The Effect of Virtual Reality in the Psychoeducation of Depressive
Patients and their Relatives
A multiple case study focusing on the feelings of loneliness and self-
stigmatization in patients and the perceived burden in their relatives
De Specialist, 2020.
E.M.A. Holtmaat
FPN Master Mental Health (Adult Psychopathology)
September 2021 – February 2022
Maastricht University
Date: January 6, 2022
Wordcount: 6721 words
, Abstract
Loneliness and stigmatization have a major influence on the severity and symptoms of a
depressive disorder and the depressive symptoms have a great impact on the burden of
care of their close relatives. Psychoeducation (PE) is an important and effective part of the
treatment of depressive disorders. However, PE does not specifically focus on loneliness or
stigmatization. The addition of the experience video in Virtual Reality (VR) can cause a
higher level of immersion because it creates a near-real environment and may therefore
also help decrease feelings of stigmatization, loneliness and perceived burden of care. The
present study investigated whether the addition of the experience video in VR to the PE as
usual led to a greater short-term reduction of feelings of loneliness and feelings of self-
stigmatization in patients and whether it led to a greater short-term reduction in the burden
of care of their relatives. A multiple case study was conducted on 20 participants aged 18-
65. 10 patients and 10 relatives were randomly assigned to PE as usual or PE with the
addition of the experience video in VR. The Short Loneliness Scale, the Internalized Stigma
of Mental Illness scale, and the Involvement Evaluation Questionnaire were used to collect
data which were analysed by the Reliable Change Index (RCI). Based on the RCI, PE as
usual seemed to have a positive effect on the feelings of loneliness, showed to not affect
the feelings of self-stigmatization and seems to worsen the burden of care of their relatives.
The addition of the experience video in VR to the PE as usual seemed to lead to a short-
term increase of feelings of loneliness and showed to have no significant effect on the
feelings of self-stigmatization. However, there is a small positive change seen in the
perceived burden of care of the relative who received PE with VR compared with PE as
usual. Nevertheless, it is seen that both the patients and their relatives experienced
increased positive effects after receiving PE as usual or PE with VR based on the
questionnaire directly after the PE session.
Keywords: Virtual Reality, Depressive Disorder, Psychoeducation, Loneliness, Self-
Stigmatization, Burden of care
2
The Effect of Virtual Reality in the Psychoeducation of Depressive Patients and their Relatives
E.M.A. Holtmaat
, Table of contents
Abstract ..................................................................................................................................................... 2
Table of contents................................................................................................................................... 3
Introduction ............................................................................................................................................ 4
Hypothesis ................................................................................................................................................... 6
Method ....................................................................................................................................................... 7
Participants..................................................................................................................................................... 7
Material ............................................................................................................................................................ 7
Short Loneliness Scale ..................................................................................................................... 8
Internalized stigma of mental illness scale (ISMI-10) ......................................................... 9
Involvement Evaluation Questionnaire (IEQ) .......................................................................... 9
Questionnaire after the PE session .............................................................................................. 9
Procedure ...................................................................................................................................................... 10
Data analysis plan ..................................................................................................................................... 10
Ethical consideration ................................................................................................................................. 11
Results ..................................................................................................................................................... 12
Loneliness ..................................................................................................................................................... 12
Self-stigmatization .................................................................................................................................... 14
The perceived burden of care ............................................................................................................... 15
Conclusion and discussion .............................................................................................................. 18
Reference list ........................................................................................................................................ 21
Appendix ................................................................................................................................................. 25
Appendix 1: Short Loneliness Scale ................................................................................................... 25
Appendix 2: Internalized Stigma of Mental Illness scale ............................................................ 26
Appendix 3: Involvement Evaluation Questionnaire .................................................................... 28
Appendix 4: Questionnaire after the psychoeducation................................................................ 34
Appendix 5: Information letter ............................................................................................................. 38
Appendix 6: Informed consent ............................................................................................................. 44
3
The Effect of Virtual Reality in the Psychoeducation of Depressive Patients and their Relatives
E.M.A. Holtmaat
Patients and their Relatives
A multiple case study focusing on the feelings of loneliness and self-
stigmatization in patients and the perceived burden in their relatives
De Specialist, 2020.
E.M.A. Holtmaat
FPN Master Mental Health (Adult Psychopathology)
September 2021 – February 2022
Maastricht University
Date: January 6, 2022
Wordcount: 6721 words
, Abstract
Loneliness and stigmatization have a major influence on the severity and symptoms of a
depressive disorder and the depressive symptoms have a great impact on the burden of
care of their close relatives. Psychoeducation (PE) is an important and effective part of the
treatment of depressive disorders. However, PE does not specifically focus on loneliness or
stigmatization. The addition of the experience video in Virtual Reality (VR) can cause a
higher level of immersion because it creates a near-real environment and may therefore
also help decrease feelings of stigmatization, loneliness and perceived burden of care. The
present study investigated whether the addition of the experience video in VR to the PE as
usual led to a greater short-term reduction of feelings of loneliness and feelings of self-
stigmatization in patients and whether it led to a greater short-term reduction in the burden
of care of their relatives. A multiple case study was conducted on 20 participants aged 18-
65. 10 patients and 10 relatives were randomly assigned to PE as usual or PE with the
addition of the experience video in VR. The Short Loneliness Scale, the Internalized Stigma
of Mental Illness scale, and the Involvement Evaluation Questionnaire were used to collect
data which were analysed by the Reliable Change Index (RCI). Based on the RCI, PE as
usual seemed to have a positive effect on the feelings of loneliness, showed to not affect
the feelings of self-stigmatization and seems to worsen the burden of care of their relatives.
The addition of the experience video in VR to the PE as usual seemed to lead to a short-
term increase of feelings of loneliness and showed to have no significant effect on the
feelings of self-stigmatization. However, there is a small positive change seen in the
perceived burden of care of the relative who received PE with VR compared with PE as
usual. Nevertheless, it is seen that both the patients and their relatives experienced
increased positive effects after receiving PE as usual or PE with VR based on the
questionnaire directly after the PE session.
Keywords: Virtual Reality, Depressive Disorder, Psychoeducation, Loneliness, Self-
Stigmatization, Burden of care
2
The Effect of Virtual Reality in the Psychoeducation of Depressive Patients and their Relatives
E.M.A. Holtmaat
, Table of contents
Abstract ..................................................................................................................................................... 2
Table of contents................................................................................................................................... 3
Introduction ............................................................................................................................................ 4
Hypothesis ................................................................................................................................................... 6
Method ....................................................................................................................................................... 7
Participants..................................................................................................................................................... 7
Material ............................................................................................................................................................ 7
Short Loneliness Scale ..................................................................................................................... 8
Internalized stigma of mental illness scale (ISMI-10) ......................................................... 9
Involvement Evaluation Questionnaire (IEQ) .......................................................................... 9
Questionnaire after the PE session .............................................................................................. 9
Procedure ...................................................................................................................................................... 10
Data analysis plan ..................................................................................................................................... 10
Ethical consideration ................................................................................................................................. 11
Results ..................................................................................................................................................... 12
Loneliness ..................................................................................................................................................... 12
Self-stigmatization .................................................................................................................................... 14
The perceived burden of care ............................................................................................................... 15
Conclusion and discussion .............................................................................................................. 18
Reference list ........................................................................................................................................ 21
Appendix ................................................................................................................................................. 25
Appendix 1: Short Loneliness Scale ................................................................................................... 25
Appendix 2: Internalized Stigma of Mental Illness scale ............................................................ 26
Appendix 3: Involvement Evaluation Questionnaire .................................................................... 28
Appendix 4: Questionnaire after the psychoeducation................................................................ 34
Appendix 5: Information letter ............................................................................................................. 38
Appendix 6: Informed consent ............................................................................................................. 44
3
The Effect of Virtual Reality in the Psychoeducation of Depressive Patients and their Relatives
E.M.A. Holtmaat
