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：受迫害妄想是精神分裂症等严重精神障碍患者的一个关键问题。示例包括：“人们试图给我造成身体、精神和情感上的伤害”;“当我出去的时候，魔鬼和其他人骚扰我”;“人们把我看作一个容易攻击的目标，做一些事情来对付我”;“人们知道我在想什么，想杀了我”。这些强烈的、毫无根据的信念与许多负面结果有关，包括孤立、抑郁、中断教育和就业以及住院。主要的治疗方法是药物治疗，但这对许多患者来说是不够的。患者需要心理帮助，但很少得到这种帮助，标准干预的有效性需要显著提高。需要一种针对这个问题的治疗方法，这种方法更有效，并且可以被更多的患者使用。一种潜在的解决方案：我们的方法是将对迫害妄想的最佳理论理解与技术发展相结合。我们想解决偏执狂背后的基本恐惧：来自他人的危险感。做到这一点的最有效方法是帮助个人从经验中学习，其他人不会攻击他们。随着安全感的增加，错觉就会减少。病人需要放下防御，进入他们害怕的情况，重新认识到他们是安全的。但这对患者来说是非常困难的，因为会产生严重的焦虑。虚拟现实（VR）为新的学习方式提供了强有力的手段。VR提供交互式的三维世界。虽然你知道你所看到的不是真实的，但你的思想和身体表现得好像它是真实的。因此，进入恐惧的情况要容易得多，但你仍然可以学到重要的知识，并将其转移到日常生活中。事实上，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个，这意味着进展可以很快。VR已经成功地用于治疗焦虑症中的恐惧-我们相信它可以对迫害妄想症做同样的事情。VR正在成为主流，价格实惠的设备可以将其从专业实验室带到诊所和家庭。我们的试点研究：在第一个VR治疗妄想的研究中，有30名患者参加，他们都经历了迫害妄想（尽管药物治疗）。我们比较了两种不同的VR疗法（仅持续30分钟），其中一半患者接受虚拟现实认知疗法（VRCT），另一半患者接受暴露疗法（VRET）。VRCT组和VRET组的患者一样，乘坐了几次虚拟的火车和电梯。但他们在没有使用防御行为的情况下得到了帮助，例如避免眼神接触或寻找逃跑路线。结果描绘了VRCT的力量非常惊人的画面。在VR治疗后，15名VRCT患者中有8名不再符合迫害妄想的标准。在所有的统计测试中，VR认知疗法明显优于VR暴露疗法。研究：我们想开发一种扩展的VRCT，使用最新的消费设备，并在临床试验中进行测试。根据患者的反馈，将开发四个治疗疗程的VRCT场景，每个场景都有不同的难度，并有一个虚拟教练来帮助鼓励患者。将为患者和精神卫生工作人员编写一份共享手册。所有这些发展工作将发生在有这种困难的病人身上。然后，我们将继续在临床试验中测试VRCT。90名患有迫害妄想的患者将接受VRCT或在放松的VR环境中度过相同的时间。患者将在6个月内接受评估。我们预测这种新疗法将为患者带来实质性的好处，这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