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Board index The 1966 Batman Message Board Off Topic Lounge
The forgotten 1994 Batsuit from DC's "Troika"
Here's a place for NON '66 Batman related subjects.
Mr. Comic Book
Post by Mr. Comic Book » Sun Nov 24, 2019 4:00 pm
Not many people remember this, but immediately following "Knightfall" and "Prodigal" (where Dick Grayson had a brief spell in the Batsuit while Bruce was out of town), DC decided they wanted to give Bruce a brand-new costume -- complete with embossed covers of varying darkness -- to signify that he was ready to get back in the game full-time. So with much hype and fanfare, a cross-title story called "Troika" served to introduce a revamped Batsuit designed by Vince Giarrano.
This new suit was still gray and blue (although the colorist never colored it consistently, even doing it as brown a few times), but the blue was restricted to the mask and cape. The bodysuit was a gray one-piece with built-in boots and gloves, both sporting the traditional Batman spines. It didn't go over very well with the artists, so three-quarters into its four-part debut storyline, this suit was scrapped, with the explanation that it didn't provide Bruce with enough protection.
For context, here's how it looked in full color, when Adrienne Roy remembered that Batman's colors are gray and blue.
At any rate, this suit didn't even last thru its debut story arc, and got replaced with a no-trunks version of Batman's classic suit that lasted until 2000.
I've shown the Troika Batsuit to various artists at comic cons, and the overwhelming response to it is that it's a dud. Nearly everyone's complained that there's not enough balance between the gray and blue, and that the boot spines would pose a huge risk of Batman getting tangled in his cape or getting his legs caught on stuff. Personally, I think it's an interesting design, but I don't think it should be Batman's regular look, and I am glad the old boots and gloves came back.
Any thoughts on this lost Batsuit?
SprangFan
Re: The forgotten 1994 Batsuit from DC's "Troika"
Post by SprangFan » Mon Nov 25, 2019 4:49 am
Hated it, and it contributed to my decision to sell off my Batman comic collection starting with "Knightfall", through "Prodigal" and up to "Troika," never to return. It was my farewell to comics.
That's not all on the suit, mind you (it just cemented my belief that things had been bad a long time, and showed no sign of improving), but it's awful. I'd also forgotten how much I hated Kelly Jones' art, with its deformed faces and anatomy. His Batman suffers from poor posture generally, and seemed to strike ridiculous poses in simple conversations, which if brought to the screen would draw bigger laughs than anything on the '66 show. In that first color panel above, he looks like he's relieving himself.
I agree about the "leg fins" and if we're going to bring real-world practicality to it, those ridiculous ears would rule out any Batmobile but a convertible. Maybe the reason Jones' Batman always seems stoop-shouldered is because he has to get through doorways.
John Mack
Post by John Mack » Mon Nov 25, 2019 1:12 pm
A low point in the adventures for sure. Not sure it's the lowest the series has ever gotten. What are some ideas on that? I'd be curious to hear you guys on that. Some would says it's the 1950's adventures story wise.
Music. BAT! Music.
Post by SprangFan » Mon Nov 25, 2019 3:09 pm
The 50s get a bad rap for the sci-fi stories that tried, incongruously, to ape the more successful Superman books, but there were a lot of great tales tucked behind those "tranformations and aliens" covers as well, focusing on Earthbound crooks and interesting travels abroad.
For me, it got worse in the 60s with "New Look" stories like the Outsider saga, and way too much Moldoff and too little Infantino. Prior to the 90s, that was the period I least enjoyed.
Lately I'm reading the early 80s period -- mostly by Gerry Conway -- that focuses an awful lot on soap-opera subplots involving a love triangle between Bruce, Vicki Vale and Catwoman. I remember being bored by it at the time and nostalgia's only giving it a partial polish in hindsight. This is the stuff that led to Miller's "Dark Knight Returns," because Miller said ( not without merit) that Batman had lost his edge and gotten "fat and happy." I welcomed DKR as a fun " alternate reality" tale but if I'd known it would kick off 30+ years on in-continuity darkness, I may not have embraced it so eagerly.
I can't really dump too much on the 90s to the present, since I've only followed it through third-hand sources and news stories. Suffice to say nothing's happened to tempt me back in a long time.
AndyFish
Post by AndyFish » Mon Nov 25, 2019 3:15 pm
I would say the most recent run of Batman has been the worst in it's 80 year history. Batman as a whiney child is worse than the psychotic Batman of the 80s. I stuck around for one issue and left.
This costume was wretched, and while I appreciate the style of Jones, it does often veer into ridiculous territory. I thought the costume was an attempt to bring the Keaton suit to comics.
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Post by Mr. Comic Book » Mon Nov 25, 2019 4:04 pm
SprangFan wrote: ↑
Funny you mention that. Jones had two different solutions to the Batmobile issue:
In Red Rain (the first installment in the Elseworlds vampire trilogy), the Batmobile was indeed an open-top job. In the mainline comics, Jones gave the Batmobile an enlarged canopy to accommodate Batman's ears.
I'll let you decide if either was a successful approach.
That convertible is a hoot! I'm imagining it sounding like Jack Benny's old "Maxwell."
https://m.youtube.com/watch?v=17N2g2Ryqi8
Even with the bubble top, he's gotta bend over the wheel like Grandma driving to bingo night.
Also gotta love panel 3 on the top page, with Batman taking a stealthy pose on an architectural detail from Mos Eisley Cantina.
I'm open to highly stylized art styles, like Mike Mignola for instance, and I'd place Jones in a similar "individuality over slavish realism" camp, but it often felt like he was exaggerating stuff just to see how much he could get away with. I felt he was always "aware" of his weirdness and it never felt like organic self-expression so much as "watch how weird I make it THIS time." It took me out of the story in the same way as Jim Carrey's " look how funny I am" mugging took me out of his films.
I might have been more forgiving if Jones could get through a whole page where a character looked the same throughout. Often until I read the word balloons, I wasn't sure whether Bruce Wayne was delivering a monologue for six panels or having a conversation with two other guys.
I preferred Berni Wrightson, basically the same Batman before drinking a case of Muscle Milk and spending three weeks on an exercise bike to turn his thighs into hamhocks.
Now I remember what got me to quit. The comics moved to glossy paper and went up in price, leaving me to ask, "why am I paying extra for a high-quality printing of sub par material?"
NJ_Batfan
Post by NJ_Batfan » Mon Nov 25, 2019 5:10 pm
I lost all interest in mainstream (read "in continuity") Batman comics by this time. Stylized artwork has its place, but how could Batman even hold his head up with the ears on that cowl?
For my money, the best Batman comics of the 90s were the adaptations of the animated series. They were mostly "done in one" stories that did not collapse under their own weight from being part of a "this changes everything" event that would change back soon after...or in the case of this costume, change in mid-story. Most of The Batman Adventures featured work by the late, great Mike Parobeck ,who could convey more with a simple facial expression than many of the era's so-called superstars could with busy linework and exaggerated anatomy. I haven't read those issues in a while, so maybe my mind is clouded with nostalgia, but at the time, they were favorite Batman comics and, in fact, the only ones that I still have from that era.
allknighters
Post by allknighters » Tue Nov 26, 2019 8:31 pm
Wow! Totally forgot about that hideous Batsuit!
Keith Mayo
Post by Keith Mayo » Tue Nov 26, 2019 9:56 pm
AndyFish wrote: ↑
I don't really care for modern comics, mainly due to the artwork. I have, however really enjoyed Mark Wagner's two series runs - Batman and the Mad Monk & Batman and the Monster Men. It's probably due to them being an homage to Golden Age Batman and the fact that I'm impressed when someone can write and draw a comic by themselves. Now that I think of it they really aren't "modern" as they were published in 2006.
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"It's the very essence of our democracy". - Batman, S1 Ep 11
Yellow Oval
Post by Yellow Oval » Wed Nov 27, 2019 11:42 am
That was one god-awful look they tried to push on him. Looking from then to now that didn't stop DC at all in their quest to warp Batman (and the others), did it? For me, asides from the first part of the Knightfall saga (the second half was pure garbage) and the No Man's Land series, I didn't get into where Batman was being taken at all in the '90s. Basically, Batman was on life support then and when I did venture into the comic stores, and saw how much he was being changed, I swear I heard the beeping of the heart machine in my mind and sensing he was going to flatline in the not-too-distant future.
Color me correct as when the 2000s hit and gushing DiDio, ever-smilin' Lee, "genius" Johns, and the rest of the clown car took the editorial/publisher driver's seats, a lone bugle somewhere in the distance played 'Taps' for me and all true Batman and comic lovers. I was out and so were my friends who also collected with some returning to the comic store only to unload their entire collections in disgust (this also included some Marvel fans as things were happening there as well). Though I still collect DC items related to older times, for me, DC Comics died around 20 years ago.
For what it's worth, I think that open air Bat-convertible belongs more in Riverdale as it looks like Archie's jalopy bouncing off the road.
"Hmmm... I don't like the twist this joke is taking. Let us away! Let us away!"
Post by SprangFan » Wed Nov 27, 2019 6:51 pm
From that "smiley face" chassis, I think it's more likely a repainted "Speed Buggy."
I may check out those Matt Wagner books if I can find them free in the library or on Hoopla; he's great. I liked his Batman/Grendel team-up and got him to sign it at a con.
A year or so ago I flipped through a Batman book and was totally lost; they're up to a half-dozen or so Robins or ex-Robins now, one of whom is his birth son (!), some sidekick named after the bat-signal(?), a super-powered Gotham Girl, the umpteenth version of the Huntress, a couple of Batgirls...for a guy presented as a social loner, this guy has the biggest entourage of any superhero at least since Silver Age Superman, and maybe ever. At this point, I'm not sure I could catch up if I wanted to. Luckily, I don't.
Post by Yellow Oval » Fri Nov 29, 2019 5:31 am
SprangFan,
Holy Automotive Dentistry! You're right. The grill and headlights do look like Speed Buggy. This makes Jones' take on Batman more of a joke.
As for 'Team Batman' in the comics it's team everything now. In comics, superhero TV shows (the absolutely horrid CW) and movies, even regular shows involving police, fire, whatever, we now see everything is always a 'team effort' concept. All dramas and comedies are multi-members (Whatever happened to smaller casts like The Odd Couple?). I mean, yeah, being ex-military I understand and appreciate teamwork is great and necessary in certain circumstances, but the concept of the individual is completely non-existent now. If you're not consistently part of a "team" you're nothing. I liked Batman and other heroes for their independence and self-reliance. I won't find that anymore.
By the way, Speed Buggy and Saturday morning rocked!!
Post by SprangFan » Fri Nov 29, 2019 2:27 pm
I enjoy team books and the Justice Society is near and dear to my heart, but Batman works better solo or at most teamed with one other character, as in the old Brave and the Bold books. And quite apart from matters of my opinion (which no one at DC cares about), the official take on Batman is that he's asocial, stand-offish and prefers solitude, which runs totally counter to what I'm actually seeing in those character-packed books. A dark figure swooping bat-like out of the shadows to mete out justice is a scary sight; the same figure accompanied by an entire Little League team? Not so much.
He needs to trade in "Speed Buggy" for a mini-van.
BTW, whenever I'm tempted to go easy on Kelly Jones, I remember this image, which besides being possibly the worst image ever of Batman (and only "possibly" because Sam Keith has also drawn him), is also one of the worst images in comics history, period.
How does this one get a free pass when Rob Liefeld's horrible Captain America image has taken on mythic infamy? Both display the same utter lack of understanding of human anatomy. What is that sticking out of Batman? A leg larger than his chest? A trash bag with a giant face trying to burst out? You got me.
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Aberavon MP Welcomes Community Leaders to Coffee Morning
Aberavon MP, Stephen Kinnock, welcomed representatives from a range of community organisations within his Constituency to a Coffee Morning held at his office in Port Talbot on 27th June, where they could meet Stephen and his staff, learn about the work of an MP, and raise issues important to them.
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There are two methods of using the fixed stars and their constellations for astrological purposes nowadays. 1) The fixed stars longitude method on the ecliptic or 2) The visual astrology of parans. The ecliptic is the path the Sun takes to travel around the earth, and it comprises the 360 degrees of the zodiac. The use of fixed stars in astrology goes back thousands of years, but since many of the important books were probably burnt in the fire of the great library in Alexandria, we may never really know precisely how the fixed stars were used astrologically as opposed to astronomically.
Hipparchus devised the first known catalogue of fixed stars in 129 BC when he projected 850 stars onto the ecliptic. Ptolemy the famed astrologer, astronomer and mathematician from Alexandria expanded this earlier work. At the end of 149 AD, Ptolemy had listed 1022 stars by longitude and latitude. This time Ptolemy took precession into account so this star list could be used by future generations.
This was a complete innovation. It was published in his influential astronomical work Almagest. This way of working with the fixed stars caught on in a big way, since it was beautifully simple. It completely wiped out the complex use of parans, which were thought to have been used previously.
Parans V Longitude
Ptolemy's tables were in use for an incredible 1000 years, but fixed star astrology fell out of favour during the uprise of Christianity. Ptolemy's work was rediscovered in the Arab world, however. Astronomer Ulugh Beg (1394-1449) produced star maps that were based on the poles of the celestial equator rather than the ecliptic.
Beg's positions differ from Ptolemy's by about 1 degree due to advanced instruments and a better understanding of physics. To get a better understanding of the differences between the two systems there is a great debate here on Skyscript's forum that explains the history and science of the longitude system of using fixed stars.
Bernadette Brady advocates the use of parans with fixed stars and refers to Anonymous of 379 CE's "Treatise On Bright Fixed Stars" in which it is stated that only fixed stars close to the ecliptic should be used in the manner of Ptolemy and that the only true way to use those above the ecliptic is by using parans. I suspect this recommendation is due to inaccuracies of measuring fixed stars off the ecliptic almost 2000 years ago. Science has moved on quite a bit since then!
Brady also says we shouldn't confuse Ptolemy's Astronomy (Almagest) with his Astrology (Tetrabiblios). I don't know if Ptolemy used parans as I can find no reference for it, neither can I find any current book on fixed stars that uses them. Since 1930, fixed star astrologers, Vivian Robson, Elsbeth Ebertin, Eric Morse and the late Diana K Rosenberg all use the longitude method for their interpretations.
I personally prefer the longtitude method because it is universal in terms of location. For example, if I used parans to read an eclipse, I would have to do a chart for every single city on earth! I also prefer the ecliptic method for natals since with parans everyone born on the same day in the same city, gets the same rising and midheaven star.
These days generally, in the US at least, birth times are recorded which again makes me think parans would've been more useful in times when birth times were not. I would like to share with you how I use the fixed stars in my own practice. It is so easy to get swamped by them, so I have arranged a tiered system. In this way we open up the mythology all the constellations, near and far. You can look up a stars latitude on constellation of words .
Constellations & Latitude
NEIGHBOURS: Fixed stars close to the ecliptic are generally those from the constellations of the zodiac. Like the star Regulus for Leo, Aldebaran for Taurus, Antares for Scorpio and so on. We can give these a 2º.30 -3º orb if they are of the 1st or 2nd magnitude because their effects are strong in that their messages speak to us loud and clear.
We don't need translation and we are familiar with their archetypes through the popular use of star sign astrology. Stars on the ecliptic are like they are standing in the same room with you, both on the same level. You can hear each other clearly and are speaking the same solar language. The language is down to earth, personality based and focuses on humanities struggle with its own ego.
FOREIGNERS: Then we have some constellations that sit close by the ecliptic, but who are not so familiar to us like Ophuichius, Orion, Corvus and Canis Minor. We can also feel their effects strongly, they might even speak the same language, but then we have to listen more carefully due to foreign accents! Examples Sirius, Fomalhaut, Capella, Ras Alhague, Rigel, Algorab, Algol.
These stars are more complex and we are starting to look at different cultures and ideologies. Just like Neptune, some of these energies can manifest negatively in an un-evolved being, the dangers of addictions and criminal tendencies are strong here especially with Algol and Algorab. These stars I use between 1º 30 -2º orb depending on their magnitude.
ALIENS: After that things get more mysterious and otherworldly. We need a radio to tune into their messages. With these far off stars are at higher latitudes so the orb has to be very tight, just like tuning into an fm station. The general rule for me is, the further off the ecliptic, the tighter the orb needed. But there is also another consideration; What is the consciousness level of the subject with this star? Can they even understand and utilize the energy that is being transmitted down to them?
Difficult stars higher up like Phecda (+47 latitude) could manifest to some ears as garble and noise. The stars could literally drive you mad. This is probably how Phecda's lower manifestations, like bloodlust and sexual obsession, end up being becoming one of its characteristics. I would give a very, very tight orb to Phecda! Maybe only 15'. Examples of other stars in this category: Phact, Canopus, Toliman, Vega, Polaris, Deneb Adige. Again bare in mind the magnitude. I'd give between 30' and 55′ (Under a degree) for these.
Decans
I think it is important to join the mythology of the zodiac back up to the sky from where it came. Precession has ripped the constellations off their original bearings. Tropical astrologers now use a system that bears no relation the actual sky co-ordinates. UPDATE: I have now finished my decans book. Here is the article on how to use them and their history. The Zodiac Decans
In modern times astrologers have no need to refer to the sky at all to practice their craft. Very few astrologers nowadays have telescopes, astrology software does the job far better of course, but our connection to the cosmos may have suffered as a consequence.
Ancient cultures had Henges (Such as Stonehenge) which gave a profound connection to the stars and planets through these stone observatories. Rituals of space and time make us self-aware, observers of ourselves and our actions, it makes us accountable. Astrology is religion in the truest sense, it re-links us with everything.
Religare in latin means "to connect". Religion can also be the tie that binds and constricts, so we must remember the planets incline they do no not compel, we have free will to use the stellar energy to it's highest or lowest potential. I have started to examine the stars and constellations as they fall into the decans of the zodiac signs.
This has proved very illuminating as I have found there is indeed a connection between the meaning of the fixed stars and the tropical zodiac signs in which they fall. The late Dane Rudhyar actually said that precession should be taken into account when reading the starsign. I do think it is significant when a fixed star changes signs. It's all synchronistic and symbolic.
The zodiac signs, the constellations and the fixed stars are all part of an evolving universe, nothing is absolute as new memes come into existence. So like we have Venus in Aries, so too we can have tropical Taurus moving through sidereal Aries, tropical Pisces in sidereal Aquarius and so on…
However as we have seen it's not that simple, there are far more constellations effecting each sign than just one, but Dane has made the connection which I respect. Diana Rosenberg took into account the tropical meaning of the signs in her interpretation of her star sets. I like the thought of re-uniting sidereal with tropical in some way, bringing some astronomy back to astrology. If grouping the fixed stars into decans can do that in some small way then I am happy.
Ptolemy is listed as being an astronomer, astrologer and a mathematician, as if those things were separate. Back in those days they were not. Ancient wisdom has been hacked into separate subjects and the connectivity and magic removed. Take a look at the beautifully illustrated "Book of Fixed Stars" by Ulagh Beg. It is a work of art, not a science manual.
Look at Albrecht Durer, this artist and mathematician produced the first printed maps of the constellations in 1515. I think we are coming full circle now though and I'm hoping astronomy and astrology will start to merge once more. Music is maths and colour has vibration. It's all linked. Astrology has correspondences in our bodies, in colour, in the chakras and even in musical notes. We are indeed made of stars.
Darkstar's list of articles on specific fixed stars & constellations. I also provide readings that incorperate the major fixed stars in your birthchart.
Categories Fixed Stars Tags Astrology 26 Comments
26 thoughts on "How To Use Fixed Stars"
Hi, you wrote: Anonymous of 379 BC's "Treatise On Bright Fixed Stars"
Just a correction, the text was written in 379 CE (Christian Era), not BC.
Raymond Nolan Scott
Not all Hellenistic Astrologers used the Tropical Zodiac
when they did, 0 Aries wasn't used as vernal point
there have been vernal points in 8,10,12,and 15 Aries
Right Ascension and Declination can be used with fixed stars.
Conjunction,Opposition in Right Ascension leads to 2 parans that don't depend on location.
Astronomers do use Right Ascension and Declination to locate the fixed stars.


Once the industrial powerhouse of the Austro-Hungarian empire, Ostrava between the wars was the coal and steel producing centre of democratic Czechoslovakia and sustained a vibrant artistic scene. After the Second World War, its dynamism diminished and only now, thirty years after the end of Communism, is it finding its feet again. Its era of prosperity coincided with a flowering of tolerance and integration, during which Jews were among the immigrants who were drawn to Ostrava and became leaders of its economic development. Some of the characters in the story are scions of the Rothschild family. Others are grafters who scratch together a living and end up growing successful businesses.
The Jewish community of pre-war Ostrava comes across as both deeply integrated into broader society and diverse in itself – socially and culturally Jewish more than it was religiously so. Secular atheistic Jews rub shoulders with the observant; religious practice ranges from the orthodox to reform Jews; and the orthodox employ a Christian organist and a non-Jewish opera singer. Marrying out is not unusual. The community enjoy all the normal things people enjoy: theatre, music, socialising in coffee shops and bars, promenading on the main drag.
The industrialised killing that awaited about 90 per cent of the Jewish community appears here largely in the interstices of the main account: relatives and friends of the protagonists who weren't so fortunate and ended up, as the authors repeatedly and correctly put it, murdered. I appreciate this plain speaking. So often we read of the victims of the Holocaust as having been gassed, or killed or simply perishing. The quiet insistence that runs through this book that they were murdered reminds us that this was criminality on a mass scale, not simply an artefact of war.
And while the book honours the memory of those who died, the sense of uplift is not inappropriate. It's important also to honour those who managed not to become victims, who had the foresight and determination to engineer their own fate. And, as in Schindler's List, the impact of their survival echoes through the subsequent generations. They went on to have families. And, thanks to the endeavours of David Lawson and his associates, they have formed a dispersed network of Ostrava Jews so their community is in a sense reconstituted.
My great-grandmother Emilie, with all her grandchildren. Heinz, my father, is on the right at the end. Pauli, Kurt and Edith (back row left to right) were all murdered by the Nazis. Eva, on her grandmother's knee, escaped on a kindertransport. Vera, between her and Heinz, survived the war in Vienna in fear of her life.
As interesting as the story of Ostrava and its Jews is the story of how it came to be told. After the war, it was discovered that there were accumulated in Prague Torah scrolls from synagogues throughout Czechoslovakia that the Nazis had destroyed. They were brought to London from where the Westminster Synagogue organised their dispersal to diaspora communities around the world. One of these scrolls, from Ostrava, ended up in the synagogue of Kingston upon Thames. There David Lawson and a number of other members of the Kingston synagogue initiated a project to enquire into its provenance. My father was the first of the Ostrava survivors that they found, coincidentally living just a few miles away.
Ostrava's story may seem of marginal interest to most people. But it has universal relevance. The echoes with our own era of the breakdown of liberalism and tolerance are impossible to ignore. We do not take seriously the threat to civilised order until nemesis is upon us. But the warning signs arise before the descent.
As I write, British democracy is in chaos – unable to resolve the deadlock over Brexit – and antisemitism has infected the main party of opposition. As the scholar David Hirsh has argued in Contemporary Left Antisemitism, many left-wingers, schooled to equate antisemitism with Nazism, struggle to recognise as antisemitism forms of bigotry that fall short of the final solution. But the Ostrava story shows that the catastrophe of Nazism was not simply the expression but the culmination of nationalistic and antisemitic sentiments which had become normalised by the time of the Nazi invasion. Antisemitism, in this sense, is a lead indicator of the threats to democratic ways of life.
For me, the story is a strange one. At some level, I owe my existence to the Holocaust. I grew up British with mixed heritage – with a pan-European sensibility and sensitised to antisemitism and racism from an early age. My upbringing was left-leaning and this seemed like common sense given our inheritance. I instinctively recoil from Brexit because it seems that the flawed co-operation of nations is preferable to competitive isolation. But I'm also averse to arbitrary authority and recognise that an alternative reading of Ostrava's story could cause me to celebrate Brexit as a reinvigoration of Britain's democratic impulse. The bigger point here is to lean towards tolerance and the respectful exploration of difference of view. This quality seems in desperately short supply at the present time.
When massive political and social forces are at work, our ability to influence them can be minimal. In such circumstances, our agency must be directed to survival. Before things reach that state, we should attune ourselves to the indicators of transgression and not allow the abhorrent to become normalised.
Ostrava and Its Jews by David Lawson, Libuše Salomonovičová and Hana Šústková. Available from Amazon.
I will be taking part in a discussion of 'Ostrava and Its Jews' with David Lawson on 24th January. David and I will be in conversation and will hopefully be joined by a representative of the Holocaust Education Trust. Please join us at Waterstones, 2-4 The Broadway, Crouch End, London N8 9SN at 7.15pm. More details here.


I was wondering - when using "while" usually the "ing" form of a verb follows but what if the sentence continues?
While his friends are enjoying (1. ing) their vacation at the beach he finally gets his snow.
While his friends are enjoying (1. ing) their vacation at the beach he is finally getting (2. ing) his snow.
The present progressive is mostly used for ongoing actions. The action takes place for a limited time and includes the time of speaking. While his friends are sleeping, he's watching TV. -> You are describing two ongoing actions which happen at the same time.
You can use the present simple for storytelling to describe events that happen one after another. The present progressive is then used to describe background events. "He gets home late, so he enters the living room quietly. He sits down on the couch and turns on the telly. While his friends are sleeping, he watches TV. Finally he falls asleep on the couch."
Not the answer you're looking for? Browse other questions tagged present-tense present-participles participle-clauses or ask your own question.
When to use –ing form and -ed form?
What does it mean when the sentence take the form of '~ , meaning ~'?
The Rules of using the "ing" verb?


text:
Dynamic Interactive Social Cognition Training in Virtual Reality (DiSCoVR) for social cognition and social functioning in people with a psychotic disorder: study protocol for a multicenter randomized controlled trial
Saskia A. Nijman ORCID: orcid.org/0000-0002-7214-66101,2,8,
Wim Veling2,
Kirstin Greaves-Lord3,4,5,
Rowina R. Vermeer6,
Maarten Vos2,
Catharina E. R. Zandee6,
Daniëlle C. Zandstra7,
Chris N. W. Geraets2 &
Gerdina H. M. Pijnenborg1,8
Problems in social functioning (e.g., unemployment, social isolation), are common in people with a psychotic disorder. Social cognition is a treatment target to improve social functioning, as it is a proximal predictor of social functioning. Social Cognition Training (SCT) improves social cognition, but may not generalize (enduringly) to social functioning, perhaps due to insufficient opportunity to practice in daily-life social situations. Using virtual reality (VR) for SCT could address this problem, as VR is customizable, accessible, and interactive. We will test the effect of a VR SCT, 'DiSCoVR', on social cognition and social functioning in a randomized controlled trial (RCT).
In total 100 people with a psychotic disorder and deficits in social cognition will be recruited for this multicenter randomized controlled trial (RCT). Participants will be randomized to VR SCT (DiSCoVR) or VR relaxation training (VRelax; active control). DiSCoVR is a 16-session individual SCT, consisting of three modules: 1) emotion perception (recognizing facial emotions in a virtual shopping street); 2) social perception and theory of mind (observing social interactions between virtual characters and assessing their behavior, emotions and thoughts); and 3) application of higher-order social cognition in social interaction (role-playing personalized situations in VR). People receiving VRelax complete sixteen individual sessions, in which they receive psycho-education about stress, identify personal stressors, learn relaxation techniques, and explore relaxing immersive virtual environments.
Assessments will be performed at baseline, post-treatment, and 3-month follow-up. Primary outcomes are emotion perception (Ekman 60 Faces), social perception and theory of mind (The Awareness of Social Inference Test). Secondary outcomes include social functioning (Personal and Social Performance Scale), experiences and social interactions in daily life (experience sampling of emotions, social participation and subjective experience of social situations), psychiatric symptoms (e.g., depression, perceived stress, anxiety, positive and negative symptoms) and self-esteem.
To our knowledge, this will be the first RCT testing the efficacy of VR SCT. It will also investigate generalization to daily life social situations, the durability of treatment effects, and moderators and mediators of treatment success.
On December 5, 2017, this trial was registered prospectively in the Dutch Trial Register as NTR6863.
For many people who have a psychotic disorder, it is a challenge to have meaningful daily activities, such as work, and to develop and maintain personal and romantic relationships; many of them experience problems in social functioning [1]. To function in daily life, it is necessary to adequately handle social situations and to be able to interpret the emotions, thoughts, intentions and behaviors of other people. These capabilities are generally referred to as social cognition. However, in people with a psychotic disorder, deficits in social cognition are common; a meta-analysis found large deficits in emotion perception and processing, social perception and theory of mind, compared to healthy controls [2]. Deficits in these key domains have been found to be important, proximal predictors for social functioning [3]. Social cognition has therefore become a target for psychosocial interventions aiming to improve social functioning through social cognitive training [4], a class of interventions also known as social cognition training (SCT).
SCT aims to improve social cognition, and ultimately social functioning through repeated practice with social stimuli (e.g., identifying emotions in pictures of faces), and compensatory strategy training (e.g., verbalization of salient facial features) [5]. A meta-analysis [6] of all types of SCT found large effects on emotion perception (recognition of emotions), and small to moderate effects on theory of mind (the ability to recognize and reflect on others' mental states). A more recent meta-analysis [7], including only comprehensive forms of SCT (i.e., targeting multiple areas of social cognition), found a large effect on emotion perception and theory of mind, and a small to moderate effect on attribution style (judgments about the causes of events and others' behavior). Together, these meta-analyses suggest that it is possible to improve social cognition with SCT in people with a psychotic disorder.
Some concerns have been raised, however, about the durability and generalizability of effects of SCT [4, 8]. While one meta-analysis [6] found a positive effect of SCT on community functioning, other reviews point out that treatment effects are most commonly and robustly found for lower-order social cognition processes such as emotion perception. On higher-order social cognition such as theory of mind, and social functioning, findings are more mixed and dependent on the specific measure used [4, 8]. We know from cognitive remediation research that integration with daily life is important for skills developed though cognitive training to generalize to social functioning [9]. Conventional SCT approaches may offer insufficient opportunity to practice in situations resembling real-life social interactions [8, 10]. Thus, effects of SCT on higher-order social cognitive processes and social functioning may be limited, as training materials may not sufficiently capture the complex, interactive and dynamic nature of real-life social situations.
The utilization of virtual reality (VR) for SCT has been proposed as a possible way to address this issue [4, 10]. VR is highly immersive, interactive and dynamic, and elicits psychological reactions similar to those in daily life [11]. Therefore, it is well-suited to simulate a variety of social situations and adequately reflect their complexity. At the same time, VR is controllable, which facilitates structured practice, and allows for situations to be scripted, repeated, varied, and personalized. Moreover, VR is a safe, accessible way to practice; participants know the virtual interactions can be stopped at any time, and that they can practice without negative repercussions and fear of embarrassment in their real social lives. Finally, VR is practical, as a wide range of situations can be generated quickly and practiced from one treatment setting, without traveling or accompanying participants in their daily environment.
VR is therefore a promising method to provide SCT. However, to our knowledge, no controlled studies of VR SCT for people with a psychotic disorder are available. Only one study on VR SCT has been published; a case report with two participants [12]. Improvements in social cognition and social functioning were reported after twenty sessions of a VR SCT. VR has also been used for social skills training (SST) in people with psychosis. A RCT of VR SST [13] among inpatients with schizophrenia (n = 91) showed that, compared to conventional SST, VR SST produced greater improvements in assertiveness and conversational skills, but no improvement was found in non-verbal skills. A pilot study of VR SST [14] reported improvement in social functioning, and VR measures revealed improvements in emotion perception, assertiveness, and time spent in conversations. Finally, pilot studies of VR SCT in people with autism spectrum disorder have reported improved emotion perception [15,16,17], attribution [16], theory of mind [15, 17], and (self-reported) social functioning [17]. Together, these studies suggest that VR SCT is promising.
To this end, we developed a novel VR SCT, Dynamic Interactive Social Cognition Training in Virtual Reality (DiSCoVR). In this randomized controlled trial (RCT), we aim to compare DiSCoVR to an active control condition, i.e., VR relaxation training (VRelax), in order to evaluate its efficacy on social cognition and social functioning. Moreover, we aim to assess the impact of the intervention on (the frequency and experience of) daily life social interactions, by using Experience Sampling Methodology (ESM), a diary method. We will also assess the durability of potential treatment effects in a 3-month follow-up period. Finally, we will perform moderator analysis to investigate who benefits from this VR SCT, and mediator analyses to examine variables mediating treatment effects. Thus, this study is the first RCT on VR SCT, using conventional measures of social cognition and functioning as well as experience sampling.
Participants are recruited from Dutch mental health treatment centers (University Center of Psychiatry of the University Medical Center Groningen, GGZ Drenthe, GGZ Delfland, and Zeeuwse Gronden). We recruit participants in two ways: 1) through advertisement of the study, by distributing posters and flyers, allowing participants to enroll themselves; and 2) through clinician referral: clinicians refer eligible and interested participants. Inclusion criteria are:
A diagnosis of a psychotic disorder according to DSM-5 criteria, either determined by a structured clinical interview (e.g., Mini-international Neuropsychiatric Interview [18], Structured Clinical Interview for DSM [19], Schedules for Clinical Assessment in Neuropsychiatry [20]) in the past three years or verified using the MINI Plus at baseline.
Deficits in social cognition, as indicated by a clinician.
Age 18–65 years.
Exclusion criteria are:
(Photosensitive) Epilepsy.
An estimated IQ below 70, and/or a diagnosis of intellectual disability.
Insufficient proficiency in the Dutch language.
Participants receive a compensation of €30 for each completed assessment, up to a total of €90. They also receive reimbursement for travel expenses incurred for the assessments.
The CONSORT inclusion flow diagram is shown in Fig. 1. This study is a multicenter single-blind randomized controlled trial (RCT) with two groups: 1) Dynamic Interactive Social Cognition Training in Virtual Reality (DiSCoVR), the experimental group; and 2) Virtual Reality Relaxation (VRelax), an active control group. Both groups receive treatment as usual alongside their designated intervention (DiSCoVR or VRelax). Participants complete three assessments: before the intervention (baseline, T0), directly after the intervention (post-treatment, T1) and three months after completing the intervention (follow-up, T2). After completion of the study, participants have the opportunity to receive the other treatment, if they wish.
CONSORT flow diagram
DiSCoVR
DiSCoVR is a 16-session individual VR SCT, taking place twice a week over a period of eight weeks. DiSCoVR is provided by psychologists with (at minimum) a master's degree in clinical psychology. A detailed treatment protocol describes the intervention, the software, the techniques that are used and the content of each session. Participants receive a workbook, containing session content summaries, exercises and worksheets (e.g., registration form of emotions they identified in their daily environment). DiSCoVR involves mass practice and compensatory strategy training. References to the patient's personal situations and goals are made in examples and/or exercises whenever possible, to facilitate generalization of training material to daily life. To the same end, through homework exercises, participants are encouraged to practice with techniques and strategies they have learned in the intervention in daily life. These homework exercises are discussed at the start of each session. The intervention consists of three parts, structured to build upon each other in increasing complexity:
Module 1: Emotion perception (5 sessions, 1–5). Participants explore a virtual shopping street where they identify emotions on virtual characters' faces. Several characteristics (e.g., intensity of emotions, time to respond) can be altered to adjust the difficulty level to the training needs of the participant. Participants practice with several strategies (e.g., mimicking emotions) to aid in emotion recognition, which they are encouraged to try at home.
Module 2: Social perception & theory of mind (4 sessions, 6–9). Participants view scripted social scenarios in VR, about which open-ended questions regarding behavior, emotions and thoughts are asked. These questions aim to stimulate mentalization. Participants can respond by stating their answer out loud. If they answer incorrectly, characters will give more explicit hints about their mental state, with intensified emotional expression. Participants continue to apply social strategies to understand situations (e.g., remembering how you felt in a similar situation), by choosing a strategy before practicing in VR. Participants learn about the connection between thoughts, emotions and behavior, and practice with recognizing these in VR scenarios, themselves, and in others around them.
Module 3: Social interaction (7 sessions, 10–16). Participants apply social cognitive skills in VR roleplay exercises with the therapist. They can practice with situations they struggle with, or that help them to achieve the goals they have set for the intervention. The protocol provides sample roleplay exercises, targeted at various social cognitive skills (e.g., detection of sarcasm and hints). Outside of VR, participants continue to practice with identifying emotions, thoughts and behavior and understanding their interrelatedness. They also learn a social problem-solving technique, in which they 1) consider their own thoughts, emotions and behavior; 2) consider the other person's thoughts, emotions and behavior; 3) consider different possible ways to react to a situation; and 4) role-play the different reactions and choose the most appropriate reaction to carry out in real life. Participants continue to practice using strategies (e.g., watching someone's emotional response to you to determine whether you should talk to them), both in VR and in real life.
The immersive VR worlds (a shopping street, a super market, an office and a bar), developed by CleVR BV, are displayed with an Oculus Rift headset (Consumer Version 1). They are shown in Fig. 2. Participants explore and interact with the virtual environment using a joystick controller. For the role play exercises, voice transformation is applied to mask the therapist's real voice. During the role plays, therapists can click buttons on the computer interface to trigger emotions and/or gesture animations (e.g., shrugging, pointing) in their virtual character.
Pictures of DiSCoVR environments and set-up. Legend: Top left: module 1 (translation: which emotion? Angry, happy, surprised); top right: module 2 (translation: what does Daniël actually mean?); bottom left: module 3, as seen from perspective of participant; bottom right: module 3, interactive role play setup. The virtual environments are property of CleVR BV; images have been used with permission from CleVR BV
VRelax
As an active control group, we chose VRelax, a VR relaxation therapy, as it matched important nonspecific characteristics of DiSCoVR (e.g., the use of VR, individual contact with a therapist twice a week), but did not target sociocognitive processes and therefore was not expected to improve social cognition. VRelax consists of sixteen sessions, provided twice a week in a period of eight weeks (the same as DiSCoVR), and aims to reduce both momentary (during sessions) and daily life stress and anxiety. VRelax is provided by therapists who either have 1) clinical experience in treating people with psychosis (e.g., psychiatric nurses); or 2) at least a bachelor's degree in psychology. In VRelax, participants' stressors are explored (i.e., which situations are stressful, and what are signs of stress). Participants learn to recognize stressful thoughts and rumination, and to apply coping strategies to address these (e.g., solving problems, asking for support and comfort, finding distraction). They also practice with relaxation exercises, such as breathing exercises, a body scan, grounding, and progressive muscle relaxation. Participants are encouraged to practice these techniques at home.
Each session starts with a discussion of stressors and negative emotions in the past few days. In some sessions, this is followed by psycho-education (e.g., about stress, coping and rumination). A large portion (±25 min) of each session is reserved for relaxation in VR. Immersive 360° video clips are shown with a Samsung Gear VR headset, running VRelax software developed by Viemr BV. Participants can visit a range of relaxing environments (Fig. 3), such as a sea in which they can swim with dolphins, a coral reef, a beach and a mountain meadow. They can control the environment using gaze; for example, to switch between environments or to engage with interactive elements (e.g., popping air bubbles underwater). Meditation exercises are embedded in the VR environment (e.g., guided meditation). Finally, part of each session is reserved for (learning to apply) relaxation techniques. These can be skipped if participants prefer to spend more time in VR.
VRelax environments, including relaxation exercises. The virtual environments are property of Viemr BV; images have been used with permission from Viemr BV
Materials and measurement instruments
The measures used in this study are summarized in Table 1.
Table 1 Measures used in this study
Primary outcome
Facial affect recognition
Ekman 60 Faces, Facial Expression of Emotions Stimuli and Tests (FEEST) [21]. 60-item computerized picture test assessing facial affect recognition. Participants view pictures of six emotions (happy, sad, angry, disgusted, surprised, anxious) and identify the expressed emotion. Total scores (0–60) are used for analysis.
Social perception and theory of mind
The Awareness of Social Inference Test part III (TASIT, Dutch version) [22, 23]. Short video clips showing social situations containing lies and sarcasm. Participants answer four questions after each video about the intentions, intended messages, beliefs and emotions of the characters. Total scores (0–32) are used for analysis. Parallel versions are used; the administration order (A-B-A or B-A-B) is randomized across participants.
Personal and Social Performance Scale (PSP) [24]. An interview assessing the degree of disability (from 1, "absent", to 5, "severe") in four areas of social functioning: 1) socially meaningful activities (e.g., work, study); 2) personal and social relationships (e.g., friendships); 3) self-care (e.g., hygiene); and 4) disturbing and aggressive behavior (e.g., problems with law enforcement). The ratings for each domain are combined into one score from 0 (very low) to 100 (very high), which will be used for analysis.
Momentary mental states and social functioning in daily life
Experience Sampling Method (ESM) dairies are used to study the effects of the interventions on daily life interactions. An online questionnaire (21–33 items, included in Additional file 1: Table S1) is administered ten times a day for seven days at semi-random moments, by sending participants text messages containing a link to the questionnaire, which they can complete in the internet browser on a smartphone. Participants use their own smartphone or one provided by the research team. The ESM questionnaire assesses: 1) emotional state (positive and negative affect and stress level; thirteen items), on a visual analogue scale (VAS; 0–100); 2) current activities and activities since the last questionnaire (five items, to assess social and societal participation), selected from a multiple choice menu, and a VAS (0–100) on the enjoyability of the activity; 3) current social interactions and interactions since the last questionnaire (fourteen items), including the enjoyability of the interaction, feelings of being accepted, knowing how to respond, and feeling able to tell what the other person is feeling (VAS, 0–100); and 4) taking social initiative (two items; VAS, 0–100).
Psychiatric symptoms
The following measures of psychopathology will be administered, since (social) cognitive training may improve psychiatric symptoms, and symptom levels could be a moderator or mediator of treatment effect:
The Positive and Negative Syndrome Scale (PANSS) [25], a semi-structured interview assessing positive (7 items, range 7–49), negative (7 items, range 7–49) and general (16 items, range 16–112) symptoms of psychosis in the past week on a 7-point scale (from 1, "absent", to 7, "very severe"). We will analyze the three subscales separately as well as the total score.
The Social Interaction Anxiety Scale (SIAS) [26], a 20-item self-report questionnaire measuring verbal and non-verbal social anxiety on a 5-point Likert scale. We will analyze the total score.
The Green Paranoid Thought Scale (GPTS) [27], a self-report questionnaire measuring paranoid thoughts of social reference ([16] items, part A) and social persecution (16 items, part B) in the past month on a 5-point Likert scale. We will analyze both subscales separately.
Perceived Stress Scale (PSS) [28], a ten-item self-report questionnaire on symptoms of stress in the past week, indicated on a 5-point Likert scale. We will analyze the total score.
The Self-Esteem Rating Scale (SERS) [29]. The SERS is a twenty-item self-report questionnaire using a 7-point Likert scale, assessing feelings of self-worth and competence. Total scores will be analyzed.
Information processing and executive functioning
The Trailmaking Test (TMT) [30]. In TMT-A, participants connect numbers in circles scattered across a page in consecutive order; in TMT-B, participants connect numbers and letters in circles scattered across a page, alternating between the letters and circles in consecutive order (1-A-2-B, etc.). The completion time in seconds for both parts is analyzed.
Demographic and clinical background
Questions on different clinical and demographic variables, including: age, gender, handedness, eyesight, family history of psychiatric illness, education level of participant and participant's parents, work history, diagnosis and illness duration (administered only at baseline); and housing status, employment status, substance use, medication use, hospitalizations and psychotic episodes (administered at each assessment).
Premorbid intelligence
The Dutch version (Nederlandse Leestest voor Volwassenen, NLV) [31] of the National Adult Reading Test [32]. Fifty increasingly uncommon words are read aloud by participants. Correct pronunciations are awarded a score of two points. The total score is used for analysis. The NLV is only administered at baseline.
Eligibility check
Mini International Neuropsychiatric Interview Plus (M.I.N.I.-plus) [18]. A structured clinical interview on symptoms of psychosis, depression and mania. The MINI-plus is administered at baseline to verify a diagnosis of psychotic disorder, if a diagnosis has not been determined by a structured clinical interview in the past three years.
Measures during treatment sessions
Cyber sickness
Simulator Sickness Questionnaire (SSQ) [33]. A self-report questionnaire on 27 common symptoms of simulator sickness (e.g., headache, nausea, dizziness), which will be administered right after the VR session 3 of both interventions to evaluate negative side effects of using VR. We will use the total score for analysis.
Performance and behavior during VR tasks
In the DiSCoVR group, the VR program will log several parameters during practice sessions (e.g., the avatars encountered, answers given to questions, time taken to answer, the number of answer attempts and interpersonal distance).
Emotions before and after relaxation
In the VRelax group, before and after each session in VR, participants complete a short questionnaire in which they rate their emotions (relaxed, anxious, gloomy, tranquil, stressed, excited, nervous and content) on a 0–100 VAS.
The assessments are carried out by trained, independent research assistants. This study is single-blind, meaning that research assistants do not know to which intervention participants have been assigned. This is achieved by instructing coordinators, therapists and participants not to divulge group allocation to research assistants. Other precautions include storing data revealing group allocation (e.g., therapist worksheets) in a separate location and using different assistants for each measurement as much as possible. Blinding is evaluated with a self-report form for research assistants at the end of the post-treatment and follow-up assessments. We will perform a sensitivity analysis by testing the treatment effect only for measurements where research assistants reported being completely blinded to group allocation.
Randomization procedure
We utilized permuted block randomization with randomized block sizes (2, 4 or 6) using the R package 'blockrand' [34]. For each participating treatment center, we created strata for age (ten-year increments) and gender (i.e., ten strata per center). This resulted in a master randomization list with either 'A' or 'B' in each stratum. An independent employee then added an additional randomization by assigning DiSCoVR or VRelax to either A or B in the master randomization list using coin flips, once for each treatment center. Upon completing T0, the participants will be placed in the appropriate stratum in order of inclusion by the independent randomizer, determining their group assignment.
Protocol fidelity
Therapists in both conditions will complete an eight-hour training. Monthly group supervision, in which all ongoing cases are discussed, will be provided for both conditions, to aid therapists and improve protocol fidelity. Therapists who are unavailable for these meetings will receive individual supervision. A weekly consultation session with the research team will also be available. After each session, therapists will complete a session form, on which they indicate whether they completed all parts of the protocol for that session, and whether any anomalies occurred.
Participants will be able to discontinue the study at any point. They can also refuse participation in part of the study, such as the ESM questionnaires. For sensitivity analyses, participants will be considered treatment completers if they complete twelve sessions or more (> 75%). If participants drop out of treatment, they are asked to continue the assessments. If participants refuse or miss T1, they are still contacted for T2.
Participant data will be coded using a study ID. Personal information and informed consent will be stored separately to ensure anonymity. We will use an electronic case report form; paper source data will be stored securely at each respective location. An independent monitor, who performs yearly routine inspections, will be appointed to ensure study quality and integrity.
For our primary outcome variables (theory of mind and emotion perception), previous meta-analyses [6, 7] have found effect sizes ranging between moderate (d = .46, theory of mind) and large (d = .84, emotion perception). We therefore assumed a conservative effect size of .5. With β = .80, α = .05, two groups and three assessments, we found we would need 86 participants. Assuming a drop-out rate of 13% [35], we concluded that the sample should consist of 100 participants (50 in each group).
The groups will be compared at baseline using t-tests for normally distributed variables, and Mann-Whitney U-test or χ2 test for other variables. Variables with a significant baseline difference between the groups will be added to the analysis as a covariate.
We will use multilevel mixed-model linear regression analysis in accordance with the intention to treat principle, with repeated assessments (level 1) nested within participants (level 2). Time and group and their interaction term will be included as fixed effects. Treatment effects will be evaluated by examining the interaction between time and group. A random intercept will be included for the participant level to account for the repeated measures. A random slope will be included for time if this improves the model, according to the AIC value. The post-treatment and follow-up assessments will be analyzed separately, comparing each to the baseline. We will also perform a multilevel regression analysis on treatment completers, defined as people who have completed at least twelve sessions (75%) of their allocated intervention. Furthermore, moderator (e.g., clinical and demographic variables) and mediator analyses will also be conducted. Significance will be accepted at α = .05 (two-tailed); in case of multiple measurements within the same domain, a correction will be applied to α.
Clinicians will approach potential participants and gauge their interest in the study. If patients express interest, or if potential participants approach the research team directly, they will be contacted and screened by the research team. They will receive written information about the study and will be given a one-week consideration period. If they are still interested after this period, participants will provide written informed consent, collected by the research assistant, and the baseline assessment will take place. In the week after the first assessment, the baseline ESM questionnaire period will take place. After this, participants are randomized to either DiSCoVR or VRelax, and receive sixteen DiSCoVR or VRelax sessions. When treatment has been completed, the post-treatment assessment will take place, followed by another ESM period of one week. Finally, three months after completing treatment, participants will complete the last follow-up assessment, followed by the final ESM questionnaire week.
The main goal of this trial is to evaluate the effect of DiSCoVR on social cognition and social functioning. We hypothesize that the DiSCoVR group will show greater improvements in emotion perception and theory of mind than VRelax at post-treatment, and that this difference will be maintained at 3-month follow-up. Additionally, we expect that participants in the DiSCoVR group will experience greater improvement in social functioning, as measured by an interview (PSP). Furthermore, we hypothesize that people in the DiSCoVR group will show more improvement in daily-life social functioning (i.e., feelings of acceptance, subjective social cognition, social participation and social initiative) than people who receive VRelax. Since VRelax targets stress, anxiety, coping and stress reactivity, we expect that participants in the control group will show equal or larger improvements in perceived stress and general anxiety.
Very little is currently known about mediators and moderators of treatment effects of SCT [4]. Therefore, mediation and moderation analyses will be explorative in nature. A meta-analysis on SCT [6] found that illness duration and education level were moderators of treatment effects on social cognition. We therefore postulate that these variables may moderate the treatment outcome of DiSCoVR, but we will also investigate other moderators (e.g., baseline levels of social anxiety and paranoia).
However, no meta-analysis thus far has investigated mediators of SCT efficacy. Both Eack et al. [36] and Hogarty et al. [37] found that improvements in neurocognition mediated improvements in social functioning after Cognitive Enhancement Training, a form of SCT targeting both social cognition and neurocognition. Neurocognition may therefore be a mediator of treatment outcome in the present study. However, since little is currently known about mediators of SCT treatment effects, we will explore additional variables.
While SCT is not a new method, the present study intends to improve upon existing methods by allowing participants to apply social cognition in personalized virtual environments and situations resembling daily life. This trial will also address some of the gaps in knowledge about SCT [4], particularly concerning generalization to daily life and durability, but also moderators and mediators of training effects.
Since there are presently no RCTs on VR SCT, the present study will shed light on the efficacy of this innovative method. If it proves to be effective, it could be an important tool to improve social cognition and social functioning – which is sorely needed, since durable functional recovery after psychosis is still uncommon [38]. Finally, because social cognitive deficits are a transdiagnostic characteristic [39], VR SCT may be a useful tool to remediate problems in social cognition and social functioning across a range of psychiatric populations, such as autism spectrum disorders.
The datasets used and/or analyzed during the current study will be available from the corresponding author on reasonable request.
Beck Anxiety Inventory
BDI:
DiSCoVR:
Dynamic Interactive Social Cognition Training in Virtual Reality
ESM:
Experience Sampling Method(ology)
FEEST:
Facial Expressions of Emotion: Stimuli and Tests
GPTS:
Green Paranoid Thought Scale
M.I.N.I.-plus:
Mini International Neuropsychiatric Interview Plus
NART:
National Adult Reading Test
NLV:
Nederlandse Leestest voor Volwassenen
PANSS:
Positive and Negative Syndrome Scale
PSP:
Personal and Social Performance Scale
PSS:
Perceived Stress Scale
RCT:
Randomized Controlled Trail
SCT:
Social Cognition Training
SERS:
Self-Esteem Rating Scale
SIAS:
Social Interaction Anxiety Scale
SSQ:
Simulator Sickness Questionnaire
T0 :
TASIT:
The Awareness of Social Inference Test
TMT:
Trailmaking Test
UMCG:
University Medical Center Groningen
VRelax:
Virtual Reality Relaxation
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We thank all participants and therapists who took part in our pilot study of DiSCoVR, for their valuable feedback towards improving the intervention and protocol. We also thank the four UMCG patients who provided us with feedback on our RCT study materials. Finally, we thank all site coordinators, therapists, participants, research assistants and referring clinicians who make this study possible.
The development of the VR software was supported by a peer-reviewed €75,000 Knowledge Innovation Mapping grant (628.005.007), awarded by the Netherlands Organization for Scientific Research (NWO). GGZ Drenthe provided €12,173 for four VR headsets and supporting research staff through an internal research grant. Finally, the University of Groningen provided a staff grant of €9,864 for participant compensation and reimbursement of their travel expenses. None of these institutions have played a role in the design of the study, data collection, analysis, and interpretation of data or in writing the manuscript.
Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, PO Box 30007, 9404, LA, Assen, the Netherlands
Saskia A. Nijman & Gerdina H. M. Pijnenborg
University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700, RB, Groningen, the Netherlands
Saskia A. Nijman, Wim Veling, Maarten Vos & Chris N. W. Geraets
Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia, Wytemaweg 8, 3015, CN, Rotterdam, The Netherlands
Kirstin Greaves-Lord
Autism Team Northern-Netherlands of Jonx, Department of (Youth) Mental Health and Autism of Lentis Psychiatric Institute, Laan Corpus den Hoorn 102-2, 9728, JR, Groningen, The Netherlands
Department of Yulius Autism, Yulius, Amazone 7, 3315, WG, Dordrecht, the Netherlands
Flexible Assertive Community Treatment Team, Outpatient Treatment Center, GGZ Delfland, Sint Jorisweg 2, 2612, GA, Delft, The Netherlands
Rowina R. Vermeer & Catharina E. R. Zandee
Zeeuwse Gronden, Axelsestraat 8/A, 4537, AJ, Terneuzen, The Netherlands
Daniëlle C. Zandstra
Department of Psychology, University of Groningen, Grote Kruisstraat 2/1, 9712, TS, Groningen, The Netherlands
Saskia A. Nijman
Wim Veling
Rowina R. Vermeer
Maarten Vos
Catharina E. R. Zandee
Chris N. W. Geraets
Gerdina H. M. Pijnenborg
GP, WV, SN, CG and KGL conceived and designed the study. SN, GP, WV and KGL wrote the DiSCoVR protocol, with contributions from MV and CZ. SN, GP, WV and CG conceived the concept and content of the VR program and supervised its development. RV, CZ and DZ arranged for and coordinated study participation at their respective locations. SN wrote the first draft of the manuscript, which was critically revised by WV and GP. All authors have read, provided input to, and approved the final manuscript.
Correspondence to Saskia A. Nijman.
Written informed consent will be collected from all participants. This study is carried out in accordance with the Declaration of Helsinki and has been approved by the Medical Ethical Committee of the University Medical Center Groningen (METc file number: 2017/573, ABR: NL63206.042.17, protocol version 2, 07-12-2017). The study was also approved by the Committee for Research and Health Care Innovation (Commissie Onderzoek en Zorginnovatie, GGZ Drenthe), Committee for Scientific Research (Commissie Wetenschappelijk Onderzoek, GGZ Delfland), and the board of directors of Zeeuwse Gronden. (Serious) adverse events are recorded and reported to the independent monitor and the Medical Ethical Committee.
Table S1. ESM questionnaire. (DOCX 21 kb)
Nijman, S.A., Veling, W., Greaves-Lord, K. et al. Dynamic Interactive Social Cognition Training in Virtual Reality (DiSCoVR) for social cognition and social functioning in people with a psychotic disorder: study protocol for a multicenter randomized controlled trial. BMC Psychiatry 19, 272 (2019). https://doi.org/10.1186/s12888-019-2250-0
Emotion perception
Psychotic disorder


text:
Pearls, swine, and the Via Pulchritudinis at the Met Gala
Belshazzar punished for his profane use of the Temple's sacred vessels.
Reflecting on the business of the A-lister fund-raising banquet at the Metropolitan Museum of Art in New York, a number of apparently contradictory thoughts spring to mind. In no special order, here are some quotations which may, to a greater or lesser extent, be relevant.
Pope John Paul II Ecclesia in Europa (2003) 60. 'Nor should we overlook the positive contribution made by the wise use of the cultural treasures of the Church. These can be a special element in the rekindling of a humanism of Christian inspiration. When properly preserved and intelligently used, these living testimonies of the faith as professed down the ages can prove a useful resource for the new evangelization and for catechesis, and lead to a rediscovery of the sense of mystery. … artistic beauty, as a sort of echo of the Spirit of God, is a symbol pointing to the mystery, an invitation to seek out the face of God made visible in Jesus of Nazareth.' (link to where I quoted this before)
The Congregation for Divine Worship: 'Any performance of sacred music which takes place during a celebration, should be fully in harmony with that celebration. This often means that musical compositions which date from a period when the active participation of the faithful was not emphasized as the source of the authentic Christian spirit are no longer to be considered suitable for inclusion within liturgical celebrations.' (Concerts in Churches, 1987).
Louis Bouyer, on the liturgy: 'What shall we give others if we have nothing left ourselves?'
Matthew 7:6: 'Give not that which is holy to dogs; neither cast ye your pearls before swine, lest perhaps they trample them under their feet, and turning upon you, they tear you.'
('nolite dare sanctum canibus neque mittatis margaritas vestras ante porcos ne forte conculcent eas pedibus suis et conversi disrumpant vos.')
The cultural treasures of the Church obviously include vestments, even if Pope John Paul II did not have them uppermost in mind. The Vatican museums are stuffed with impressive vestments, and vestments are found also in the other great museums of the world, of which (let us not forget) the 'Met' is one of the greatest. There is more than a little irony is attempting to use these treasures as a form of evangelisation after having removed them, for practical purposes, from the daily life of the Church, as Ross Douthat has pointed out. But this irony is a well-established one, as the quotation from the Congregation for Divine Worship document shows. Yes, it says, the great treasures of Catholic art--in this case, music--of some of which, indeed the world is in justified awe, are no longer suitable for use in the liturgy, and for that very reason it makes sense to show them off in a desacralised context: in this case, in concerts in churches; in other contexts, in museums.
Actually, this argument is not really coherent. If the Church's patrimony of music and other art is unsuitable for the liturgy, because it fails to foster genuine participation or gives rise to an unhelpful or theologically misguided impression of God and our relationship with Him, then it will not succeed any better outside the liturgical context which, presumably, added a great deal of context to it. In point of fact the late Cardinal Mayer, under whom that CDW document was produced, was a liturgical conservative and a great friend of the Traditional Mass. What he, and later Pope John Paul II, was trying to do was to scrabble out some conceptual space for the preservation of the Church's cultural patrimony about whose intrinsic value he was in no doubt, without undertaking a suicidal frontal assault on the assumptions of the entire liturgical reform. This approach, which was anticipated also by Pope Paul VI, was the argument of the 'Via pulchritudinis', the 'way of beauty'.
It is no surprise, in this context, that it was the two biggest liturgical conservatives of the Papal household, Archbishop Ganswein and Mgr Marini the Papal MC, who were key to the organisation of the Met's special exhibition of Vatican vestments. Did they have misgivings, in advance, about these items becoming the backdrop for a get-together of the American cultural elite and the inspiration of costumes which included some in poor taste, and others which were downright scandalous? I do not know, but I am sure they were thinking, like Cardinal Mayer, that if these items were not going to see much, if any, liturgical use, they might as well be allowed to exercise their considerable evangelising power as museum pieces on a fresh audience. This was not a project of liturgical progressives, for all the involvement, at a later stage, of Fr James Martin SJ and Cardinal Dolan.
That is not to say that we are obliged to agree with Ganswein and Marini. The Gala dinner aspect of the event puts it into a somewhat different context from the usual lending of items by one museum to another for a special exhibition. The consternation of Catholic conservatives at seeing Rihanna and others desporting themselves in what could be described as mocking mimicries of liturgical vestments has been huge. It is little comfort to remind ourselves that it could have been much worse, and that the celebrities, with a very few exceptions, did not take the opportunity to engage in calculated defilement of the sacred. The general tone of the event, and the presence of Cardinal Dolan as a guest of honour, was no doubt helpful. But the question remains whether allowing this use of these vestments was an instance of casting pearls before swine.
What does this idea mean? What Christ is talking about is the separation of the sacred and the profane which is intrinsic to the very idea of the sacred. The sacred is what is set apart: God is sacred because he is set apart from us, and items used in His worship are set apart from profane use. Catholics at the coal-face of the kind of liturgical restoration of which Ganswein and Marini approve become uncomfortable about the idea of trade in sacred things, which indeed is in some cases ruled out by Canon Law, even if in other cases it is a necessary fact of life. It's not that they wouldn't want people to see them; it is rather that they are set apart for a sacred purpose, and should be used for that purpose and not for profane purposes. It is necessary for us to recover this instinctive discomfort about seeing, say, real vestments being used in a theatrical performance, or even in a museum, if we are to recover the sense of the sacred as a whole. You can't nurture the sense of the sacred without doing the spadework of the conceptual and practical separation of the putatively sacred from the profane.
Liturgical conservatives will naturally recognise the subtle evangelising power of the liturgical items displayed in the Met and the V&A, but wouldn't necessarily want these collections to exist at all, in an ideal world. It's not appropriate: this stuff should be in churches, and it should be being used, if it is in a condition to be used. Then we would see, what of course to some extent we do see, the far greater evangelising power it has when plugged into its proper liturgical context.
He loved to kneel down on the cold marble pavement, and watch the priest, in his stiff flowered vestment, slowly and with white hands moving aside the veil of the tabernacle, or raising aloft the jewelled lantern-shaped monstrance with that pallid wafer that at times, one would fain think, is indeed the "panem caelestis," the bread of angels, or, robed in the garments of the Passion of Christ, breaking the Host into the chalice, and smiting his breast for his sins. The fuming censers, that the grave boys, in their lace and scarlet, tossed into the air like great gilt flowers, had their subtle fascination for him.
Oscar Wilde, The Picture of Dorian Grey.
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