Dynamic Interactive Social Cognition Virtual Reality training for adults with autism spectrum disorder

Rationale: People with autism spectrum disorder (ASD) commonly experience deficits in social cognition, skills and functioning. Social cognition training (SCT) has been shown to have beneficial effects on social cognition tasks, but generalization to social functioning in daily life is limited. Current individual SCT does not seem to be ecologically valid, and patients cannot practice skills in dynamic social interactions. We propose that this problem could be solved by providing SCT in Virtual Reality (VR). VR allows for practice of skills in situations resembling real life, yet remaining safe and controllable.
Objectives: To 1) determine the feasibility and acceptability of VR SCT on patients and for clinicians, and 2) explore the effects of VR SCT on social cognition, social anxiety, social behaviours and cognitive flexibility (neurocognitive measure) and in people with ASD.
Study design: Pre-post design; this study is a feasibility study in a patient group with an autism spectrum disorder. Patients will receive the training, pre-, post-intervention and follow-up assessments will be obtained.
Study population: 25 individuals with a confirmed clinical diagnosis of autism spectrum disorder and social cognition problems, aged 18-65.
Intervention: The VR SCT consists of sixteen sessions, during an 12-week timeframe. Sessions last 60 minutes. During sessions, social cognition is trained in virtual environments. The intervention consists of three modules: facial affect recognition, emotion recognition within a context &theory of mind and interaction training.
Main study parameters/endpoints:
Primary outcome: Acceptability and feasibility of the training, measured using questionnaires and interviews.
Secondary outcome: social cognitive, social anxiety, social behavioural, neurocognitive outcome measures and social functioning.
Nature and extent of the burden and risks associated with participation, benefit and group relatedness: Participants will be interviewed at screening and tested at baseline, post intervention, and at follow-up, with an average total duration of approximately one hour to 75 minutes for each assessment, and 10 minutes for the screening. The intervention will take sixteen hours in total (sixteen sessions of 60 minutes each). We expect patients to benefit from the therapy by increasing social cognitive skills. Some patients might experience simulator sickness symptoms during the therapy. No major adverse events are expected or have been documented previously with a similar VR-SCT protocol (Pot-Kolder et al., 2018).

VR is a feasible instrument in training social cognition, decreasing social anxiety and improving overall social functioning

Pre-assessment (T0)
Post-assessment (T1)
Follow-up (T2 - 16 weeks after T1)

Protocolized Virtual Reality social cognition training