M230. VIRTUAL REALITY FOR IMPROVING SOCIAL ACTIVITIES AND PARTICIPATION (VR-SOAP): DEVELOPMENT OF A NEW TREATMENT FOR YOUNG PEOPLE WITH PSYCHOSIS
Authors: Muijsson Dauw , van der Stouwe Elise , Greaves-Lord Kirstin , Nijman Saskia , Pijnenborg Marieke , Veling Wim 
Published: May 2020

Abstract

Background
Young people with a psychotic disorder have the same social goals as their healthy peers, but their social networks are smaller, they participate less often in leisure activities and are less successful in work and education. Current treatments have only moderate effects on social functioning. Virtual Reality (VR) has a great potential to improve the social functioning of young people with psychosis. With VR, individuals can practice with simulations of difficult social situations in a safe and personalized way. Therefore, we aimed to develop and investigate feasibility of a novel VR treatment (VR-SOAP) for improving social contacts, leisure activities and social participation of young people with a psychotic disorder.

Methods
As a first step, a literature search of causes of impaired social functioning was conducted. Underlying relationships and mechanisms of the causes were identified. The causes of impaired social functioning were translated into concepts for the VR modules. The concepts were translated into requirements for the VR modules. Subsequently, the software and the treatment manual were developed in an iterative process with a team of experiential experts, psychosis therapists, researchers, VR experts and software engineers. The final prototype will be tested in a small pilot study with three therapists and six patients. In order to determine the feasibility and acceptability of the treatment and to evaluate and improve the treatment protocol using input from therapists and patients.

Results
Several determinants of impaired social functioning were identified: negative symptoms, impaired social cognition, paranoid ideations, social anxiety, low self-esteem, self-stigma and poor communication skills. These causes are multifaceted, but at the same time interrelated and overlapping. VR-SOAP was designed as five modules that address these causes, four optional modules (1–4) and one fixed module (5). The treatment is personalized and takes the specific individual contributing causes into account. Patient and therapist select two out of four optional modules. In module 1 (Negative symptoms) patients will focus on increasing their motivation and pleasure in dealing with amotivation and anhedonia. In module 2 (Social cognition) patients will practice with recognizing facial emotions and interpreting social situations. Module 3 (Paranoid ideations) consists of exposure exercises and behavioural experiments testing harm expectancies. In module 4 (Self-esteem and self-stigma) patients will focus on positive aspects of the self and challenge self-criticism. All patients will end with module 5 (Communication and Interaction skills), in which experiences, knowledge and skills from other modules are integrated and applied in role-plays. Currently, the pilot feasibility study is ongoing. Preliminary results will be presented.

Discussion
VR-SOAP is a promising new intervention for enhancing the social functioning of young adults with psychosis. VR is very useful for practising new social behaviour. It enables patients to practice with real-world social situations in a safe and gradual way. In the coming years, a single-blind randomized controlled trial will be conducted to test the effect of VR-SOAP on social contacts, leisure activities and social participation.