A virtual reality-based intervention to train cognitive empathy and prevent emotional distress in informal caregivers of people with dementia

Objectives. Empathy is defined as a complex bio-psycho-social concept, consisting of two distinct components (the cognitive and the affective component) mapped by two distinct neural systems. Recent evidence shows that experiential learning through virtual reality (VR) may be an appropriate and effective method for eliciting empathic behaviour. This study will implement an intervention for informal caregivers (CGs) of persons with dementia (PWD) that combines psycho-educational programme with VR to train cognitive empathy and decreasing the emotional distress. Methods. 100 CGs will be randomised into two arms: i) the control group will participate in a validated psycho-educational intervention; ii) the experimental group will participate in the same psycho-educational intervention integrated with VR. VR consists of 360-degree videos and allows to experience dementia symptoms. Before and after intervention, all participants will complete validated scales for emotional distress. A subsample will also undergo fMRI task, modified from Ashar (2017), to investigate the effect of the intervention on the neural circuits that underlie empathy components. Results. The 6-weeks psycho-education intervention is modelled on the Savvy Caregiver paradigm and aims to support the CGs in empathically managing PWD. During each session, CGs will be exposed to an empathy training based on i) reading autobiographical texts of CGs or ii) VR. Emotional activation will be normalised by a psychotherapist. The intervention is expected to result in deeper disease comprehension, thereby reducing the CGs affective empathy. At the network level, we expect to observe a greater activation of cognitive empathy circuits and a lower activation of affective empathy circuits in the experimental group. Conclusion. To our knowledge, this will be the first randomized controlled trial that will combine VR with psychoeducation and that will test its efficacy with both clinical and imaging markers.