Virtual Reality Frontiers in Bipolar Disorders: A Recovery Oriented Cognitive Rehabilitation tool.

Background: Cognitive impairment is a fundamental rehabilitation outcome for people with mental disorders. This represents a barrier to achieve clinical, personal and social outcomes essential for a good quality of life. In line with the WHO innovation objective are increasing the use of technologies for treatment of mental disorders. This study aims at evaluating the feasibility and preliminary effectiveness of the first Cognitive Remediation Virtual Reality Program for people with bipolar disorder. Methods: Feasibility randomized controlled cross-over clinical study; we randomized 50 people from the Consultation and Psychosomatic Psychiatry Center of the University Hospital of Cagliari with a diagnosis of bipolar disorder. We proposed a CR/VR recoveryoriented program, 3 months with 2 weekly sessions, for the experimental group and a usual care program for the control group (psychiatric visit and/or psychotherapy). Results: We observed a significant feasibility outcome and clinical outcomes, both cognitive and personal and social functioning. In particular in memory (Ray’s Word Test p<0.003), attention (Matrix Test p<0.002), verbal fluency (FAS Test p<0.010), executive function in terms of cognitive esteem function (CET p<0.003), depressive symptoms (PHQ-9 p< 0.030), alexithymia (TAS-20 p<0.007) and in biological rhythms (BRIAN è<0.029). Conclusion: This RCT aims, with regards to it feasibility and design, to inform a confirmatory trial that evaluates the effectiveness of a VR CR program in psychiatric rehabilitation for the treatment of cognitive dysfunction in people with bipolar disorder. The results could have an impact on psychiatric rehabilitation research with a focus on improving the application of technologies for mental health.