Bogie Bryce J M, Noël Chelsea, Gu Feng, Nadeau Sébastien, Shvetz Cecelia, Khan Hassan, Rivard Marie-Christine, Bouchard Stéphane, Lepage Martin, Guimond Synthia
MD/PhD Program, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Schizophr Res Cogn. 2024 Mar 7;36:100305. doi: 10.1016/j.scog.2024.100305. eCollection 2024 Jun.
Schizophrenia is associated with impairments in verbal episodic memory. Strategy for Semantic Association Memory (SESAME) training represents a promising cognitive remediation program to improve verbal episodic memory. Virtual reality (VR) may be a novel tool to increase the ecological validity and transfer of learned skills of traditional cognitive remediation programs. The present proof-of-concept study aimed to assess the feasibility, acceptability, and preliminary efficacy of a VR-based cognitive remediation module inspired by SESAME principles to improve the use of verbal episodic memory strategies in schizophrenia.
Thirty individuals with schizophrenia/schizoaffective disorder completed this study. Participants were randomized to either a VR-based verbal episodic memory training condition inspired by SESAME principles (intervention group) or an active control condition (control group). In the training condition, a coach taught semantic encoding strategies (active rehearsal and semantic clustering) to help participants remember restaurant orders in VR. In the active control condition, participants completed visuospatial puzzles in VR. Attrition rate, participant experience ratings, and cybersickness questionnaires were used to assess feasibility and acceptability. Trial 1 of the Hopkins Verbal Learning Test - Revised was administered pre- and post-intervention to assess preliminary efficacy.
Feasibility was demonstrated by a low attrition rate (5.88 %), and acceptability was demonstrated by limited cybersickness and high levels of enjoyment. Although the increase in the number of semantic clusters used following the module did not reach conventional levels of statistical significance in the intervention group, it demonstrated a notable trend with a medium effect size ( = 1.48, = 0.15, = 0.54), in contrast to the control group where it remained stable ( = 0.36, = 0.72, = 0.13). These findings were similar for the semantic clustering ratio in the intervention ( = 1.61, = 0.12, = 0.59) and control ( = 0.36, = 0.72, = 0.13) groups. There was no significant change in the number of recalled words in either group following VR immersion.
This VR intervention was feasible, acceptable, and may be useful for improving the use of semantic encoding strategies. These findings support the use of more ecological approaches for the treatment of cognitive impairments in schizophrenia, such as VR-based cognitive remediation.
精神分裂症与言语情景记忆受损有关。语义联想记忆策略（SESAME）训练是一种很有前景的认知康复计划，旨在改善言语情景记忆。虚拟现实（VR）可能是一种新颖的工具，可提高传统认知康复计划所学技能的生态效度和迁移能力。本概念验证研究旨在评估受SESAME原则启发的基于VR的认知康复模块在改善精神分裂症患者言语情景记忆策略使用方面的可行性、可接受性和初步疗效。
30名精神分裂症/分裂情感性障碍患者完成了本研究。参与者被随机分为受SESAME原则启发的基于VR的言语情景记忆训练组（干预组）或积极对照组（对照组）。在训练组中，一名教练教授语义编码策略（主动复述和语义聚类），以帮助参与者在VR中记住餐厅订单。在积极对照组中，参与者在VR中完成视觉空间拼图。使用失访率、参与者体验评分和晕动症问卷来评估可行性和可接受性。在干预前后进行霍普金斯言语学习测试修订版的第1次试验，以评估初步疗效。
低失访率（5.88%）证明了可行性，有限的晕动症和高度的愉悦感证明了可接受性。尽管干预组在模块后使用的语义聚类数量增加未达到传统的统计学显著水平，但显示出显著趋势，效应量中等（=1.48，=0.15，=0.54），而对照组则保持稳定（=0.36，=0.72，=0.13）。干预组（=1.61，=0.12，=0.59）和对照组（=0.36，=0.72，=0.13）的语义聚类率结果相似。VR沉浸后，两组的回忆单词数量均无显著变化。
这种VR干预是可行的、可接受的，可能有助于改善语义编码策略的使用。这些发现支持使用更具生态性的方法来治疗精神分裂症的认知障碍，如基于VR的认知康复。
