t there) can make it hard for young people to function around others. These symptoms are usually triggered in social situations, which can make young people want to avoid them, ultimately making the problem worse and causing them to become more withdrawn. Psychological treatments like cognitive behavioural therapy can be effective for helping young people feel comfortable in social situations. However, these treatments are delivered in clinics, removed from the social situations where they need the most help, and are therefore have limited effectiveness. Virtual reality (VR) is a technology that involves wearing a headset which projects 3D images of real world environments onto a screen so the user feels like they are immersed in that environment. Users can interact with the virtual environment using hand controllers, and virtual characters (‘avatars’) are often present to simulate social interactions. Research has found that VR can be used to support treatment of social difficulties by guiding people to learn and practice social skills in virtual environments. This technology therefore has potential to help young people who experience symptoms of psychosis, which is yet to be explored. This research aims to evaluate a new VR treatment based on cognitive behavioural therapy for young people experiencing hallucinations (a common and distressing symptom of psychosis) to understand whether it is feasible and safe to deliver, and whether it has potential to improve social functioning.
Interventions
The Revive – Hallucinations virtual reality (VR) treatment has been adapted from an existing
evidence based protocol for cognitive behavioural therapy for hallucinations (see Turner et al., 2020). This protocol involves a core focus on learning to cope with hallucinations in social situations in such a way that they no longer interfere with social functioning. The primary treatment activities involve addressing avoidance of social situations in which hallucinations are likely to be triggered, ex
The Revive – Hallucinations virtual reality (VR) treatment has been adapted from an existing evidence based protocol for cognitive behavioural therapy for hallucinations (see Turner et al., 2020). This protocol involves a core focus on learning to cope with hallucinations in social situations in such a way that they no longer interfere with social functioning. The primary treatment activities involve addressing avoidance of social situations in which hallucinations are likely to be triggered, excessive attention to the hallucinations within social situations, and trying to suppress the hallucinations to the detriment of social participation. The treatment will be delivered one-on-one by a psychologist and involve using a VR headset within sessions. Within the VR, the participant will be immersed in a virtual environment that contains relevant social scenarios, such as a cafe, public transport or a lecture theatre. These environments were designed based on feedback from young people who have experiences of hallucinations and social anxiety who suggested they were the most relevant to their social difficulties. Session 1 will involve an orientation and explanation of the treatment process, and basic training in how to use the VR headset, and setting a personal social goal. Sessions 2 through 9 will involve working with the young person to map which of their current strategies to manage hallucinations in social situations to identify strategies which are counterproductive, and then replacing these with more effective coping strategies within the virtual environments. The therapist will guide young people through personally relevant social VR scenarios in order to identify, understand and address counter-productive strategies. Session 10 will involve a review of treatment progress and a focus on maintenance of gains following the end of the treatment. During VR scenarios, participants will be immersed into a personally selected VR environment that is relevant to their own social concerns (e.g. a cafe, university, bus). The participant can move around the environment and 'play out' social interactions by talking to an avatar. The avatar will play a roll in the situation, such as ordering a coffee from a barista or buying a ticket from a bus driver, and will be voiced by the therapist. The therapist can switch between speaking as themselves or the avatar. The young person will be offered 10 sessions to complete over 10 weeks (1 x 1 hour session per week for 10 weeks). A post session log book will be kept by the therapist.
Sponsors
The Royal Melbourne Hospital
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
16 Years to 25 Years
Healthy volunteers
No
Inclusion criteria
1) Any service users aged 16-25 within an early psychosis or ultra-high risk for psychosis service who are experiencing current hallucinations, defined by the occurrence of sensory experience in the absence of external stimuli, occurring at least once in the past month 2) The hallucinations are interfering with social functioning, as reported by the young person and/or clinician
Exclusion criteria
1) Inability to communicate via English language 2) Recent change in mental health treatment, including new medication or initiation of psychological therapy within last 8 weeks 3) Moderate or severe intellectual disability as determined by the treating clinician 4) Moderate or severe audio or visual condition precluding engagement with the VR equipment 5) Current risk of harm to self or others, as judged by treating clinician 6) Current inpatient of a psychiatric hospital
Outcome results
None listed