A Feasibility and Acceptability Trial of Social Cognitive Therapy in Early Psychosis Delivered Through a Virtual World: The VEEP Study

Andrew Thompson; Farah Elahi; Alba Realpe; Max Birchwood; David Taylor; Ivo Vlaev; Fiona Leahy; Sandra Bucci

doi:10.3389/fpsyt.2020.00219

A Feasibility and Acceptability Trial of Social Cognitive Therapy in Early Psychosis Delivered Through a Virtual World: The VEEP Study

Front Psychiatry. 2020 Mar 25:11:219. doi: 10.3389/fpsyt.2020.00219. eCollection 2020.

Authors

Andrew Thompson^{1

2}, Farah Elahi², Alba Realpe³, Max Birchwood², David Taylor⁴, Ivo Vlaev⁵, Fiona Leahy², Sandra Bucci^{6

7}

Affiliations

¹ Orygen, the Centre for Excellence in Youth Mental Health, Melbourne, VIC, Australia.
² Warwick Medical School, University of Warwick, Coventry, United Kingdom.
³ Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
⁴ Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, University of London, London, United Kingdom.
⁵ Behavioural Science Group, Warwick Business School, University of Warwick, Coventry, United Kingdom.
⁶ Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, Manchester, United Kingdom.
⁷ Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom.

Abstract

Background: Addressing specific social cognitive difficulties is an important target in early psychosis and may help address poor functional outcomes. However, structured interventions using standard therapy settings including groups suffer from difficulties in recruitment and retention.

Aims: To address these issues, we aimed to modify an existing group social cognitive intervention entitled 'Social Cognition and Interaction Training' (SCIT) to be delivered through a virtual world environment (Second Life ©).

Methods: A single arm nonrandomized proof-of-concept trial of SCIT-VR was conducted. Five groups of three to five individuals per group were recruited over 6 months. Eight sessions of SCIT-VR therapy were delivered through the virtual world platform Second Life© over a 5-week intervention window. Feasibility was examined using recruitment rates and retention. Acceptability was examined using qualitative methods. Secondary outcomes including social cognitive indices, functioning, and anxiety were measured pre- and postintervention.

Results: The SCIT-VR therapy delivered was feasible (36% consent rate and 73.3% intervention completion rate), acceptable (high overall postsession satisfaction scores) and safe (no serious adverse events), and had high levels of participant satisfaction. Users found the environment immersive. Prepost changes were found in emotion recognition scores and levels of anxiety. There were no signs of clinical deterioration on any of the secondary measures.

Conclusion: This proof-of-concept pilot trial suggested that delivering SCIT-VR through a virtual world is feasible and acceptable. There were some changes in prepost outcome measures that suggest the intervention has face validity. There is sufficient evidence to support a larger powered randomized controlled trial.

Clinical trial registration: ISRCTN, identifier 41443166.

Keywords: first episode psychosis; proof-of-concept trial; psychosis; social cognition therapy; virtual environments; virtual world.