"Paranoia is when people strongly believe that others are going to deliberately harm them in some way, and in severe cases, it leads to patients becoming very isolated," Daniel Freeman, a clinical psychologist and researcher at Oxford University's Department of Psychiatry, said over the phone.
"What we want to do with people who have severe paranoia is to let them relearn that they are safe, and the best way of doing that is to go back into the situation that they fear using VR, and to relearn that nothing bad happens," added Freeman.
In a study published Thursday in the British Journal of Psychiatry, the researchers describe working with 30 patients suffering from persecutory delusions—when patients believe that the people around them might threaten them in some way. The patients all spent 30 minutes in VR, with half the group told to rely on their normal defensive behaviours, and the other half told to "do the same but also to drop their defences" by actively approaching VR characters, and staring at them. This tactic is used to grow people's confidence as they learn that the situation they are confronting is actually less scary than they previously thought.
The two scenarios included a London Tube train and an elevator full of people, which both started off empty, before researchers gradually populated them with more computer-generated avatars at five minute intervals.
Over half of the patients who lowered their defenses reported reductions in their paranoid delusions after just 30 minutes. Before the VR experiment, the patients averaged an 80 percent conviction in their paranoia, while after the experiment, those who dropped their defenses only averaged a 47 percent conviction.
The results, said Freeman, were pretty "remarkable."
In their paper, the researchers describe how difficult it can be for patients to confront situations they fear while deliberately "letting down long-built defences." "Even in virtual reality the anxiety generated and effort required of the patients was plain to see," they wrote.
Traditional methods of dealing with paranoia include going to several therapy sessions to discuss problems and possible solutions, as well as sessions that involve confronting fears in the real world.
According to Lucia Valmaggia, a senior lecturer and consultant clinical psychologist at King's College London, virtual reality environments allow researchers to expose their patients slowly to triggers that cause paranoia and control the situation they are confronting.
"VR lets you manipulate each trigger and tailor it to the needs of the patient," said Valmaggia, noting that whereas researchers could control a virtual environment for their patients, they couldn't necessarily manipulate a real one.
"People's minds and bodies behave as though VR was real, but as patients know it's not real, they're less afraid to try it"
VR, said Freeman, could also provide cheaper and quicker treatment methods. As headset costs plummet, more people will have access to them at home, and the team envision specially tailored VR therapy sessions at home or in walk-in clinics in the future.
"People's minds and bodies behave as though VR was real, but as patients know it's not real, they're less afraid to try it," said Freeman.
Next up, the team want to work on a more personalised batch of scenarios tailored around different individual needs, and testing these in a larger clinical trial.
"What I'd like to have is a whole range of scenarios and for the patient to choose the one that is most relevant to them," explained Freeman. "Some patients might not, for example, be affected by being in the tube or in lifts—they might be affected when they're in their local shop or in the bus. We need more of these scenarios."