Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
Schizophr Res. 2022 Dec;250:50-59. doi: 10.1016/j.schres.2022.10.008. Epub 2022 Nov 4.
The social withdrawal of many patients with psychosis can be conceptualised as agoraphobic avoidance due to a range of long-standing fears. We hypothesised that greater severity of agoraphobic avoidance is associated with higher levels of psychiatric symptoms and lower levels of quality of life. We also hypothesised that patients with severe agoraphobic avoidance would experience a range of benefits from an automated virtual reality (VR) therapy that allows them to practise everyday anxiety-provoking situations in simulated environments.
345 patients with psychosis in a randomised controlled trial were categorised into average, moderate, high, and severe avoidance groups using the Oxford Agoraphobic Avoidance Scale. Associations of agoraphobia severity with symptom and functioning variables, and response over six months to brief automated VR therapy (gameChange), were tested.
Greater severity of agoraphobic avoidance was associated with higher levels of persecutory ideation, auditory hallucinations, depression, hopelessness, and threat cognitions, and lower levels of meaningful activity, quality of life, and perceptions of recovery. Patients with severe agoraphobia showed the greatest benefits with gameChange VR therapy, with significant improvements at end of treatment in agoraphobic avoidance, agoraphobic distress, ideas of reference, persecutory ideation, paranoia worries, recovering quality of life, and perceived recovery, but no significant improvements in depression, suicidal ideation, or health-related quality of life.
Patients with psychosis with severe agoraphobic avoidance, such as being unable to leave the home, have high clinical need. Automated VR therapy can deliver clinical improvement in agoraphobia for these patients, leading to a number of wider benefits.
许多精神病患者的社交退缩可以被概念化为由于一系列长期存在的恐惧而导致的广场恐惧症回避。我们假设，回避程度越严重，精神症状越严重，生活质量越低。我们还假设，严重回避广场恐惧症的患者将从一种自动化虚拟现实（VR）治疗中获得一系列益处，这种治疗允许他们在模拟环境中练习日常引起焦虑的情况。
345 名随机对照试验中的精神病患者使用牛津广场恐惧症回避量表分为回避平均、中度、高度和严重组。测试了广场恐惧症严重程度与症状和功能变量的关联，以及对简短自动化 VR 治疗（gameChange）的六个月反应。
回避程度越严重，被害妄想、幻听、抑郁、绝望和威胁认知程度越高，有意义的活动、生活质量和康复感知程度越低。回避严重的患者从 gameChange VR 治疗中获益最大，治疗结束时在广场恐惧症回避、广场恐惧症痛苦、参照观念、被害妄想、偏执担忧、康复生活质量和感知康复方面有显著改善，但抑郁、自杀意念和健康相关生活质量没有显著改善。
回避程度严重的精神病患者，如无法离开家，有很高的临床需求。自动化 VR 治疗可以为这些患者提供恐惧症的临床改善，并带来许多其他益处。
