Reading the mind of the avatar: demonstration of a new virtual reality social cognition training for people with psychotic disorders

Background: Individuals with psychotic disorders commonly experi- ence deficits in social cognition and limited social functioning. Social Cognition Training (SCT) has been shown to have beneficial effects on proximal social cognition tasks, but generalization to social function- ing is limited and interventions may not have long-term effects. We speculate that this may be due to limited ecological validity of SCT stimuli, and the absence of opportunities for guided practice in realistic, dynamic social interactions. Methods: We propose that this problem could be solved by providing SCT in virtual reality (VR). VR allows for practice of skills in situations mimicking real life, yet is safe and controllable, and facilitates structured training guided by a therapist. The proposed intervention aims to improve social cognition through CRT principles such as errorless learning, scaffolding, and coaching. It builds complex social cognitive skills, such as higher-order Theory of Mind, upon elementary social processes, such as facial affect perception. Results: The virtual reality SCT consists of four modules: 1) facial affect recognition training: encountering avatars showing emotion and identifying their affective expressions; 2) facial affect recognition in social contexts: identifying and understanding expressed emotions using social contextual information; 3) Theory of Mind (ToM) training (progressing from simple, first-order scenarios to complex, higher- order ToM): encountering increasingly complex social situations and inferring virtual characters’ mental states; and 4) integration and practice of FAR and ToM in dynamic interactions with virtual characters, that change according to clients’ choices and psychophy- siological responses in the interactions. Training is delivered using four interactive virtual environments that are common in daily life situations: a shopping street, a super market, a bus and a café. Conclusions: The intervention described above, as well as plans to empirically test its efficacy, are demonstrated and presented in further detail