Virtual Reality Training for Social Skills in Schizophrenia
Condition: Schizophrenia
MeSH terms: Schizophrenia
Study type: Interventional

Summary: 
      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, we must 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.

      The investigators will test 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. VR technology offers a flexible
      alternative to conventional therapies, with several advantages, including a simplified and
      low-stress social interaction environment with targeted opportunities to simulate, exercise
      and reinforce basic elements of social skills in a very wide range of realistic scenarios,
      and to repeat exposure to naturalistic situations from multiple angles.
    

Detailed description: 
      Social impairments present a major barrier toward good outcome in schizophrenia (SZ). Social
      skills and social competence protect against stress-related exacerbation of symptoms while
      supporting interpersonal interactions and social affiliation that help enhance the quality of
      life. Improving social functions could lead to better outcome and reduce healthcare costs and
      societal burden. Pharmacotherapy has shown to be inadequate in improving social impairments
      in schizophrenia, and although existing psychosocial interventions can be moderately
      effective, the time- and effort-intensive nature (high-burden), low adherence, and weak
      transfer of skills to real life present significant hurdles. Thus, there is a strong need to
      develop effective and low-burden social interventions that can be personalized to optimize
      learning and increase adherence.

      Virtual reality (VR) technology offers a very promising alternative to conventional
      interventions, with several advantages. Controllable complexity of the VR world provides a
      simplified and low-stress social interaction environment with targeted opportunities to
      simulate, exercise and reinforce basic elements of social skills and to repeat exposure to
      naturalistic situations from multiple angles. Simulation of a wide variety of social
      situations that allows for targeted practice is crucial for learning and transfer of skills.
      In our proposed VR system, the capacity for personalized social skills training is achieved
      by automatic and adaptive feedback, based on the affective and attentional states of the
      participant in real-time, using closed-loop, emotion-sensing VR technology that integrates
      physiological signals, eye-tracking data and performance data from the participants to
      rapidly adjust the task parameters. This approach enables realistic, and adaptive
      interactions in VR games to provide scaffolded social skills exercises in an engaging and
      enjoyable manner.

      The major aim of this proposal is to implement a personalized VR-based social skills training
      program with high efficacy for individuals with SZ by capitalizing on innovations in
      adaptive, emotion-sensing technology, designed to increase engagement and learning. This work
      will be conducted in two phases. The R21 phase will focus on implementing an adaptive social
      intervention VR game, optimizing the dose and measuring targeted social cognitive outcome.
      Upon meeting the milestones of the R21 (see 'Approach'), the R33 project will evaluate the
      feasibility of recruitment, and retention of SZ participants in a pilot randomized controlled
      trial (RCT) of VR training compared with an active control condition and assess long-term
      outcome.

      The long-term goal of this proposal is to develop and implement a personalized social
      intervention method for individuals with schizophrenia that is efficacious, low-burden,
      enjoyable, and with generalizable and enduring benefits. Within the R21 phase, a
      physiology-based, closed-loop, adaptive VR task will be developed to determine the optimal
      dose for improving targeted social functions in individuals with SZ. If these goals are met
      for the R21 phase, a pilot RCT will be conducted in R33 to compare the social, cognitive,
      neural effects of adaptive social VR versus an active control condition. Furthermore, the
      physiological and eye tracking data and the outcome data from both R21 and R33 phases will be
      used to refine and improve this VR protocol and technology. It is hoped that the results of
      this study will lead to a large scale RCT in the future, and the implementation of a
      portable, low-cost and widely available intervention that can be personalized for optimal
      learning. In short, the investigators will implement an efficacious, engaging, low-burden, VR
      intervention to ameliorate social impairments of SZ and improve functional outcome.
    

Intervention name(s): Virtual reality social skills training
Intervention type(s): Behavioral
Intervention description(s): Participants play a virtual reality video game involving social interactions with various characters ( avatars) at a bus stop, a cafeteria and a grocery store. The games become progressively more complex as the participant improves task performance. Eye tracking patterns are recorded throughout the game to observe the patterns of social attention
Other intervention name(s): physiology based virtual reality social skills training
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Half the participants play the virtual reality video game for one hour per session (low dose).
The other half play the virtual reality video game for 2 hours per session (high dose).
Both groups visit the lab 10 times ( twice a week for 5 weeks)
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Basic Science
Keywords: Social Skills; Social attention; Virtual reality; Eye tracking