PETER & ESTINGOY, Video games as a therapeutic mediation : a new approach in treating schizophrenia. Lyon : Etudes et pratiques en psychologie, 2014. 6. (ISBN)
Key-words : schizophrenia, virtual reality gambling, cognitive function, video game, mediation tool.
Nowadays, virtual reality games are arousing the curiosity of many mental health researchers and practitioners. However, there is still little research studying the risks and benefits of this innovative practice in behavioural therapies. The results of this research have brought considerable progress in the treatment of anxiety disorders (specific phobia, social phobia, etc.) but other pathologies such as schizophrenia have not yet been the subject of such progress. Pierrette Estingoy a psychiatrist at the Hospital Center of Lyon and professor of psychopathology at the University of Lyon as well as Chloe Peter, a psychologist at the University Hospital Center of Lyon have chosen to study the benefits of the use of video games in the treatment of schizophrenia. More specifically, the authors believe that virtual reality gambling can be a beneficial mediation tool in the management of schizophrenia. Therefor, the implications of this article are the possibilities to allowing researchers to make advances on this subject but also for psychologists to propose new approaches of care and offering an additional tool to practitioners.
Schizophrenia
Schizophrenia is a mental disorder known for its symptoms of loss of internal coherence in psychic life, rupture of contact with reality (delusions and hallucinations), autistic withdrawal and social interaction disorders described by Bleuler (1908). However, it was only in the second half of the 20th century that cognitive sciences added symptoms such as difficulties in attributing action and metacognition (Frith, 1996; Georgieff, 2004) as well as the deficits in certain cognitive functions such as attention, memory and executive functions (Van der Linden & Ceschi, 2008).
Virtual reality in psychology
At first, virtual reality was a research tool in psychology and then it became a relevant therapeutic tool. Indeed, it makes it possible to redefine the therapeutic approach by offering the patient a work on several aspects of his psyche. It allows him to forget his body (thanks to the visuocouple) or on the contrary to reclaim it. Thus, experimenting with projection and identification allows the patient to question himself on different sensory fields, within the protected framework of simulation. Finally, unlike analytical therapy, the patient is not invited to talk but to act, then to mentalize his actions (Virole & Radillo, 2010).
Video games and schizophrenia
Currently, Virolle and Radillo (2010) believe that this practice does not have the risk of aggravating the symptoms of derealization and disorganization of schizophrenia, since the virtual is not similar enough to reality to generate such confusion (there are no smells, no depths or sensations). Recent research supports this idea and demonstrates the absence of negative effects of this type of tool on people with psychosis (Lallart & Jouvent, 2008). Thus, video games could be an asset in the management of schizophrenia, thanks to the stability of the virtual world, the permanence of the setting, the infinite repetition of situations that can reassure this type of population and allow psychotic thinking to be deployed to find a way to reconstruct a reality other than delusions and hallucinations (Virolle & Radillo, 2010).
Assumptions
- Playing video games with Kinect improves some cognitive deficits (memory, attention, executive functions and cognitive inhibition).
- The tool helps to strengthen self-image, self-confidence and self-esteem.
- Used in groups, video games are a mediator of social ties and allow the emergence of cooperative behaviours.
Methodology
In order to respond to these hypotheses, the researchers created two groups of three people. The first was composed of three men and the second of a woman and two men. All participants had been diagnosed with schizophrenia for more than two years and are all followed up in day hospitals. The average total age was 36 years. Each group participated in 10 virtual reality game sessions. During these sessions, participants played in pairs in non-competitive, low difficulty, non-violent and non-anxiety games.
Results
The results of this study show that in a safe environment, this type of gambling does not seem to cause problems for people with schizophrenia. On the contrary, virtual reality gambling seems to improve certain cognitive functions (attention, concentration and short-term memory) and strengthen self-image, through the encouragement of social cooperation. All participants attended the sessions with a clear pleasure to play and made it clear that they wanted to continue the sessions beyond the protocol.
Criticisms
We believe that the article is particularly innovative and allows us to offer more up-to-date and fun tools in therapeutic mediation. The results of this research make it possible to counter some prejudices and reassure practitioners about the use of digital and new technologies in therapeutic methods. The authors succeeded in achieving their objective since it would seem that the use of this tool would enrich the management of patients suffering from schizophrenia, a pathology requiring pharmacological treatment but above all an intense therapeutic follow-up. Beyond this objective, the authors found that in addition to improving participants’ cognitive skills, this method also allows them to restore their self-awareness and socialization behaviours and thus contributes to improving their well-being. We consider these elements important since behavioural therapies often deal with improving the cognitive aspects impacted by pathologies, while the well-being and quality of life of the patient are essential elements to be taken into account in the smooth running of a treatment. Also, we are particularly attentive to the fact that participants enjoyed participating in the sessions, we believe that the motivation of patients to participate in their therapy is an extremely important point in their management and that this can positively affect the results of their therapy.
However, we believe that this study is biased in some ways. Indeed, the small number of participants hinders the generalization of the results of this study since only six people took part in the study. Also, the experimenters announced the specific objectives of the study to the participants before the start of the study, which can lead to a social desirability bias since patients were able to modify their behaviour in order to achieve the results expected by the researchers. Finally, we think that such care is very expensive since the equipment necessary for such therapy is not accessible to all structures (television, headphones and virtual reality sensors, game consoles, games, etc.).
In conclusion, we believe that modernisation, innovation and renewal of therapeutic care are necessary in the world of mental health. However, it is necessary to remain cautious in their use and to keep a certain distance from their long-term effects. Moreover, as digital technology is increasingly present in our society, such use in care has the advantage of stimulating the interest of a large number of patients, but can also add more digital hours during the day for some. We therefore believe that it is relevant to use such a tool but that we must be careful that it does not replace the therapist’s role and basic tools (e.g. exchange, interview, discussion groups etc.). Finally, we have chosen this title because it illustrates the fact that the patient can “work” on his cognitive and conative remediation while having fun and just having the impression of “playing”.
PS: The Department of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine has been very interested in how virtual reality could be a care in many mental pathologies (e.g. addictions, psychoses, autism, depression…) if this subject interests you, you can consult their video channel.
Words we have learned:
- a mediation tool : un outil de médiation
- a delusion : un délire
- a smooth running : un fonctionnement régulier, sans problème
- self-awareness : conscience de soi
- virtual reality gambling: jeu en réalité virtuelle
- to arouse : susciter l’interêt
- a practitioner : un praticien
- a visuocouple : un visuocasque
- to reclaim : récupérer
- an asset : un atout, un avantage
- to strengthen : renforcer
- the social ties : les liens sociaux