Table 4.
Studies that addressed quality of life.
| Reference and country | Assessment of bias (ROB 2/ROBINS-I) | Treatment modalities/methods and therapist/trainer facilitation | Experimental conditiona | Control condition (if applicable)b | Duration and frequency of intervention | Skills and/or functional domains targeted | Outcome measurements | Results/effects of intervention |
|---|---|---|---|---|---|---|---|---|
| Dellazizzo et al. (51) Canada |
ROBINS I: serious risk of bias | Virtual reality assisted therapy (VRT): participants created an avatar best resembling the most distressing entity believed to be the source of the malevolent voice and engaged in a dialogue with it. Idiosyncratic avatars were created using Unity 3D game engine and voice was simulated with a voice transformer. Participants were immersed through Samsung GearVR head-mounted display and smartphone. Facilitated by a psychiatrist. Participants engaged with the therapist via the personalized avatars. |
Single arm pretest-post-test. Participants who had completed Cognitive-Behavioral Therapy for Auditory Verbal Hallucinations received VRT. Persons with refractory schizophrenia or schizoaffective disorders. n = 10 M = 43.4 (no SD provided). 20% female and 80% male. |
NIL | Six sessions 1 h per session |
Quality of life | Quality of life: Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (QLESQ-SF). Other scales: Psychotic Symptoms Rating Scale, Beliefs About Voices Questionnaire-Revised, BDI-II, and PANNS. |
Significant changes from pre-VRT to follow-up VRT, yielding a moderate effect size. |
| Du Sert et al. (48) Canada |
ROB2: high risk of bias | VR-assisted therapy (VRT): Immersive virtual reality in which participants created an avatar best resembling the most distressing entity believed to be the source of the malevolent voice and engaged in a dialogue with it. Idiosyncratic avatars were created using Unity 3D game engine and voice was simulated with a voice transformer. Participants were immersed through Samsung GearVR head mounted display and smartphone. Facilitated by a psychiatrist. Participants engaged with the therapist via the personalized avatars. |
Randomized, partial cross-over trial. VR-assisted therapy (VRT) group Persons with refractory schizophrenia or schizoaffective disorders. Total n = 15 (unclear on sample size in experimental and control conditions, although randomized in 1:1 ratio) M = 42.9 (total participants including controls) |
Treatment-as-usual. | 7 weekly sessions (one avatar creation session and six 45-min therapeutic sessions). | Quality of life. | Quality of life: Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form (QLESQ-SF) Other scales: Psychotic Symptoms Rating Scale, Beliefs About Voices Questionnaire-Re-vised, PANNS, and BDI-II |
No analysis between experimental and control group reported. Statistically significant change in QLESQ-SF scores between baseline and post-intervention. |
| Maskey et al. (52) United Kingdom |
ROBINS-I: serious risk of bias | Cognitive Behavior Therapy combined with Virtual Reality Exposure (VRE) to reduce anxiety. Initial sessions conducted with participants and their supporters at home. Subsequently, the participants and supporters visited Blue Room VRE, a 360-degree seamless screened room with computer-generated images projected onto the walls and ceilings. No headsets and goggles used and navigated using tablet by psychologist. Conducted by clinical psychologist. |
Single arm pre-post study Adults diagnosed with ASD. n = 8 M = 29.8 (range 18.8–57.0) |
NIL | One session with therapist to learn anxiety management techniques. Then, four 20-min sessions of graded exposure in an immersive VR room. Participant then tried real-life exposure. Measured progress at 6 weeks and 6 months after the last VR session. |
Quality of life and self-reported functional outcomes | Quality of life: WHOQOL-BREF Self-report ratings of participants' confidence in managing the target anxiety situation, using 6-point visual analog scale. Other scales: BAI, GAD-7, and PHQ-9. |
No significant changes in WHOQOL-BREF measures. Five out of eight participants reported improvements in day-to-day situations. |
aSample characteristic: n = x denotes the number of patients in that condition, M = mean age in years and standard deviation (given in parentheses), sample type.
bSample characteristics: n = x denotes the number of patients in that condition, M = mean age in years and standard deviation (given in parentheses), sample type.
ACS-SP, Advanced Clinical Solutions for WAIS-IV and WMS-IV Social Perception Subtest; BAI, Beck Anxiety Inventory; BDI, Beck Depression Inventory; BDI-II, Beck Depression Inventory II; BLERT, Bell-Lysaker Emotion Recognition Task; BPRS, Brief Psychiatric Rating Scale; ESM, Experience Sampling Method; GAD-7, Generalized Anxiety Disorder 7; HADS, Hospital Anxiety and Depression Scale; HMD, Head Mounted Display; IQ, Intellectual Quotient; MBI, Modified Barthel Index; MMSE, Mini Mental State Examination; MoCA, Montreal Cognitive Assessment; PDD-NOS, Pervasive Developmental Disorder-Not Otherwise Specified; PHQ-9, Patient Health Questionnaire-9; PSP, Personal and Social Performance Scale; PTSD, Post-Traumatic Stress Disorder; QOL, Quality of Life; RBANS, Repeatable Battery for the Assessment of Neuropsychological Status; RCFT, Rey–Osterrieth Complex Figure Test; SANS, Scale for the Assessment of Negative Symptoms; SOFA, Social and Occupational Functioning Assessment Scale; SRS, Social Responsiveness Scale; SFS, Social Functioning Scale; VABS, Vineland Adaptive Behavior Scales; WAIS III, Wechsler Adult Intelligence Scale III; VCRS, Vocational Cognitive Rating Scale; WCST, Wisconsin Card Sorting Test; WHOQOL-BREF, World Health Organization Quality of Life abbreviated.