Making hallucinations a virtual reality

Up to 80 per cent of people diagnosed with schizophrenia suffer from verbal auditory hallucinations which can be highly distressing to the individual, particularly if the voices are perceived as malevolent, and having control over the individual. In addition, some people do not respond to conventional treatments and psychological interventions for treatment-resistant symptoms of schizophrenia are limited. Approaches which foster engagement with the voices, personifying them and entering into dialogue are showing promise by reducing the individual’s sense of helplessness and increasing their sense of control. A limitation however with approaches to date (either using a therapist in the dialogue or more recently, a computer-generated avatar) is the disconnect between the individual and the voices in this dialogue.

This study, conducted by researchers in Canada, piloted the use of immersive virtual reality with 19 patients diagnosed with schizophrenia or schizoaffective disorder, who had not responded to two trials of antipsychotic medication. Participants were assigned to VR assisted therapy or treatment as usual (antipsychotic treatment and meetings with a clinician). Participants were given seven weekly virtual reality sessions.

Participants first selected the most distressing or dominant person or entity believed to be the source of the malevolent voice and based on this, created an avatar designed to closely resemble in facial and vocal features the ‘persecutor’. They were then immersed in dialogue with this avatar using a head-mounted display and smartphone. Sessions focused on building emotion–regulation, assertiveness, self-expression, and self-esteem through the consideration of their own personal qualities. Sessions were manualised and audio-recorded.

Virtual-reality assisted therapy produced significant improvements in auditory verbal hallucinations, depressive symptoms, distress in relation to the persecutory voices, and quality of life. Improvements continued at three-month follow-up.

The researchers believe that this immersive approach enhances the participant’s capacity to personalise the source of the persecutory voice and their capacity to enter into a more profound relationship with this personified voice, in a setting where they can then more effectively exercise assertiveness and control in these dialogues. As such, emotion regulation and self-efficacy were seen as the agents for change, rather than a process of challenging beliefs about the nature of the voices.

Limitations, including the non-blinding to treatment allocation of assessors, the exclusion of data from dropouts, and the lack of an active treatment comparison group were noted by the authors with recommendations that this form the next phase of virtual-reality assisted therapy trials.

doi.org/10.1016/j.schres.2018.02.031