title: Can virtual reality reduce reality distortion? Impact of performance feedback on symptom change in schizophrenia patients.
abstract: OBJECTIVE
  There is emerging evidence that the induction of doubt can reduce positive symptoms in patients with schizophrenia. Based on prior investigations indicating that brief psychological interventions may attenuate core aspects of delusions, we set up a proof of concept study using a virtual reality experiment. We explored whether feedback for false judgments positively influences delusion severity.
  
  
  METHODS
  A total of 33 patients with schizophrenia participated in the experiment. Following a short practice trial, patients were instructed to navigate through a virtual street on two occasions (noise versus no noise), where they met six different pedestrians in each condition. Subsequently, patients were asked to recollect the pedestrians and their corresponding facial affect in a recognition task graded for confidence. Before and after the experiment, the Paranoia Checklist (frequency subscale) was administered.
  
  
  RESULTS
  The Paranoia Checklist score declined significantly from pre to post at a medium effect size. We split the sample into those with some improvement versus those that either showed no improvement, or worsened. Improvement was associated with lower confidence ratings (both during the experiment, particularly for incorrect responses, and according to retrospect assessment).
  
  
  CONCLUSIONS
  No control condition, unclear if improvement is sustained.
  
  
  CONCLUSIONS
  The study tentatively suggests that a brief virtual reality experiment involving error feedback may ameliorate delusional ideas. Randomized controlled trials and dismantling studies are now needed to substantiate the findings and to pinpoint the underlying therapeutic mechanisms, for example error feedback or fostering attenuation of confidence judgments in the face of incomplete evidence.
authors.affiliation: University Medical Center Hamburg Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany. Electronic address: moritz@uke.uni-hamburg.de.
authors.forename: Steffen
authors.initials: S
authors.lastname: Moritz
authors.affiliation: University Medical Center Hamburg Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany.
authors.forename: Miriam
authors.initials: M
authors.lastname: Voigt
authors.affiliation: University Medical Center Hamburg Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Köther
authors.affiliation: University Medical Center Hamburg Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany.
authors.forename: Lucy
authors.initials: L
authors.lastname: Leighton
authors.affiliation: University Medical Center Hamburg Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany.
authors.forename: Besiane
authors.initials: B
authors.lastname: Kjahili
authors.affiliation: University Medical Center Hamburg Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany.
authors.forename: Zehra
authors.initials: Z
authors.lastname: Babur
authors.affiliation: University Medical Center Hamburg Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany.
authors.forename: David
authors.initials: D
authors.lastname: Jungclaussen
authors.affiliation: University Medical Center Hamburg Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany.
authors.forename: Ruth
authors.initials: R
authors.lastname: Veckenstedt
authors.affiliation: University Medical Center Hamburg Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, 20246 Hamburg, Germany.
authors.forename: Karsten
authors.initials: K
authors.lastname: Grzella
mesh_terms: D000328:Adult; D005246:Feedback; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010775:Photic Stimulation; D011237:Predictive Value of Tests; D021641:Recognition, Psychology; D015203:Reproducibility of Results; D012559:Schizophrenia / Q000534:rehabilitation*; D012565:Schizophrenic Psychology; D011795:Surveys and Questionnaires; D014584:User-Computer Interface; D063367:Virtual Reality Exposure Therapy / Q000379:methods*
keywords: Bias modification; Confidence; Error feedback; Schizophrenia; Virtual reality