An expert in the field of youth psychiatry, Dr Andrew Thompson works at Orygen, a youth psychiatry clinical research institute, within theUniversity of Melbourne, where he also holds an academic position. His primary interest is on first episode psychosis, with a main focus on prevention or early intervention of psychosis in order to avoid further detriment of psychological functioning. This is of great importance because the outcome of treatment can be substantially better with early intervention.
Psychosis is characterised by a cluster of symptoms, namely hallucinations, delusions and disturbed thoughts, which create a distorted perception of the world. Psychotic episodes are not immediately present at birth. Rather, peak vulnerability for a first episode is commonly observed around the age of 20. There are a number of risk factors which increase the likelihood of developing this disorder. These risk factors include, but are not limited to, genetics, substance use and traumatic life experiences. A first episode is often triggered by a stressful life event. Psychosis is known to have a prodrome – a period of nonspecific symptoms that occur before the disorder. The prodrome for psychosis is marked by social decline and psychological issues such as depression, paranoia and anxiety and can last for a number of years. Carefully monitoring and investigating the trajectory of this period can potentially create opportunities for intervention to avoid further detriment. In practice, individuals at risk can be identified with a diagnostic interview. One type of treatment in the prodromal phase is medication. However, since not all people in the prodromal phase develop psychosis, medication with its side effects may not be the preferred choice of intervention. Consequently, other less invasive treatments were developed such as talking therapy and nutrition.
Virtual reality therapy
There is special interest in social therapy, since the prodrome is characterised by problems in social functioning. Patients with psychosis may experience difficulty in recognising emotions and can hence misinterpret them. Therefore, training in emotional recognition and theory of mind – the ability to understand the perspective of others – are common focus points in therapy sessions. However, a significant problem for therapists is a disinclination by the patient to attend group therapy due to their anxieties, for example. Virtual Reality offers real potential to improve attendance rates.In the virtual environment each participant can pick their own avatar and then receive treatment in this accommodating setting.. However, this form of therapy is not designed to replace any in-person therapies. Instead, it is a way of increasing accessibility to therapy. While patients can find the idea of sitting in a room with strangers and talking about their problems quite overwhelming, the virtual world encourages an ‘online disinhibition effect’ – an increase in self-disclosure due to the greater sense of anonymity. Given the promising results of his work, Dr. Thompson has received funding to create a new virtual tool to increase the privacy and safety of the patients and to provide a higher degree of control in the design of the virtual environment to effectively target individual differences.
Embodiment of hallucinations and exposure
The potential of VR in treating psychosis is not limited to virtual group therapy sessions. VR may also have great potential in treatment. One notable study, performed by the VR research group at King’s College London, paired the auditory hallucinations of patients with virtually designed faces. Thus, technology is used to embody thoughts. This externalisation of hallucinations allows the patient to learn techniques to control, dismiss and challenge the imagined voices. In addition, VR has been proven to be of great value in treating anxiety. Avoidance is a commonly deployed tactic by humans faced with fear, however, avoidance increases anxiety in future encounters, thereby creating a downward spiral. Exposure is therefore crucial in treating anxiety and this is a key benefit of VR – it makes it possible to expose patients to normally highly distressing situations in a safe, personalised and controlled fashion. In this gentle, but at the same time provoking immersive environment, the anxiety can be treated safely and effectively.
In summary, virtual realities have demonstrated to be of great value in treating psychosis. Remote therapy sessions with increased patient attendance and self-disclosure can be held, hallucinations can be embodied and safe environments can be simulated to effectively treat individuals suffering from this distressing disorder. The benefit of virtual realities is also accentuated by the current pandemic constraints and promising technologies are on their way.
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