Personal narratives describing lived experiences of the entire spectrum of mental health challenges are now widely available to the public, including through autobiographies from public figures, thematic collections of narratives assembled by mental health organizations, and individual narratives published on video sharing services. Mental health lived experience narratives have been used as an “active ingredient” in interventions intended to create change, such as in campaigns against mental health stigma. In the narrative inquiry research approach, they are used to explore mental health phenomenology. Researchers and organizations working with mental health lived experience narratives have to contend with a wide range of legal and ethical challenges, such as how to handle narratives disclosing sensitive personal information about third parties and the ethical trade-off between preserving narrator autonomy over their presentation of personal identity and protecting narrators from harm due to mental health stigma if a narrator is identifiable in their narrative. In 2022, we formed the Interdisciplinary Consortium on Narratives in Context (ICONIC) of people with knowledge of narrative practices across disciplines. Members are engaged in health research, liberal arts, modern languages, history, and philosophy. In this viewpoint, we present four case studies of narrative practices by ICONIC members: (1) a narrative inquiry into the experiences of Ethiopian citizens with schizophrenia, (2) work to curate and share 2 collections of mental health recovery narratives, (3) an exploration of the use of poetic transcription to condense narrative interviews with mental health content, and (4) the development of safe approaches to working with personal narratives shared through an online mental health peer support service. In presenting these case studies, we focused on documenting decision-making on ethical and legal challenges as the best knowledge on ethical and legal decision-making regarding mental health lived experience narratives may come from integrating knowledge across disciplines. Through reflecting on these case studies, we identified cross-cutting challenges regarding consent processes, narrative analysis, and the interpretation and dissemination of data and findings. These challenges have transdisciplinary and disciplinary-specific features and can be used as a preliminary checklist in research design processes. In presenting what we learned, our intent was to demonstrate that greater knowledge on narrative practices can emerge through interdisciplinary contact and inform future decision-making on narrative practices by researchers working across disciplines. We conclude by contemplating interdisciplinary explorations with the potential to expand knowledge, including examining the use of pathographic narratives in philosophical inquiry.
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Virtual Reality–Assisted Therapy Compared to Cognitive Behavioral Therapy for Patients With Treatment-Resistant Schizophrenia: Assessor-Blind Randomized Controlled Trial
Background: Auditory verbal hallucinations (AVH) are among the most disabling symptoms of schizophrenia and often persist despite treatment. Virtual reality–assisted therapies (VRTs) are a new generation of relational interventions for AVH, but comparative evidence against active interventions is currently lacking. Objective: This study aimed to assess whether VRT (9 sessions) is superior to a short course of cognitive behavioral therapy (CBT) targeting AVH (9 sessions) in reducing AVH in individuals with treatment-resistant schizophrenia. Methods: In this assessor-blind, parallel-group randomized controlled trial conducted from 2019 to 2026 at an academic center in Montreal (Canada), adults with schizophrenia or schizoaffective disorder and persistent AVH were either referred by their health care team or self-referred. A total of 136 participants were randomly assigned 1:1 to VRT or CBT, stratified by sex and clozapine use status. Both 9-session interventions targeted maladaptive beliefs and relationships with voices and were administered by trained psychotherapists. The predetermined primary outcome was the evolution of AVH severity over time, measured at baseline, post treatment, and 3 months post therapy using the auditory hallucination subscale of the Psychotic Symptoms Rating Scale. Secondary outcomes notably included the general psychotic symptomatology measured using the Positive and Negative Syndrome Scale. Linear mixed-effects models were used to assess time-by-treatment interactions. Psychotherapy sessions and assessments were conducted primarily in person, with CBT being occasionally delivered via videoconferencing during the COVID-19 pandemic. Results: Participants had a mean age of 40.3 (SD 12.8) years, 63.2% (86/136) were male, and 56.6% (77/136) received clozapine. Intention-to-treat analyses (VRT, n=67; CBT, n=69) showed a significant time-by-treatment interaction favoring VRT (=.013) with a moderate effect size at 3 months post therapy (Cohen =0.614). Both therapies showed significant within-group improvements in the primary outcome, with large effect sizes for VRT (Cohen =0.81 post therapy and Cohen =1.17 at 3 months) and moderate for CBT (Cohen =0.58 post therapy and Cohen =0.39 at 3 months). While there were no between-group differences for secondary outcomes, within-group improvements were observed in psychotic symptoms, emotional regulation, and voice acceptance for both therapies, and VRT also reduced maladaptive beliefs about voices and improved self-esteem. Conclusions: VRT outperformed a targeted short course of CBT in reducing persistent AVH for up to 3 months after the intervention in a North American population with treatment-resistant schizophrenia. Improvements were also seen in some secondary outcomes, such as general psychotic symptomatology, and those were similar for both interventions. Overall, these findings support the value of VRT as a personalized and clinically effective intervention. Trial Registration: ClinicalTrials.gov NCT04054778; https://clinicaltrials.gov/study/NCT04054778
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Neural encoding of auditory processing in schizophrenia
IntroductionAuditory processing abnormalities are a core feature of schizophrenia and are linked to deficits in speech perception, cognitive function, and everyday communication. It remains unclear which stages of auditory processing are most disrupted and how these disruptions relate to symptoms at the level of population-wide neural representations.MethodsWe used fMRI recordings acquired while individuals with schizophrenia and matched healthy controls completed a controlled block-design speech-perception task. Voxel-wise encoding models mapped self-supervised speech-model representations, together with complementary acoustic and linguistic features, to neural responses.ResultsAcross cross-validated evaluations, individuals with schizophrenia showed numerically higher encoding alignment than matched controls across all evaluated regions of interest, although no effect survived false discovery rate correction in this small sample. The largest numerical group differences occurred in frontal language regions, including the middle frontal gyrus and dorsomedial prefrontal cortex, and in early auditory cortex. Subgroup analyses suggested that patients without auditory verbal hallucinations drove much of this numerical separation.DiscussionThese descriptive, hypothesis-generating findings suggest that model-based encoding can reveal a frontal-auditory signature in schizophrenia, but they do not establish a clinically actionable biomarker or preserved or enhanced speech encoding. Larger, adequately powered studies with richer feature spaces are needed for confirmatory inference and to test whether encoding-based measures can serve as clinically meaningful biomarkers.
Neurophysiological Signatures of Negative Symptom Improvement After High-Definition Transcranial Direct Current Stimulation: A Transcranial Magnetic Stimulation-Electroencephalography Study
Schizophrenia remains a major health challenge, partly because conventional antipsychotics show limited efficacy for negative symptoms. High-definition transcranial direct current stimulation (HD-tDCS) may improve these symptoms, but its neurophysiological mechanisms remain unclear.
Dexamphetamine-induced striatal hyperdopaminergia attenuates reward-related neural activation: A11C-PHNO PET-fMRI study
Ventral striatum (VS) and ventromedial prefrontal cortex (vmPFC) encode the value of stimulus and outcome phases in a context-dependent manner to support motivated behaviour. In psychosis, disrupted motivational coding has been hypothesised to contribute to negative symptoms via reduced sensitivity to goal-relevant information, potentially linked to elevated striatal dopamine. Direct causal evidence for this mechanism in humans remains limited.
[Comment] Relapse or rebound: the case for personalisation in antipsychotic discontinuation
For people with schizophrenia and their psychiatrists, deciding whether to discontinue antipsychotic treatment is a crucial decision. On average, stopping medication roughly doubles relapse risk and increases rates of rehospitalisation and mortality.1,2 However, continued treatment carries its own burden of metabolic harm and sedation, leading many patients to consider stopping.3 The clinical challenge, then, is not a simple choice between continue and discontinue, but identifying who can safely discontinue, and when.
[Comment] Psychodynamic psychotherapy in schizophrenia: where do we stand?
The role of psychodynamic psychotherapy for schizophrenia spectrum disorders has been debated for decades. During the 1960s and 1970s, psychodynamic and psychoanalytical therapies were widely used and were often the main treatment for individuals with schizophrenia-spectrum disorders.1 However, as more rigorous randomised controlled studies and longitudinal naturalistic follow-up studies accumulated, psychodynamic approaches failed to show benefits beyond standard of care.2,3 Some studies even raised concerns about potential negative effects, including increased suicidality.
Mobile Application-Based Interventions for Cannabis Use in Young Adults With First Episode Psychosis
Conditions: First Episode Psychosis (FEP); Psychosis; Schizophreni-form Disorder; Dependence Addictive
Interventions: Other: CHAMPS; Other: I Can Change
Sponsors: Centre hospitalier de l’Université de Montréal (CHUM); Integrated University Health and Social Services Center of the Capitale-Nationale; Nova Scotia Health Authority; Centre Intégré de Santé et de Services Sociaux de la Montérégie-Centre; Centre Integre Universitaire de Sante et Services Sociaux du Nord de l’ile de Montreal; Ottawa Hospital Research Institute
Not yet recruiting
Interventions: Other: CHAMPS; Other: I Can Change
Sponsors: Centre hospitalier de l’Université de Montréal (CHUM); Integrated University Health and Social Services Center of the Capitale-Nationale; Nova Scotia Health Authority; Centre Intégré de Santé et de Services Sociaux de la Montérégie-Centre; Centre Integre Universitaire de Sante et Services Sociaux du Nord de l’ile de Montreal; Ottawa Hospital Research Institute
Not yet recruiting
Virtual Care Expansion and Physician Follow-Up Among Youth With First Mental Health Contact Through a Hospital: Population-Based Repeated Cross-Sectional Study
<strong>Background:</strong> Timely follow-up is crucial for youth whose first mental health contact is through a hospital; virtual care could facilitate this. <strong>Objective:</strong> This study aimed to examine the association between the significant expansion of virtual care in Ontario, Canada, and follow-up mental health care rates for these youths. <strong>Methods:</strong> We conducted a population-based repeated cross-sectional study using linked health administrative databases. We identified first-contact emergency department (ED) visits or hospital admissions for self-harm, mood disorders, or psychosis from March 1, 2009, to February 29, 2024, among Ontario youth (aged 10-24 years). Virtual care was expanded in March 2020; we examined 2 expansion stages (temporary and permanent). Autoregressive integrated moving average analyses estimated level and slope changes (vs before virtual care) in age- and sex-standardized monthly rates of 7-day mental health follow-up. Subgroup analyses examined rurality and socioeconomic status. <strong>Results:</strong> We identified 42,208 first-contact ED visits and 17,701 first-contact hospital admissions. Pre–virtual care mean follow-up rates were 17.64 (SD 2.97) per 100 first-contact ED visits and 21.90 (SD 5.05) per 100 first-contact hospital admissions. Temporary expansion was associated with immediate increases in follow-up that declined (level changes: 4.81, 95% CI 2.82-6.81 for ED visits and 7.51, 95% CI 4.41-10.60 for hospital admissions; slope changes: −0.31, 95% CI −0.42 to −0.21 for ED visits and −0.32, 95% CI −0.48 to −0.15 for hospital admissions). Permanent expansion was associated only with an immediate decrease in ED visit follow-up (level change: −3.81, 95% CI −6.70 to −0.92) that was significant in rural (−1.06, 95% CI −1.93 to −0.184) but not urban (0.44, 95% CI −0.179 to 1.06) areas; results were otherwise similar between subgroups. <strong>Conclusions:</strong> Virtual care was not associated with sustained changes or equity improvements in mental health follow-up for high-acuity youth, representing a missed opportunity to extend physician reach and address barriers. Further research and quality improvement are needed. <strong>Trial Registration:</strong>
From facing fears to experimental frontiers: immersive cinematic virtual reality environments as a catalyst for innovation in behavioral neuroscience
Virtual reality (VR) has gained traction in psychiatric research in exposure-based interventions for phobias, simulations of hallucinations in psychosis, and adaptations of cognitive-behavioral therapy. These applications demonstrate that emotionally immersive digital environments can meaningfully engage pathological processes in controlled settings. Yet VR’s potential in psychiatry goes beyond providing new contexts for well-established therapeutic interventions. Here, we argue that while emotionally rich, interactive VR scenarios can be leveraged to radically improve translational experimental design in behavioral neuroscience, there are not yet clear conceptual frameworks for the incorporation of these elements. Traditional lab tasks with theoretical implications for therapeutic interventions often rely on abstract procedures that fail to capture the immersive, affective dynamics of real-world maladaptive behaviors. Here, we discuss how high-fidelity VR scenarios simulate complex emotional naturalistic contexts while retaining precise experimental control. We illustrate this drawing on our recent work using high-fidelity, game-engine-based VR scenarios and consider how these environments offer a scalable and accessible platform for large-sample studies, as VR hardware becomes more common in the household. We propose a set of dimensions called the Immersive Behavioral Translation Framework (IBTF) that suggest conceptual considerations for VR in neuroscientific research: (i) The controllability of immersive environments; (ii) features of immersive environments that bridge ecological validity gaps; and (iii) the relatability of these emotionally immersive experiments to clinical conditions in translational research. We illustrate this framework with reference to emerging findings in associative learning and threat sensitivity, while emphasizing the broader implications for rethinking how we study cognition, emotion, and psychopathology.