Immersive Virtual Reality Cognitive Treatment (VRCT) for persecutory delusions.

针对被害妄想的沉浸式虚拟现实认知治疗（VRCT）。

• 批准号: MR/P02629X/1
• 负责人: Daniel Freeman
• 金额: $ 98.48万
• 依托单位: University of Oxford
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2017
• 资助国家: 英国
• 起止时间: 2017 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FP02629X%2F1
• 关键词: Immersive; Virtual; Reality; Cognitive; Treatment

The issue: Persecutory delusions are a key problem for patients with severe mental disorders such as schizophrenia. Examples include: 'People are trying to cause me physical, mental, and emotional harm'; 'When I go out the devil and other people persecute me'; 'People see me as an easy target and do things to get at me'; 'People know what I'm thinking and want to kill me'. These strongly held, unfounded beliefs are associated with many negative outcomes, including isolation, depression, disrupted education and employment, and hospital admission. The main treatment is medication but this is inadequate for too many patients. Patients want psychological help, but rarely get such help, and the effectiveness of standard intervention needs significant improvement. A treatment is needed, targeted for this problem, that is much more effective, and that can be accessed by a greater number of patients.A potential solution: Our approach is to combine the best theoretical understanding of persecutory delusions with developments in technology. We want to tackle the fundamental fear that underlies paranoia: the sense of danger from other people. The most effective way to do that is to help individuals learn from experience that others will not attack them. As the feeling of safety increases, so the delusion diminishes. Patients need to drop their defences, go into the situations that they fear, and relearn that they are safe. But this is very difficult for patients to do because of the severe anxiety generated. Virtual reality (VR) provides a powerful means to make the new learning. VR provides interactive, three-dimensional worlds. Although you know what you're seeing isn't real, your mind and body behave as if it were. So it is much easier to enter feared situations, but you still make important learning that transfers to everyday life. The fact that patients can try the same situation many times, and be instantly transported from one challenging situation to another, means that progress can be fast. VR has successfully been used to treat the fears in anxiety disorders - we believe it can do the same for persecutory delusions. VR is emerging into the mainstream, with affordable equipment that can take it from specialist labs into clinics and homes.Our pilot study: In the first VR treatment study for delusions, 30 patients took part, all of whom were experiencing persecutory delusions (despite medication). We compared two different VR therapies (lasting just 30 minutes), with half the patients undergoing virtual reality cognitive therapy (VRCT) and the other participants undergoing exposure therapy (VRET). The VRCT group, like the VRET patients, took several virtual train and lift rides. But they were helped to do so without using defensive behaviours, such as avoiding eye contact or looking for escape routes. The results paint a very striking picture of the power of VRCT. Immediately after the VR therapy session, eight of the 15 patients who had VRCT no longer met the criteria for persecutory delusions. VR cognitive therapy very clearly outperformed VR exposure therapy in all the statistical testing.The research: We want to develop an extended VRCT, use the latest consumer equipment, and test it in a clinical trial. Based on patient feedback, VRCT scenarios for four treatment sessions will be developed, each scenario having different levels of difficulty, and with a virtual coach present to help encourage the patient. A shared manual for patients and mental health staff will be written. All this development work will occur with patients who have had such difficulties. We will then go on to test VRCT in a clinical trial. 90 patients with persecutory delusions will either have VRCT or spend identical time in relaxing VR environments. Patients will be assessed over six months. We predict substantial benefits for patients with this new treatment that will help to transform the mental health services of the future.

问题：对于严重精神疾病（如精神分裂症）患者而言，迫害妄想是一个关键问题。例子包括：“人们正在努力使我身体，精神和情感伤害”； “当我出去魔鬼，其他人迫害我”； “人们将我视为一个简单的目标，并为我做一些事情''； “人们知道我在想什么，想杀死我”。这些强烈的，无根据的信念与许多负面结果有关，包括孤立，抑郁，受教育和就业中断以及医院入院。主要治疗方法是药物，但对于太多患者而言，这是不足的。患者需要心理帮助，但很少获得这种帮助，并且标准干预的有效性需要显着改善。需要治疗这个问题，这是更有效的目标，并且可以通过更多的患者来接受。一种潜在的解决方案：我们的方法是将对迫害妄想的理论理解与技术发展相结合。我们想解决基本的偏执狂的基本恐惧：其他人的危险感。最有效的方法是帮助个人从其他人不会攻击他们的经验中学习。随着安全感的增加，妄想减少了。患者需要放弃防御措施，进入他们担心的情况，然后重新学习他们是安全的。但由于产生了严重的焦虑，患者很难做到这一点。虚拟现实（VR）提供了一种有力的方法来进行新的学习。 VR提供互动的三维世界。尽管您知道自己所看到的不是真实的，但您的思想和身体的表现就好像是真实的。因此，进入恐惧的情况要容易得多，但是您仍然会进行重要的学习，从而转移到日常生活中。患者可以多次尝试相同的情况，并立即从一个具有挑战性的情况转移到另一种情况，这一事实意味着进步可能会很快。 VR已成功地用于治疗焦虑症中的恐惧 - 我们认为这可以对迫害妄想做同样的事情。 VR正在成为主流，可负担得起的设备可以将其从专业实验室带入诊所和家庭。我们比较了两种不同的VR疗法（仅持续30分钟），其中一半接受了虚拟现实认知疗法（VRCT）和其他接受暴露疗法的参与者（VRET）。 VRCT组和VRET患者一样，乘坐了几列虚拟火车和乘车。但是他们没有使用防御行为，例如避免眼神接触或寻找逃生路线。结果描绘了VRCT力量的非常惊人的图片。 VR疗法会议结束后，有15例VRCT患者中有8名不再符合迫害妄想的标准。在所有统计测试中，VR认知疗法的表现非常明显优于VR暴露疗法。研究：我们希望开发扩展的VRCT，使用最新的消费者设备，并在临床试验中对其进行测试。根据患者的反馈，将开发四个治疗课程的VRCT方案，每个方案都有不同程度的难度，并且在有一个虚拟教练的情况下，以帮助鼓励患者。将编写针对患者和心理健康人员的共享手册。遇到如此困难的患者将发生所有这些开发工作。然后，我们将继续在临床试验中测试VRCT。 90例迫害妄想的患者将具有VRCT或在放松VR环境中花费相同的时间。将在六个月内评估患者。我们预测对这种新疗法的患者的重大收益将有助于改变未来的心理健康服务。

项目成果

Additional file 1: of Automated psychological therapy using virtual reality (VR) for patients with persecutory delusions: study protocol for a single-blind parallel-group randomised controlled trial (THRIVE)

附加文件 1：使用虚拟现实 (VR) 对被害妄想患者进行自动心理治疗：单盲平行组随机对照试验 (THRIVE) 的研究方案

• DOI: 10.6084/m9.figshare.7648571
• 发表时间: 2019
• 作者: Freeman D

Automated virtual reality cognitive therapy versus virtual reality mental relaxation therapy for the treatment of persistent persecutory delusions in patients with psychosis (THRIVE): a parallel-group, single-blind, randomised controlled trial in England with mediation analyses.

自动虚拟现实认知疗法与虚拟现实精神放松疗法治疗精神病患者持续性被害妄想（THRIVE）：在英国进行的一项平行组、单盲、随机对照试验，并进行中介分析。

• DOI: 10.1016/s2215-0366(23)00257-2
• 发表时间: 2023
• 期刊: The lancet. Psychiatry
• 作者: Freeman D

The revised Green et al., Paranoid Thoughts Scale (R-GPTS): psychometric properties, severity ranges, and clinical cut-offs.

• DOI: 10.1017/s0033291719003155
• 发表时间: 2021-01
• 期刊: Psychological medicine
• 影响因子: 6.9
• 作者: Freeman D;Loe BS;Kingdon D;Startup H;Molodynski A;Rosebrock L;Brown P;Sheaves B;Waite F;Bird JC
• 通讯作者: Bird JC