Physician Burnout: Improving Treatment Efficacy with Virtual Reality

Creating a significant negative impact on both their quality of life and the quality of patient care with an evident economical burden for the healthcare system, there is a growing concern over physician burnout. The range of interventions and treatments that have been used to address this problem, however, appear quite fragmented and lack compelling efficacy. We describe the main factors known to contribute to the development of physician burnout as well as currently available treatments. Studies seem to indicate that both specialisation area as well as personality traits may contribute to the manifestation. The highest risk specialties appear to be critical care physicians, emergency physicians, oncologists and internal medicine physicians, while the highest risk personality attributes are high neuroticism, low agreeableness, introversion, and negative affectivity. In addition, being exceedingly enthusiastic about one's work and having high aspirations at work, with an idealistic approach, also serve as factors which contribute to increased risk of burnout, and in particular for those who are new to the occupation.

Future Directions: How Virtual Reality Can Further Improve the Assessment and Treatment of Eating Disorders and Obesity

Transdisciplinary efforts for further elucidating the etiology of eating and weight disorders and improving the effectiveness of the available evidence-based interventions are imperative at this time. Recent studies indicate that computer-generated graphic environments-virtual reality (VR)-can integrate and extend existing treatments for eating and weight disorders (EWDs). Future possibilities for VR to improve actual approaches include its use for altering in real time the experience of the body (embodiment) and as a cue exposure tool for reducing food craving.

The New Dawn of Virtual Reality in Health Care: Medical Simulation and Experiential Interface

The 90s and 00s saw great hopes that virtual reality was poised to sweep health care and change everything. But it didn't. Though researchers could immerse themselves in more complex virtual environments, the chasm between that digital experience and the complexity of real life - using a VR system in an hospital without a dedicated technician was a real challenge - just was too great. Now the situation is changing quickly. The rise of Oculus Rift and the shift of virtual reality from PC to mobile phones thanks to both the Oculus designed Gear VR headsets for Samsung phones and the Google Cardboard project are going to transform health care tools and experiences.

Clinical use of virtual reality distraction system to reduce anxiety and pain in dental procedures

Virtual reality (VR) has been used by clinicians to manage pain in clinical populations. This study examines the use of VR as a form of distraction for dental patients using both subjective and objective measures to determine how a VR system affects patients' reported anxiety level, pain level, and physiological factors. As predicted, results of self-evaluation questionnaires showed that patients experienced less anxiety and pain after undergoing VR treatment. Physiological data reported similar trends in decreased anxiety. Overall, the favorable subjective and objective responses suggest that VR distraction systems can reduce discomfort and pain for patients with mild to moderate fear and anxiety.

Virtual reality as a distraction technique in chronic pain patients

We explored the use of virtual reality distraction techniques for use as adjunctive therapy to treat chronic pain. Virtual environments were specifically created to provide pleasant and engaging experiences where patients navigated on their own through rich and varied simulated worlds. Real-time physiological monitoring was used as a guide to determine the effectiveness and sustainability of this intervention. Human factors studies showed that virtual navigation is a safe and effective method for use with chronic pain patients. Chronic pain patients demonstrated significant relief in subjective ratings of pain that corresponded to objective measurements in peripheral, noninvasive physiological measures.

Future directions: advances and implications of virtual environments designed for pain management

Pain symptoms have been addressed with a variety of therapeutic measures in the past, but as we look to the future, we begin encountering new options for patient care and individual health and well-being. Recent studies indicate that computer-generated graphic environments--virtual reality (VR)--can offer effective cognitive distractions for individuals suffering from pain arising from a variety of physical and psychological illnesses. Studies also indicate the effectiveness of VR for both chronic and acute pain conditions. Future possibilities for VR to address pain-related concerns include such diverse groups as military personnel, space exploration teams, the general labor force, and our ever increasing elderly population. VR also shows promise to help in such areas as drug abuse, at-home treatments, and athletic injuries.

Virtual reality for pain management in cardiac surgery

Surgical anxiety creates psychological and physiological stress, causes complications in surgical procedures, and prolongs recovery. Relaxation of patients in postoperative intensive care units can moderate patient vital signs and reduce discomfort. This experiment explores the use of virtual reality (VR) cybertherapy to reduce postoperative distress in patients that have recently undergone cardiac surgery. Sixty-seven patients were monitored at IMSS La Raza National Medical Center within 24 hours of cardiac surgery. Patients navigated through a 30 minute VR simulation designed for pain management. Results were analyzed through comparison of pre- and postoperative vital signs and Likert scale survey data. A connection was found in several physiological factors with subjective responses from the Likert scale survey. Heavy positive correlation existed between breathing rate and Likert ratings, and a moderate correlation was found between mean arterial pressure and Likert ratings and heart rate and Likert ratings, all of which indicated lower pain and stress within patients. Further study of these factors resulted in the categorization of patients based upon their vital signs and subjective response, providing a context for the effectiveness of the therapy to specific groups of patients.

Mobile devices as adjunctive pain management tools

Approximately 108 million people in North America and Europe suffer from chronic pain. Virtual reality (VR) is a promising method for pain management in a clinical setting due to the distracting properties of an immersive virtual environment. In this study, we demonstrated the potential use of mobile phones as a means of delivering an easily accessible, immersive experience. Thirty-one patients tested VR pain distraction. Objective measurements of heart rate correlated to decreased anxiety, while, subjectively, patients also reported reduced levels of discomfort. The positive results of this study indicate that mobile phones can provide an immersive experience sufficient to deliver pain management distraction. Because mobile devices are widely available, the potential for developing pain management programs that are accessible has become a realistic possibility.

Sleep enhances exposure therapy

BACKGROUND

Sleep benefits memory consolidation. Here, we tested the beneficial effect of sleep on memory consolidation following exposure psychotherapy of phobic anxiety.

METHOD

A total of 40 individuals afflicted with spider phobia according to DSM-IV underwent a one-session virtual reality exposure treatment and either slept for 90 min or stayed awake afterwards.

RESULTS

Sleep following exposure therapy compared with wakefulness led to better reductions in self-reported fear (p = 0.045, d = 0.47) and catastrophic spider-related cognitions (p = 0.026, d = 0.53) during approaching a live spider, both tested after 1 week. Both reductions were associated with greater percentages of stage 2 sleep.

CONCLUSIONS

Our results indicate that sleep following successful psychotherapy, such as exposure therapy, improves therapeutic effectiveness, possibly by strengthening new non-fearful memory traces established during therapy. These findings offer an important non-invasive alternative to recent attempts to facilitate therapeutic memory extinction and consolidation processes with pharmacological or behavioral interventions.

Enabling eHealth as a Pathway for Patient Engagement: a Toolkit for Medical Practice

Academic and managerial interest in patient engagement is rapidly earning attention and becoming a necessary tool for researchers, clinicians and policymakers worldwide to manage the increasing burden of chronic conditions. The concept of patient engagement calls for a reframe of healthcare organizations' models and approaches to care. This also requires innovations in the direction of facilitating the exchanges between the patients and the healthcare. eHealth, namely the use of new communication technologies to provide healthcare, is proved to be proposable to innovate healthcare organizations and to improve exchanges between patients and health providers. However, little attention has been still devoted to how to best design eHealth tools in order to engage patients in their care. eHealth tools have to be appropriately designed according to the specific patients' unmet needs and priorities featuring the different phases of the engagement process. Basing on the Patient Engagement model and on the Positive Technology paradigm, we suggest a toolkit of phase-specific technological resources, highlighting their specific potentialities in fostering the patient engagement process.

Quantifying the effectiveness of virtual reality pain management: a pilot study

Sensory pathways, consisting of chains of neurons, which spread from the receptor organ to the cerebral cortex, are responsible for the perception of sensations (including pain). In this study, we set out to determine how effective virtual reality (VR) could be in distracting patients from pain experienced through thermoreceptors on the skin. Six healthy subjects were exposed to uncomfortable pain stimuli with and without VR distraction. Subjects reported a drop in pain while in the VR environment, and mean pain rating was significantly lower than the session with no VR distraction. These results indicate that VR distraction can diminish pain experienced by subjects, thus we conclude by eliciting future directions for quantifying effectiveness of VR as a pain management solution.

Virtual reality graded exposure therapy with arousal control for the treatment of combat related posttraumatic stress disorder: a follow up case series

Important challenges confronting DOD/military medical care are that of maintaining or increasing quality of care and increasing the effectiveness of treatments for warriors diagnosed with Posttraumatic Stress Disorder (PTSD) secondary to their combat deployments to Iraq and/or Afghanistan. Virtual Reality Graded Exposure Therapy with Arousal Control (VR-GET) has demonstrated a positive treatment effectiveness resulting in significant reductions of PTSD symptom severity. This positive treatment effectiveness has been maintained for up to 22 weeks after VR-GET therapy was completed. A robust methodology for the assessment of Virtual Reality efficacy suggests that the ideal time for follow-up begins at twelve months. Others have suggested that follow-up should occur between two and four years post treatment. In this report we describe the outcome of VR-GET for the treatment of combat-related PTSD with three warriors between five and seven years following their having completed treatment.

Positive change: connecting the virtual and the real

How do we lastingly change our lives for the better? There is not an easy answer to this question. However, due to the advances in psychology and neuroscience, now we have a better view of personal change, that is not limited to a specific viewpoint. In particular, the emergence of integrative and transdiagnostic accounts suggests that change is contextual, depending on the person, the issues, and the situation. More, personal change is a process, happening in discontinuous and nonlinear ways, following life transitions and traumatic events. In this process a key role can be played by technology: using the "Positive Technology" approach it is possible to use technology to manipulate the quality of experience, with the goal of increasing wellness, and generating strengths and resilience in individuals, organizations and society.

Positive technology: a free mobile platform for the self-management of psychological stress

We describe the main features and preliminary evaluation of Positive Technology, a free mobile platform for the self-management of psychological stress (http://positiveapp.info/). The mobile platform features three main components: (i) guided relaxation, which provides the user with the opportunity of browsing a gallery of relaxation music and video-narrative resources for reducing stress; (ii) 3D biofeedback, which helps the user learning to control his/her responses, by visualizing variations of heart rate in an engaging 3D environment; (iii) stress tracking, by the recording of heart rate and self-reports. We evaluated the Positive Technology app in an online trial involving 32 participants, out of which 7 used the application in combination with the wrist sensor. Overall, feedback from users was satisfactory and the analysis of data collected online indicated the capability of the app for reducing perceived stress levels. A future goal is to improve the usability of the application and include more advanced stress monitoring features, based on the analysis of heart rate variability indexes.

Marketing analysis of a positive technology app for the self-management of psychological stress

The INTERSTRESS project developed a completely new concept in the treatment of psychological stress: Interreality, a concept that combines cognitive behavioral therapy with a hybrid, closed-loop empowering experience bridging real and virtual worlds. This model provides the opportunity for individual citizens to become active participants in their own health and well-being. This article contains the results of the Marketing Trial and analysis of the opinions of individual consumers/end users of the INTERSTRESS product. The specific objective of this study was to evaluate the feasibility, efficacy and user acceptance of a novel mobile-based relaxation training tool in combination with biofeedback exercises and wearable biosensors. Relaxation was aided through immersion in a mobile virtual scenario (a virtual island) featuring pre-recorded audio narratives guiding a series of relaxation exercises. During biofeedback exercises, a wearable biosensor system provided data which directly modified the virtual reality experience in real-time. Thirty-six participants evaluated the product and overall feedback from users was positive, with some variation seen based on participant gender. A larger market study is now underway to understand if there are cultural variations in acceptability of the device.

VR Mobile Solutions For Chronic Stress Reduction in Young Adults

Chronic stress in young adults has become a growing problem within recent decades and many are unable to find cost-effective and accessible treatment for psychological stress in their daily lives. We analyze the market of using a mobile application, Positive Technology, as a solution. Eleven participants, aged between 18 and 24, participated in the exercise. Self-reported stress reduction was measured via an online marketing survey, while physiological measurements were monitored via peripheral devices. Secondary goals assessed the app's ease-of-use, accessibility, and cost. Results indicate that participants enjoyed the availability of the mobile solution and found the app to be fun and easy to learn. Stress levels were reduced in 73% of the participants, with higher effects in females and in participants aged 18-24. We conclude that the mobile platform is an effective means of delivering psychological stress reduction, and could provide an accessible, cost-effective solution.

A European Profile of Games for Health

October is time for the Games for Health Europe meeting in Amsterdam, The Netherlands. Games for Health Journal would like to highlight exciting developments in games for health in Europe by asking European members of our Editorial Board to comment on what developments they see.

Positive technology as a driver for health engagement

Despite the fact that older adults are healthier than in the past, the current trend of an ageing population implies an increased risk and severity of chronic diseases. Low-resource healthcare systems face increased organizational healthcare costs, which is likely to result in an allocation of limited health resources. Healthcare organizations themselves must deal with patients' increasing need for a more active role in all the steps of the care & cure process. Technological advances may play a crucial role in sustaining people's health management in daily life, but only if it is "ecologically" designed and well-attuned to people's health needs and expectations. Healthcare is more and more called to orient innovative research approaches that recognize the crucial role of a person's engagement in health and well-being. This will enable patients to reach a higher quality of life and achieve a general psychophysical well-being. Thus, positive technological innovation can sustain people's engagement in health and invoke community empowerment, as we shall discuss in this document.

The quest for active and healthy ageing: what cyberpsychology can offer

The European Commission identified active and healthy ageing as a societal challenge common to all European countries, and an area which presents considerable potential for Europe to lead the world in providing innovative responses to this challenge (http://ec.europa.eu/active-healthy-ageing). To tackle the challenge of an ageing population, the European Commission launched the European Innovation Partnership (EIP) on Active and Healthy Ageing. What can cyberpsychology offer to this process? After presenting the main features of cyberpsychology, this paper identifies in patient engagement and positive technologies the key assets that will allow the technological innovations constantly being developed to provide greater help and care in enabling elderly people to live more normal, happier, fulfilling lives.

Methodology case study of the application of haptics to combat medic training programs

Of the available training methods for emergency responders, including other methods based on computer technology, virtual reality video game training with haptics (tactile) features will be shown to provide the most effective transfer of skills to real-world emergency situations, providing a model for the development of new training products for combat medics and civilian first responders. This paper aims to provide a methodological case study of haptics use in medical training programs and highlight achievements in terms of performance. Review of these cases show that the addition of haptics to an existing simulation-based training program increases user performance in terms of completion time, error rates, and learning rate. With this case study, haptics can be further incorporated into training programs designed for military combat medics.

Clinical experiment to assess effectiveness of virtual reality teen smoking cessation program

Smoking has increasingly become a burden on America's health and economic status. The fact that four out of every five adult smokers begins tobacco use before the age of eighteen indicates a need for teenage smoking cessation programs. The Virtual Reality Medical Center created an internet-based program that addresses the issue by utilizing cue exposure therapy in home and school environments to teach teens which cues trigger nicotine cravings and how to combat those cravings. The effectiveness of the program was measured through questionnaires administered before and after its use. Results indicated that the participants were engaged in the virtual environment, and that, in every aspect of the program, at least 8% more participants were knowledgeable about the subject than prior to the use of the program. Success of such a program could reduce teen smoking rates, ultimately leading to reduced smoking mortalities, complications, and costs overall.

Emotionally based strategic communications and societal stress-related disorders

This article discusses the potential of emotionally based strategic communications (EBSCs) as an extension of traditional strategic communications in prevention of societal stress-related disorders. The concept of EBSCs takes into consideration dominant emotional maps of a specific sociocultural environment in which communications take place. EBSCs may have a significant potential to transform mainly negative-dominant emotional maps of targeted social groups into more positive ones, as a precondition of building a more resilient and stress-resistant social environment. A better understanding of dominant emotional maps and their conditioning may facilitate restoration of more positive emotional maps by touching the right emotions of significant parts of the targeted social groups in the right way. Dominant emotional maps of societies afflicted by economic downturns, natural disasters, conflicts etc., are typically characterized by negatively valenced emotions. Persistent negatively valenced group-based dominant emotions may be used as a quantitative statistical measure of potential stress-related disorders and post-traumatic stress disorders among respected group members. The toxic power of extreme negative emotions, attitudes, actions, and behavior might be reduced by EBSCs as a communication method for transforming negative-dominant emotional maps into more positive ones. EBSCs are conceptualized as the positively valenced stimulation of a negatively emotionally affected group by an appropriate communication strategy to minimize dominant-negative emotional maps and behavior of the targeted group.