A novel virtual environment (VE) system was developed and used as an adjunct to cognitive behavior therapy (CBT) with six socially anxious patients recovering from psychosis. The novel aspect of the VE system is that it uses video capture so the patients can see a life-size projection of themselves interacting with a specially scripted and digitally edited filmed environment played in real time on a screen in front of them. Within-session process outcomes (subjective units of distress and belief ratings on individual behavioral experiments), as well as patient feedback, generated the hypothesis that this type of virtual environment can potentially add value to CBT by helping patients understand the role of avoidance and safety behaviors in the maintenance of social anxiety and paranoia and by boosting their confidence to carry out “real-life” behavioral experiments.
Get full access to this article
View all access options for this article.
References
1.
BirchwoodM, TrowerP, BrunetKet al.Social anxiety and the shame of psychosis: a study in first episode psychosis. Behaviour Research & Therapy, 2006; 45:1025–1037.
2.
TollefsonGD, SangerTM. Anxious-depressive symptoms in schizophrenia: a new treatment target for pharmacotherapy?Schizophrenia Research, 1999; 35,suppl:S13–S21.
3.
GoodwinRD, AmadorXF, MalaspinaDet al.Anxiety and substance use comorbidity among inpatients with schizophrenia. Schizophrenia Research, 2003; 61:89–95.
4.
PallantiS, QuercioliL, HollanderE. Social anxiety in outpatients with schizophrenia: a relevant cause of disability. American Journal of Psychiatry, 2004; 161:53–58.
5.
KendlerKS, GallagherTJ, AbelsonJM, KesslerRC. Lifetime prevalence, demographic risk factors and diagnostic validity of nonaffective psychosis as assessed in a US community sample: The National Comorbidity Survey. Archives of General Psychiatry, 1996; 53:1022–1031.
6.
FowlerD, HodgekinsJ, PainterMet al.Cognitive behaviour therapy for improving social recovery in psychosis: a report from the ISREP MRC Trial Platform study (Improving Social Recovery in Early Psychosis)Psychological Medicine, 2009; 38:101–111.
7.
HuppertJD, WeissKA, LimRet al.Quality of life in Schizophrenia: contribution of anxiety and depression. Schizophrenia Research, 2001; 51:171–180.
8.
ClarkDM. Anxiety disorders: Why they persist and how to treat them. Behaviour Research and Therapy, 1999; 37:S5–S27.
9.
SalkovskisPM. The importance of behaviour in the maintenance of anxiety and panic: A cognitive account. Behavioural Psychotherapy, 1991; 19:6–19.
10.
FeskeU, ChamblessDL. Cognitive behavioral versus exposure only treatment for social phobia: a meta-analysis. Behavior Therapy, 1995; 26:695–720.
11.
RodebaughTL, HolawayRM, HeimbergRG. The treatment of social anxiety disorder. Clinical Psychology Review, 2004; 24:883–908.
12.
ScholingA, EmmelkampPMG. Exposure with and without cognitive therapy for generalized social phobia: effects of individual and group treatment. Behaviour Research & Therapy, 1993; 31:667–681.
13.
PowersMB, EmmelkampPMG. Virtual reality exposure therapy for anxiety disorders: A meta-analysis. Journal of Anxiety Disorders, 2008; 22:561–569.
14.
BushJ. Viability of virtual reality exposure therapy as a treatment alternative. Computers in Human Behavior, 2008; 24:1032–1040.
DifedeJ, HoffmanHG. VR exposure therapy for World Trade Center posttraumatic stress disorder: Case report. Cyberpsychology & Behavior, 2002; 5:529–535.
17.
RothbaumBO, HodgesL, ReadyDet al.Virtual reality exposure therapy for Vietnam veterans with posttraumatic stress disorder. Journal of Clinical Psychiatry, 2001; 62:617–622.
18.
KlingerE, BouchardS, LégeronPet al.Virtual reality therapy versus cognitive behavior therapy for social phobia: a preliminary controlled study. Cyberpsychology & Behavior, 2005; 8:76–88.
19.
FreemanD. 2008. Studying and treating schizophrenia using virtual reality: a new paradigm. Schizophrenia Bulletin, 2008; 34:605–610.
20.
Fornells-AmbrojoM, BarkerC, SwappDet al.Virtual reality and persecutory delusions: safety and feasibility. Schizophrenia Research, 2008; 104:228–236.
21.
ChandlerGM, BurckHD, SampsonJ. Generic computer program for systematic desensitization: Description, construction and case study. Journal of Behavior Therapy and Experimental Psychiatry, 1986; 17:171–174.
22.
ClarkA, KirkbyKC, DanielsBA, MarksIM. A pilot study of computer-aided vicarious exposure for OCD. Australian & New Zealand Journal of Psychiatry, 1998; 32:268–275.
23.
AndersonP, RothbaumBO, HodgesLF. Virtual reality exposure in the treatment of social anxiety. Cognitive and Behavioral Practice, 2003; 10:240–247.
24.
LeeJM, KuJH, JangDPet al.Virtual reality system for treatment of the fear of public speaking using image-based rendering and moving pictures. Cyberpsychology & Behavior, 2002; 5:191–195.
25.
KaySR, OplarLA, LindenmayerJP. Reliability and validity of the positive and negative syndrome scale for schizophrenics. Psychiatry Research, 1987; 23:111–114.
26.
MattickRP, ClarkeJC. Development and validation of measures of social phobia, scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 1998; 36:455–470.
27.
PetersL. Discriminant validity of the Social Phobia and Anxiety Inventory (SPAI), the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS)Behaviour Research and Therapy, 2000; 38:943–950.
28.
ButlerG. 2007. Overcoming Social Anxiety and Shyness Self-help Course (3 Parts): A 3-part Programme Based on Cognitive Behavioural Techniques. London: Robinson.
29.
ClarkDM, WellsA. 1995. A cognitive model of social phobia. HeimbergRG, LiebowitzMR, HopeDA, SchneierER. Social phobia: Diagnosis, assessment and treatment. New York: Guilford Press, 69–93.
30.
GreenCEL, FreemanD, KuipersEet al.Measuring ideas of persecution and social reference: the Green et al. Paranoid Thought Scales (GPTS)Psychological Medicine, 2008; 38:101–111.
31.
FowlerD, FreemanD, SmithBet al.The Brief Core Schema Scales (BCSS): psychometric properties and associations with paranoia and grandiosity in non-clinical and psychosis samples. Psychological Medicine, 2006; 36:749–759.
32.
PriceM, AndersonP. The role of presence in virtual reality exposure therapy. Journal of Anxiety Disorders, 2007; 21:742–775.
33.
WiederholdBK, WiederholdMD. 2005. The effect of presence on virtual reality treatment. WiederholdBK, WiederholdMD. Virtual reality therapy for anxiety disorders: advances in evaluation and treatment. Washington, DC: American Psychological Association, 77–86.
34.
KrijnM, EmmelkampPMG, BiemondRet al.Treatment of acrophobia in virtual reality: The role of immersion and presence. Behaviour Research and Therapy, 2004; 42:229–239.
35.
RapeeRM, HeimbergRG. A cognitive-behavioral model of anxiety in social phobia. Behaviour Research & Therapy, 1997; 35:741–756.
36.
SierraM. 2009. Depersonalization: A New Look at a Neglected Syndrome. Cambridge, United Kingdom: Cambridge University Press.
