A virtual reality experience to improve psychoeducation for depression

Depression is a prevalent mental disorder, causing tremendous suffering for
those affected and their relatives. Patients with depression often deal with
stigma. We developed a virtual reality (VR) environment to experience a
depression from the perspective of a patient and her relative (VR depression
experience). We hypothesize that when patients and their relative experience
the VR in a psychoeducation session, this will lead to less self-stigma, an
increase in perceived social support, less loneliness and consequently less
depressive symptoms for patients. We also hypothese that the VR experience will
lead to a decrease in perceived burden of care, and an increase in quality of
life of the relative.

In the present study our main aim is to assess whether VR psycho-education will
lead to a larger decrease in feelings of self-stigma for the patient, as
compared to traditional psychoeducation. Our secondary aim would be to test the
effect of the VR psychoeducation on social support, loneliness, and depressive
symptoms for the patient, and perceived burden of care and quality of life of
the person closest to the patient, as compared to traditional psychoeducation.

We will conduct a randomized controlled trial in the four largest outpatient
clinics within mental health care institution GGZ Delfland, and within the
outpatient clinic for Psychiatry of the Amsterdam UMC. When the diagnosis is
confirmed, the participant and a relative of their choice will be randomized
into either the VR psychoeducation protocol or the standard psychoeducation
protocol. After randomization, the patient and their relative are invited for
the psychoeducation session. The patients will fill in questionnaires before
and after the psychoeducation session, after 1 week and after 10 weeks during
their further psychological treatment. The relatives will fill in
questionnaires before the psychoeducation session, after one week and after 10
weeks.

In both conditions, patients and their relative receive psychoeducation. This
is manualized and consists of an explanation of the symptoms, possible causes,
diagnosis and treatment of depression according to the Dutch CBT protocol book
*Protocollaire behandelingen voor volwassenen*, section depressive disorder.

In addition to the above, in the VR psychoeducation condition, patients and
relatives also watch the VR depression experience video. This consists of two
360º videos which summarize multiple fragments of a day in the life of a female
depressive patient (1) from her perspective and (2) from the perspective of her
male partner.The VR-experience includes getting up in the morning, having
breakfast, interaction with the partner, sitting around in the afternoon not
being able to undertake an activity and taking medication through the eyes of
the patient whilst hearing her inner thoughts. The relative watches the video
from the patient*s perspective, this takes 6 minutes. The study participant
has the possibility to watch along on a screen. The study participant watches
the VR-experience from the perspective of the partner, this experience takes 4
minutes in total. This experience includes mainly the same scenes; getting up
in the morning, having breakfast, the evening after the partner returns from
his job. This time, the study participant watches the scenes whilst hearing the
inner thoughts of the partner, and the relative of the study participant has
the possibility to watch along on a screen. After both the study participant
and the relative have undergone the VR depression experience, the study
participant and the relative will answer some questions related to the VR
experience and the therapist will stimulate a mutual discussion about the
content of the experience.

If a patient wants to participate, the researcher will conduct a semi
structured interview by telephone, to conform the diagnosis. Furthermore,
patients will answer four, and relatives two questionnaires at three time
points (for patients there is one more measurement with one questionnaire). The
total amount of time to fill in the questionnaires for the patient is 50
minutes, and for the relative 30 minutes.

Some participants might experience some nausea (e.g. cybersickness), dizziness
or headache, whilst wearing the Head Mounted Display (HMD). The experience of
patients so far is that this usually disappears quickly after removing the HMD.

The burden of participation is minimal for depressive patients and their
relatives; they will receive psychoeducation as usual, with or without the VR
depression experience. Session length will be the same, as will be the
information about depression provided in the session. No additional site visits
are required, questionnaires will be administered before a scheduled therapy
session, or by telephone or digitally by means of Castor.