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Paranoia 'reduced' by virtual reality therapy

Virtual reality has been used to treat conditions like autism, PTSD and depression; now a new study claims that it could be used to reduce persecutory delusions in patients with paranoia. 

In a study published in the British Journal of Psychiatry, an Oxford University team found that patients experiencing paranoia could have their symptoms alleviated through a VR experience. 

"The patients had tried standard treatments, like medication, but still had strong paranoia," Daniel Freeman told WIRED. Freeman, who is a professor of clinical psychology at Oxford University, worked on the project.

"So the benefits of VR were shown for people who had difficulties despite treatment in mental health services."

The experiment used patients with persecutory delusions – people who mistakenly think that others are watching them or are trying to cause them harm of some kind. This can often lead to safety-seeking behaviour, wherein patients believe that particular threats were averted because of avoidance rather than because the threat was erroneous to begin with. For example, a patient may believe that they weren't attacked because they got off a bus when they felt paranoid, rather than because they were unlikely to be attacked in the first place. Almost all patients with persecutory paranoia indulge in this kind of safety-seeking behaviour. 

To examine how to alleviate or reduce this kind of behaviour, the team developed a VR experience to expose patients to situations that were likely to cause them paranoia-related anxiety. "Virtual social environments could provide a means for patients with severe paranoid to make the first steps towards entering their feared situations before taking the learning into the real world," the team write. 

30 patients with persecutory delusions were first asked to complete a 5 minute behavioural test in which they entered a real life social environment they were scared of (for example entering the Tube or walking to a shop). They were then given virtual reality cognitive therapy, and asked to rate how strong their conviction in their delusion was before and after each VR experience. 

Compared to patients who underwent exposure therapy, VR cognitive therapy led to "large reductions in delusional conviction". 

Freeman hopes that the technique could be used further – "undoubtedly, VR could go on to have a central role in mental health clinics and wards" – and thinks that the best time to target patients is during an early onset of an episode.

"Arguably, the best treatment approach would be to help people at the earliest stages of their problems," he said. "One could envisage people using VR at home delivered via a smartphone. Generally, the longer and more severe a problem then the greater the therapist time needed to help complement a technological treatment device."

"So the earlier the problem is caught, the greater the likelihood the person can overcome it alone using VR."

At this point in the research, the team view the project as "another treatment to add to those provided in services". But they also say that VR could be "especially potent" for the treatment of persecutory paranoia because it targets the key issue of a sense of danger. "With VR, we can help patients relearn safety, and in this way the paranoia begins to fade away." Barriers to access are slowly lifting, though – while such services were previously limited because of "the cost and specialist technological support needed" to run programs like this, this is now changing.

"High quality affordable equipment is becoming available that will need much less support," Freeman explained to WIRED. 

"It's a very exciting time to be working in VR. Our problems are inseparable from the environments in which we experience them. VR will enable us to repeatedly go into the situations that trouble us and learn to overcome our problems." 

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