A virtual reality cognitive remediation intervention improved activity, social, and chronotype rhythms among patients with bipolar disorder.

A virtual reality (VR) cognitive remediation intervention improved synchronization of personal and social rhythms in patients with bipolar disorder (BD), particularly in younger patients, according to findings published in the Journal of Clinical Medicine.

Diego Primavera, MD, PhD, and colleagues conducted a post-hoc analysis of a 12-week randomized controlled cross-over feasibility trial in people aged 18–75 who were diagnosed with bipolar disorder by a psychiatrist. In total, 39 patients were exposed to the experimental VR-based cognitive remediation, and 25 patients on an inactive waiting list were treated as usual (pharmacotherapy and psychiatric visits).

The study omitted patients with bipolar relapse, epilepsy, or severe eye diseases due to the potential risks of VR exposure. Investigators used the Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) to measure the outcome.

Improved Activity, Social and Chronotype Rhythms

The study team observed no statistically significant differences between the experimental and control groups in age or sex. Researchers found that personal rhythm scores improved over the study follow-up for patients in the experimental compared with the control group in both young (18–45; P<0.001) and, to a smaller degree, older (>46) adults (P=0.002).

VR treatment was associated with improvements in activity, social, and chronotype rhythms in the experimental group compared with the control group. However, scales related to sleep and meal patterns did not improve. The results indicate “differences in the specific dimensions of rhythms, particularly improved social activities and chronotype rhythms and not sleep rhythms, and in the subgroups of younger and older individuals,” Dr. Primavera and colleagues wrote.

Implications for Clinical Practice

The study showed that “the intervention with VR (which proposes exercises based on activities of daily life) improves the aspects linked to chronotypes of social interactions and common life activities but not specifically the aspects more deeply linked to biorhythms such as sleep and the rhythm of meals,” the researchers continued.

Further, the findings are consistent with other studies that assessed the impact of cognitive rehabilitation and psychoeducation interventions for improving cognitive processes, symptoms, and biological and social rhythms using the BRIAN measurement outcomes.

“Clinically, this supports using virtual reality for cognitive remediation with integrated, recovery-oriented approaches in both young and older individuals with [bipolar disorder],” Dr. Primavera and colleagues wrote.