Using virtual reality to improve verbal episodic memory in schizophrenia: A proof-of-concept trial

Bryce J M Bogie; Chelsea Noël; Feng Gu; Sébastien Nadeau; Cecelia Shvetz; Hassan Khan; Marie-Christine Rivard; Stéphane Bouchard; Martin Lepage; Synthia Guimond

doi:10.1016/j.scog.2024.100305

Using virtual reality to improve verbal episodic memory in schizophrenia: A proof-of-concept trial

Schizophr Res Cogn. 2024 Mar 7:36:100305. doi: 10.1016/j.scog.2024.100305. eCollection 2024 Jun.

Authors

Bryce J M Bogie^{1

2

3}, Chelsea Noël⁴, Feng Gu³, Sébastien Nadeau⁵, Cecelia Shvetz^{3

6}, Hassan Khan⁷, Marie-Christine Rivard⁵, Stéphane Bouchard^{5

8

9}, Martin Lepage^{10

11}, Synthia Guimond^{2

3

6

5

12}

Affiliations

¹ MD/PhD Program, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
² Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
³ The Royal's Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada.
⁴ Department of Psychology, Lakehead University, Thunder Bay, ON, Canada.
⁵ Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada.
⁶ Department of Neuroscience, Carleton University, Ottawa, ON, Canada.
⁷ School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
⁸ Centre de recherche, Centre Intégré de Santé et de Services Sociaux de l'Outaouais, Gatineau, QC, Canada.
⁹ School of Psychology, University of Ottawa, Ottawa, ON, Canada.
¹⁰ Douglas Research Centre, Montréal, QC, Canada.
¹¹ Department of Psychiatry, McGill University, Montréal, QC, Canada.
¹² Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.

Abstract

Background: Schizophrenia is associated with impairments in verbal episodic memory. Strategy for Semantic Association Memory (SESAME) training represents a promising cognitive remediation program to improve verbal episodic memory. Virtual reality (VR) may be a novel tool to increase the ecological validity and transfer of learned skills of traditional cognitive remediation programs. The present proof-of-concept study aimed to assess the feasibility, acceptability, and preliminary efficacy of a VR-based cognitive remediation module inspired by SESAME principles to improve the use of verbal episodic memory strategies in schizophrenia.

Methods: Thirty individuals with schizophrenia/schizoaffective disorder completed this study. Participants were randomized to either a VR-based verbal episodic memory training condition inspired by SESAME principles (intervention group) or an active control condition (control group). In the training condition, a coach taught semantic encoding strategies (active rehearsal and semantic clustering) to help participants remember restaurant orders in VR. In the active control condition, participants completed visuospatial puzzles in VR. Attrition rate, participant experience ratings, and cybersickness questionnaires were used to assess feasibility and acceptability. Trial 1 of the Hopkins Verbal Learning Test - Revised was administered pre- and post-intervention to assess preliminary efficacy.

Results: Feasibility was demonstrated by a low attrition rate (5.88 %), and acceptability was demonstrated by limited cybersickness and high levels of enjoyment. Although the increase in the number of semantic clusters used following the module did not reach conventional levels of statistical significance in the intervention group, it demonstrated a notable trend with a medium effect size (t = 1.48, p = 0.15, d = 0.54), in contrast to the control group where it remained stable (t = 0.36, p = 0.72, d = 0.13). These findings were similar for the semantic clustering ratio in the intervention (t = 1.61, p = 0.12, d = 0.59) and control (t = 0.36, p = 0.72, d = 0.13) groups. There was no significant change in the number of recalled words in either group following VR immersion.

Discussion: This VR intervention was feasible, acceptable, and may be useful for improving the use of semantic encoding strategies. These findings support the use of more ecological approaches for the treatment of cognitive impairments in schizophrenia, such as VR-based cognitive remediation.

Keywords: Cognitive remediation therapy; Ecological treatment; Episodic memory; Schizophrenia; Semantic encoding; Verbal memory; Virtual reality.