Virtual Reality as a Tool for Cognitive Behavioral Therapy: A Review

Efficacy of virtual reality exposure therapy and eye movement desensitization and reprocessing therapy on symptoms of acrophobia and anxiety sensitivity in adolescent girls: A randomized controlled trial

Background

Acrophobia is a specific phobia characterized by a severe fear of heights. The purpose of the present study was to investigate the efficacy of two therapies that may ameliorate symptoms of acrophobia and anxiety sensitivity, i.e., virtual reality exposure therapy (VRET) and eye movement desensitization and reprocessing (EMDR) therapy with a Waiting List Control Condition (WLCC).

Methods

We applied a three-armed randomized controlled pre-post-test design with 45 female adolescent students. Students who met DSM-5 criteria for acrophobia were randomly assigned to either VRET (N = 15; Mage = 17.26; SD = 1.32), EMDR (N = 15; Mage = 17.15; SD = 1.57), or a WLCC (N = 15; Mage = 17.50; SD = 1.26). The study groups were evaluated one week before the intervention and one week after the last intervention session regarding symptoms of acrophobia (Severity Measure for Acrophobia) and anxiety sensitivity (Anxiety Sensitivity Index).

Results

The data showed that both the application of VRET and EMDR therapy were associated with significantly reduced symptoms of acrophobia (d = 1.03 for VRET and d = 1.08 for EMDR) and anxiety sensitivity (d = 1.15 for VRET and d = 1.13 for EMDR) in comparison to the Waiting List.

Limitations

The sample consisted only of adolescent women. Due to the recognizable differences between the two interventions, the therapists and the participants were not blind to the conditions.

Conclusion

The results suggest that both VRET and EMDR are interventions that can significantly improve symptoms of acrophobia and anxiety sensitivity in female adolescents.

Clinical Trial Registration

https://www.irct.ir/trial/57391, identifier: IRCT20210213050343N1.

Reconstructing Personal Stories in Virtual Reality sas a Mechanism to Recover the Self

Advances in virtual reality present opportunities to relive experiences in an immersive medium that can change the way we perceive our life stories, potentially shaping our realities for the better. This paper studies the role of virtual reality as a tool for the creation of stories with the concept of the self as a narrator and the life of the self as a storyline. The basis of the study is the philosophical notion of the self-narrative as an explanatory story of the events in one’s life that constitutes the notion of one’s self. This application is suitable for cases when individuals need to recreate their self, such as during recovery after traumatic events. The analysis of the effects of virtual reality shows that it enables a person to engage in a process of deeper self-observation to understand and explain adverse events and to give meaning to these events to form a new story, which can complement the therapeutic outcomes of exposure treatments. This study proposes concrete examples of immersive scenarios used to reconstruct personal stories. Several possible levels of experience are proposed to suggest that recovery can be achieved through the gradual retelling of the self-narrative, addressing all of the underlying narratives. Considering the ethical challenges that might arise, this paper explores the ways in which immersion in virtual reality can benefit a person’s view toward life as a story and his or her self as its author, comparing this idea with previous research on the application of virtual reality for trauma treatment. The analysis also emphasizes the perception of narrative authorship in virtual reality as an essential method for recovering the self-narrative and improving a patient’s mental health during self-actualization.

Qualitative Synthesis of Young People's Experiences With Technology-Assisted Cognitive Behavioral Therapy: Systematic Review

Background

Cognitive behavioral therapy (CBT) for young people is increasingly being provided using technology-assisted formats. Although there is increasing evidence regarding the efficacy of such approaches, as illustrated by quantitative systematic reviews, the literature has also highlighted challenges with implementation factors, including high attrition rates and variable user engagement. Qualitative review methods can help to address the factors that impact young peoples’ experience of technology-assisted cognitive behavioral therapy (tech-assisted CBT) and, thus, enable us to better understand such implementation factors. To date, no such qualitative synthesis exists.

Objective

The primary aim of this review was to systematically identify and synthesize the qualitative literature concerning the experiences of young people who have used tech-assisted CBT.

Methods

This systematic review applied Thomas and Harden’s 2008 qualitative thematic synthesis approach. This involved line-by-line coding of the results sections of included studies and an inductive analysis on identified themes, followed by the generation of analytical themes through a process of iteration and interpretation of the descriptive themes. PsycINFO, ACM Digital Library, PubMed, EMBASE, and JMIR Publications databases were searched. The inclusion criteria were (1) studies involving school-aged young people over preschool age (6 years) but under the age of 18 years, (2) use of any form of tech-assisted CBT for any time period, (3) a stated focus of qualitative data to document the experiences of participants, and (4) studies published in English. The exclusion criteria were (1) interventions only provided face-to-face with no technological component, (2) only focused on the performance of the technology rather than participant experience, and (3) numerical data that sought to represent qualitative data.

Results

A total of 14 studies were included in this review. Overall, these studies represented interventions for low mood and anxiety (n=10), trauma or self-harm (n=2), and physical difficulties (n=2). Overall, 5 analytical themes emerged on young people’s experiences with tech-assisted CBT: (1) helpfulness, (2) therapeutic process, (3) transferability, (4) gameplay experience, and (5) limitations. In addition, these analytical themes contained the following subthemes: positive experiences, tech-assisted CBT versus face-to-face CBT, understanding of a CBT model, process of change, skills development, application to everyday life settings, parental involvement, character relatedness, playability, negative experiences, and broad content.

Conclusions

Overall, young people’s experiences with tech-assisted CBT were mostly positive. The use of gaming environments, relatable characters, concrete metaphors, and age-appropriate narratives contributed to these positive experiences. Evidence suggests that technology can help to mediate face-to-face relationships with therapists and help young people to understand the CBT model. Clear barriers also emerged, including over-reliance on reading and writing skills and dissatisfaction with overly generalized content and comparison with commercial technologies.

Trial Registration

International Prospective Register of Systematic Reviews (PROSPERO) CRD42018103388; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018103388

Dynamic Context Sensory Testing-A Proof of Concept Study Bringing Virtual Reality to the Sensory Booth

Eating is a multimodal experience. When we eat, we perceive not just the taste and aroma of foods, but also their visual, auditory, and tactile properties, as well as sensory input from our surroundings. Foods are commonly tested within a sensory booth, designed specifically to limit such input. Foods are not commonly experienced in such isolation, but alongside this context, which can alter how a food is perceived. In this study, we show that the sensory properties of food can be altered by changing the environment it is consumed in, using virtual reality (VR) to provide an immersive, dynamic context to the eating experience. The purpose of this project was to develop an affordable and easy-to-implement methodology for adapting VR technology to sensory evaluation, without prohibitive amounts of expensive equipment or specialized programming knowledge. Virtual environments were formed by processing custom-recorded 360 degree videos and overlaying audio, text, sensory scales, and images to simulate a typical sensory evaluation ballot within the VR headset. In a pilot test, participants were asked to taste 3 identical blue cheese samples in 3 virtual contexts-a sensory booth, a park bench, and a cow barn. Respondents rated their liking of the sample, as well as its saltiness, and pungency, attributes either reflective of one context (pungency in the barn), or presumably unrelated (saltiness). Panelists duly rated the sample's flavor as being more pungent when consumed in the barn context. These results provide proof of concept for VR in applied sensory studies, providing an immersive context to a sensory test while remaining in place.

PRACTICAL APPLICATION

We consume foods in environments that can "spill over" into our perceptions of the food. Thus, we consider some foods "unsuitable" for certain settings, with others deemed more suitable for this locale. This has been studied for many years as sensory "context," with written descriptions, pictures, or videos of such contexts. We present a method generating virtual reality contexts without any specist programming knowledge, for a few hundred dollars. In an accompanying pilot test, perception of a sample was significantly influenced by the VR context in which it was delivered.

Substance Use, Bullying, and Body Image Disturbances in Adolescents and Young Adults Under the Prism of a 3D Simulation Program: Validation of MySchool4web

BACKGROUND

The use of virtual reality or three-dimensional (3D) simulation programs has been explored in different mental health problems and contexts. One of the applications that showed evidence of a suitable assessment for behavioral and emotional problems in adolescents is the 3D questionnaire called MySchool4web. The aim of this work was to analyze the psychometric properties of a tailored version of MySchool4web.

MATERIALS AND METHODS

A correlational, nonexperimental, cross-sectional study was carried out. The participants were 668 secondary students from schools in Santiago, Chile with a mean age of 15.74 years. Adolescents completed MySchool4web in the informatics classroom of each school.

RESULTS

Results indicated that two of the items had to be removed, and a three-factor solution was found representing the dimensions substance use, bullying, and body image. This final model of 10 items showed acceptable internal consistency per factor, and its scores were significantly associated with other related measures in nine items.

CONCLUSIONS

These outcomes suggest that this version of MySchool4web is a reliable and valid measure of a 3D instrument for the screening of risky behaviors and emotional problems in adolescents and young adults in a school context.

The Use of Virtual Reality in Psychology: A Case Study in Visual Perception

Recent proliferation of available virtual reality (VR) tools has seen increased use in psychological research. This is due to a number of advantages afforded over traditional experimental apparatus such as tighter control of the environment and the possibility of creating more ecologically valid stimulus presentation and response protocols. At the same time, higher levels of immersion and visual fidelity afforded by VR do not necessarily evoke presence or elicit a "realistic" psychological response. The current paper reviews some current uses for VR environments in psychological research and discusses some ongoing questions for researchers. Finally, we focus on the area of visual perception, where both the advantages and challenges of VR are particularly salient.

Craving for Food in Virtual Reality Scenarios in Non-Clinical Sample: Analysis of its Relationship with Body Mass Index and Eating Disorder Symptoms

Virtual reality (VR) technology has been successfully used to study the influence of specific and contextual food-related cues on emotional, cognitive and behavioural responses in patients with eating disorders (ED) and healthy controls. Following this research line, the present study assesses the effect on reported food craving of the type of food (low calorie versus high calorie) and the presence or absence of other people (private versus social context) in VR environments. Relationships between craving and body mass index (BMI) and ED symptoms are also explored. Eighty-seven female students were exposed to four VR scenarios presented in random order: a low-calorie kitchen, a high-calorie kitchen, a low-calorie restaurant and a high-calorie restaurant. After 2 minutes of exposure to each virtual scenario, food craving was assessed. Repeated measures analyses of covariance were conducted to assess changes in food craving following exposure to the different VR environments. Time elapsed since the last meal was introduced as a covariate to control for responses produced by food deprivation. Correlation and hierarchical multiple regression analyses were also conducted to assess the relationship between reported food craving and BMI and ED symptoms. Participants experienced higher levels of food craving after exposure to high-calorie foods (in both the kitchen and restaurant environments) than after exposure to low-calorie foods. Being alone in the kitchen or with friends in the restaurant had no effect on reported craving. Overall, neither BMI nor ED symptoms were related with reported food craving; only in the restaurant with low-calorie food was a significant negative correlation found between BMI and food craving. The results suggest that cue exposure in virtual environments is an effective procedure for inducing food craving in healthy controls and may be useful as a research and therapeutic tool in clinical populations.