Freeman et al : virtual reality assessment of schizophrenia

Question 1

what is persecutory ideation

Answer 1

-The persistent false belief that there is a conspiracy against you

Question 2

what is Interpersonal sensitivity

Answer 2

The vulnerability to perceived signs of rejection in interpersonal spaces i.e feelings of inadequacy in social settings

Question 3

What is state anxiety

Answer 3

-Temporary state of anxiety in response to a particular situation.

Question 4

What is the aim of the study

Answer 4

1) To investigate whether a non-clinical sample have thoughts of persecutory nature in virtual reality

2) To investigate whether there are cognitive or emotional factors that predict likelihood of persecutory ideations in subjects in the vr interactions

Question 5

Describe the sample

Answer 5

-24 subjects , 12 males 12 females
-They were recruited from the student body and university staff at UCL
-Average age of 22 years
-They were a volunteer sample as they responded to an ad in the university asking for participants for a study.
- They were paid for their participation - incentive

Question 6

What were the materials used

Answer 6

-A projection system with four projection walls (3 walls and a floor) (a cave)
- An inter sensed tracker for monitoring the ss head position and orientation
- an inter sensed joystick for navigating the virtual world by pressing a button to move you forward
-Lightweight crystal eye glasses that deliver a stereo view of the world

Question 7

What are the outcome measures/questionnaires used

Answer 7

1)BSI - Brief symptom inventory
2)Paranoia scale
3) Spielberger state anxiety questionnaire
4) VR - paranoia
5)Sense of presence questionnaire

Question 8

Describe the BSI - Brief symptom inventory

Answer 8

-A 53 item questionnaire
-Has 9 sub scales
- The sub scales are quantified over the past 7 days
The 9 sub scales are :
1) somatization
2) interpersonal sensitivity
3)OCD
4)Depression trait
5) Anxiety trait
6) Hostility
7) Phobic anxiety
8)Paranoid ideation

A total severity score called the global severity index GSI is obtained by summing up the scores in all the 53 items.

-Each item is rated on a 5 point rating scale. From 0=not at all
4= extreme

The higher the GSI score the more the global severity

Question 10

Describe the general procedure

Question 11

What did they do to prevent priming (hinting) of reactions

Answer 11

To prevent priming of reactions participants were not informed that the study was specifically examining persecutory ideas

Question 12

How long were participants asked to enter the virtual world

Answer 12

5 minutes

Question 13

What were the instructions given to the participants

Answer 13

“Please explore the room and try to form some impression of what you think about the people in the room and what they think about you “

Question 14

How many avatars were in the library room

Answer 14

5

Question 15

Where were the avatars

Answer 15

3 sat at one desk and two at another desk

Question 16

What ambiguous behavior did the avatars show

Answer 16

Smiling, looking , talking to each other

Question 17

What did the participants do after leaving the virtual world

Answer 17

They completed a questionnaire and a short semi-structured interview concerning their experience in the virtual world

Question 18

What did the experimenters do to prevent priming of persecutory thoughts by the questionnaires

Answer 18

• Half the subjects completed the questionnaires post exposure
• the other half completed the questionnaires pre and post exposure

Question 19

Describe the paranoia scale

Answer 19

-Has 20 items used to measure paranoia in college students

• contains items measuring both ideas of persecution and social reference
• Each item is rated on a 5 point scale from 1-5
• the higher the score the greater the paranoid ideation

Question 20

Spielberger State Anxiety Questionnaire

Answer 20

-It has 20 items developed to measure state anxiety
-Each item is measured on a scale of 1-4 rated on a 4 point rating scale

-The score ranges from 20-80
-High scores indicate greater state anxiety

Question 21

VR - paranoia

Answer 21

-Designed to measure paranoid ideation as a response to the feedback of the avatar

-Has 15 items assessing 3 areas of paranoia
- The areas are ; a) Persecutory thoughts about the avatar - items 1-5

b)ideas of reference about the avatars. items 6-10

c)Positive beliefs about the avatars . items 11-15

Question 22

Sense of presence questionnaire

Answer 22

-Measured the extent of imartion of participants in the virtual world

-This is done using 3 main criteria ;
1) sense of “being there”
2) sense of having visited a place rather than just having seeing images
3) The extent to which the virtual world dominated behaviour relative to the virtual world rather than the real world , in which participants were really located

Question 23

Describe the semi-structured interview used in Freeman et al

Answer 23

They offered an opportunity for the ss to report any distress associated with the VR environment.

-The interviews were rated for persecutory content on a 6 point rating scale

-The interview was videotaped

Question 24

List four results form Freeman et Al

Answer 24

-There was a positive correlation between scores on the paranoia questionnaire and the paranoia scores given based on the interview

• There was no gender differences in persecutory ideas. Although some participants had ideas of persecution.

-Higher levels of interpersonal sensitivity and higher levels of anxiety were significantly correlated with higher levels of persecutory thoughts in the VR

-VR persecution scores were positively associated with BSI paranoia scores

Question 25

What are the methodological strengths and weaknesses of the study

Answer 25

One weakness was that the participants reported relatively low levels of presence within the virtual library. Presence refers to feelings of actually 'being there' and was measured on a six-point scale used in previous VR studies. The average presence rating was 2.3/6 (the higher the score, the more present the participants felt). This suggests that the findings may lack ecological validity as the participants were not fully immersed in the experience; this may be due to the short duration in the room (five minutes) and the relatively passive nature of the task. A strength was that half the participants answered the BSI, paranoia and anxiety questionnaires before and after their time in the virtual room and the other group only completed them after the VR experience. This was done to see whether completing the questionnaires primed the participants to experience persecutory thoughts while in the room. This did not appear to be the case, suggesting that any such thoughts were triggered by the avatars and not the overall procedure. Another weakness is sampling bias. The participants were all drawn from a London university, recruited via advertisements; they were all free from prior clinical diagnoses and were relatively young (mean age = 26). The participants would all have been relatively intelligent and interested in psychology and virtual reality. This means that the findings may not generalise to people outside this population.`

Question 26

Ethics

Answer 26

Ethics Protection from psychological harm: Guideline of protection from psychological harm was upheld. Freeman et al. (2003) checked to see whether time spent in the room created any distress during the semi-structured interview and found that this was not the case. Also, anxiety scores were very similar before and after the VR task, suggesting that the experience did not leave the participants with any lasting psychological harm. Furthermore, all participants gave their consent to take part.

Question 27

situational vs individual

Answer 27

Individual and situational explanations This study highlights the role of both individual and situational explanations in the development of persecutory ideation. A range of questionnaires were used to measure trait anxiety, paranoia and other clinical symptoms (e.g. The Spielberger State Anxiety Questionnaire) and these relate to individual explanations (i.e. that certain people are more vulnerable to developing psychotic symptoms due to the way they typically process information from the social and physical world). But the researchers also point to the potential for VR research to reveal environmental (situational) factors associated with persecutory thoughts, noting that experimental manipulation of aspects of the virtual environment could help to identify factors which make such thoughts more or less likely.

Question 28

idiographic vs nomothetic

Answer 28

A strength of this study was that it used both nomothetic and idiographic approaches. Quantitative data was collected using the VR-Paranoia questionnaire. The psychometric test collected self-reported data on 4-point scales (0-3: 'do not agree' to 'totally agree'], which can be analysed using statistics in order to draw conclusions that can be generalised to the wider target population, thus illustrated the use of the nomothetic approach. However, Freeman et al. also took an idiographic approach when they collected qualitative data through asking participants to explain their experiences in their own words in semi-structured interviews. Using both approaches and types of data increases the validity of Freeman et al.'s findings regarding the frequency of persecutory ideation in the general population.

Question 29

Application to everyday life

Answer 29

Application to everyday life A strength of this study is that it helps to deepen our understanding of the cognitive and emotional processes that underpin the development of psychotic symptoms. Exploring how people interpret mental states/intentions in others in VR settings can inform theoretical models of schizophrenia, and in turn, the development of new VR therapies where people can focus on developing new ways of interacting in the real world. This will only be possible if the VR environments have strong ecological validity, such as incorporating credible avatars that demonstrate a full range of human behaviours.