Virtual Reality Training for Social Skills in Schizophrenia - Comparison With Cognitive Training
Purpose
Social impairments are core features of schizophrenia that lead to poor outcome. Social skills and competence improve quality of life and protect against stress-related exacerbation of symptoms, while supporting resilience, interpersonal interactions, and social affiliation. To improve outcome, it is necessary to remediate social deficits. Existing psychosocial interventions are moderately effective but the effort-intensive nature (high burden), low adherence, and weak transfer of skills to everyday life present significant hurdles toward recovery. Thus, there is a dire need to develop effective, engaging and low-burden social interventions for people with schizophrenia that will result in better compliance rates and functional outcome. In a previous pilot study, the investigators tested the effectiveness of a novel adaptive virtual reality (VR) intervention in improving targeted social cognitive function (social attention, as indexed by eye scanning patterns) in individuals with schizophrenia. 10 sessions of 1-hour VR intervention were sufficient to engage the target mechanism of social attention and improve negative symptoms. Acceptability and compliance were very high among the participants. ' The next phase, supported by a R33 grant will compare the VR social skills training with a control condition. This new protocol includes a control condition for the exposure to computerized training across the 10 sessions and incidental exposure to social interactions (i.e. interactions with experimenters twice a week for 5 weeks) by including a control condition, which involves computerized brain fitness training for 10 sessions.
Conditions
- Schizophrenia
- Schizo Affective Disorder
- Social Skills
Eligibility
- Eligible Ages
- Between 18 Years and 65 Years
- Eligible Genders
- All
- Accepts Healthy Volunteers
- Yes
Inclusion Criteria
- Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) Axis 1 Diagnosis of schizophrenia - Wechsler Abbreviated Scale of Intelligence (WASI) intelligence quotient (IQ) > 90 - Currently taking antipsychotic medication - No change in current psychotropic medications or housing within the past 30 days. Those patients whose medication or housing situation has changed within a month, we will wait list them until their situation stabilizes.
Exclusion Criteria
- DSM 5 Axis 1 diagnosis other than schizophrenia - Diagnosed organic brain disease, brain lesions, history of head traumas, neurological disorders or other conditions that involve the degeneration of the central nervous system (e.g. multiple sclerosis) - Substance/alcohol dependence during the past 1 year - Tardive dyskinesia 2. Inclusion and Exclusion Criteria for Healthy Control Participants: Inclusion Criteria: - WAIS IQ > 90. - No DSM-5 Axis 1 diagnosis of psychotic disorders in themselves or their families (e.g. schizophrenia, bipolar disorder). - No antipsychotic medications - No diagnosed organic brain disease, brain lesions, history of head traumas, neurological disorders or other conditions that involve the degeneration of the central nervous system (e.g. multiple sclerosis) - No substance/alcohol dependence during the past 1 year
Study Design
- Phase
- N/A
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel Assignment
- Intervention Model Description
- Two conditions are compared in individuals with schizophrenia: VR social training and active control condition of computerized cognitive training. Healthy controls are run on the baseline tasks to provide the comparison data for the patient groups but the controls do not undergo VR training.
- Primary Purpose
- Basic Science
- Masking
- Double (Participant, Outcomes Assessor)
- Masking Description
- Participants with schizophrenia and Outcome assessors will be blind to the training condition.
Arm Groups
| Arm | Description | Assigned Intervention |
|---|---|---|
|
Active Comparator VR Social Skills Training |
Participants will undergo a virtual reality social skills training program for 10 sessions. Each session takes about an hour. Participants visit the lab twice a week. Therefore, the training duration is 5 weeks. |
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Other Cognitive training game |
If there is a significant improvement in social skills for the active treatment condition, the reason might be that the participants were exposed to social environment by coming to the lab and interacting with the research staff twice a week for 5 weeks and/or they used a computerized training tool twice a week for 5 weeks. In order to control for these potential confounds, we included a cognitive training arm. Participants will undergo a commercially available cognitive training program for ten 1-hour sessions (twice a week for 5 weeks). |
|
|
No Intervention Healthy Controls |
Healthy controls are recruited to yield comparison data. They do not undergo training. |
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Recruiting Locations
Nashville, Tennessee 37240
More Details
- Status
- Recruiting
- Sponsor
- Vanderbilt University
Detailed Description
The effectiveness of the social VR training (n=20) at an optimal dose will be compared with an active control condition (computerized cognitive training) (n=20) in improving social attention (Social Engagement Latency: SEL) and social brain network in a pilot randomized control trial (RCT). Participants with schizophrenia will undergo a baseline assessment of cognition, social functioning, symptoms and social brain network functioning. These behavioral, clinical and functional neuroimaging (fMRI of social imitation task, and resting state connectivity analyses of the social brain network) methods will be used to assess changes. Individuals with schizophrenia will be randomized to either the social skills training or the computerized cognitive training at baseline. They will then participate in 10 sessions of social skills VR training or computerized cognitive training (1 hour per session, twice a week for 5 weeks). In addition, long-term social outcome will be assessed approximately 2 months after the end of training with the Social Functional Scale (Birchwood, 1991), the the Scale for the Assessment of Negative Symptoms (SANS) and the Scale for the Assessment of Positive Symptoms (SAPS). For the long-term outcome assessment, no neuroimaging or behavioral assessments will be conducted because the primary goal of the follow-up is to assess broad levels of social functioning in the real world and because there is not sufficient time within the R33 mechanism. 16 matched control participants will be recruited to obtain behavioral and neuroimaging comparison data for optimal performance levels but these healthy control participants will not undergo social skills training. Lastly, at the end of the R33 project, if this adaptive VR technology shows that it can improve social attention, which in turn improves social outcome in schizophrenia, it will be possible to refine the protocol to make the method more accessible, less burdensome and widely available in the future by moving towards a mobile application.