Citation: Miranda, B.; Moreira, P.M.;
Romero, L.; Rego, P.A. Therapeutic
Use of VR Serious Games in the
Treatment of Negative Schizophrenia
Symptoms: A Systematic Review.
Healthcare 2022, 10, 1497. https://
doi.org/10.3390/healthcare10081497
Academic Editors: Daniele Giansanti
and Alyx Taylor
Received: 1 June 2022
Accepted: 5 August 2022
Published: 9 August 2022
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Review
Therapeutic Use of VR Serious Games in the Treatment of
Negative Schizophrenia Symptoms: A Systematic Review
Beatriz Miranda
1,
*, Pedro Miguel Moreira
1,2
, Luís Romero
1
and Paula Alexandra Rego
1,2
1
ADiT-Lab—Applied Digital Transformation Laboratory, Instituto Politécnico de Viana do Castelo,
4900-347 Viana do Castelo, Portugal
2
LIACC—Laboratório de Inteligência Artificial e Ciência de Computadores, Universidade do Porto,
4200-465 Porto, Portugal
* Correspondence: beatrizmiranda@ipvc.pt
Abstract:
Schizophrenia is a chronic brain disorder that affects 1 in every 300 people worldwide.
This study intended to perform a systematic review to describe the state-of-the-art of interventions
involving patients with negative symptoms of schizophrenia that use Virtual Reality (VR) games as
a complement to therapy, and to analyze the key features of such games. Literature research was
conducted in three databases, namely, the Institute of Electrical and Electronics Engineers (IEEE),
Scopus, and PubMed, to identify relevant publications dated from 2010 to 2021. Of the initial
74 publications found, only 11 satisfied the eligibility requirements and were included in this study.
The results were then organized and displayed in a flow diagram. Overall, the results from the
studies suggest that the use of VR in therapies enables an increase in social skills and a decrease in
anxiety symptoms. The use of such technology in therapy has proven to be effective, although it still
lacks features to provide better long-term results.
Keywords: virtual reality; game design; serious games; schizophrenia
1. Introduction
One of the key characteristics of schizophrenia has been recognized as psychosocial
impairment, which includes a deficit in social cognition and social behavior [
1
]. Symptoms
such as depression, cognition, and even social functions have all been found to be influenced
by the use of VR environments [
2
]. Thus, by using an immersive VR environment, it is
possible to create realistic situations which could possibly trigger negative symptoms in
patients but, in a secure simulation, enable users to build their confidence and cope with
their struggles better.
VR is an interesting tool that has started to be used in remediation therapies [
1
].
Although it is typically used as an exposure technique for specific phobias, VR has recently
been applied, with encouraging results, to the study and treatment of schizophrenia [
3
]. It
can offer the potential for a significant therapeutic benefit [
4
], since patients are more willing
to enter challenging situations and experiment with alternative ways of responding [
5
].
Patients can put on a headset and be immersed in multiple situations ranging in difficulty,
which may cause them to experience different levels of psychological distress [6].
Individuals, not only in their own life activities but also in treatment, may be hesitant
with respect to face-to-face engagement [
7
]. The causes of this anxious withdrawal may
be many: social anxiety, negative self-image, panic attacks, and a lack of confidence [
5
].
Studies have shown that psychosocial interventions in schizophrenia have positive effects
on disease symptoms, treatment compliance, quality of life, social cognition, social func-
tioning, and employment [
1
], generating positive perceptions and pleasant emotions. An
improvement in relationships and peer motivation was reported [
8
] in group therapy ses-
sions with digital games, where patients can play together. The power of VR interventions
thus far has been most evident in the treatment of anxiety disorders [5]. Yet, some studies
Healthcare 2022, 10, 1497. https://doi.org/10.3390/healthcare10081497 https://www.mdpi.com/journal/healthcare
