title: Virtual reality in the treatment of persecutory delusions: randomised controlled experimental study testing how to reduce delusional conviction.
abstract: Persecutory delusions may be unfounded threat beliefs maintained by safety-seeking behaviours that prevent disconfirmatory evidence being successfully processed. Use of virtual reality could facilitate new learning.
  
  
  
  To test the hypothesis that enabling patients to test the threat predictions of persecutory delusions in virtual reality social environments with the dropping of safety-seeking behaviours (virtual reality cognitive therapy) would lead to greater delusion reduction than exposure alone (virtual reality exposure).
  
  
  
  Conviction in delusions and distress in a real-world situation were assessed in 30 patients with persecutory delusions. Patients were then randomised to virtual reality cognitive therapy or virtual reality exposure, both with 30 min in graded virtual reality social environments. Delusion conviction and real-world distress were then reassessed.
  
  
  
  In comparison with exposure, virtual reality cognitive therapy led to large reductions in delusional conviction (reduction 22.0%, P = 0.024, Cohen's d = 1.3) and real-world distress (reduction 19.6%, P = 0.020, Cohen's d = 0.8).
  
  
  
  Cognitive therapy using virtual reality could prove highly effective in treating delusions.
authors.affiliation: Daniel Freeman, PhD, DClinPsy, Jonathan Bradley, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Angus Antley, PhD, Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK; Emilie Bourke, ScM, Natalie DeWeever, BSc, Nicole Evans, BSc, Emma Černis, MSc, Bryony Sheaves, DClinPsy, Felicity Waite, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK; Mel Slater, DSc, Department of Computer Science, University College London, London, UK and Institució Catalana de Recerca i Estudis Avançats (ICREA), University of Barcelona, Spain; David M. Clark, DPhil, Department of Experimental Psychology, University of Oxford, Oxford, UK daniel.freeman@psych.ox.ac.uk.
authors.forename: Daniel
authors.initials: D
authors.lastname: Freeman
authors.affiliation: Daniel Freeman, PhD, DClinPsy, Jonathan Bradley, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Angus Antley, PhD, Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK; Emilie Bourke, ScM, Natalie DeWeever, BSc, Nicole Evans, BSc, Emma Černis, MSc, Bryony Sheaves, DClinPsy, Felicity Waite, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK; Mel Slater, DSc, Department of Computer Science, University College London, London, UK and Institució Catalana de Recerca i Estudis Avançats (ICREA), University of Barcelona, Spain; David M. Clark, DPhil, Department of Experimental Psychology, University of Oxford, Oxford, UK.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bradley
authors.affiliation: Daniel Freeman, PhD, DClinPsy, Jonathan Bradley, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Angus Antley, PhD, Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK; Emilie Bourke, ScM, Natalie DeWeever, BSc, Nicole Evans, BSc, Emma Černis, MSc, Bryony Sheaves, DClinPsy, Felicity Waite, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK; Mel Slater, DSc, Department of Computer Science, University College London, London, UK and Institució Catalana de Recerca i Estudis Avançats (ICREA), University of Barcelona, Spain; David M. Clark, DPhil, Department of Experimental Psychology, University of Oxford, Oxford, UK.
authors.forename: Angus
authors.initials: A
authors.lastname: Antley
authors.affiliation: Daniel Freeman, PhD, DClinPsy, Jonathan Bradley, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Angus Antley, PhD, Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK; Emilie Bourke, ScM, Natalie DeWeever, BSc, Nicole Evans, BSc, Emma Černis, MSc, Bryony Sheaves, DClinPsy, Felicity Waite, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK; Mel Slater, DSc, Department of Computer Science, University College London, London, UK and Institució Catalana de Recerca i Estudis Avançats (ICREA), University of Barcelona, Spain; David M. Clark, DPhil, Department of Experimental Psychology, University of Oxford, Oxford, UK.
authors.forename: Emilie
authors.initials: E
authors.lastname: Bourke
authors.affiliation: Daniel Freeman, PhD, DClinPsy, Jonathan Bradley, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Angus Antley, PhD, Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK; Emilie Bourke, ScM, Natalie DeWeever, BSc, Nicole Evans, BSc, Emma Černis, MSc, Bryony Sheaves, DClinPsy, Felicity Waite, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK; Mel Slater, DSc, Department of Computer Science, University College London, London, UK and Institució Catalana de Recerca i Estudis Avançats (ICREA), University of Barcelona, Spain; David M. Clark, DPhil, Department of Experimental Psychology, University of Oxford, Oxford, UK.
authors.forename: Natalie
authors.initials: N
authors.lastname: DeWeever
authors.affiliation: Daniel Freeman, PhD, DClinPsy, Jonathan Bradley, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Angus Antley, PhD, Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK; Emilie Bourke, ScM, Natalie DeWeever, BSc, Nicole Evans, BSc, Emma Černis, MSc, Bryony Sheaves, DClinPsy, Felicity Waite, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK; Mel Slater, DSc, Department of Computer Science, University College London, London, UK and Institució Catalana de Recerca i Estudis Avançats (ICREA), University of Barcelona, Spain; David M. Clark, DPhil, Department of Experimental Psychology, University of Oxford, Oxford, UK.
authors.forename: Nicole
authors.initials: N
authors.lastname: Evans
authors.affiliation: Daniel Freeman, PhD, DClinPsy, Jonathan Bradley, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Angus Antley, PhD, Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK; Emilie Bourke, ScM, Natalie DeWeever, BSc, Nicole Evans, BSc, Emma Černis, MSc, Bryony Sheaves, DClinPsy, Felicity Waite, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK; Mel Slater, DSc, Department of Computer Science, University College London, London, UK and Institució Catalana de Recerca i Estudis Avançats (ICREA), University of Barcelona, Spain; David M. Clark, DPhil, Department of Experimental Psychology, University of Oxford, Oxford, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Černis
authors.affiliation: Daniel Freeman, PhD, DClinPsy, Jonathan Bradley, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Angus Antley, PhD, Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK; Emilie Bourke, ScM, Natalie DeWeever, BSc, Nicole Evans, BSc, Emma Černis, MSc, Bryony Sheaves, DClinPsy, Felicity Waite, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK; Mel Slater, DSc, Department of Computer Science, University College London, London, UK and Institució Catalana de Recerca i Estudis Avançats (ICREA), University of Barcelona, Spain; David M. Clark, DPhil, Department of Experimental Psychology, University of Oxford, Oxford, UK.
authors.forename: Bryony
authors.initials: B
authors.lastname: Sheaves
authors.affiliation: Daniel Freeman, PhD, DClinPsy, Jonathan Bradley, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Angus Antley, PhD, Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK; Emilie Bourke, ScM, Natalie DeWeever, BSc, Nicole Evans, BSc, Emma Černis, MSc, Bryony Sheaves, DClinPsy, Felicity Waite, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK; Mel Slater, DSc, Department of Computer Science, University College London, London, UK and Institució Catalana de Recerca i Estudis Avançats (ICREA), University of Barcelona, Spain; David M. Clark, DPhil, Department of Experimental Psychology, University of Oxford, Oxford, UK.
authors.forename: Felicity
authors.initials: F
authors.lastname: Waite
authors.affiliation: Daniel Freeman, PhD, DClinPsy, Jonathan Bradley, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Angus Antley, PhD, Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK; Emilie Bourke, ScM, Natalie DeWeever, BSc, Nicole Evans, BSc, Emma Černis, MSc, Bryony Sheaves, DClinPsy, Felicity Waite, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK; Mel Slater, DSc, Department of Computer Science, University College London, London, UK and Institució Catalana de Recerca i Estudis Avançats (ICREA), University of Barcelona, Spain; David M. Clark, DPhil, Department of Experimental Psychology, University of Oxford, Oxford, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Dunn
authors.affiliation: Daniel Freeman, PhD, DClinPsy, Jonathan Bradley, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Angus Antley, PhD, Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK; Emilie Bourke, ScM, Natalie DeWeever, BSc, Nicole Evans, BSc, Emma Černis, MSc, Bryony Sheaves, DClinPsy, Felicity Waite, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK; Mel Slater, DSc, Department of Computer Science, University College London, London, UK and Institució Catalana de Recerca i Estudis Avançats (ICREA), University of Barcelona, Spain; David M. Clark, DPhil, Department of Experimental Psychology, University of Oxford, Oxford, UK.
authors.forename: Mel
authors.initials: M
authors.lastname: Slater
authors.affiliation: Daniel Freeman, PhD, DClinPsy, Jonathan Bradley, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Angus Antley, PhD, Department of Psychiatry, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK; Emilie Bourke, ScM, Natalie DeWeever, BSc, Nicole Evans, BSc, Emma Černis, MSc, Bryony Sheaves, DClinPsy, Felicity Waite, DClinPsy, Department of Psychiatry, University of Oxford, Oxford, UK; Graham Dunn, PhD, Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK; Mel Slater, DSc, Department of Computer Science, University College London, London, UK and Institució Catalana de Recerca i Estudis Avançats (ICREA), University of Barcelona, Spain; David M. Clark, DPhil, Department of Experimental Psychology, University of Oxford, Oxford, UK.
authors.forename: David M
authors.initials: DM
authors.lastname: Clark
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003702:Delusions / Q000628:therapy*; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010259:Paranoid Disorders / Q000628:therapy*; D014584:User-Computer Interface