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Can Virtual Reality be Used to Investigate Persecutory Ideation?

Freeman, Daniel BA, PhD, DClinPsy*; Slater, Mel MSc, DSc†; Bebbington, Paul E. MA, PhD, FRCP, FRCPsych‡; Garety, Philippa A. MA, MPhil, PhD*§; Kuipers, Elizabeth BSc, MSc, PhD*; Fowler, David BSc, MSc∥; Met, Alican BSc, MSc†; Read, Cristina M. BSc*; Jordan, Joel BSc†; Vinayagamoorthy, Vinoba BEng†

Journal of Nervous & Mental Disease: August 2003 - Volume 191 - Issue 8 - pp 509-514
Original Articles

The use of virtual reality permits individuals’ reactions to standard controlled environments to be studied. It may therefore provide a means for understanding the interpretations of experience relevant to clinical disorders. The use of this technology for understanding persecutory ideation has not been investigated. A pilot study was undertaken to examine whether individuals have persecutory thoughts about virtual reality characters under controlled conditions and if there are factors that predict the occurrence of such thoughts.

Twenty-four nonclinical participants entered a neutral virtual environment that contained computer-generated people. The participants completed dimensional assessments of items related to psychiatric symptoms and their thoughts about the virtual characters.

Positive views about the virtual characters were common. However, a number of participants had ideas of reference and ideas of persecution about the virtual characters. Individuals who had persecutory thoughts about the virtual characters had significantly higher levels of interpersonal sensitivity and anxiety.

The study provides direct evidence that individuals attribute mental states to virtual reality characters. Important for the study of clinical phenomena, some individuals have thoughts of a persecutory nature about virtual characters. Additionally, the findings indicate that feelings of interpersonal vulnerability and anxiety may directly contribute to the development of persecutory ideation in response to essentially neutral contexts. Virtual reality may prove to be a valuable methodology for developing an understanding of persecutory ideation.

There is evidence that people react in virtual (computer-generated) environments as if they are real. Most strikingly, individuals with conditions such as fear of heights, flying phobia, PTSD, and claustrophobia have been successfully treated by exposure-therapy in virtual environments (Rothbaum et al., 2000;Rothbaum et al., 2001;Botella et al., 2000). The effects of exposure in virtual reality (VR) are comparable with exposure in the real environment. In a step towards the treatment of the fear of public speaking, it has been shown that computer-generated people (avatars) can elicit anxiety (Slater et al., 1999;Pertaub et al., 2001, 2002). Evidence suggests that human responses to virtual characters are similar to their responses to real people. It is therefore reasonable to investigate whether avatars can trigger persecutory ideation. The use of virtual reality has the potential to develop theoretical understanding of persecutory delusions, which is one of the most common symptoms of psychosis. Personal characteristics associated with persecutory thoughts could be investigated by the assessment of individuals entering the same virtual environment; experimentally altering the virtual environment has the potential to lead to the discovery of environmental factors associated with persecutory thoughts.

This exploratory investigation aims to study whether nonclinical individuals have thoughts of a persecutory nature in virtual reality. Two additional concerns influenced the study design. The study of persecutory ideation in virtual reality will be of most clinical relevance if the participants experience such thoughts in their daily lives. A virtual environment is therefore needed that elicits persecutory ideation in some (but not all) participants. It is also of interest to examine whether, drawing upon the theoretical literature, there are cognitive factors that predict the occurrence of persecutory ideation in virtual reality. In our multifactorial model of persecutory delusions, it is posited that emotional processes may have a direct role in the development of persecutory ideation (Freeman et al., 2002;Freeman and Garety, in press). Therefore, the assessment of emotional processes is incorporated into the study design. We predicted that a small proportion of individuals would experience thoughts of persecutory content in a neutral virtual environment, and that these individuals would have higher levels of trait paranoia and emotional distress than individuals who did not have persecutory thoughts in the virtual environment. In a neutral virtual environment, the virtual characters do not exhibit any hostile or persecutory behavior.

*Department of Psychology, Institute of Psychiatry, King’s College London, Denmark Hill, London and South London and Maudsley NHS Trust, UK;

†Department of Computer Science, University College London, London, UK;

‡Department of Psychiatry and Behavioural Sciences, University College London, Royal Free and University College Medical School, London, and Camden and Islington Mental Health and Social Care NHS Trust, UK;

§Division of Psychological Medicine, GKT Medical School, King’s College London, St. Thomas’ Hospital, London, UK; and

¶School Of Medicine, Health Policy and Practice, University of East Anglia, Norwich, and Norfolk Mental Health Care NHS Trust, UK.

Reprints: Dr. Freeman, Department of Psychology, PO Box 77, Institute of Psychiatry, King’s College London, Denmark Hill, London, SE5 8AF, UK.

Supported by a program grant from the Wellcome Trust (No. 062452) and by the UK EPSRC funded Equator Interdisciplinary Research collaboration http://www.equator.ac.uk.

© 2003 Lippincott Williams & Wilkins, Inc.