Comparison of VR-Assisted Therapy to Cognitive-Behavioral Therapy in the treatment of verbal hallucinations in patient with treatment-resistant schizophrenia
Bibliographic record
Abstract
Introduction Auditory verbal hallucinations (AVH), which often present in individuals with schizophrenia, can cause great psychological distress. Although antipsychotic medication can reduce AVH, 30% of patients will be resistant. Treatment resistance could be associated with important consequences, and there are only few treatment alternatives. Unfortunately, more than 50% of patients will not respond favorably to the best available psychological therapy, cognitive-behavioral therapy (CBT). However, using virtual reality (VR), our research team has adapted a therapy whose goal is to recreate the faces and voices of the patients’ persecutory voices as avatars. By interacting with an external representation of their hallucinations, patients implement new strategies to control their voices and to regulate their emotions. A small clinical trial (proof of concept) has demonstrated the safety and validity of this therapy as well as its superiority compared to the usual treatment. Objectives (1) To verify whether VR-Assisted Therapy (VRT) is superior to CBT for the treatment of AVH; and (2) to examine the effects of VRT and CBT on the symptomatology and quality of life. Methods For this single-blind randomized controlled clinical trial, 136 patients will by recruited (68/intervention) The effects on psychotic symptomatology as well as on quality of life is assessed using standardized questionnaires. Patients are included if they hear persecutory voices and have not responded to at least 2 trials of antipsychotics. Both groups are randomized from an external site and begin with an initial clinical assessment prior to randomization. Participants then receive 9 weekly one-hour therapy sessions (CBT or VRT), beginning the following week. A second clinical evaluation is carried out one week after the last session. A linear mixed effects model will be used to compare the effects of the 2 interventions. Results Results from a pilot randomized comparative trial evaluating the short- and long-term efficacy of VRT over CBT for patients with treatment-resistant schizophrenia (N=37/group) showed that both interventions produced significant improvements in AVH severity and depressive symptoms. Although results did not show a statistically significant superiority of VRT over CBT for AVH, VRT did achieve larger effects particularly on overall AVH (d = 1.080 for VRT and d = 0.555 for CBT). The recruitment of the current clinical trial is in progress. Image: Conclusions VRT, which is currently under clinical investigation, presents itself as an interesting complement to existing pharmacological treatments. Since VR technologies allow the recreation of scenarios that are nearly impossible to reproduce in real life, VR-assisted psychotherapy could eventually become an integral part of our clinical practices. Disclosure of Interest None Declared
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".