DiSCoVR: A pilot study of social cognition training in virtual reality

Background: Social cognitive deficits have been linked to social dysfunction in people with a psychotic disorder. Social Cognition Training (SCT) aims to improve social cognition and social functioning by practicing with social stimuli and teaching compensatory strategies. Meta-analyses indicate that social cognition can be improved with SCT. However, evidence regarding generalization and long-term efficacy is mixed. A possible explanation for this may be that current approaches may not provide sufficient practice in circumstances highly resembling daily life social situations. Virtual Reality (VR) is highly realistic and produces a psychological response similar to real-life situations, but it can also be controlled and personalized, making it a promising tool for SCT. Method: In a pilot study (n=22), we investigated the feasibility, acceptance and preliminary effects on social cognition and psychiatric symptoms of DiSCoVR (Dynamic Interactive Social Cognition Training in Virtual Reality), a 16-session individual VR SCT. Emotion perception, social perception and theory of mind, and social interaction were practiced in immersive, interactive virtual environments. Feasibility and acceptance were evaluated using a survey for participants and therapists. Social cognition was assessed using picture, video and story tasks (e.g., Ekman 60 Faces, The Awareness of Social Inference Test). Psychiatric symptoms were measured using interviews and questionnaires. Results: Participants (completers: n=17) indicated that they enjoyed DiSCoVR (M=7.3 out of 10), liked the combination of VR and a therapist (M=7.9) and considered it to be helpful for daily social contact (M=7.0). 70% of participants indicated that the opportunity to practice with social situations in VR was the most important strength of the intervention. Facial affect recognition improved significantly after treatment (t=-4.79, p<.001). No change was found on the other measures. Discussion: The intervention was considered to be feasible and acceptable by participants and therapists. While an improvement in facial affect recognition was found, no change was observed in higher-order social cognition (e.g., empathic accuracy, Theory of Mind). We are currently studying a new version of the DiSCoVR treatment protocol and software in a multicenter randomized controlled trial.