ARTICLE REVIEW - NATASHA - WEEK 5

Education About Hallucinations Using an Internet Virtual Reality System: A Qualitative Survey

Academic Psychiatry, 2006, Volume 30, Number 6, Page 534

Peter M. Yellowlees, James N. Cook

AIMS OF THE STUDY:

Evaluation of VR as an educational tool about psychotic hallucination. Mainly in regards to Schizophrenia where most patients experience auditory hallucinations, particularly hearing voices, and approximately one-quarter of patients experience visual hallucinations.

The researchers wants to see whether they could create a “ virtual psychotic environment” in order to increase its educational reach. They also wanted to see if personal computer graphics systems could reproduce hallucinations sufficiently well that users would feel they learned something from the experience.

METHODOLOGY:

This is a pilot project using Second Life, in which a virtual reality environment was constructed to simulate the auditory and visual hallucinations of two patients with schizophrenia. Eight hundred sixty-three self-referred users took a self-guided tour.

Created a virtual educational environment in the form of a hospital ward using Second Life.

Inserted the hallucinations as individual objects throughout the virtual ward so that they appeared automatically, triggered by an avatar’s presence as the avatar toured the environment.

The hallucinations included: • Multiple voices, occasionally overlapping, criticizing the user • A poster that would change its text to obscenities • A newspaper where the word “death” would stand out of a headline • A floor that would fall away, leaving the user walking on stepping stones above a bank of clouds • Books on bookshelves with titles related to fascism • A TV that would play a political speech, then criticize the user and encourage suicide • A gun which would appear under a cone of light and pulse, with associated voices telling the user to take the gun and commit suicide • A mirror in which a person’s reflection would appear to die, becoming gaunt with bleeding eyes.

A survey collection system was placed at the end of the ward. This allowed users to respond to questions immediately after their tour and while they were still inside the environment by simply clicking on the response of their choice. Their answers were automatically e-mailed to us and downloaded directly to a spreadsheet for analysis.

MAIN FINDINGS:

-  The population surveyed is a significantly biased convenience sample. Existing users of an online virtual world system are not a representative sample of the general population.

- There was no pre-test given, so we cannot prove that participants improved their knowledge. We relied on the participants’ own perceptions of educational value.

-  The environment focuses only on the hallucinations of patients with schizophrenia. Users might therefore give inappropriate weight to these symptoms of the disease, rather than having a more balanced view incorporating other symptoms, such as delusions, disordered speech and behaviour, and negative symptoms

BUT

Users of the environment felt it improved their understanding of the experience of hallucinations. Of the survey responders, 440 (76%) thought the environment improved their understanding of auditory hallucinations, 69% thought it improved their understanding of visual hallucinations, and 82% said they would recommend the environment to a friend.

Over a period of 2 months, the virtual psychosis environment was toured 836 times with 579 (69%) valid survey responses received. The demographics of the survey responders closely mirrored the demographics of the Second Life system at large. Most responders were men (N366, 63%), but this represented a more balanced gender distribution than other online communities.

No significant differences were found when replies were analyzed by gender, occupation, or income group.

Although the survey object in this first version had no formal mechanism for narrative comments or feedback from users, many spontaneously sent comments, showing that engagement was high enough for participants to make the effort.

This project has demonstrated that an Internet-based virtual reality system for personal computers can be used to create simulations of hallucinations and that it is possible to integrate evaluation tools into a virtual reality environment. Furthermore, users of the Internet based simulation felt that it improved their understanding of the experience of hallucinations. More comprehensive studies of this approach to online education are warranted.

I think that this was a very good demonstration on how SL and VR can be used to create an empathetic experience for people to begin to relate to those with psychotic symptoms, I think this is an important part of health education as it makes understanding patients easier because it can be personally relatable (though not identical). It could help to decrease stigma surrounding mental illness, but it is still debateable about whether gaming tools further ostracise patients because gaming makes someone feel like a “player” or “character” which has the connotation of the avatar being othered.