Virtual reality interventions to improve cognitive functioning in adults with major psychiatric disorders: A narrative systematic review (Preprint)

Abstract

Cognitive dysfunction is an impairing and difficult to treat feature of psychiatric illnesses. Virtual Reality (VR) has shown promise in improving cognition in neurologic disorders, but its role in improving cognitive outcomes in adults with major psychiatric disorders is unclear.

To conduct a review of the efficacy and usability of VR interventions to improve cognitive functioning in psychiatric disorders.

Following PRISMA guidelines, a systematic review of controlled and uncontrolled English-language studies that assessed changes in cognition following an immersive or non-immersive VR intervention, in adults with a mood, psychotic, anxiety, or substance use disorder was conducted. Studies were searched on MEDLINE, EMBASE, PsychINFO, and Web of Science until May 2021.

Thirteen studies were included [primary psychotic disorder (n=10), substance use disorder (n=2) and major depressive disorder (n=1)]. Intervention strategies included drill and practice cognitive remediation (i.e. repeated practice of targeted skills, n=2), social cognitive/skills training (n=5), real world simulations (n=3) and vocational training (n=3). VR social cognitive/skills training resulted in improvements in social cognition, while the other remediation strategies resulted in generalized improvements across multiple cognitive domains. Both immersive and non-immersive VR appeared to be effective. In studies with an active control group (n=5), therapist led VR treatment resulted in equivalent or greater cognitive improvements versus non VR therapist led training. Changes in real-world functioning were inconsistently reported.

Preliminary evidence suggests VR interventions can improve cognitive outcomes in psychiatric disorders; however, significant variability in study design and outcome measures, small sample sizes and a focus on primary psychotic disorders limit the literature. More rigorous assessment of long-term cognitive and functional outcomes, and the comparative utility of immersive versus non-immersive modalities and different remediation strategies, is required.