Schizophrenia is a chronic mental disorder that significantly affects thinking, emotions, perception of reality and behaviour. It is characterised by a break with reality (psychosis), often manifested by hallucinations (such as hearing non-existent voices), delusions (false or irrational beliefs), disorganised speech, emotional changes and difficulties in social interactions. It is considered one of the most disabling psychiatric illnesses and tends to appear in late adolescence or early adulthood. According to the World Health Organisation, it affects more than 20 million people worldwide and is associated with a substantial reduction in average life expectancy, mainly due to physical comorbidities, an increased risk of suicide and difficulties in accessing adequate healthcare.
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IMMERSIVE REALITY AS A FORMATIVE TOOL FOR UNDERSTANDING SCHIZOPHRENIA
Publication type: Article Summary
Original title: Using Immersive Environments in E-Mental Health Rehabilitation Programs Directed to Future Health Professionals to Promote Empathy and Health Literacy about Schizophrenia
Article publication date: August 2024
Source: Healthcare
Authors: Paulo Gomes, António Marques, Javier Pereira, Rui Pimenta, João Donga & Raquel Almeida
What is the goal, target audience, and areas of digital health it addresses?
The study aims to evaluate the impact of two different types of immersive environments — computer graphics virtual reality and 360º video — in building the capacity of professionals to deal with people with schizophrenia. The target audience includes students on social rehabilitation programmes such as nursing, occupational therapy, psychology, medicine, social work and rehabilitation, as well as health professionals in continuing training. The work falls within the areas of digital health, with a focus on e-mental health, the use of immersive technologies as pedagogical tools and the promotion of mental health literacy.
What is the context?
Schizophrenia is a chronic mental disorder that significantly affects thinking, emotions, perception of reality and behaviour. It is characterised by a break with reality (psychosis), often manifested by hallucinations (such as hearing non-existent voices), delusions (false or irrational beliefs), disorganised speech, emotional changes and difficulties in social interactions. It is considered one of the most disabling psychiatric illnesses and tends to appear in late adolescence or early adulthood. According to the World Health Organisation, it affects more than 20 million people worldwide and is associated with a substantial reduction in average life expectancy, mainly due to physical comorbidities, an increased risk of suicide and difficulties in accessing adequate healthcare.
In addition to the clinical impact, schizophrenia is strongly associated with stigma, discrimination and social isolation, factors that jeopardise community integration and hinder access to psychosocial support. Among healthcare professionals, interaction with people with this condition can be marked by insecurity, emotional detachment or hesitation, often resulting from insufficient mental health literacy. The lack of empathy and understanding of the illness compromises the therapeutic relationship, causes distance between professional and patient and reduces the effectiveness of clinical intervention.
What are the current approaches?
Current approaches to treating schizophrenia are based on an integrated model that combines medication, psychosocial interventions and community care. Medication is the main resource for stabilising symptoms such as hallucinations and delusions, with antipsychotics being the most used drugs. Despite their effectiveness, these drugs are associated with significant side effects, which contributes to low adherence to treatment, especially when there is resistance on the part of the patient or limited understanding of the illness.
Psychosocial interventions — such as psychotherapy, psychoeducation, social skills training and rehabilitation programmes — play a central role in promoting autonomy and social inclusion. However, their effectiveness depends on continuity of care and adaptation to individual needs. Community care complements these approaches, being provided by multidisciplinary teams that accompany patients in their living context and seek to ensure an integrated response. Even so, they face significant constraints, such as a shortage of professionals, overloaded services and fragmented responses.
In recent years, innovative digital solutions have emerged, such as mobile applications like MindLAMP and Schizophrenia HealthStorylines, teleconsultation platforms and virtual reality-based experiences. These technologies show potential in improving mental health literacy, promoting self-care, and reducing stigma. However, important challenges remain related to inequality in digital access, the lack of scientific validation in real clinical contexts, adaptation to different user profiles and the need for specialized training for effective implementation.
What does innovation consist of? How is the impact of this study assessed?
The innovation of this study consisted of using immersive technologies to simulate, in an educational context, the subjective experience of a person with schizophrenia, with the aim of promoting empathy, reducing social distance and improving attitudes among future health professionals. Two different exhibition formats were compared: an interactive three-dimensional graphic environment and a 360º video, both built on the same immersive narrative and the same visual and auditory stimuli, ensuring the equivalence of the experimental conditions.
Both experiences were explored with HTC Vive Pro™ virtual reality glasses, connected to high-performance computers and wireless adapters, enabling total mobility and an experience with high visual and sound fidelity. During the exhibition, participants focused on performing the Stroop test — identifying the color in which the words were written, even when it did not match the word’s meaning (e.g., the word “green” written in blue) — while simultaneously receiving sensory stimuli typical of psychotic episodes — such as auditory hallucinations, visual distortions and environmental interference — which gradually intensified, promoting a symbolic immersion in the experience of a person with schizophrenia.
The final sample consisted of 88 students from the occupational therapy course at the Escola Superior de Saúde do Politécnico do Porto, randomly allocated to two experimental groups (graphic environment vs 360º video) and a control group.
A multimodal approach was used to assess the impact, combining subjective and objective measures. Before and after exposure to the immersive environments, the participants completed the Virtual Doppelganger Questionnaire, a validated questionnaire that assesses three aspects: empathic feelings (assessed with 12 items), social distance (7 items) and attitudes towards schizophrenia (7 items), with Likert response scales — a format that allowed quantifying the degree of agreement, frequency or perceived intensity in relation to the questionnaire items. After the exhibition, a simulation evaluation scale (5 items) was also applied, which collected perceptions of the realism and involvement experienced. In addition to these questionnaires, the Igroup Presence Questionnaire was used to assess the perception of presence in virtual environments. At the same time, physiological data was collected in real time, namely heart rate and electrodermal activity, using the Biopac™ MP160 system, making it possible to gauge the intensity of the emotional response during exposure.
What are the main results? What is the future of this approach?
Both immersive environments demonstrated significant and consistent improvements in participants’ ability to interact with people with schizophrenia, fostering more positive attitudes. The 360° video slightly stood out in reducing social distance and increasing empathy, while the graphic virtual reality showed slightly higher engagement levels, though without statistically significant differences. No relevant differences were found in perceived realism or sense of presence. Psychophysiological data showed intense emotional responses during high sensory load moments, with slight variations between formats but no statistical significance: the graphic virtual reality showed a slightly higher average heart rate, while the 360° video recorded greater electrodermal activity. Thus, the choice between formats should be based on project’s objectives, target audience, and available resources. The 360° video is recommended for quicker, more accessible, and lower-cost solutions, while three-dimensional graphic environments are ideal for experiences requiring higher interactivity, customization, and dynamic scenarios.
This approach represents an evolution in mental health teaching by providing sensory experiences that bring students closer to the subjective reality of people with mental disorders. The integration of virtual reality into the educational context is proving to be effective in reducing stigma, strengthening mental health literacy and promoting more humanised attitudes.
In the future, it would be pertinent to extend this strategy to other populations, such as practising health professionals, informal carers or students from different disciplines. In addition, longitudinal studies could clarify the sustained impact of these experiences over time. With the growing accessibility of immersive technology, this approach presents itself as a promising, structured and replicable teaching resource with the potential to contribute to a more empathetic, informed and person-centred clinical practice.
Would you like to know all the details?
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Home / Publications / Publication
IMMERSIVE REALITY AS A FORMATIVE TOOL FOR UNDERSTANDING SCHIZOPHRENIA
Publication type: Article Summary
Original title: Using Immersive Environments in E-Mental Health Rehabilitation Programs Directed to Future Health Professionals to Promote Empathy and Health Literacy about Schizophrenia
Article publication date: August 2024
Source: Healthcare
Authors: Paulo Gomes, António Marques, Javier Pereira, Rui Pimenta, João Donga & Raquel Almeida
What is the goal, target audience, and areas of digital health it addresses?
The study aims to evaluate the impact of two different types of immersive environments — computer graphics virtual reality and 360º video — in building the capacity of professionals to deal with people with schizophrenia. The target audience includes students on social rehabilitation programmes such as nursing, occupational therapy, psychology, medicine, social work and rehabilitation, as well as health professionals in continuing training. The work falls within the areas of digital health, with a focus on e-mental health, the use of immersive technologies as pedagogical tools and the promotion of mental health literacy.
What is the context?
Schizophrenia is a chronic mental disorder that significantly affects thinking, emotions, perception of reality and behaviour. It is characterised by a break with reality (psychosis), often manifested by hallucinations (such as hearing non-existent voices), delusions (false or irrational beliefs), disorganised speech, emotional changes and difficulties in social interactions. It is considered one of the most disabling psychiatric illnesses and tends to appear in late adolescence or early adulthood. According to the World Health Organisation, it affects more than 20 million people worldwide and is associated with a substantial reduction in average life expectancy, mainly due to physical comorbidities, an increased risk of suicide and difficulties in accessing adequate healthcare.
In addition to the clinical impact, schizophrenia is strongly associated with stigma, discrimination and social isolation, factors that jeopardise community integration and hinder access to psychosocial support. Among healthcare professionals, interaction with people with this condition can be marked by insecurity, emotional detachment or hesitation, often resulting from insufficient mental health literacy. The lack of empathy and understanding of the illness compromises the therapeutic relationship, causes distance between professional and patient and reduces the effectiveness of clinical intervention.
What are the current approaches?
Current approaches to treating schizophrenia are based on an integrated model that combines medication, psychosocial interventions and community care. Medication is the main resource for stabilising symptoms such as hallucinations and delusions, with antipsychotics being the most used drugs. Despite their effectiveness, these drugs are associated with significant side effects, which contributes to low adherence to treatment, especially when there is resistance on the part of the patient or limited understanding of the illness.
Psychosocial interventions — such as psychotherapy, psychoeducation, social skills training and rehabilitation programmes — play a central role in promoting autonomy and social inclusion. However, their effectiveness depends on continuity of care and adaptation to individual needs. Community care complements these approaches, being provided by multidisciplinary teams that accompany patients in their living context and seek to ensure an integrated response. Even so, they face significant constraints, such as a shortage of professionals, overloaded services and fragmented responses.
In recent years, innovative digital solutions have emerged, such as mobile applications like MindLAMP and Schizophrenia HealthStorylines, teleconsultation platforms and virtual reality-based experiences. These technologies show potential in improving mental health literacy, promoting self-care, and reducing stigma. However, important challenges remain related to inequality in digital access, the lack of scientific validation in real clinical contexts, adaptation to different user profiles and the need for specialized training for effective implementation.
What does innovation consist of? How is the impact of this study assessed?
The innovation of this study consisted of using immersive technologies to simulate, in an educational context, the subjective experience of a person with schizophrenia, with the aim of promoting empathy, reducing social distance and improving attitudes among future health professionals. Two different exhibition formats were compared: an interactive three-dimensional graphic environment and a 360º video, both built on the same immersive narrative and the same visual and auditory stimuli, ensuring the equivalence of the experimental conditions.
Both experiences were explored with HTC Vive Pro™ virtual reality glasses, connected to high-performance computers and wireless adapters, enabling total mobility and an experience with high visual and sound fidelity. During the exhibition, participants focused on performing the Stroop test — identifying the color in which the words were written, even when it did not match the word’s meaning (e.g., the word “green” written in blue) — while simultaneously receiving sensory stimuli typical of psychotic episodes — such as auditory hallucinations, visual distortions and environmental interference — which gradually intensified, promoting a symbolic immersion in the experience of a person with schizophrenia.
The final sample consisted of 88 students from the occupational therapy course at the Escola Superior de Saúde do Politécnico do Porto, randomly allocated to two experimental groups (graphic environment vs 360º video) and a control group.
A multimodal approach was used to assess the impact, combining subjective and objective measures. Before and after exposure to the immersive environments, the participants completed the Virtual Doppelganger Questionnaire, a validated questionnaire that assesses three aspects: empathic feelings (assessed with 12 items), social distance (7 items) and attitudes towards schizophrenia (7 items), with Likert response scales — a format that allowed quantifying the degree of agreement, frequency or perceived intensity in relation to the questionnaire items. After the exhibition, a simulation evaluation scale (5 items) was also applied, which collected perceptions of the realism and involvement experienced. In addition to these questionnaires, the Igroup Presence Questionnaire was used to assess the perception of presence in virtual environments. At the same time, physiological data was collected in real time, namely heart rate and electrodermal activity, using the Biopac™ MP160 system, making it possible to gauge the intensity of the emotional response during exposure.
What are the main results? What is the future of this approach?
Both immersive environments demonstrated significant and consistent improvements in participants’ ability to interact with people with schizophrenia, fostering more positive attitudes. The 360° video slightly stood out in reducing social distance and increasing empathy, while the graphic virtual reality showed slightly higher engagement levels, though without statistically significant differences. No relevant differences were found in perceived realism or sense of presence. Psychophysiological data showed intense emotional responses during high sensory load moments, with slight variations between formats but no statistical significance: the graphic virtual reality showed a slightly higher average heart rate, while the 360° video recorded greater electrodermal activity. Thus, the choice between formats should be based on project’s objectives, target audience, and available resources. The 360° video is recommended for quicker, more accessible, and lower-cost solutions, while three-dimensional graphic environments are ideal for experiences requiring higher interactivity, customization, and dynamic scenarios.
This approach represents an evolution in mental health teaching by providing sensory experiences that bring students closer to the subjective reality of people with mental disorders. The integration of virtual reality into the educational context is proving to be effective in reducing stigma, strengthening mental health literacy and promoting more humanised attitudes.
In the future, it would be pertinent to extend this strategy to other populations, such as practising health professionals, informal carers or students from different disciplines. In addition, longitudinal studies could clarify the sustained impact of these experiences over time. With the growing accessibility of immersive technology, this approach presents itself as a promising, structured and replicable teaching resource with the potential to contribute to a more empathetic, informed and person-centred clinical practice.
Would you like to know all the details?
Autonomous Patient Mobility in a Hospital Environment
The internal transport of patients in healthcare institutions, although at first glance it may seem like a simple task, represents a complex, continuous, demanding and time-consuming logistical operation that cuts across all levels of the…
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Speech is a biomarker that reflects, in a sensitive way, the integrated functioning of several physiological systems, namely the nervous, respiratory, and muscular systems. This complexity makes it a promising resource for detecting changes associated…
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Minimally invasive surgery is a procedure performed inside the body through small incisions and is referred to by different names depending on the region intervened. When it occurs in the abdominal or pelvic cavity, it…
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The healthcare sector is undergoing rapid transformation driven by population aging, increasing complexity of care, and digital advancements, in a context that requires greater integration, sustainability and adaptation to new realities such as the European…
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Induction of labor is a frequently performed obstetric procedure that involves the artificial initiation of uterine contractions before spontaneous onset. Its use has been increasing globally, particularly in high-income countries, where it accounts for about…
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Digital transformation has reconfigured healthcare systems, by integrating digital technologies into clinical and administrative processes, driving improvements in the quality of services, patient safety and the organizational efficiency of institutions. In addition to the computerization…
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Insomnia is a sleep disorder characterised by persistent difficulties in initiating sleep, maintaining sleep during the night, or achieving restful sleep. These difficulties arise even in the presence of adequate sleeping conditions and are often…
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According to the World Health Organisation, cardiovascular disease remains the leading cause of death worldwide, responsible for around 17.9 million deaths a year. Its high prevalence is associated with unhealthy lifestyles characterised by poor diet,…
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Eye diseases represent a growing public health challenge in Portugal, significantly compromising the population’s quality of life. The increase in their prevalence is associated with various factors, such as demographic ageing, excessive use of digital…
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Alzheimer’s disease is the most common form of dementia, affecting more than 55 million people globally and accounting for around 70 percent of dementia cases. In Portugal, it is estimated that 200,000 people live with…
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Portugal has one of the highest aging populations in the world, placing increasing pressure on elderly care services, especially in nursing homes. Healthcare professionals in these facilities are often overwhelmed due to the increasing number…
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Paroxysmal diseases are characterized by sudden, episodic conditions that cause temporary changes in the body. Among them, epilepsy stands out for causing synchronous and uncontrolled neuronal discharges, resulting in recurrent and unprovoked seizures. These seizures…
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Vascular diseases, such as carotid stenosis (narrowing of the carotid arteries, which connect the heart to the brain, caused by the accumulation of fatty atheroma plaques), cerebrovascular accidents (CVA) (sudden interruption of blood flow to…
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The growing use of electronic health records, digital diagnostic systems and remote monitoring technologies has led to a significant increase in the volume and complexity of health data. This increase intensifies the need for continuous,…
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Many patients face difficulties scheduling medical appointments in hospital units, and, when successful, they often endure long waiting times to be attended. This situation is aggravated by problems such as the incompatibility of schedules between…
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In recent years, digital transformation in healthcare has played a crucial role, driven by the exponential increase in medical data. This ranges from administrative information to detailed records of diagnoses, laboratory tests, medical images and…
ULS Almada-Seixal Revolutionizes With the Region’s First Surgical Robot
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Anxiety disorders are a global problem, affecting 300 million people worldwide and placing significant pressure on individuals and healthcare systems. In Europe alone, the economic impact reached 74.380 million in 2010, with 62.2% attributed to…
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Currently, robotic systems for ultrasound diagnostic procedures fall into two main categories: portable robots that require manual positioning and fully autonomous robotic systems that independently control the ultrasound probe’s orientation and positioning. Portable robots rely…
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From “Free Text” to Structured Clinical Data: the Foundation for Clinical Decision Support Systems
Currently, the practice of recording clinical information in “free text” offers flexibility, but hinders automatic data extraction, limiting the application of analytical models. Most records are unstructured, and the use of non-standard abbreviations increases ambiguity,…
Artificial Intelligence used in Depression Detection in Cancer Survivors
The goal of the FAITH project (Federated Artificial Intelligence solution for moniToring mental Health status after cancer treatment) is to remotely identify and predict depressive symptoms in cancer survivors using a federated machine learning approach…
Integration of SONHO v2 and SClínico Systems at ULS of Coimbra to Improve Healthcare Services
With more than half a million hospital medical consultations carried out in the first half of 2024, the ULS of Coimbra stands out as an institution dedicated to integrated, high-quality and patient-centered healthcare, with 8…
Elderly Care Ecosystem: an Innovative Platform for Personalized and Efficient Services
The Elderly Care Ecosystem (ECE) is an integration of various digital health technologies, exploring the areas of telehealth and predictive analytics. The goal of this ecosystem is to improve the quality of life for elderly…
Innovative technology that subconsciously relieves anxiety through a scarf
The SCAARF technology aims to offer an alternative method to alleviate anxiety symptoms in a non-intrusive and subconscious way. This technology is an innovative idea in the field of digital health and wearable technology, designed…
Digital Health Interventions: Equity in Hypertension Care for Everyone
Nearly half of all adults in the United States have hypertension, one of the leading risk factors for cardiovascular disease, and only about a quarter (24%) of those people have their hypertension under control. Studies…
Personalization and Technology in Diabetes Management
IPDM has significant potential to improve diabetes management and drive health system reforms to become high-performing, effective, equitable, accessible, and sustainable. Evidence and good practices inspire health system transformation. Adopting person-centred approaches like co-creation and…
Negotiations on the European Health Data Space Advance With the Participation of the SPMS
The European Health Data Space will be a common health data sharing system across the European Union. It foresees the use of data for purposes that benefit people and society. It will ensure citizens have…
Secretary of State Margarida Tavares Emphasizes Digital Innovation in Health Promotion
Margarida Tavares spoke at the opening of the conference ” O Digital na promoção contínua da saúde e do bem-estar”, organized by the Associação para a Promoção e Desenvolvimento da Sociedade da Informação (APDSI) and…
ARS Algarve Modernizes Radiology With AI and New Data Center
The radiology service of ARS Algarve has already performed nearly 29,000 exams using Artificial Intelligence (AI) technology. In recent years, there has been a significant investment in image digitization and data storage, as well as…
European Health Data Space: Unified Access To Health Data In The EU
The COVID-19 pandemic highlighted the importance of digital services in health, but complex rules and increasing cyberattacks make it difficult to share data across Member States; the EHDS, based on several regulations, provides tailor-made rules…
European Commission Amends Digital Europe Programme With an Investment of €762.7 Million
The European Commission has amended the Digital Europe Programme work programmes 2023-2024, investing an additional €762.7 million in Europe’s digital transition and cybersecurity. The digital transition is the main work programme with a budget of…
SPMS Integrates the TEF-Health Initiative
SPMS participates in the TEF-Health initiative as a partner in a consortium composed of 51 entities from 9 European Union countries. This action is co-financed by the European Commission and has a duration of five…
FMUP Creates Inhealth Junior Academy for High School Students
The InHealth Junior Academy — Academia Júnior de Inovação em Saúde is an initiative of the Departamento de Medicina da Comunidade, Informação e Decisão em Saúde da Faculdade de Medicina da Universidade do Porto (FMUP)….
SPMS Represents Portugal as Vice-president of GDHP
The GDHP is an intergovernmental organization in the digital health sector that facilitates cooperation and collaboration between government representatives and the World Health Organization (WHO). Its purpose is to foster policymaking that promote the digitalization…
Digital Transformation of Health at INCoDe.2030 in Tomar
The “National Digital Skills Initiative e.2030, Portugal” (INCoDe.2030) is an initiative that aims to improve the Portuguese population’s level of digital skills, placing Portugal at the level of the most advanced European countries in this…
Braga Hospital Evaluates Memory With Interactive Game in Patients With Multiple Sclerosis
Multiple Sclerosis is known as a chronic disease of the central nervous system, with a wide variety of motor and sensory symptoms that can lead to work disability, socioeconomic burden, and reduced quality of life…
Neurosurgery Teleconsultation Wins Innovation Award
The aim of the BI Award for Innovation in Healthcare is to recognize innovative projects in the healthcare sector that improve the quality of life for the Portuguese people. In 2021, the specific theme was…
HealthData@PT: New SPMS Initiative for Health Data
Action HealthData@PT is launched in the context of the implementation of the European Health Data Space, and is an initiative approved by the European Commission under the EU4Health 2021-2027 programme. This initiative contributes to the…
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