Cognitive Remediation for Psychosis in Virtual Reality (ThinkTactic VR): Qualitative, Iterative, and User-Centered Codevelopment Study.

BACKGROUND

Cognitive remediation improves cognition and psychosocial functioning in individuals with psychotic disorders. The use of virtual reality (VR) to deliver cognitive remediation in immersive environments that mimic real cognitively challenging situations has the potential to increase engagement to treatment and further enhance its impact on functioning.

OBJECTIVE

We aimed to codevelop a cognitive remediation program in VR with individuals with psychotic disorders and health care professionals to identify and address their needs.

METHODS

Individuals with lived experience of a psychosis-spectrum condition (n=11) met 9 times and the health care professionals (n=7) met 3 times. Participants discussed personal and professional opinions on the challenges associated with cognitive difficulties in individuals with psychotic disorders. They also provided feedback on the program development.

RESULTS

We discerned 4 themes from the content expert working groups: the need for a program to address cognitive impairments, the key program design elements to support cognitive rehabilitation, the importance of leveraging technology as an intervention tool, and the need to improve community functioning. In total, 3 themes were identified for the health care professionals: the need for a clinically relevant program that addresses the research-to-practice gap, the need to improve patient engagement in services, and the need for a program that addresses the limited resources in health care. The needs of our end-user experts were placed at the center of the program development process. When possible, we also integrated their suggestions, like the incorporation of a virtual coach within the immersive environment.

CONCLUSIONS

Individuals with lived experience and health care professionals have distinct needs, which have informed the co-design of a novel cognitive remediation program in VR, ThinkTactic VR. To our knowledge, ThinkTactic VR is one of the first co-designed and codeveloped cognitive remediation programs in VR using an iterative, user-centered approach involving both individuals with psychotic disorders and health care professionals.