The simulation of hallucinations to reduce the stigma of schizophrenia: a systematic review

Many people with schizophrenia face stigmatisation. Several methods have been produced to simulate the auditory and visual hallucinations experienced by people with schizophrenia in order to increase empathy and understanding about the condition. However, there has been no review of such methods. This systematic review aims to determine whether and how simulated hallucinations are effective in reducing stigma, and if simulated hallucinations are safe and acceptable.

Medline, Embase, PsycInfo, the Cochrane Library, CINAHL, and Worldcat Dissertations and Theses were searched from 1980 to September 2010. Reference checking, hand-searching, and contacting of experts in the field were also performed. A narrative synthesis of quantitative studies was conducted, and qualitative studies were synthesised using meta-ethnography.

Ten studies were included. Simulation tools varied in context, but consistently increased both empathy towards, and desire for social distance from, people with schizophrenia whilst findings for other attitudes were inconsistent. Participants reported physical, cognitive and emotional discomfort. Qualitative data suggest that these discomforts give participants an 'insider's perspective' which produced empathy and respect. Simulated hallucinations sometimes produced concurrent negative affect, and physical and emotional distress, but were considered a highly acceptable learning tool.

Simulated hallucinations have contradictory effects on stigma, increasing empathy but also the desire for social distance. They should therefore be used with caution. Further research is required to discover if there is a way of using simulated hallucination interventions that increases empathy without increasing the desire for social distance from people with mental illness.