Holopainen Roope, Tiihonen Jari, Lähteenvuo Markku
Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Front Psychiatry. 2023 Aug 4;14:1208287. doi: 10.3389/fpsyt.2023.1208287. eCollection 2023.
Extended reality (XR) is an umbrella term for virtual reality (VR) and augmented reality (AR), both novel vectors for therapeutic intervention modalities. In VR, head-mounted devices (HMD) allow interaction with three-dimensional virtual environments and simulated avatars, while AR overlaps virtual, simulated objects to observe physical reality. Treatment through immersive VR has been studied in psychiatry, including patients suffering from schizophrenia spectrum disorders, while there has not been much attention to AR technologies in psychiatry. Our systematic review aimed to examine the currently available literature regarding the treatment efficacy of immersive VR or AR technologies on different symptom domains of schizophrenia spectrum disorders, screen for potential adverse effects, and gather data on the technological and human resource requirements of such interventions to help guide future research.
We conducted a systematic literature review with database searches carried out between 9/2021 and 8/2022 through PubMed, Scopus, EBSCOhost Academic Search Premier, and Web of Science.
We identified 2,157 records, 214 were assessed further for eligibility and 12 met inclusion criteria. All included articles studied immersive VR and none used AR technology. Included studies were heterogenous in nature, including AVATAR therapy (3) and CBT-based (5) VR interventions, as well as cognitive (2), social (1), and relaxation (1) training through VR. The comparison groups were either passive controls (waitlist and treatment as usual), therapeutic interventions (CBT and Integrated psychological treatment), passive VR environments, or traditional, comparable, non-virtual treatment modalities (social roleplay and progressive muscle relaxation training). Pooled together, the included studies on VR show positive treatment effects in all major symptom domains of schizophrenia spectrum disorders with hardly any adverse effects related to the intervention modalities.
In this review, we have showcased how different symptom domains can be targeted through VR interventions, highlighting VR as a potential new vector for a diverse range of psychosocial therapeutic modalities that allow for completely new possibilities in the treatment of schizophrenia spectrum disorders. VR technology still requires more research and validation. Our review also shows that there are currently no studies examining AR technology in the treatment of schizophrenia spectrum disorders, indicating a distinctive research gap.
扩展现实（XR）是虚拟现实（VR）和增强现实（AR）的统称，二者都是治疗干预方式的新型载体。在VR中，头戴式设备（HMD）可实现与三维虚拟环境及模拟化身的交互，而AR则是将虚拟的模拟物体叠加于物理现实之上以供观察。沉浸式VR治疗已在精神病学领域得到研究，包括针对精神分裂症谱系障碍患者的研究，但AR技术在精神病学领域尚未受到太多关注。我们的系统评价旨在审视关于沉浸式VR或AR技术对精神分裂症谱系障碍不同症状领域治疗效果的现有文献，筛查潜在不良反应，并收集此类干预措施的技术和人力资源需求数据，以助力指导未来研究。
我们进行了一项系统文献综述，于2021年9月至2022年8月期间通过PubMed、Scopus、EBSCOhost学术搜索高级版和科学网进行数据库检索。
我们共识别出2157条记录，其中214条记录进一步评估了其 eligibility，12条符合纳入标准。所有纳入文章均研究了沉浸式VR，无一使用AR技术。纳入研究性质各异，包括阿凡达疗法（3项）和基于认知行为疗法（CBT）的VR干预（5项），以及通过VR进行的认知训练（2项）、社交训练（1项）和放松训练（1项）。对照组包括被动对照组（等待名单和常规治疗）、治疗性干预措施（CBT和综合心理治疗）、被动VR环境，或传统的、可比的非虚拟治疗方式（社会角色扮演和渐进性肌肉松弛训练）。综合来看，纳入的关于VR的研究显示，在精神分裂症谱系障碍的所有主要症状领域均有积极的治疗效果，且几乎没有与干预方式相关的不良反应。
在本综述中，我们展示了如何通过VR干预针对不同症状领域，强调VR作为一系列心理社会治疗方式的潜在新载体，为精神分裂症谱系障碍的治疗带来全新可能性。VR技术仍需更多研究和验证。我们的综述还表明，目前尚无研究考察AR技术在精神分裂症谱系障碍治疗中的应用，这显示出一个明显的研究空白。
