S125. THE PREDICTORS AND MEDIATORS OF IMPROVEMENT FOLLOWING VIRTUAL REALITY BASED SOCIAL SKILL TRAINING

Abstract

Background: Social impairment is a core feature of schizophrenia. It is present throughout the course of the illness from the premorbid stage and resistant to treatments (Green et al, 2008). Given the important role of social deficits in poor outcome, it is imperative to improve social functioning in individuals with schizophrenia (SZ), but currently available pharmacological and psychosocial interventions have not proven to be very effective. However, recent technological advances have enabled the use of virtual reality (VR) to develop novel psychiatric interventions. We have previously reported preliminary feasibility and acceptability findings from a new VR-based social interaction training program that suggests the benefits of simulating and rehearsing social interactions situations in VR (Adery et al, 2018). In the present study, we evaluated predictors and mediators of the clinical outcome of this VR-intervention. Methods: 18 outpatients with schizophrenia completed 10 sessions of the social VR training over the course of 5 weeks. At each session, participants were asked to approach and interact with avatars by making appropriate conversations to accomplish social 'missions'. There were 12 different missions varying in difficulty levels and social settings (café, bus stop and shop). Symptoms (BPRS, SAPS, SANS), emotion recognition (BLERT and a novel facial emotion recognition task), social functioning (Social Functioning Scale) and cognitive functioning (IQ, CogState) were examined in relation to the VR game performance at pre- and post-treatment. Multivariate regression models with backward elimination method were used to verify significant predictors of the outcome. Lastly, mediation analyses were evaluated using bootstrapping (n=5000) to specify the relationship between predictors and behavioral changes. Results: Negative symptoms, especially alogia, anhedonia and asociality improved significantly by post-assessment. Additionally, attention and emotion recognition improved. Within the VR game, number of incorrect responses declined significantly throughout the training period. In multivariate regression models, baseline and changes in social functioning scores predicted clinical symptom improvement. Furthermore, IQ mediated the relationship between performance change in high-difficulty sessions and improvement in alogia. Alogia improvement mediated the relationship between interpersonal communication changes and VR performance. Discussion: Simulation-based social skills VR training game improved clinical symptoms, especially negative symptoms, via changes in social functioning and emotion recognition in schizophrenia. These results suggest that VR-based social skills training may be an effective social intervention method. Although the small sample size limits the scope of our conclusion, the results of the present study illustrate the potential power of technologybased psychiatric interventions.