Virtual Reality for People With Schizophrenia
Improving Psychosocial Rehabilitation Through the Use of Virtual Reality and Supportive Therapeutic Relationships
Virtual reality (VR) is a three-dimensional computer-generated environment that can be explored and interacted with by a person. Unlike traditional 2D displays, VR uses 3D computer graphics to generate an immersive virtual world. Current psychosocial rehabilitation (PSR) interventions for individuals with schizophrenia are offered within conventional clinical settings. Though valuable, the skills acquired in a clinical setting may not transfer to a real-world environment outside the clinic.1
A clinical setting cannot fully replicate the nuances of real-world environments. Using VR technology, individuals can practice task performance in familiar situations. VR may allow skills to be more generalizable to real-world problems while maintaining the safety of the clinical setting.
Several VR applications are utilized for the treatment of schizophrenia. The Multimodal Adaptive Social Intervention in Virtual Reality (MASI-VR) enhances social skills and engages participants in a low-stress environment.2 MASI-VR promotes social skill acquisition by requiring participants to engage with avatars. Tasks include making eye contact and paying close attention to facial expressions and body language across three different environments: a bus stop, a store, and a cafeteria. Participants are encouraged to start conversations with unfamiliar people to request or ask for information. Participants can work through different missions and scenarios to improve their skill-building and social awareness.
The Virtual Supermarket Shopping Task program simulates a shopping activity where participants have to memorize and collect items from a virtual supermarket.3 Simulating a grocery shopping experience allows participants to practice shopping skills and reduce the fear associated with this activity. Practice and mastery of this activity of daily living facilitates the transfer of skills from VR to real-life scenarios.
VR job interviewing training (VR-JIT) is an application introduced to provide participants with disabilities the opportunity to repeatedly practice job interviews in a risk-free environment.4,5 The avatar “Molly Porter,” a human resource manager at a large department store, asks questions about skills and experiences. Molly is customizable, with 1,200 possible question options to tailor each interview based on needs, skill levels, and responses. VR-JIT provides three levels of difficulty that can help participants identify their strengths and areas for improvement. The flexibility of VRJIT allows them to focus their efforts on the areas where they need the most improvement. MASI-VR, the Virtual Supermarket Shopping Task, and VRJIT are all customizable to meet participants’ individualized goals.
VR effectively treats schizophrenia and provides an immersive, lifelike environment to explore without any severe side effects.6 It demonstrates improved self-esteem, reduces isolation, and provides control over the environment through purposeful interactions with objects in the virtual world. PSR VR interventions, such as MASI-VR and VR-JIT, enhance the development of transferable skills to multiple life domains. Interventions are adaptable by practitioners and provide a more immersive and engaging experience for users to develop life skills to overcome their mental health barriers.
Definition and Prevalence of Schizophrenia
Treatment Options to Reduce Symptoms of Schizophrenia
Recovery Is More Than Symptom Management
PR Key Components
Psychosocial Interventions to Promote Recovery
IPS is a critical psychosocial model for employment. Approximately 60% of individuals receiving mental health services want to work and may actively seek employment.4 They have lost jobs due to illness or disability or because their employer does not accommodate their needs. They may be unemployed or underemployed due to difficulties in finding or maintaining employment owing to symptoms related to their condition. They may be unable (or unwilling) to work without adequate support.4 IPS incorporates eight fundamental principles: focus on competitive employment, job development, rapid job search, integrated services, benefits planning, zero exclusion, time-unlimited support, and worker preference.5,17 Employment provides a sense of purpose, self-esteem, and hope for the future. It increases prosocial behavior, builds natural social support, and offers reintegration into the community. SST, IRS, and IPS are effective in community integration, developing social support, and recovery for individuals with schizophrenia. PSR interventions are customizable, and person-centered approaches focus on goal attainment. Practitioners by creating real-life simulations help individuals practice skill development and mastery based on their strengths and deficits. Safe and controlled spaces explore complex social situations and emotions. The VR environment allows clients to gain a new perspective on their experiences and allows the opportunity for growth and corrective feedback.
VR Promotes Gainful Employment
Employment is a critical factor in recovery from mental illness and provides a purpose, meaning, and a sense of community connection. The social deficits experienced by an individual with schizophrenia may interfere with successful navigation of the job market and workplace because the individuals may not understand social cues or pick up on subtle hints, which can lead to misunderstandings in conversation or at work. VR-JIT allows individuals to engage in repeated interviewing trials with a virtual human resource representative.4
The VR environment is motivating15 and safe,19 and the interview can be tailored and customized based on skill level and responses. An individual can master skills while utilizing the VR environment for job-related tasks. Mastering skills builds confidence to continue in the employment process. Learned skills are then easily transferable to a real-world job interview. Individuals utilizing the VR-JIT can simulate different job environments replicating worker job preferences. Preference is an essential component of the IPS model. Using VR interventions increases the likelihood of engaging in job interviews and receiving job offers.5 Successful employment creates a sense of meaning and community inclusion and promotes sustained recovery. VR interventions are as effective as face-to-face treatments when accompanied by a cooperative shared relationship with a practitioner.9
Shared Relationships Are Vital to Recovery
Recovery-oriented practitioners can establish an effective shared relationship by helping the individual effectively navigate the complexities of the recovery process. Practitioners can help the individual understand the strengths of PSR VR in symptom management and life role attainment. The success of rehabilitation efforts is not solely dependent on a shared relationship between the client and practitioner. Discussing and agreeing on goals with individuals is crucial for achieving successful outcomes. Investing in supporting clients in achieving their rehabilitation goals directly impacts their quality of life.21Recovery plans may involve creating virtual environments designed to simulate real-life situations that trigger symptoms while practicing coping skills and other strategies for managing illness. Practitioners can adjust the PSR VR recovery plan to the individual as needed to ensure that it is person-centered and relevant. A recovery-oriented practitioner must have the willingness and ability to shape services and elicit feedback to effectively meet the needs and preferences of each individual.22 VR interventions supported by a practitioner are more effective than unsupported VR interventions in treating schizophrenia.9 Supported VR allows for establishing a shared therapeutic relationship, discussions of individual preferences, and personalized treatment planning, which are essential components of evidence-based practices for schizophrenia recovery.
Implications for Practice
— Patricia A. Huber-Villano, LCSW, is a licensed clinical social worker in New York and a DSW student at the University of Buffalo. She has practiced community mental health for 24 years and has designed and implemented recovery-oriented psychiatric rehabilitation programs utilizing psychosocial rehabilitation interventions that serve adults ages 18+ diagnosed with severe mental illness and substance use. Huber-Villano operates an entirely virtual psychotherapy practice for children and adults and utilizes psychiatric rehabilitation and supported technology.
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