Paranoid delusions1/28/2024 VR provides a powerful experience that can be used to help patients with paranoid delusions dealing with environments and social situations that make them paranoid or anxious. VR is the computer-generated simulation of a three-dimensional environment in which patients can interact with objects and virtual characters in a seemingly real or physical way using special electronic equipment, such as a helmet with a screen inside (head-mounted display, HMD). Virtual Reality (VR) has a great potential to improve psychological treatment of paranoid delusions. Therefore, an improvement of treatment is urgently required. Nearly half of the patients with schizophrenia and other psychotic disorders do not benefit from current treatments. Although CBTp is the most effective psychological treatment for paranoid delusions, a recent meta-analysis reported only a small to medium effect size of 0.36. Moreover, the meticulous preparation required preceding behavioural interventions is time-consuming for therapists, as a result of which this part of CBTp is often not properly performed in clinical practice. However, behavioural interventions are often too stressful for patients, as a result of which they avoid those interventions. CBTp for paranoid delusions aims to challenge delusional beliefs by means of cognitive restructuring and behavioural interventions such as exposure and experiments testing thoughts and beliefs. Cognitive-behavioural therapy for psychosis (CBTp) is the main evidence-based psychological treatment for paranoid delusions. Many patients discontinue their medication regime due to the serious side effects of antipsychotics. A meta-analysis calculated a small to medium effect size of 0.44 for antipsychotic medication. Main treatment options for schizophrenia and other psychotic disorders are antipsychotic medication and psychological treatment. Since paranoid delusions and associated difficulties in social functioning cause a large burden on patients, effective interventions are of great importance. Many patients are socially isolated, have small social networks, and are unemployed. This complicates daily life, as regular activities such as seeing friends, talking to people, shopping, walking on the street or using public transport pose a major challenge. To avoid perceived threat, i.e., the fear that others may deliberately cause them harm, patients withdraw from social interactions and crowded places. Furthermore, patients with paranoid delusions often experience problems in social functioning. Paranoid delusions are associated with great distress, anxiety, depression, suicidal thoughts, and hospital admission. Seventy per cent of patients with schizophrenia and other psychotic disorders suffer from paranoid delusions, that are characterized by strong suspiciousness with the unfounded belief that other people are trying to harm them. VRcbt may become a preferred psychological treatment for paranoid delusions and social anxiety in patients with psychotic disorder. DiscussionĬomparison of VRcbt and CBTp will provide information about the relative (cost-) effectiveness of VRcbt for this population. Every session, participants and therapists will rate the level of paranoid ideation and global clinical impression. Primary outcome is the level of paranoid ideations in daily life social situations, measured with ecological momentary assessments (EMA) at semi-random moments ten times a day during seven days, before and after treatment. The two groups will be compared at baseline, post-treatment and six months follow-up. Standard CBTp also consists of maximum 16 sessions including exposure and behavioural experiments, delivered in an 8–12 week time frame. VRcbt consists of maximum 16 sessions in virtual social situations that trigger paranoid ideations and distress, delivered in an 8–12 week time frame. Patients will be randomized to either VRcbt or standard CBTp for paranoid delusions. MethodsĪ total of 106 patients with DSM-5 diagnosis of psychotic disorder and at least moderate level of paranoid ideations will be recruited for this multicentre randomized controlled trial (RCT). The present study aims to investigate whether VRcbt is more effective and cost-effective than regular CBTp in treating paranoid delusions and improving daily life social functioning of patients with psychotic disorders. As a next step, a direct comparison with CBTp is needed. In a previous study, we found that VR based CBT (VRcbt) for paranoid delusions is superior to waiting list. Virtual reality (VR) has a great potential to improve the effectiveness of CBTp. Cognitive-behavioural therapy for psychosis (CBTp) is the primary psychological treatment, but the median effect size is only small to medium. Paranoid delusions are associated with significant distress, hospital admission and social isolation. Seventy per cent of patients with psychotic disorders has paranoid delusions.
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