Virtual Reality for Rehabilitation Interventions in Individuals with Psychosis: Systematic Review (Preprint)

Abstract

Recovery for people with psychosis remains a challenge despite psychiatric care and rehabilitation interventions aimed at improving functional outcomes. Cognitive, social, and vocational skills are strong predictors for quality of life and deficits in these areas may persist despite current treatments for psychosis. Recent advances in virtual reality applications have enabled the development of realistic environments wherein individuals with psychosis can receive rehabilitation treatments that are more ecological than traditional clinical settings. Therefore, virtual reality rehabilitation interventions may increase the transfer of skills to real-world environments and improve recovery for individuals with psychosis.

This systematic review synthesized the current evidence on the feasibility and efficacy of virtual reality as a rehabilitation intervention for individuals with psychosis.

This research followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Literature searches were conducted in PubMed and PsycINFO using the following search strategy: (“cognitive” or “cognition”) OR ("social") OR ("vocational") AND (“training” or “remediation” or “rehabilitation” or “enhancement”) AND “schizophrenia” or "schizoaffective" or "psychosis" AND "virtual reality”. English peer-reviewed studies were included and divided into three categories: (1) cognitive rehabilitation studies; (2) social skills rehabilitation studies; and (3) vocational rehabilitation studies.

Nine studies were included in this systematic review. Four were single arm studies, four were randomized controlled trials, and one was a non-randomized controlled trial. A total of 257 individuals with psychosis were included across all studies. All the studies that evaluated feasibility showed that virtual reality rehabilitation interventions were feasible and enjoyable for individuals with psychosis. Preliminary evidence suggests that rehabilitation interventions using virtual reality can increase cognitive, social, and vocational skills in these individuals. In six studies, rehabilitation interventions using virtual reality also improved functional outcomes, such as autonomy, managing housework, and work performance.

Virtual reality rehabilitation interventions represent a promising avenue to improve cognitive, social, and vocational deficits in individuals with psychosis. Most studies we identified were conducted using small sample sizes and with no active control group. Therefore, more rigorous research in this area is warranted. Nevertheless, our findings show that virtual reality rehabilitation interventions may represent a promising adjunctive therapy for improving recovery in people with psychosis.