![]() 11, 12 A remarkable example is how graded exposure in virtual reality for anxiety disorders is as efficacious as exposure in the real world. ![]() Virtual reality elicits responses in individuals similar to those that would occur in the real situation. 10 An immersive virtual reality system creates a surrounding three-dimensional computer-generated world in which a person can physically move and interact with objects and virtual people (avatars). ![]() The solution we have been developing is to use virtual reality. When they are admitted to psychiatric hospital, their opportunities for such learning are often even more restricted. However, many patients with persecutory delusions find it too difficult to enter their feared situations because of the intolerable anxiety generated. Therefore, patients need to test out the persecutory threat beliefs by entering the feared situations and not using safety-seeking behaviours. The target for successful treatment is for patients to relearn that they are safe and hence diminish their delusional conviction and related distress. For example, patients take steps to decrease their visibility, enhance their vigilance and look out for escape routes. More subtle, but equally important, within-situation behaviours occur when in the places of perceived threat. For example, patients often try to minimise the number of times that they go outside the home, particularly avoiding being in enclosed public places with other people. 8, 9 The most common type of safety behaviour is avoidance. 3– 7 In this report we conduct such a test for the first time in patients with persecutory delusions.Īlmost all patients with persecutory delusions report using safety-seeking behaviours. A number of experimental studies have evaluated safety behaviours as a maintenance factor in anxiety disorders, finding that testing out the fear cognitions by dropping safety behaviours (a key technique of cognitive therapy) leads to greater reductions in the threat beliefs than exposure methods alone. When the judgement of a threat is unrealistic the use of safety-seeking behaviours has important consequences: individuals believe that the threat was averted by the use of the safety-seeking behaviour (for example ‘The reason I wasn't attacked was because I quickly got off the bus’, ‘I was safe because I didn't go out’) rather than conclude that the original idea was inaccurate. 2 Individuals who consider themselves threatened carry out actions designed to prevent the feared catastrophe from occurring. The concept of safety-seeking behaviours was developed in cognitive accounts of anxiety. 1 One reason for the persistence of the threat beliefs is a failure to obtain and process disconfirmatory evidence as a result of the use of safety-seeking behaviours. Our psychological conceptualisation is that at the heart of persecutory delusions are unfounded threat beliefs. Individuals with persecutory delusions erroneously believe that others are trying to cause them physical, psychological or social harm. 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).Ĭognitive therapy using virtual reality could prove highly effective in treating delusions. Delusion conviction and real-world distress were then reassessed. Patients were then randomised to virtual reality cognitive therapy or virtual reality exposure, both with 30 min in graded virtual reality social environments. 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).Ĭonviction in delusions and distress in a real-world situation were assessed in 30 patients with persecutory delusions. Use of virtual reality could facilitate new learning. Persecutory delusions may be unfounded threat beliefs maintained by safety-seeking behaviours that prevent disconfirmatory evidence being successfully processed.
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