Researchers at Semmelweis University in Budapest have drawn on VR to help the rehabilitation process of schizophrenic patients.
According WHOthe disease affects approximately 24 million people worldwide and is associated with considerable disability, often affecting all areas of life such as personal, social and occupational functioning.
Scientists have developed the so-called VR-ToMIS method of therapy (abbreviation of “Virtual-Reality based Theory of Mind Intervention in Schizophrenia”), which aims to improve the mentalizing skills (theory of mind) of the patient – a fundamental component of human cognition and social interaction.
“Theory of mind is our ability to interpret the feelings, thoughts, and desires of others. Patients with schizophrenia tend to decode these messages incorrectly. They often have difficulty understanding irony and metaphors, or misunderstand certain gestures. Our method aims to improve these skills,” explain Dr Lajos Simon, head of the university’s Reality and Emotion research group.
How it works?
VR-ToMIS, developed using software from British start vTime, consists of nine sessions in total. It starts with an introduction to familiarize patients with technology and basic concepts such as theory of mind. This is followed by eight 50-minute intervention sessions.
At first, patients wear VR glasses and are immersed in everyday situations ranging from a walk on the beach or a blind date, to moving in with a roommate or meeting a new colleague. In all simulated scenarios, patients interact with an avatar controlled by a therapist. To uncover mentalizing deficits during interaction, therapists use several language tools, including metaphors, irony, humor, and double-meaning sentences.
Once this simulation is complete, patients participate in a second interactive exercise with another new VR device, the Time Disc Controller. They are shown a 3D face on a screen and asked to deduce the correct emotions it displays by moving a mouse around it.
“It’s a very useful task because patients can display these emotions even if they don’t have the vocabulary to do so due to their illness,” Dr. Edit Vass, assistant lecturer in the Department of Psychiatry and Psychotherapy and co-developer of VR therapy, told TNW.
Both simulations are followed by an analytical discussion between therapist and patient. This process identifies any behavioral changes needed to help the patient better adapt to the situations they have practiced on.
“Before suggesting practicing these modified behavioral techniques as homework between sessions, we offer patients the opportunity to repeat the simulations so they can see how changing their behavior may affect their emotions and thoughts about the situation,” Vass added.
She believes that the overall “iterative approach” to therapy contributes significantly to its success.
The test phase of the VR-ToMIS method ended in 2022, involving 43 patients. The researchers observed significant improvements in participants’ cognitive and negative symptoms. These include coherent thinking, social cognitive deficit, theory of mind, emotional brutality, diminished facial expressions, and apathy.
Patient feedback has also been very positive. 93.3% of participants found the method entertaining and 78% considered it an important part of their rehabilitation.
Meanwhile, 77.3% tried to apply the learned skills in real-life situations, with 93.3% of them reporting a subjective improvement in their communication skills, even though they did not practice to a large extent. On the other hand, 26.7% of patients found the task of the temporal disc controller to be a difficult part of the procedure and 13.4% considered it heavy.
Another crucial element of the method’s success, according to Vass, was the “exceptional rate of patient compliance.”
“Compliance is the biggest barrier to recovery in schizophrenia,” she told TNW. “In our therapy, there was no dropout, so I think virtual reality might have a non-specific motivational effect. Of course, the therapist’s approach might also be another important factor.
Vass noted that while a direct link between virtual reality and motivation is not yet supported by studies, “the main contributor would be the balance between the therapist’s empathic attitude and the fact that this new technology is very exciting for patients”.
Semmelweis University has already obtained the Hungarian industrial mark for VR-ToMIS, with the intention of obtaining an international mark within two years. The next step is to train professionals in the field to use the method, initially in Hungary.