van der Stouwe Elisabeth C D, Booij Sanne H, Geraets Chris N W, Pot-Kolder Roos M C A, Kuranova Anna, van der Gaag Mark, Veling Wim
University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, Netherlands.
University Medical Center Groningen, University Center Psychiatry (UCP) Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, Groningen, Netherlands.
Front Psychiatry. 2024 Apr 30;15:1360165. doi: 10.3389/fpsyt.2024.1360165. eCollection 2024.
Studies have consistently demonstrated increased stress sensitivity in individuals with psychosis. Since stress sensitivity may play a role in the onset and maintenance of psychosis, this could potentially be a promising target for treatment. The current study was the first to investigate whether reactivity to and recovery from daily-life stressors in psychosis change in response to treatment, namely virtual-reality-based cognitive behavioral therapy (VR-CBT).
116 patients were randomized to either VR-CBT or the waiting list control group (WL). Pre-treatment and post-treatment participants completed a diary ten times a day during six to ten days. Multilevel analyses were used to model the time-lagged effects of daily stressful events on negative affect (NA) and paranoia symptoms to examine reactivity and recovery.
There was a significant difference in NA reactivity. VR-CBT showed higher NA at post-treatment compared to pre-treatment than WL (b=0.14; b=0.19 vs b=0.18; b=0.14). There was a significant difference in NA recovery and paranoia recovery between the groups at lag 1: VR-CBT showed relatively lower negative affect (b=0.07; b=-0.06) and paranoia (b= 0.08; b=-0.10) at post-treatment compared to pre-treatment than WL (b=0.08; b=0.08; b=0.04; b=0.03).
Negative affect and paranoia recovery improved in response to treatment. Increased NA reactivity may be explained by a decrease in safety behavior in the VR-CBT group. The discrepancy between reactivity and recovery findings may be explained by the inhibitory learning theory that suggests that an original threat reaction may not erase but can be inhibited as a consequence of exposure therapy.
研究一直表明，精神病患者的应激敏感性增强。由于应激敏感性可能在精神病的发作和维持中起作用，这可能成为一个有前景的治疗靶点。当前的研究首次调查了精神病患者对日常生活应激源的反应性以及从应激源中恢复的情况是否会因治疗（即基于虚拟现实的认知行为疗法，VR - CBT）而发生变化。
116名患者被随机分为VR - CBT组或等待名单对照组（WL）。治疗前和治疗后，参与者在六至十天内每天记录十次日记。采用多层次分析来模拟日常应激事件对消极情绪（NA）和偏执症状的时间滞后效应，以检验反应性和恢复情况。
NA反应性存在显著差异。与WL相比，VR - CBT组治疗后NA较治疗前升高（b = 0.14；b = 0.19对比b = 0.18；b = 0.14）。在滞后1时，两组间NA恢复和偏执恢复存在显著差异：与WL相比，VR - CBT组治疗后消极情绪（b = 0.07；b = - 0.06）和偏执（b = 0.08；b = - 0.10）较治疗前相对更低（b = 0.08；b = 0.08；b = 0.04；b = 0.03）。
消极情绪和偏执恢复情况因治疗而改善。VR - CBT组中NA反应性增加可能是由于安全行为减少所致。反应性和恢复结果之间的差异可能由抑制性学习理论解释，该理论表明，最初的威胁反应可能不会消除，但由于暴露疗法可能会受到抑制。
