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Bogie BJ, Noël C, Gu F, Nadeau S, Shvetz C, Khan H, Rivard MC, Bouchard S, Lepage M, Guimond S. Using virtual reality to improve verbal episodic memory in schizophrenia: A proof-of-concept trial. Schizophr Res Cogn 2024; 36:100305. [PMID: 38486790 PMCID: PMC10937232 DOI: 10.1016/j.scog.2024.100305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 03/17/2024]
Abstract
Background Schizophrenia is associated with impairments in verbal episodic memory. Strategy for Semantic Association Memory (SESAME) training represents a promising cognitive remediation program to improve verbal episodic memory. Virtual reality (VR) may be a novel tool to increase the ecological validity and transfer of learned skills of traditional cognitive remediation programs. The present proof-of-concept study aimed to assess the feasibility, acceptability, and preliminary efficacy of a VR-based cognitive remediation module inspired by SESAME principles to improve the use of verbal episodic memory strategies in schizophrenia. Methods Thirty individuals with schizophrenia/schizoaffective disorder completed this study. Participants were randomized to either a VR-based verbal episodic memory training condition inspired by SESAME principles (intervention group) or an active control condition (control group). In the training condition, a coach taught semantic encoding strategies (active rehearsal and semantic clustering) to help participants remember restaurant orders in VR. In the active control condition, participants completed visuospatial puzzles in VR. Attrition rate, participant experience ratings, and cybersickness questionnaires were used to assess feasibility and acceptability. Trial 1 of the Hopkins Verbal Learning Test - Revised was administered pre- and post-intervention to assess preliminary efficacy. Results Feasibility was demonstrated by a low attrition rate (5.88 %), and acceptability was demonstrated by limited cybersickness and high levels of enjoyment. Although the increase in the number of semantic clusters used following the module did not reach conventional levels of statistical significance in the intervention group, it demonstrated a notable trend with a medium effect size (t = 1.48, p = 0.15, d = 0.54), in contrast to the control group where it remained stable (t = 0.36, p = 0.72, d = 0.13). These findings were similar for the semantic clustering ratio in the intervention (t = 1.61, p = 0.12, d = 0.59) and control (t = 0.36, p = 0.72, d = 0.13) groups. There was no significant change in the number of recalled words in either group following VR immersion. Discussion This VR intervention was feasible, acceptable, and may be useful for improving the use of semantic encoding strategies. These findings support the use of more ecological approaches for the treatment of cognitive impairments in schizophrenia, such as VR-based cognitive remediation.
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Affiliation(s)
- Bryce J.M. Bogie
- MD/PhD Program, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Royal's Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Chelsea Noël
- Department of Psychology, Lakehead University, Thunder Bay, ON, Canada
| | - Feng Gu
- The Royal's Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Sébastien Nadeau
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Cecelia Shvetz
- The Royal's Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
| | - Hassan Khan
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Marie-Christine Rivard
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Stéphane Bouchard
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
- Centre de recherche, Centre Intégré de Santé et de Services Sociaux de l'Outaouais, Gatineau, QC, Canada
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Martin Lepage
- Douglas Research Centre, Montréal, QC, Canada
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Synthia Guimond
- Department of Cellular and Molecular Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- The Royal's Institute of Mental Health Research, Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
- Department of Neuroscience, Carleton University, Ottawa, ON, Canada
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
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Borelle C, Forner E. Reality check. The issue of social plausibility in Virtual reality therapy with addiction patients. Soc Sci Med 2024; 344:116653. [PMID: 38354480 DOI: 10.1016/j.socscimed.2024.116653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/25/2024] [Accepted: 02/02/2024] [Indexed: 02/16/2024]
Abstract
In France, virtual reality has been experimented since 2016 to address addictive behaviors. The existing literature insists on the "immersive" dimension of the technology as a significant factor in the efficacy of exposure. An ethnographic approach, however, suggests that the realism criterion should be reassessed. Based on a fieldwork conducted in the addictology department of a French hospital that made use of Virtual reality therapy (VRT), the article shows that it is a form of technical reiteration designed to develop reflexivity about one's actions, provoking the craving so that it can be domesticated. The patient's engagement in "as if" mode is facilitated by the therapist's work in mapping the patient's addictive practices, personalizing the exposure situations, and elaborating the simulation as being part of a practical experiment. While the question of graphic realism does not seem especially problematic, the question of social plausibility can put the simulation operation under strain.
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Affiliation(s)
- Céline Borelle
- CEMS (EHESS-CNRS-INSERM), France; SENSE (Orange), France.
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3
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Sommer JL, Reynolds K, Hebbard P, Smith MSD, Mota N, Mutch WAC, Maples-Keller J, Roos L, El-Gabalawy R. Preoperative Virtual Reality to Expose Patients With Breast Cancer to the Operating Room Environment: Feasibility and Pilot Case Series Study. JMIR Form Res 2024; 8:e46367. [PMID: 38231570 PMCID: PMC10831694 DOI: 10.2196/46367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 11/16/2023] [Accepted: 12/04/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Clinically elevated preoperative distress and anxiety are common among patients undergoing cancer surgery. Preoperative interventions have been developed to mitigate this distress and anxiety but are inconsistent in efficacy and feasibility for broad implementation. OBJECTIVE This preliminary pilot study aims to assess the feasibility and utility of a newly developed virtual reality (VR) intervention to expose patients awaiting breast cancer surgery to the operating room environment and a simulation of anesthetic induction. METHODS Patients undergoing breast cancer surgery (N=7) were assigned to the VR intervention or control (treatment as usual) group and completed self-report measures of distress and anxiety before surgery, on the day of surgery, and after surgery (5 and 30 d postoperatively). Those in the intervention group trialed the VR simulation 1 to 2 weeks preoperatively and provided qualitative and quantitative feedback. We assessed the feasibility of recruitment capability and study design and evaluated participants' impressions of the intervention using self-report rating scales and open-ended questions. We also descriptively examined distress and anxiety levels throughout the duration of the study. RESULTS Recruitment occurred between December 2021 and December 2022 and progressed slowly (rate: 1 participant/7 wk on average; some hesitancy because of stress and being overwhelmed). All participants who consented to participate completed the entire study. All participants were female and aged 56 (SD 10.56) years on average. In total, 57% (4/7) of the participants were assigned to the intervention group. On average, intervention participants spent 12 minutes engaged in the VR simulation. In general, the intervention was rated favorably (eg, clear information, enjoyable, and attractive presentation; mean% agreement 95.00-96.25, SD 4.79-10.00) and as helpful (mean% agreement 87.50, SD 25.00). Participants described the intervention as realistic (eg, "It was realistic to my past surgical experiences"), impacting their degree of preparedness and expectations for surgery (eg, "The sounds and sights and procedures give you a test run; they prepare you for the actual day"), and having a calming or relaxing effect (eg, "You feel more relaxed for the surgery"). CONCLUSIONS This preoperative VR intervention demonstrated preliminary feasibility among a sample of patients undergoing breast cancer surgery. Results and participant feedback will inform modifications to the VR intervention and the study design of a large-scale randomized controlled trial to examine the efficacy of this intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT04544618; https://clinicaltrials.gov/study/NCT04544618.
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Affiliation(s)
- Jordana L Sommer
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Kristin Reynolds
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Pamela Hebbard
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba, Winnipeg, MB, Canada
| | | | - Natalie Mota
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - W Alan C Mutch
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jessica Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States
| | - Leslie Roos
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Renée El-Gabalawy
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
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4
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Wray TB, Kemp JJ, Adams Larsen M. Virtual reality (VR) treatments for anxiety disorders are unambiguously successful, so why are so few therapists using it? Barriers to adoption and potential solutions. Cogn Behav Ther 2023; 52:603-624. [PMID: 37376984 PMCID: PMC10592498 DOI: 10.1080/16506073.2023.2229017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023]
Abstract
Anxiety disorders are a significant cause of disability globally, yet only one in ten sufferers receives adequate quality treatment. Exposure-based therapies are effective in reducing symptoms associated with a number of anxiety disorders. However, few therapists use exposure techniques to treat these conditions, even when they are adequately trained in them, often because of concerns about provoking distress, drop out, logistical barriers, and other concerns. Virtual reality exposure therapy (VRET) can address many of these concerns, and a large body of research decisively shows that VRET is as efficacious for treating these conditions as in vivo exposures. Yet, use of VRET remains low. In this article, we discuss several factors we believe are contributing to low VRET adoption among therapists and raise potential solutions to address them. We consider steps that VR experience developers and researchers might take, such as leading studies of VRET's real-world effectiveness and treatment optimization trials and continuing to improve the fit of platforms with clinicians' workflows. We also discuss steps to address therapist reservations using aligned implementation strategies, as well as barriers for clinics, and the roles that professional organizations and payers could have in improving care by encouraging adoption of VRET.
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Affiliation(s)
- Tyler B. Wray
- Center for Alcohol and Addictions Studies, Brown University School of Public Health, Providence, RI
| | - Joshua J. Kemp
- Pediatric Anxiety Research Center, Warren Alpert Medical School of Brown University, Providence, RI
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Verdi EK, Katz AC, Gramlich MA, Rothbaum BO, Reger GM. Impact of dissociation on exposure therapy for PTSD outcomes and Adherence among U.S. Military service members. J Psychiatr Res 2023; 166:86-91. [PMID: 37751659 DOI: 10.1016/j.jpsychires.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/28/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023]
Abstract
Emotional engagement is necessary for successful exposure therapy for posttraumatic stress disorder (PTSD), but dissociation is considered a barrier to emotional engagement. Virtual reality exposure therapy (VRE) uses multi-sensory virtual environments to increase emotional engagement during exposure therapy, and average treatment outcomes are comparable to traditional exposure therapy. However, individual factors (e.g., depression) can predict differential responses to VRE. Studies have yet to investigate whether VRE would be more effective in treating patients with dissociation compared to traditional PE. This secondary analysis of a randomized clinical trial explores whether dissociation predicts treatment outcomes to exposure therapy among active-duty soldiers (N = 108) diagnosed with PTSD. We also examine whether individuals reporting dissociative symptoms demonstrated differential treatment responses to VRE and PE. Results indicated a significant two-way interaction between dissociation and time in treatment, such that dissociation blunted the negative relationship between time and PTSD symptoms. Dissociation was not associated with treatment session attendance or drop out. Results also revealed no significant effect of treatment group (PE or VRE) on the relationship between dissociation and PTSD symptoms. Findings contribute to a body of literature supporting the potential clinical and research utility of a dissociative subtype of PTSD.
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Affiliation(s)
- Erin K Verdi
- VA Puget Sound Health Care System, American Lake Division, 9600 Veterans Drive Southwest, Tacoma, WA, 98493, USA.
| | - Andrea C Katz
- VA Puget Sound Health Care System, Seattle Division, 1660 S Columbian Way, Seattle, WA, 98174, USA.
| | - Michael A Gramlich
- VA Puget Sound Health Care System, American Lake Division, 9600 Veterans Drive Southwest, Tacoma, WA, 98493, USA.
| | - Barbara O Rothbaum
- Emory University School of Medicine, 1648 Pierce Dr NE, Atlanta, GA, 30307, USA.
| | - Greg M Reger
- VA Puget Sound Health Care System, American Lake Division, 9600 Veterans Drive Southwest, Tacoma, WA, 98493, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA.
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Draschkow D, Anderson NC, David E, Gauge N, Kingstone A, Kumle L, Laurent X, Nobre AC, Shiels S, Võ MLH. Using XR (Extended Reality) for Behavioral, Clinical, and Learning Sciences Requires Updates in Infrastructure and Funding. POLICY INSIGHTS FROM THE BEHAVIORAL AND BRAIN SCIENCES 2023; 10:317-323. [PMID: 37900910 PMCID: PMC10602770 DOI: 10.1177/23727322231196305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Extended reality (XR, including augmented and virtual reality) creates a powerful intersection between information technology and cognitive, clinical, and education sciences. XR technology has long captured the public imagination, and its development is the focus of major technology companies. This article demonstrates the potential of XR to (1) deliver behavioral insights, (2) transform clinical treatments, and (3) improve learning and education. However, without appropriate policy, funding, and infrastructural investment, many research institutions will struggle to keep pace with the advances and opportunities of XR. To realize the full potential of XR for basic and translational research, funding should incentivize (1) appropriate training, (2) open software solutions, and (3) collaborations between complementary academic and industry partners. Bolstering the XR research infrastructure with the right investments and incentives is vital for delivering on the potential for transformative discoveries, innovations, and applications.
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Affiliation(s)
- Dejan Draschkow
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Nicola C. Anderson
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Erwan David
- Department of Psychology, Scene Grammar Lab, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Nathan Gauge
- OxSTaR Oxford Simulation Teaching and Research, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Alan Kingstone
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Levi Kumle
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Xavier Laurent
- Centre for Teaching and Learning, University of Oxford, Oxford, UK
| | - Anna C. Nobre
- Oxford Centre for Human Brain Activity, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Wu Tsai Institute, Yale University, New Haven, USA
| | - Sally Shiels
- OxSTaR Oxford Simulation Teaching and Research, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Melissa L.-H. Võ
- Department of Psychology, Scene Grammar Lab, Goethe University Frankfurt, Frankfurt am Main, Germany
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Forner-Ordioni E. Virtual Reality Therapy in France: A Therapeutic Innovation Between Technology and Care. Cult Med Psychiatry 2023; 47:722-742. [PMID: 35771307 DOI: 10.1007/s11013-022-09801-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/26/2022]
Abstract
The latest form of cognitive behavioral therapy, virtual reality therapy has been developing in France since 2012, in both university hospitals and private practices. Patients receiving this therapy are immersed in a digitally created environment, using a virtual reality headset, in order to be exposed to their phobias. How does the introduction of technical objects such as the virtual reality headset affect and transform the care relationship between the patient and the therapist? Based on an ethnographic study conducted between 2012 and 2018 in the psychiatric unit of a French university hospital, this article outlines the emergence of virtual reality therapy, describes how it operates, and analyzes how it shapes the patient-therapist relationship. I argue that this device-namely virtual reality therapy-promotes a new therapeutic style in psychiatry, whose format and therapeutic indications align with the requirements of evidence-based medicine.
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Affiliation(s)
- Elsa Forner-Ordioni
- École des Hautes Études en Sciences Sociales, Centre d'Étude des Mouvements Sociaux, 54, boulevard Raspail, Paris 6e, France.
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Zhu HY, Chen HT, Lin CT. The Effects of Virtual and Physical Elevation on Physiological Stress During Virtual Reality Height Exposure. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2023; 29:1937-1950. [PMID: 34898434 DOI: 10.1109/tvcg.2021.3134412] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Advances in virtual reality technology have greatly benefited the acrophobia research field. Virtual reality height exposure is a reliable method of inducing stress with low variance across ages and demographics. When creating a virtual height exposure environment, researchers have often used haptic feedback elements to improve the sense of realism of a virtual environment. While the quality of the rendered for the virtual environment increases over time, the physical environment is often simplified to a conservative passive haptic feedback platform. The impact of the increasing disparity between the virtual and physical environment on the induced stress levels is unclear. This article presents an experiment that explored the effect of combining an elevated physical platform with different levels of virtual heights to induce stress. Eighteen participants experienced four different conditions of varying physical and virtual heights. The measurements included gait parameters, heart rate, heart rate variability, and electrodermal activity. The results show that the added physical elevation at a low virtual height shifts the participant's walking behaviour and increases the perception of danger. However, the virtual environment still plays an essential role in manipulating height exposure and inducing physiological stress. Another finding is that a person's behaviour always corresponds to the more significant perceived threat, whether from the physical or virtual environment.
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Effects of virtual reality exposure therapy on state-trait anxiety in individuals with dentophobia. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-023-04485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Matthie NS. The management of chronic pain in sickle cell disease: an interview with Nadine Matthie. Pain Manag 2023; 13:71-75. [PMID: 36718836 DOI: 10.2217/pmt-2022-0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Nadine Matthie, PhD, RN, CNL is an Assistant Professor in the Nell Hodgson Woodruff School of Nursing at Emory University in Atlanta, GA, USA. As a nurse scientist, she has conducted behavioral research to investigate pain and self-management in adults living with sickle cell disease, and address chronic, non vaso-occlusive pain in this population. Dr Matthie is developing non pharmacological, patient-centered, self-management strategies that incorporate virtual reality and biopsychosocial approaches to help manage chronic pain and reduce the burden of sickle cell; thereby, facilitating new, personalized approaches to management of chronic pain conditions in the home setting. Her research has been published in several national and international peer-reviewed sources for various disciplines, including nursing, medicine, music therapy and psychology.
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Affiliation(s)
- Nadine S Matthie
- Nell Hodgson Woodruff School of Nursing, Emory University; Atlanta, GA 30322, USA
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Maples-Keller JL, Sherrill A, Reddi P, Norrholm SD, Rothbaum BO. Extinction-Based Exposure Therapies Using Virtual Reality. Curr Top Behav Neurosci 2023; 64:335-352. [PMID: 37566312 DOI: 10.1007/7854_2023_437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
The focus of this chapter is an overview of integrating virtual reality (VR) technology within the context of exposure therapy for anxiety disorders, a gold standard treatment, with a focus on how VR can help facilitate extinction learning processes integral to these interventions. The chapter will include an overview of advantages of incorporating VR within exposure therapy, and benefits specifically within an inhibitory learning approach for extinction training. A review of the empirical literature on the effectiveness of VR exposure therapy for specific phobia and PTSD will be provided, as well as practical overview of how to effectively incorporate VR within exposure therapy.
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Affiliation(s)
- Jessica L Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Andrew Sherrill
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Preethi Reddi
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Seth D Norrholm
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Barbara O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Tsamitros N, Beck A, Sebold M, Schouler-Ocak M, Bermpohl F, Gutwinski S. [The application of virtual reality in the treatment of mental disorders]. DER NERVENARZT 2023; 94:27-33. [PMID: 36053303 PMCID: PMC9859917 DOI: 10.1007/s00115-022-01378-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Virtual reality (VR) enables immersion in an interactive digital world with realistic experiences, that can be applied for controlled and personalized interventions. This review summarizes the current research on VR in the treatment of mental disorders. METHODS Selective literature search in PubMed and Google Scholar. RESULTS An increasing number of publications report the therapeutic application of VR for the treatment of mental disorders. Most VR applications are based on established therapy approaches, such as exposure therapy. According to meta-analytic data, virtual exposure therapy (VRET) for specific phobia and agoraphobia with panic disorder is as effective as traditional in vivo exposure therapy. VRET for the treatment of social phobia is significantly more effective than waitlist and placebo control groups with, however, currently inconsistent metanalytic results when compared to in vivo exposure therapy. VRET for the treatment of posttraumatic stress disorder (PTSD) is similar in effectiveness compared to active psychotherapy. For psychosis, positive results have been reported for the VR-based treatment of auditory verbal hallucinations. For patients with a substance use disorder, VR can induce craving, with still unverified diagnostic and therapeutic relevance. CONCLUSIONS VRET can broaden the psychotherapy options for anxiety disorders. Encouraging results of VR-based treatments for psychosis and PTSD indicate the need for further research concerning its effectiveness and safety. In the field of substance use disorders, evaluation of clinical-orientated VR applications is needed.
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Affiliation(s)
- N. Tsamitros
- Psychiatrische Universitätsklinik der Charité – Universitätsmedizin Berlin im St. Hedwig-Krankenhaus/Institutsambulanz, Müllerstr. 56–58, 13349 Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - A. Beck
- Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland ,Fakultät Gesundheit, Health and Medical University, Campus Potsdam, Potsdam, Deutschland
| | - M. Sebold
- Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - M. Schouler-Ocak
- Psychiatrische Universitätsklinik der Charité – Universitätsmedizin Berlin im St. Hedwig-Krankenhaus/Institutsambulanz, Müllerstr. 56–58, 13349 Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - F. Bermpohl
- Psychiatrische Universitätsklinik der Charité – Universitätsmedizin Berlin im St. Hedwig-Krankenhaus/Institutsambulanz, Müllerstr. 56–58, 13349 Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - S. Gutwinski
- Psychiatrische Universitätsklinik der Charité – Universitätsmedizin Berlin im St. Hedwig-Krankenhaus/Institutsambulanz, Müllerstr. 56–58, 13349 Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
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Ford T, Buchanan DM, Azeez A, Benrimoh DA, Kaloiani I, Bandeira ID, Hunegnaw S, Lan L, Gholmieh M, Buch V, Williams NR. Taking modern psychiatry into the metaverse: Integrating augmented, virtual, and mixed reality technologies into psychiatric care. Front Digit Health 2023; 5:1146806. [PMID: 37035477 PMCID: PMC10080019 DOI: 10.3389/fdgth.2023.1146806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/27/2023] [Indexed: 04/11/2023] Open
Abstract
The landscape of psychiatry is ever evolving and has recently begun to be influenced more heavily by new technologies. One novel technology which may have particular application to psychiatry is the metaverse, a three-dimensional digital social platform accessed via augmented, virtual, and mixed reality (AR/VR/MR). The metaverse allows the interaction of users in a virtual world which can be measured and manipulated, posing at once exciting new possibilities and significant potential challenges and risks. While the final form of the nascent metaverse is not yet clear, the immersive simulation and holographic mixed reality-based worlds made possible by the metaverse have the potential to redefine neuropsychiatric care for both patients and their providers. While a number of applications for this technology can be envisioned, this article will focus on leveraging the metaverse in three specific domains: medical education, brain stimulation, and biofeedback. Within medical education, the metaverse could allow for more precise feedback to students performing patient interviews as well as the ability to more easily disseminate highly specialized technical skills, such as those used in advanced neurostimulation paradigms. Examples of potential applications in brain stimulation and biofeedback range from using AR to improve precision targeting of non-invasive neuromodulation modalities to more innovative practices, such as using physiological and behavioral measures derived from interactions in VR environments to directly inform and personalize treatment parameters for patients. Along with promising future applications, we also discuss ethical implications and data security concerns that arise when considering the introduction of the metaverse and related AR/VR technologies to psychiatric research and care.
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Affiliation(s)
- T.J. Ford
- Brain Stimulation Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
| | - Derrick M. Buchanan
- Brain Stimulation Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
- Correspondence: Derrick M. Buchanan
| | - Azeezat Azeez
- Brain Stimulation Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
| | - David A. Benrimoh
- Brain Stimulation Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Irakli Kaloiani
- Brain Stimulation Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
| | - Igor D. Bandeira
- Brain Stimulation Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
| | - Saron Hunegnaw
- Brain Stimulation Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
| | - Lucy Lan
- Brain Stimulation Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
| | - Mia Gholmieh
- Brain Stimulation Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
| | - Vivek Buch
- Brain Stimulation Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
- Neurosurgery, Stanford University, Palo Alto, CA, United States
| | - Nolan R. Williams
- Brain Stimulation Laboratory, Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, United States
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Shaikh TA, Dar TR, Sofi S. A data-centric artificial intelligent and extended reality technology in smart healthcare systems. SOCIAL NETWORK ANALYSIS AND MINING 2022; 12:122. [PMID: 36065420 PMCID: PMC9434088 DOI: 10.1007/s13278-022-00888-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 05/08/2022] [Accepted: 05/16/2022] [Indexed: 12/01/2022]
Abstract
Extended reality (XR) solutions are quietly maturing, and their novel use cases are already being investigated, particularly in the healthcare industry. By 2022, the extended reality market is anticipated to be worth $209 billion. Certain diseases, such as Alzheimer's, Schizophrenia, Stroke rehabilitation stimulating specific areas of the patient's brain, healing brain injuries, surgeon training, realistic 3D visualization, touch-free interfaces, and teaching social skills to children with autism, have shown promising results with XR-assisted treatments. Similar effects have been used in video game therapies like Akili Interactive's EndeavorRx, which has previously been approved by the Food and Drug Administration (FDA) as a treatment regimen for children with attention deficit hyperactivity disorder (ADHD). However, while these improvements have received positive feedback, the field of XR-assisted patient treatment is in its infancy. The growth of XR in the healthcare sphere has the potential to transform the delivery of medical services. Imagine an elderly patient in a remote setting having a consultation with a world-renowned expert without ever having to leave their house. Rather than operating on cadavers in a medical facility, a surgical resident does surgery in a virtual setting at home. On the first try, a nurse uses a vein finder to implant an IV. Through cognitive treatment in a virtual world, a war veteran recovers from post-traumatic stress disorder (PTSD). The paper discusses the potential impact of XR in transforming the healthcare industry, as well as its use cases, challenges, XR tools and techniques for intelligent health care, recent developments of XR in intelligent healthcare services, and the potential benefits and future aspects of XR techniques in the medical domain.
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15
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Matthie NS, Giordano NA, Jenerette CM, Magwood GS, Leslie SL, Northey EE, Webster CI, Sil S. Use and efficacy of virtual, augmented, or mixed reality technology for chronic pain: a systematic review. Pain Manag 2022; 12:859-878. [PMID: 36098065 PMCID: PMC9517958 DOI: 10.2217/pmt-2022-0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 08/24/2022] [Indexed: 01/11/2023] Open
Abstract
Aim: Characterize use and efficacy/effectiveness of virtual, augmented, or mixed reality (VR/AR/MR) technology as non-pharmacological therapy for chronic pain. Methods: Systematic search of 12 databases to identify empirical studies, of individuals who experience chronic pain or illness involving chronic pain, published between 1990 and 2021. JBI Critical Appraisal Checklists assessed study bias and a narrative synthesis was provided. Results: 46 studies, investigating a total of 1456 participants and including 19 randomized controlled trials (RCT), were reviewed. VR/AR/MR was associated with improved pain-related outcomes in 78% of the RCTs. Conclusion: While most studies showed effects immediately or up to one month post treatment, RCTs are needed to further evaluate VR/AR/MR, establish long-term benefits, and assess accessibility, especially among individuals who experience pain management disparities.
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Affiliation(s)
- Nadine S Matthie
- Nell Hodgson Woodruff School of Nursing, Emory University; Atlanta, GA 30322, USA
| | - Nicholas A Giordano
- Nell Hodgson Woodruff School of Nursing, Emory University; Atlanta, GA 30322, USA
| | | | - Gayenell S Magwood
- College of Nursing, Medical University of South Carolina; Charleston, SC 29425, USA
| | - Sharon L Leslie
- Woodruff Health Sciences Center Library, Emory University; Atlanta, GA 30322, USA
| | - Emily E Northey
- Nell Hodgson Woodruff School of Nursing, Emory University; Atlanta, GA 30322, USA
| | | | - Soumitri Sil
- School of Medicine, Emory University; Aflac Cancer & Blood Disorders Center, Children's Healthcare of Atlanta; Atlanta, GA 30322, USA
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16
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Gutiérrez-Maldonado J. The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders. J Clin Med 2022; 11:jcm11185358. [PMID: 36143005 PMCID: PMC9501337 DOI: 10.3390/jcm11185358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/06/2022] [Indexed: 11/26/2022] Open
Affiliation(s)
- José Gutiérrez-Maldonado
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Paseo Valle de Hebrón, 171, 08035 Barcelona, Spain
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Slater M, Cabriera C, Senel G, Banakou D, Beacco A, Oliva R, Gallego J. The sentiment of a virtual rock concert. VIRTUAL REALITY 2022; 27:651-675. [PMID: 36034584 PMCID: PMC9396608 DOI: 10.1007/s10055-022-00685-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/30/2022] [Indexed: 06/05/2023]
Abstract
We created a virtual reality version of a 1983 performance by Dire Straits, this being a highly complex scenario consisting of both the virtual band performance and the appearance and behaviour of the virtual audience surrounding the participants. Our goal was to understand the responses of participants, and to learn how this type of scenario might be improved for later reconstructions of other concerts. To understand the responses of participants we carried out two studies which used sentiment analysis of texts written by the participants. Study 1 (n = 25) (Beacco et al. in IEEE Virtual Reality: 538-545, 2021) had the unexpected finding that negative sentiment was caused by the virtual audience, where e.g. some participants were fearful of being harassed by audience members. In Study 2 (n = 26) notwithstanding some changes, the audience again led to negative sentiment-e.g. a feeling of being stared at. For Study 2 we compared sentiment with questionnaire scores, finding that the illusion of being at the concert was associated with positive sentiment for males but negative for females. Overall, we found sentiment was dominated by responses to the audience rather than the band. Participants had been placed in an unusual situation, being alone at a concert, surrounded by strangers, who seemed to pose a social threat for some of them. We relate our findings to the concept of Plausibility, the illusion that events and situations in the VR are really happening. The results indicate high Plausibility, since the negative sentiment, for example in response to being started at, only makes sense if the events are experienced as actually happening. We conclude with the need for co-design of VR scenarios, and the use of sentiment analysis in this process, rather than sole reliance on concepts proposed by researchers, typically expressed through questionnaires, which may not reflect the experiences of participants. Supplementary Information The online version contains supplementary material available at 10.1007/s10055-022-00685-9.
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Affiliation(s)
- Mel Slater
- Event Lab, Faculty of Psychology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences of the University of Barcelona, Barcelona, Spain
| | - Carlos Cabriera
- Event Lab, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Gizem Senel
- Event Lab, Faculty of Psychology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences of the University of Barcelona, Barcelona, Spain
| | - Domna Banakou
- Event Lab, Faculty of Psychology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences of the University of Barcelona, Barcelona, Spain
| | - Alejandro Beacco
- Event Lab, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Ramon Oliva
- Event Lab, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Jaime Gallego
- Event Lab, Faculty of Psychology, University of Barcelona, Barcelona, Spain
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18
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Dy M, Olazo K, Lisker S, Brown E, Saha A, Weinberg J, Sarkar U. Virtual Reality for Chronic Pain Management Among Historically Marginalized Populations: A Systematic Review of Usability Studies (Preprint). J Med Internet Res 2022. [DOI: 10.2196/40044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
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19
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Teunisse AK, Pembroke L, O’Gradey‐Lee M, Sy M, Rapee RM, Wuthrich VM, Creswell C, Hudson JL. A scoping review investigating the use of exposure for the treatment and targeted prevention of anxiety and related disorders in young people. JCPP ADVANCES 2022; 2:e12080. [PMID: 37431458 PMCID: PMC10242975 DOI: 10.1002/jcv2.12080] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/01/2022] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Cognitive Behavioural Therapy (CBT) is the gold standard intervention for anxiety and related mental health disorders among young people; however, the efficacy of individual elements of CBT (e.g., exposure to feared stimuli) have received little scrutiny. AIMS This scoping review, informed by three stakeholder groups and a scientific advisory group, aimed to identify the nature and extent of the available research literature on the efficacy of exposure to feared stimuli, moderators of effectiveness in young people aged 14-24 years. METHOD Three international stakeholder groups composed of clinicians (N = 8), parents/carers (N = 5) and youth with lived experience of anxiety (N = 7) provided input into study design and results. Using the PRISMA extension for scoping reviews, a search of MEDLINE/Ovid, PsycINFO, PubMed, CINAHL, SCOPUS, EMBASE, ERIC, and Health Collection (informit) was conducted using terms related to anxiety, ages 14-24, and exposure. RESULTS From 3508 unique abstracts, 64 papers were included for the review. While there was evidence for the efficacy of exposure as a treatment for youth anxiety disorders, fundamental gaps in knowledge of exposure in this age group were identified. Most studies examined post-traumatic stress disorder, obsessive-compulsive disorder, and specific phobias with no randomised clinical trials uniquely evaluating exposure for the treatment of DSM-5 anxiety disorders. Exposure was typically delivered accompanied by other anxiety management techniques. A multitude of optimisation strategies have been tested, yet only one of these effects (timing relative to sleep) showed preliminary evidence of replication. CONCLUSIONS A systematic and theoretically driven program of research investigating the efficacy of exposure in young people and factors that moderate its efficacy, along with methods to overcome barriers for delivery, is urgently needed.
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Affiliation(s)
- Alessandra K. Teunisse
- Centre for Emotional HealthSchool of Psychological SciencesMacquarie University, Macquarie ParkNew South WalesAustralia
| | - Lorna Pembroke
- Centre for Emotional HealthSchool of Psychological SciencesMacquarie University, Macquarie ParkNew South WalesAustralia
| | - Maddison O’Gradey‐Lee
- Centre for Emotional HealthSchool of Psychological SciencesMacquarie University, Macquarie ParkNew South WalesAustralia
- Black Dog InstituteUniversity of New South WalesRandwickNew South WalesAustralia
| | - Megan Sy
- Centre for Emotional HealthSchool of Psychological SciencesMacquarie University, Macquarie ParkNew South WalesAustralia
| | - Ronald M. Rapee
- Centre for Emotional HealthSchool of Psychological SciencesMacquarie University, Macquarie ParkNew South WalesAustralia
| | - Viviana M. Wuthrich
- Centre for Emotional HealthSchool of Psychological SciencesMacquarie University, Macquarie ParkNew South WalesAustralia
| | - Cathy Creswell
- Department of Experimental Psychology and Department of PsychiatryUniversity of OxfordOxfordUK
| | - Jennifer L. Hudson
- Centre for Emotional HealthSchool of Psychological SciencesMacquarie University, Macquarie ParkNew South WalesAustralia
- Black Dog InstituteUniversity of New South WalesRandwickNew South WalesAustralia
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20
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Giordano R, Donati MA, Zamboni L, Fusina F, Primi C, Lugoboni F. Alter Game: A Study Protocol on a Virtual "Serious Game" for Relapse Prevention in Patients With Gambling Disorder. Front Psychiatry 2022; 13:854088. [PMID: 35432033 PMCID: PMC9010883 DOI: 10.3389/fpsyt.2022.854088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Cognitive behavioral therapy (CBT) is the most successful protocol in gambling disorder (GD) treatment. However, it presents some weaknesses, especially concerning relapse prevention (RP). RP is one of the most important therapeutic steps, aiming at managing cravings and to avoid future relapse increasing perceived self-efficacy. Encouraging results come from the blending of psychotherapy and virtual reality (VR), containing gambling cues. The goal of Alter Game (approved by the Ethical Commission, Prot. No. 69346) is verifying the efficacy of an innovative psychological treatment for GD based on the integration of traditional CBT therapy and an immersive VR cue exposure therapy using a serious virtual game, which is a game designed for purposes other than entertainment. RP in virtual cue-exposure therapy allows pathological gamblers to manage the urge to gamble and to avoid relapse by becoming aware of which internal and external triggers are related to craving. We hypothesize that the integrated intervention will be more effective than simple CBT with regard to self-efficacy, craving, and gambling-related distortions. Four virtual ecological environments were developed, and a virtual app, Exludo, interfaced with a computerized multiparametric acquisition system for biofeedback, was created. A sample of about 60 patients aged between 18 and 65 with GD referring to the Addiction Medicine Unit of Verona (Rossi Hospital) will be recruited. Patients will be randomly assigned to the CBT group (16 CBT sessions) or the CBT + VR group (8 CBT sessions + 8 VR cue-exposure therapy sessions). The MCMI-III, the BIS-11, and the SOGS will be used to evaluate inclusion and exclusion criteria, while the Gambling Related Cognitions Scale and the Multidimensional Gambling Self-Efficacy Scale will be used to verify changes as a function of the treatment. Craving will be evaluated through VAS, and psychophysiological variables will be assessed through biofeedback. A pre-test/post-test experimental design with a 1-month follow-up will be conducted. This study will examine an innovative psychotherapeutic protocol for GD treatment, and it will help in identifying new virtual tools to increase the efficacy of traditional therapeutic approaches that could also be applied to treat other addictions.
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Affiliation(s)
- Rosaria Giordano
- Department of Internal Medicine, Unit of Addiction Medicine, G.B. Rossi Hospital, Verona, Italy
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Maria Anna Donati
- Department of Neuroscience, Psychology, Drug, and Child's Health, Section of Psychology, University of Florence, Florence, Italy
| | - Lorenzo Zamboni
- Department of Internal Medicine, Unit of Addiction Medicine, G.B. Rossi Hospital, Verona, Italy
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Francesca Fusina
- Department of General Psychology, University of Padova, Padua, Italy
- Padova Neuroscience Center, University of Padova, Padua, Italy
| | - Caterina Primi
- Department of Neuroscience, Psychology, Drug, and Child's Health, Section of Psychology, University of Florence, Florence, Italy
| | - Fabio Lugoboni
- Department of Internal Medicine, Unit of Addiction Medicine, G.B. Rossi Hospital, Verona, Italy
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21
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López-Ojeda W, Hurley RA. Extended Reality Technologies: Expanding Therapeutic Approaches for PTSD. J Neuropsychiatry Clin Neurosci 2022; 34:A4-5. [PMID: 35113666 DOI: 10.1176/appi.neuropsych.21100244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Wilfredo López-Ojeda
- The Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center, and the Research and Academic Affairs Service Line, W.G. Hefner Veterans Affairs Medical Center, Salisbury, N.C. (López-Ojeda, Hurley); the Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, N.C. (López-Ojeda); the Departments of Psychiatry and Radiology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hurley); and the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Hurley)
| | - Robin A Hurley
- The Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center, and the Research and Academic Affairs Service Line, W.G. Hefner Veterans Affairs Medical Center, Salisbury, N.C. (López-Ojeda, Hurley); the Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, N.C. (López-Ojeda); the Departments of Psychiatry and Radiology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hurley); and the Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Hurley)
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22
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O'Gara G, Murray L, Georgopoulou S, Anstiss T, Macquarrie A, Wheatstone P, Bellman B, Gilbert P, Steed A, Wiseman T. SafeSpace: what is the feasibility and acceptability of a codesigned virtual reality intervention, incorporating compassionate mind training, to support people undergoing cancer treatment in a clinical setting? BMJ Open 2022; 12:e047626. [PMID: 35144943 PMCID: PMC8845220 DOI: 10.1136/bmjopen-2020-047626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The SafeSpace study codesigned and tested a virtual reality (VR) intervention, incorporating relaxation and compassionate mind training to determine acceptability/feasibility in an oncology setting and evaluate impact on physical/psychological well-being and quality of life. DESIGN A two-phase study. Phase I determined key characteristics using an experienced-based codesign approach. Phase II evaluated the intervention using various measures and qualitative interviews in a mixed methods approach. Descriptive statistics were used to analyse measures data and framework analysis to analyse interviews. SETTING A specialist cancer centre, UK. PARTICIPANTS 11 in phase I and 21 in phase II. Participants were in cancer treatment, recovery or palliative care. PRIMARY AND SECONDARY OUTCOME Primary outcome: acceptability of the intervention, assessed by >60% uptake of three sessions. SECONDARY OUTCOMES impact on psychological well-being using EQ-5D/QLQ-C30, Profile of Mood Scale, Warwick and Edinburgh Mental Well-being Scale, Depression and Anxiety Severity Scale 21, Self-Compassion Scale, Acceptance and Action Questionnaire and a locally developed questionnaire to capture self-compassion post use. Physiological impact was assessed by change in heart rate (HR)/HR variability and electrodermal activity (EDA). RESULTS Twenty participants (mean age=48.7 years; SD=16.87); 65% (n=13) completed three sessions. Mental well-being improved following each use and from baseline to after session 3 (VR 1-z=2.846, p≤0.01; VR 2-z=2.501, p≤0.01; VR 3-z=2.492, p≤0.01). There was statistically significant difference in mean scores for EDA at mid-session and post session compared with pre session (F (1.658, 4.973)=13.364, p<0.05). There was statistically significant reduction in stress levels from baseline to post session 3. Participants found the intervention acceptable and highlighted areas for development. CONCLUSION The intervention is acceptable and feasible and has shown positive effects on mental well-being/stress in the oncology setting. Larger studies are needed to confirm findings.
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Affiliation(s)
- Geraldine O'Gara
- Applied Health Research, Royal Marsden NHS Foundation Trust, London, UK Geraldine.O'
| | - Lisa Murray
- Department of Research and Innovation, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | | | | | - Andrew Macquarrie
- School of Computing and Mathematical Sciences, University of Greenwich, London, UK
| | - Pete Wheatstone
- Patient and Public Representative, Royal Marsden NHS Foundation Trust, London, UK
| | - Barbie Bellman
- Patient and Public Representative, Royal Marsden NHS Foundation Trust, London, UK
| | - Paul Gilbert
- Mental Health Research Unit, Derbyshire Healthcare NHS Foundation Trust, Derby, Derbyshire, UK
| | - Anthony Steed
- Department of Computer Science, University College London, London, UK
| | - Theresa Wiseman
- Applied Health Research, Royal Marsden NHS Foundation Trust, London, UK
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Lee H, Choi J, Jung D, Hur JW, Cho CH. The Effects of Virtual Reality Treatment on Prefrontal Cortex Activity in Patients With Social Anxiety Disorder: Participatory and Interactive Virtual Reality Treatment Study. J Med Internet Res 2021; 23:e31844. [PMID: 34801979 PMCID: PMC8726045 DOI: 10.2196/31844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/25/2021] [Accepted: 11/21/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Attempts to use virtual reality (VR) as a treatment for various psychiatric disorders have been made recently, and many researchers have identified the effects of VR in psychiatric disorders. Studies have reported that VR therapy is effective in social anxiety disorder (SAD). However, there is no prior study on the neural correlates of VR therapy in patients with SAD. OBJECTIVE The aim of this study is to find the neural correlates of VR therapy by evaluating the treatment effectiveness of VR in patients with SAD using portable functional near-infrared spectroscopy (fNIRS). METHODS Patients with SAD (n=28) were provided with 6 sessions of VR treatment that was developed for exposure to social situations with a recording system of each participant's self-introduction in VR. After each VR treatment session, the first-person view (video 1) and third-person view (video 2) clips of the participant's self-introduction were automatically generated. The functional activities of prefrontal regions were measured by fNIRS while watching videos 1 and 2 with a cognitive task, before and after whole VR treatment sessions, and after the first session of VR treatment. We compared the data of fNIRS between patients with SAD and healthy controls (HCs; n=27). RESULTS We found that reduction in activities of the right frontopolar prefrontal cortex (FPPFC) in HCs was greater than in the SAD group at baseline (t=-2.01, P=.049). Comparing the frontal cortex activation before and after VR treatment sessions in the SAD group showed significant differences in activities of the FPPFC (right: t=-2.93, P<.001; left: t=-2.25, P=.03) and the orbitofrontal cortex (OFC) (right: t=-2.10, P=.045; left: t=-2.21, P=.04) while watching video 2. CONCLUSIONS Activities of the FPPFC and OFC were associated with symptom reduction after VR treatment for SAD. Our study findings might provide a clue to understanding the mechanisms underlying VR treatment for SAD. TRIAL REGISTRATION Clinical Research Information Service (CRIS) KCT0003854; https://tinyurl.com/559jp2kp.
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Affiliation(s)
- Hojun Lee
- Department of Psychiatry, School of Medicine, Keimyung University, Daegu, Republic of Korea.,Department of Psychiatry, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | | | - Dooyoung Jung
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Ji-Won Hur
- School of Psychology, Korea University, Seoul, Republic of Korea
| | - Chul-Hyun Cho
- Department of Psychiatry, College of Medicine, Chungnam National University, Daejeon, Republic of Korea.,Department of Psychiatry, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
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24
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Gorisse G, Senel G, Banakou D, Beacco A, Oliva R, Freeman D, Slater M. Self-observation of a virtual body-double engaged in social interaction reduces persecutory thoughts. Sci Rep 2021; 11:23923. [PMID: 34907279 PMCID: PMC8671390 DOI: 10.1038/s41598-021-03373-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022] Open
Abstract
The proportion of the population who experience persecutory thoughts is 10-15%. People then engage in safety-seeking behaviours, typically avoiding social interactions, which prevents disconfirmatory experiences and hence paranoia persists. Here we show that persecutory thoughts can be reduced if prior to engaging in social interaction in VR participants first see their virtual body-double doing so. Thirty non-clinical participants were recruited to take part in a study, where they were embodied in a virtual body that closely resembled themselves, and asked to interact with members of a crowd. In the Random condition (n = 15) they observed their body-double wandering around but not engaging with the crowd. In the Targeted condition the body-double correctly interacted with members of the crowd. The Green Paranoid Thoughts Scale was measured 1 week before and 1 week after the exposure and decreased only for those in the Targeted condition. The results suggest that the observation of the body-double correctly carrying out a social interaction task in VR may lead to anxiety-reducing mental rehearsal for interaction thus overcoming safety behaviours. The results also extend knowledge of the effects of vicarious agency, suggesting that identification with the actions of body-double can influence subsequent psychological state.
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Affiliation(s)
- Geoffrey Gorisse
- Event Lab, Faculty of Psychology, University of Barcelona, Barcelona, Spain
- LAMPA, Arts et Métiers Institute of Technology, Changé, France
| | - Gizem Senel
- Event Lab, Faculty of Psychology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences of the University of Barcelona, Barcelona, Spain
| | - Domna Banakou
- Event Lab, Faculty of Psychology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences of the University of Barcelona, Barcelona, Spain
| | - Alejandro Beacco
- Event Lab, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Ramon Oliva
- Event Lab, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Mel Slater
- Event Lab, Faculty of Psychology, University of Barcelona, Barcelona, Spain.
- Institute of Neurosciences of the University of Barcelona, Barcelona, Spain.
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25
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Ma L, Mor S, Anderson PL, Baños RM, Botella C, Bouchard S, Cárdenas-López G, Donker T, Fernández-Álvarez J, Lindner P, Mühlberger A, Powers MB, Quero S, Rothbaum B, Wiederhold BK, Carlbring P. Integrating virtual realities and psychotherapy: SWOT analysis on VR and MR based treatments of anxiety and stress-related disorders. Cogn Behav Ther 2021; 50:509-526. [PMID: 34342251 DOI: 10.1080/16506073.2021.1939410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The use of virtual reality (VR) and mixed reality (MR) technology in clinical psychology is growing. Efficacious VR-based treatments for a variety of disorders have been developed. However, the field of technology-assisted psychotherapy is constantly changing with the advancement in technology. Factors such as interdisciplinary collaboration, consumer familiarity and adoption of VR products, and progress in clinical science all need to be taken into consideration when integrating virtual technologies into psychotherapies. We aim to present an overview of current expert opinions on the use of virtual technologies in the treatment of anxiety and stress-related disorders. An anonymous survey was distributed to a select group of researchers and clinicians, using an analytic framework known as Strengths, Weaknesses, Opportunities, and Threats (SWOT). Overall, the respondents had an optimistic outlook regarding the current use as well as future development and implementation of technology-assisted interventions. VR and MR psychotherapies offer distinct advantages that can overcome shortcomings associated with traditional therapy. The respondents acknowledged and discussed current limitations of VR and MR psychotherapies. They recommended consolidation of existing knowledge and encouraged standardisation in both theory and practice. Continued research is needed to leverage the strengths of VR and MR to develop better treatments.Abbreviations: AR: Augmented Reality; MR: Mixed Reality; RCT: Randomised Controlled Trial; SWOT: Strengths, Weaknesses, Opportunities, and Threats; VR: Virtual Reality; VR-EBT: Virtual Reality Exposure-Based Therapy.
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Affiliation(s)
- Lichen Ma
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Sonia Mor
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Page L Anderson
- Department of Psychology, Georgia State University, Atlanta, USA
| | - Rosa M Baños
- Department of Personality, Evaluation and Psychological Treatment, Universitat de València, Valencia, Spain.,Instituto Salud Carlos III, Madrid, Spain
| | - Cristina Botella
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain.,Instituto Salud Carlos III, Madrid, Spain
| | - Stephane Bouchard
- Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, Canada
| | | | - Tara Donker
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Albert-LudwigsUniversität Freiburg, Freiburg, Germany
| | - Javier Fernández-Álvarez
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain.,Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Philip Lindner
- Centre for Psychiatry Research, Karolinska Institutet & Stockholm Healthcare Services, Sweden
| | | | | | - Soledad Quero
- Department of Basic and Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain.,Instituto Salud Carlos III, Madrid, Spain
| | - Barbara Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, USA
| | | | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
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26
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Jóźwik S, Cieślik B, Gajda R, Szczepańska-Gieracha J. The Use of Virtual Therapy in Cardiac Rehabilitation of Female Patients with Heart Disease. ACTA ACUST UNITED AC 2021; 57:medicina57080768. [PMID: 34440974 PMCID: PMC8401556 DOI: 10.3390/medicina57080768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 12/30/2022]
Abstract
Background and Objectives: Cardiovascular disease (CVD) has become increasingly prevalent in women, and it is also in this group that the risk of developing depression is the highest. The most commonly applied therapeutic intervention in cardiac rehabilitation is Schultz’s autogenic training, which has proven to be of little efficacy in reducing depression and anxiety disorders. At the same time, a growing number of scientific reports have been looking at the use of virtual reality (VR) to treat mental health problems. This study aimed at assessing the efficacy of virtual therapy in reducing levels of depression, anxiety, and stress in female CVD patients. Materials and Methods: The study included 43 women who were randomly divided into two groups: experimental group (N = 17), where eight-week cardiac rehabilitation was enhanced with VR-based therapeutic sessions, and control group (N = 26), where the VR therapy was replaced with Schultz’s autogenic training. Mental state parameters were measured using the Perception of Stress Questionnaire and Hospital Anxiety and Depression Scale (HADS). Results: In the experimental group, the sole parameter which failed to improve was HADS-Anxiety, which remained at the baseline level. In the control group, there was a deterioration in nearly all tested parameters except for HADS-Depression. Statistically significant differences in the efficacy of rehabilitation were recorded in relation to the level of stress in the sub-scales: emotional tension (p = 0.005), external stress (p = 0.012), intrapsychic stress (p = 0.023) and the generalized stress scale (p = 0.004). Conclusions: VR therapy is an efficient and interesting complement to cardiac rehabilitation, with proven efficacy in reducing stress levels.
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Affiliation(s)
- Sandra Jóźwik
- Faculty of Physiotherapy, University School of Physical Education in Wroclaw, 51-612 Wroclaw, Poland; (S.J.); (J.S.-G.)
| | - Błażej Cieślik
- Faculty of Health Sciences, Jan Dlugosz University in Czestochowa, 42-200 Czestochowa, Poland
- Correspondence:
| | - Robert Gajda
- Center for Sports Cardiology at the Gajda-Med Medical Center in Pułtusk, 06-102 Pultusk, Poland;
| | - Joanna Szczepańska-Gieracha
- Faculty of Physiotherapy, University School of Physical Education in Wroclaw, 51-612 Wroclaw, Poland; (S.J.); (J.S.-G.)
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López-Ojeda W, Hurley RA. Extended-Reality Technologies: An Overview of Emerging Applications in Medical Education and Clinical Care. J Neuropsychiatry Clin Neurosci 2021; 33:A4-177. [PMID: 34289698 DOI: 10.1176/appi.neuropsych.21030067] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Wilfredo López-Ojeda
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center, and Research and Academic Affairs Service Line, W.G. Hefner Veterans Affairs Medical Center, Salisbury, N.C. (López-Ojeda, Hurley); Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, N.C. (López-Ojeda); Departments of Psychiatry and Radiology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hurley); and Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Hurley)
| | - Robin A Hurley
- Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center, and Research and Academic Affairs Service Line, W.G. Hefner Veterans Affairs Medical Center, Salisbury, N.C. (López-Ojeda, Hurley); Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, N.C. (López-Ojeda); Departments of Psychiatry and Radiology, Wake Forest School of Medicine, Winston-Salem, N.C. (Hurley); and Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston (Hurley)
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28
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Zhai K, Dilawar A, Yousef MS, Holroyd S, El-Hammali H, Abdelmonem M. Virtual Reality Therapy for Depression and Mood in Long-Term Care Facilities. Geriatrics (Basel) 2021; 6:58. [PMID: 34199801 PMCID: PMC8293126 DOI: 10.3390/geriatrics6020058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/26/2021] [Accepted: 06/02/2021] [Indexed: 11/16/2022] Open
Abstract
Virtual reality (VR) describes a family of technologies which immerse users in sensorily-stimulating virtual environments. Such technologies have increasingly found applications in the treatment of neurological and mental health disorders. Depression, anxiety, and other mood abnormalities are of concern in the growing older population-especially those who reside in long-term care facilities (LTCFs). The transition from the familiar home environment to the foreign LTCF introduces a number of stressors that can precipitate depression. However, recent studies reveal that VR therapy (VRT) can promote positive emotionality and improve cognitive abilities in older people, both at home and in LTCFs. VR thus holds potential in allowing older individuals to gradually adapt to their new environments-thereby mitigating the detrimental effects of place attachment and social exclusion. Nevertheless, while the current psychological literature is promising, the implementation of VR in LTCFs faces many challenges. LTCF residents must gain trust in VR technologies, care providers require training to maximize the positive effects of VRT, and decision makers must evaluate both the opportunities and obstacles in adopting VR. In this review article, we concisely discuss the implications of depression related to place attachment in LTCFs, and explore the potential therapeutic applications of VR.
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Affiliation(s)
- Kevin Zhai
- Premedical Unit, Weill Cornell Medicine-Qatar, Cornell University, Doha P.O. Box 24144, Qatar; (K.Z.); (A.D.); (M.S.Y.)
- Department of Physiology and Biophysics, Weill Cornell Medicine-Qatar, Cornell University, Doha P.O. Box 24144, Qatar;
| | - Azwa Dilawar
- Premedical Unit, Weill Cornell Medicine-Qatar, Cornell University, Doha P.O. Box 24144, Qatar; (K.Z.); (A.D.); (M.S.Y.)
| | - Mohammad S. Yousef
- Premedical Unit, Weill Cornell Medicine-Qatar, Cornell University, Doha P.O. Box 24144, Qatar; (K.Z.); (A.D.); (M.S.Y.)
| | - Sean Holroyd
- Department of Physiology and Biophysics, Weill Cornell Medicine-Qatar, Cornell University, Doha P.O. Box 24144, Qatar;
| | - Haithem El-Hammali
- VCU School of the Arts in Qatar, Virginia Commonwealth University, Doha P.O. Box 8095, Qatar
| | - Marwa Abdelmonem
- VCU School of the Arts in Qatar, Virginia Commonwealth University, Doha P.O. Box 8095, Qatar
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29
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Gramlich MA, Smolenski DJ, Norr AM, Rothbaum BO, Rizzo AA, Andrasik F, Fantelli E, Reger GM. Psychophysiology during exposure to trauma memories: Comparative effects of virtual reality and imaginal exposure for posttraumatic stress disorder. Depress Anxiety 2021; 38:626-638. [PMID: 33666322 DOI: 10.1002/da.23141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/29/2020] [Accepted: 02/12/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND This investigation involved an in-depth examination of psychophysiological responses during exposure to the trauma memory across 10 sessions among active duty soldiers with combat-related posttraumatic stress disorder (PTSD) treated by Prolonged Exposure (PE) or Virtual Reality Exposure (VRE). We compared psychophysiological changes, session-by-session, between VRE and traditional imaginal exposure. METHODS Heart rate (HR), galvanic skin response (GSR), and peripheral skin temperature were collected every 5 min during exposure sessions with 61 combat veterans of Iraq/Afghanistan and compared to the PTSD Checklist (PCL-C) and Clinician-Administered PTSD Scale (CAPS) outcomes using multilevel modeling. RESULTS Over the course of treatment, participants in the PE group had higher HR arousal compared to participants in the VRE group. With reference to GSR, in earlier sessions, participants demonstrated a within-session increase, whereas, in later sessions, participants showed a within-session habituation response. A significant interaction was found for GSR and treatment assignment for within-session change, within-person effect, predicting CAPS (d = 0.70) and PCL-C (d = 0.66) outcomes. CONCLUSION Overall, these findings suggest that exposure to traumatic memories activates arousal across sessions, with GSR being most associated with reductions in PTSD symptoms for participants in the PE group.
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Affiliation(s)
| | - Derek J Smolenski
- Psychological Health Center of Excellence, Defense Health Agency, Joint Base Lewis-McChord, Washington, USA
| | - Aaron M Norr
- VISN 20 Northwest Network Mental Illness Research, Education and Clinical Center (MIRECC), Seattle, Washington, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Barbara O Rothbaum
- Department of Psychiatry, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Albert A Rizzo
- Institute for Creative Technologies, University of Southern California, Los Angeles, California, USA
| | - Frank Andrasik
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | | | - Greg M Reger
- VA Puget Sound Health Care System, Tacoma, Washington, USA.,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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30
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Stevens ES, Bourassa KJ, Norr AM, Reger GM. Posttraumatic Stress Disorder Symptom Cluster Structure in Prolonged Exposure Therapy and Virtual Reality Exposure. J Trauma Stress 2021; 34:287-297. [PMID: 33128806 PMCID: PMC8035142 DOI: 10.1002/jts.22602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 07/01/2020] [Accepted: 07/15/2020] [Indexed: 11/12/2022]
Abstract
The emotional processing theory of posttraumatic stress disorder (PTSD) posits that avoidance is central to PTSD development and maintenance. Prolonged exposure (PE) therapy, which clinically focuses on avoidance reduction, has strong empirical support as a PTSD treatment. Virtual reality exposure (VRE) has been utilized to accelerate avoidance reduction by increasing multisensory engagement. Although some exposure therapy studies have found associations between avoidance and PTSD symptoms, others have indicated that reexperiencing or hyperarousal symptoms drive symptom trajectories. Using a cross-lagged panel design, the present secondary data analysis examined temporal associations between clinician-assessed PTSD symptom clusters during treatment with PE, VRE, or a waitlist control condition. There were no significant differences between PE and VRE regarding symptom clusters at any assessment. Compared to the waitlist condition, individuals who received VRE or PE exhibited earlier reductions in avoidance/numbing symptoms, β = -.19, 95% CI [-.33, -.05], followed by reductions in hyperarousal symptoms, β = -.21, 95% CI [-.33, -.09]. Hyperarousal symptoms predicted changes in later avoidance/numbing and reexperiencing outcomes across treatment: pretreatment to midtreatment, β = .29, 95% CI [.17, .42]; midtreatment to posttreatment, β = .23, 95% CI [.07, .39]. Reexperiencing symptoms predicted changes in hyperarousal outcomes earlier in treatment, β = .22, 95% CI [.02, .37], whereas avoidance/numbing symptoms predicted changes in hyperarousal outcomes later in treatment, β = .18, 95% CI [.04, .32]. These findings support the efficacy of exposure therapy in addressing avoidance/numbing symptoms and highlight the potential importance of hyperarousal symptoms in relation to other symptom clusters.
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Affiliation(s)
- Elizabeth S. Stevens
- VA Puget Sound Healthcare System, Seattle, Washington, USA,Department of Psychology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kyle J. Bourassa
- VA Puget Sound Healthcare System, Seattle, Washington, USA,Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina, USA
| | - Aaron M. Norr
- VA Northwest Network Mental Illness, Research, Education, and Clinical Center (MIRECC), Seattle, Washington, USA,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Greg M. Reger
- VA Puget Sound Healthcare System, Seattle, Washington, USA,Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
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31
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Weitzman RE, Wong K, Worrall DM, Park C, McKee S, Tufts RE, Teng MS, Iloreta AM. Incorporating Virtual Reality to Improve Otolaryngology Resident Wellness: One Institution's Experience. Laryngoscope 2021; 131:1972-1976. [PMID: 33764531 DOI: 10.1002/lary.29529] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/08/2021] [Accepted: 03/03/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Burnout is defined as work-related emotional exhaustion, depersonalization, and decreased sense of accomplishment. Virtual reality (VR) has emerged as an effective treatment modality for various conditions related to anxiety, however, few studies have assessed its role for stress management in residents. We hypothesize that VR-based mindfulness meditation can reduce resident burnout in real-world settings. STUDY DESIGN Prospective randomized crossover trial. METHODS Resident participants completed the validated Maslach Burnout Inventory (MBI). One group used a VR-based meditation app; the second group received no intervention. After a 2-month rotation, all subjects completed an MBI and crossed over to the other arm. Wilcoxon rank-sum tests were used to compare MBI scores before and after intervention, and to compare results by gender and postgraduate year. Mann-Whitney U tests were used to assess qualitative differences between participants. RESULTS Eighteen residents completed the study. Five participants were female and 13 were male. Weekly use of VR-guided meditation and paced breathing was associated with a significant decrease in emotional exhaustion (P = .009), and on subgroup analysis, male gender specifically was associated with a decrease in emotional exhaustion (P = .027). In the post-intervention survey, 42.9% subjects reported that VR encouraged them to employ paced breathing techniques, 71.4% reported that they would use the technology if regularly available, and 21.4% reported they would use paced breathing in the future. CONCLUSION VR-based therapy may serve as a successful tool in stress management and reduce the rate of burnout among otolaryngology residents. LEVEL OF EVIDENCE NA Laryngoscope, 131:1972-1976, 2021.
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Affiliation(s)
- Rachel E Weitzman
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Kevin Wong
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Douglas M Worrall
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Christopher Park
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Sean McKee
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Ryan E Tufts
- Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Marita S Teng
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Alfred M Iloreta
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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32
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Bentz D, Wang N, Ibach MK, Schicktanz NS, Zimmer A, Papassotiropoulos A, de Quervain DJF. Effectiveness of a stand-alone, smartphone-based virtual reality exposure app to reduce fear of heights in real-life: a randomized trial. NPJ Digit Med 2021; 4:16. [PMID: 33558625 PMCID: PMC7870885 DOI: 10.1038/s41746-021-00387-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/06/2021] [Indexed: 11/09/2022] Open
Abstract
Smartphone-based virtual reality (VR) applications (apps) might help to counter low utilization rates of available treatments for fear of heights. Demonstration of effectiveness in real-life situations of such apps is crucial, but lacking so far. Objective of this study was to develop a stand-alone, smartphone-based VR exposure app-Easy Heights-and to test its effectiveness in a real-life situation. We performed a single-blind, parallel group, randomized controlled trial. We recruited 70 participants with fear of heights, aged 18-60 years. Primary outcome was performance in a real-life Behavioral Avoidance Test (BAT) on a lookout tower after a single 1-h app use (phase 1) and after additional repeated (6 × 30 min) app use at home (phase 2). After phase 2, but not phase 1, participants in the Easy Heights condition showed significantly higher BAT scores compared to participants in the control condition (Cohen's d = 1.3, p = 0.0001). Repeated use of our stand-alone, smartphone-based VR exposure app reduces avoidance behavior and fear, providing a low-threshold treatment for fear of heights.
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Affiliation(s)
- Dorothée Bentz
- Division of Cognitive Neuroscience, Faculty of Psychology, University of Basel, Basel, Switzerland.,Transfaculty Research Platform, University of Basel, Basel, Switzerland
| | - Nan Wang
- Division of Cognitive Neuroscience, Faculty of Psychology, University of Basel, Basel, Switzerland.,Transfaculty Research Platform, University of Basel, Basel, Switzerland
| | - Merle K Ibach
- Division of Cognitive Neuroscience, Faculty of Psychology, University of Basel, Basel, Switzerland.,Transfaculty Research Platform, University of Basel, Basel, Switzerland
| | - Nathalie S Schicktanz
- Division of Cognitive Neuroscience, Faculty of Psychology, University of Basel, Basel, Switzerland.,Transfaculty Research Platform, University of Basel, Basel, Switzerland
| | - Anja Zimmer
- Division of Cognitive Neuroscience, Faculty of Psychology, University of Basel, Basel, Switzerland.,Transfaculty Research Platform, University of Basel, Basel, Switzerland
| | - Andreas Papassotiropoulos
- Transfaculty Research Platform, University of Basel, Basel, Switzerland.,Division of Molecular Neuroscience, Faculty of Psychology, University of Basel, Basel, Switzerland.,Life Sciences Training Facility, Department Biozentrum, University of Basel, Basel, Switzerland.,University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Dominique J F de Quervain
- Division of Cognitive Neuroscience, Faculty of Psychology, University of Basel, Basel, Switzerland. .,Transfaculty Research Platform, University of Basel, Basel, Switzerland. .,University Psychiatric Clinics, University of Basel, Basel, Switzerland.
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Shin M, Lee S, Song SW, Chung D. Enhancement of perceived body ownership in virtual reality-based teleoperation may backfire in the execution of high-risk tasks. COMPUTERS IN HUMAN BEHAVIOR 2021; 115:106605. [PMID: 33100505 PMCID: PMC7568672 DOI: 10.1016/j.chb.2020.106605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 10/07/2020] [Accepted: 10/14/2020] [Indexed: 11/26/2022]
Abstract
Guided by previous research on the role of embodiment in virtual environments, this study aimed to investigate the potential effects of using human-like (compared to robotic) virtual hands on work performances in the context of virtual reality (VR)-based teleoperation of high-risk machinery. A 2 × 2 mixed factorial design experiment (N = 74), with the virtual hand representation as a within-subjects factor (robotic vs. human-like virtual hands) and the risk of danger as a between-subjects factor (low vs. high), was conducted to examine the effects of virtual hand representations (i.e., human-likeness) on perceived body ownership (i.e., embodiment), risk perception, intention to work using the teleoperator, and work performance (i.e., the number of successful task completions). In addition, the moderating effects of the risk of danger on the relationship between perceived body ownership and risk perception were explored. Results showed that the enhancement of perceived body ownership in VR-based teleoperation, induced by the use of human-like hands, increased the risk perception and degraded workers' task performances in the execution of high-risk tasks. Further implications of the findings were discussed.
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Affiliation(s)
- Mincheol Shin
- Department of Communication and Cognition, Tilburg University, Tilburg, Netherlands
| | - Sanguk Lee
- Department of Communication, Michigan State University, MI, USA
| | - Stephen W Song
- Comm. & Tech. Lab, Kwangwoon University, Seoul, South Korea
| | - Donghun Chung
- School of Media and Communication, Kwangwoon University, Seoul, South Korea
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34
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Anxiety and threat magnification in subjective and physiological responses of fear of heights induced by virtual reality. PERSONALITY AND INDIVIDUAL DIFFERENCES 2021. [DOI: 10.1016/j.paid.2019.109720] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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35
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Organizational principles of amygdalar input-output neuronal circuits. Mol Psychiatry 2021; 26:7118-7129. [PMID: 34400771 PMCID: PMC8873025 DOI: 10.1038/s41380-021-01262-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 07/20/2021] [Accepted: 08/02/2021] [Indexed: 02/07/2023]
Abstract
The amygdala, one of the most studied brain structures, integrates brain-wide heterogeneous inputs and governs multidimensional outputs to control diverse behaviors central to survival, yet how amygdalar input-output neuronal circuits are organized remains unclear. Using a simplified cell-type- and projection-specific retrograde transsynaptic tracing technique, we scrutinized brain-wide afferent inputs of four major output neuronal groups in the amygdalar basolateral complex (BLA) that project to the bed nucleus of the stria terminals (BNST), ventral hippocampus (vHPC), medial prefrontal cortex (mPFC) and nucleus accumbens (NAc), respectively. Brain-wide input-output quantitative analysis unveils that BLA efferent neurons receive a diverse array of afferents with varied input weights and predominant contextual representation. Notably, the afferents received by BNST-, vHPC-, mPFC- and NAc-projecting BLA neurons exhibit virtually identical origins and input weights. These results indicate that the organization of amygdalar BLA input-output neuronal circuits follows the input-dependent and output-independent principles, ideal for integrating brain-wide diverse afferent stimuli to control parallel efferent actions. The data provide the objective basis for improving the virtual reality exposure therapy for anxiety disorders and validate the simplified cell-type- and projection-specific retrograde transsynaptic tracing method.
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36
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Dehghan B, Saeidimehr S, Sayyah M, Rahim F. The Effect of Virtual Reality on Emotional Response and Symptoms Provocation in Patients With OCD: A Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:733584. [PMID: 35177996 PMCID: PMC8846333 DOI: 10.3389/fpsyt.2021.733584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/22/2021] [Indexed: 12/15/2022] Open
Abstract
This systematic review and meta-analysis aimed to evaluate the effectiveness of virtual reality (VR)-based technology on emotional response and symptoms in patients with obsessive-compulsive disorder (OCD). We systematically searched major electronic databases, including PubMed/Medline, Scopus, Embase, ISI Web of Science, PsycINFO, and Cochrane central, up to April 14, 2021, with no data or language limits. We performed reference, related articles, and citation searches to find additional articles. We included original articles comparing and studying VR-based technology in patients with OCD against the control group. We observed that VR significantly increases in anxiety (SMD = 2.92; 95% CI 1.89-3.94, p < 0.0001; I 2 = 95%), disgust (SMD = 2.52; 95% CI 1.36-3.68, p < 0.0001; I 2 = 95%), urge to wash (SMD = 3.12; 95% CI 1.92-4.32, p < 0.0001; I 2 = 94%), checking time (SMD = 1.06; 95% CI 0.71-1.4, p < 0.0001; I 2 = 44%), number of checking behavior (SMD = 1.45; 95% CI 0.06-2.83, p = 0.04; I 2 = 93%), and uncertainty (SMD = 2.59; 95% CI 0.90-4.27, p = 0.003; I 2 = 70%) in OCD patients compared with healthy controls using a random-effect model. This meta-analysis found that this environment has a moderate enhancement in emotional response and symptoms test scores of patients with OCD. However, our findings should be generalized with caution due to the lack of standardized methods and high heterogeneity among included evidence. The appropriate mode of integrating VR-based technology for patients with OCD requires more exploration.
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Affiliation(s)
- Bahram Dehghan
- Department of Medicine, Naft Grand Hospital, The Health Affair Organization of Oils and Refineries Industry, Ahvaz, Iran
| | - Saied Saeidimehr
- Department of Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Sayyah
- Education Development Center (EDC), Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fakher Rahim
- Research Center of Thalassemia and Hemoglobinopathies, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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37
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Kim H, Kim DJ, Kim S, Chung WH, Park KA, Kim JDK, Kim D, Kim MJ, Kim K, Jeon HJ. Effect of Virtual Reality on Stress Reduction and Change of Physiological Parameters Including Heart Rate Variability in People With High Stress: An Open Randomized Crossover Trial. Front Psychiatry 2021; 12:614539. [PMID: 34447320 PMCID: PMC8384255 DOI: 10.3389/fpsyt.2021.614539] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 07/12/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction: Although, attempts to apply virtual reality (VR) in mental healthcare are rapidly increasing, it is still unclear whether VR relaxation can reduce stress more than conventional biofeedback. Methods: Participants consisted of 83 healthy adult volunteers with high stress, which was defined as a score of 20 or more on the Perceived Stress Scale-10 (PSS-10). This study used an open, randomized, crossover design with baseline, stress, and relaxation phases. During the stress phase, participants experienced an intentionally generated shaking VR and serial-7 subtraction. For the relaxation phase, participants underwent a randomly assigned relaxation session on day 1 among VR relaxation and biofeedack, and the other type of relaxation session was applied on day 2. We compared the State-Trait Anxiety Inventory-X1 (STAI-X1), STAI-X2, the Numeric Rating Scale (NRS), and physiological parameters including heart rate variability (HRV) indexes in the stress and relaxation phases. Results: A total of 74 participants were included in the analyses. The median age of participants was 39 years, STAI-X1 was 47.27 (SD = 9.92), and NRS was 55.51 (SD = 24.48) at baseline. VR and biofeedback significantly decreased STAI-X1 and NRS from the stress phase to the relaxation phase, while the difference of effect between VR and biofeedback was not significant. However, there was a significant difference in electromyography, LF/HF ratio, LF total, and NN50 between VR relaxation and biofeedback. Conclusion: VR relaxation was effective in reducing subjectively reported stress in individuals with high stress.
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Affiliation(s)
- Hyewon Kim
- Department of Psychiatry, Hanyang University Medical Center, Seoul, South Korea
| | - Dong Jun Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Health Sciences and Technology, Department of Medical Device Management and Research, and Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
| | - Seonwoo Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
| | - Won Ho Chung
- Department of Otorhinolaryngology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - James D K Kim
- AR Lab, Samsung Research, Samsung Electronics Co., Ltd, Seoul, South Korea
| | - Dowan Kim
- Advanced Solution Team, Samsung Research, Samsung Electronics Co., Ltd, Seoul, South Korea
| | - Min Ji Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, South Korea
| | - Kiwon Kim
- Department of Psychiatry, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Department of Health Sciences and Technology, Department of Medical Device Management and Research, and Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
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Banerjee A, Raoniar R, Maurya AK. Pedestrian overpass utilization modeling based on mobility friction, safety and security, and connectivity using machine learning techniques. Soft comput 2020. [DOI: 10.1007/s00500-020-05277-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Imperatori C, Dakanalis A, Farina B, Pallavicini F, Colmegna F, Mantovani F, Clerici M. Global Storm of Stress-Related Psychopathological Symptoms: A Brief Overview on the Usefulness of Virtual Reality in Facing the Mental Health Impact of COVID-19. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2020; 23:782-788. [DOI: 10.1089/cyber.2020.0339] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Claudio Imperatori
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Benedetto Farina
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Rome, Italy
| | - Federica Pallavicini
- Department of Human Sciences for Education “Riccardo Massa,” University of Milano Bicocca, Milan, Italy
| | - Fabrizia Colmegna
- Mental Health Department, San Gerardo Monza Health and Social Care Trust, Monza, Italy
| | - Fabrizia Mantovani
- Department of Human Sciences for Education “Riccardo Massa,” University of Milano Bicocca, Milan, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
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Abstract
AbstractVirtual reality (VR) is an immersive technology capable of creating a powerful, perceptual illusion of being present in a virtual environment. VR technology has been used in cognitive behavior therapy since the 1990s and accumulated an impressive evidence base, yet with the recent release of consumer VR platforms came a true paradigm shift in the capabilities and scalability of VR for mental health. This narrative review summarizes the past, present, and future of the field, including milestone studies and discussions on the clinical potential of alternative embodiment, gamification, avatar therapists, virtual gatherings, immersive storytelling, and more. Although the future is hard to predict, clinical VR has and will continue to be inherently intertwined with what are now rapid developments in technology, presenting both challenges and exciting opportunities to do what is not possible in the real world.
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41
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Proniewska K, Pregowska A, Walecki P, Dołęga-Dołęgowski D, Ferrari R, Dudek D. Overview of the holographic-guided cardiovascular interventions and training – a perspective. BIO-ALGORITHMS AND MED-SYSTEMS 2020. [DOI: 10.1515/bams-2020-0043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AbstractImmersive technologies, like Virtual Reality (VR), Augmented Reality (AR) and Mixed Reality (MR) have undergone technical evolutions over the last few decades. Their rapid development and dynamic changes enable their effective applications in medicine, in fields like imaging, preprocedural planning, treatment, operations planning, medical students training, and active support during therapeutic and rehabilitation procedures. Within this paper, a comprehensive analysis of VR/AR/MR application in the medical industry and education is presented. We overview and discuss our previous experience with AR/MR and 3D visual environment and MR-based imaging systems in cardiology and interventional cardiology. Our research shows that using immersive technologies users can not only visualize the heart and its structure but also obtain quantitative feedback on their location. The MR-based imaging system proposed offers better visualization to interventionists and potentially helps users understand complex operational cases. The results obtained suggest that technology using VR/AR/MR can be successfully used in the teaching process of future doctors, both in aspects related to anatomy and clinical classes. Moreover, the system proposed provides a unique opportunity to break the boundaries, interact in the learning process, and exchange experiences inside the medical community.
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Affiliation(s)
- Klaudia Proniewska
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Krakow, Poland
| | - Agnieszka Pregowska
- Institute of Fundamental Technological Research, Polish Academy of Sciences, Warsaw, Poland
| | - Piotr Walecki
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Krakow, Poland
| | - Damian Dołęga-Dołęgowski
- Department of Bioinformatics and Telemedicine, Jagiellonian University Medical College, Krakow, Poland
| | - Roberto Ferrari
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
- Department of Medical Sciences, Ferrara University, Ferrara, Italy
| | - Dariusz Dudek
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
- Jagiellonian University Medical College, Institute of Cardiology, Krakow, Poland
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42
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An Experimental Test Proposal to Study Human Behaviour in Fires Using Virtual Environments. SENSORS 2020; 20:s20123607. [PMID: 32604864 PMCID: PMC7348952 DOI: 10.3390/s20123607] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/20/2020] [Accepted: 06/24/2020] [Indexed: 12/12/2022]
Abstract
Human behavior in an emergency situation is the starting point for all evacuation planning projects. A better understanding of the decisions made by the occupants during an emergency can help to develop calculation tools that can create more efficient forms of visual and audio communication and implement better procedures for evacuating people. The difficulty in studying human behavior lies in the very nature of emergencies, as they are unpredictable, somewhat exceptional and not reproducible. Fire drills play a role in training emergency teams and building occupants, but they cannot be used to collect real data on people’s behavior unless the drill is so realistic that it could endanger the occupants’ safety. In the procedure described here, through the use of a Virtual Reality device that encompasses all critical phases, including user characterization data before the virtual experience, building design parameters and fire scenario, key variables of human behavior can be recorded in order to evaluate each user’s experience satisfactorily. This research shows that the average delay in starting an evacuation is greater than one minute, that anxiety levels and heart rates increase during a fire and that people do not pay attention to evacuation signals. Further analysis of the quantitative data may also provide the causes for decision-making. The use of devices that create realistic virtual environments is a solution for conducting “what if” tests to study and record the decisions taken by the users who undergo the experience in a way that is completely safe for them.
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Gonzalez-Liencres C, Zapata LE, Iruretagoyena G, Seinfeld S, Perez-Mendez L, Arroyo-Palacios J, Borland D, Slater M, Sanchez-Vives MV. Being the Victim of Intimate Partner Violence in Virtual Reality: First- Versus Third-Person Perspective. Front Psychol 2020; 11:820. [PMID: 32457681 PMCID: PMC7225265 DOI: 10.3389/fpsyg.2020.00820] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/02/2020] [Indexed: 01/10/2023] Open
Abstract
Immersive virtual reality is widely used for research and clinical purposes. Here we explored the impact of an immersive virtual scene of intimate partner violence experienced from the victim’s perspective (first person), as opposed to witnessing it as an observer (third person). We are ultimately interested in the potential of this approach to rehabilitate batterers and in understanding the mechanisms underlying this process. For this, non-offender men experienced the scene either from the perspective of the victim’s virtual body (a female avatar), which moved synchronously with the participants’ real movements, or from the perspective of an observer, while we recorded their behavior and physiological responses. We also evaluated through questionnaires, interviews and implicit association tests their subjective impressions and potential pre/post changes in implicit gender bias following the experience. We found that in all participants, regardless of perspective, the magnitude of the physiological reactions to virtual threatening stimuli was related to how vulnerable they felt for being a woman, the sensation that they could be assaulted, how useful the scene could be for batterer rehabilitation, and how different it would have been to experience the scenario on TV. Furthermore, we found that their level of identification with the female avatar correlated with the decrease in prejudice against women. Although the first-person perspective (1PP) facilitated taking the scene personally, generated a sensation of fear, helplessness, and vulnerability, and tended to induce greater behavioral and physiological reactions, we show that the potential for batterer rehabilitation originates from presence and identification with the victim, which in turn is more easily, but not exclusively, achieved through 1PP. This study is relevant for the development of advanced virtual reality tools for clinical purposes.
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Affiliation(s)
| | - Luis E Zapata
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Experimental Virtual Environments for Neuroscience and Technology Laboratory, University of Barcelona, Barcelona, Spain
| | - Guillermo Iruretagoyena
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Experimental Virtual Environments for Neuroscience and Technology Laboratory, University of Barcelona, Barcelona, Spain
| | - Sofia Seinfeld
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Experimental Virtual Environments for Neuroscience and Technology Laboratory, University of Barcelona, Barcelona, Spain
| | | | - Jorge Arroyo-Palacios
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Experimental Virtual Environments for Neuroscience and Technology Laboratory, University of Barcelona, Barcelona, Spain
| | - David Borland
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Experimental Virtual Environments for Neuroscience and Technology Laboratory, University of Barcelona, Barcelona, Spain
| | - Mel Slater
- Experimental Virtual Environments for Neuroscience and Technology Laboratory, University of Barcelona, Barcelona, Spain.,Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.,Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Maria V Sanchez-Vives
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.,Experimental Virtual Environments for Neuroscience and Technology Laboratory, University of Barcelona, Barcelona, Spain.,Department of Cognition, Development and Educational Science, University of Barcelona, Barcelona, Spain.,ICREA, Barcelona, Spain
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44
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Viaud-Delmon I, Warusfel O, Seguelas A, Rio E, Jouvent R. High sensitivity to multisensory conflicts in agoraphobia exhibited by virtual reality. Eur Psychiatry 2020; 21:501-8. [PMID: 17055951 DOI: 10.1016/j.eurpsy.2004.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2004] [Revised: 10/13/2004] [Accepted: 10/21/2004] [Indexed: 11/16/2022] Open
Abstract
AbstractThe primary aim of this study was to evaluate the effect of auditory feedback in a VR system planned for clinical use and to address the different factors that should be taken into account in building a bimodal virtual environment (VE). We conducted an experiment in which we assessed spatial performances in agoraphobic patients and normal subjects comparing two kinds of VEs, visual alone (Vis) and auditory–visual (AVis), during separate sessions. Subjects were equipped with a head-mounted display coupled with an electromagnetic sensor system and immersed in a virtual town. Their task was to locate different landmarks and become familiar with the town. In the AVis condition subjects were equipped with the head-mounted display and headphones, which delivered a soundscape updated in real-time according to their movement in the virtual town. While general performances remained comparable across the conditions, the reported feeling of immersion was more compelling in the AVis environment. However, patients exhibited more cybersickness symptoms in this condition. The result of this study points to the multisensory integration deficit of agoraphobic patients and underline the need for further research on multimodal VR systems for clinical use.
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Affiliation(s)
- Isabelle Viaud-Delmon
- CNRS - UPMC UMR 7593, Pavillon Clérambault, Hôpital de la Salpêtrière, 47, boulevard de l'Hôpital, 75013 Paris, France.
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45
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Thng CEW, Lim-Ashworth NSJ, Poh BZQ, Lim CG. Recent developments in the intervention of specific phobia among adults: a rapid review. F1000Res 2020; 9. [PMID: 32226611 PMCID: PMC7096216 DOI: 10.12688/f1000research.20082.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2020] [Indexed: 12/03/2022] Open
Abstract
Specific phobia is highly prevalent worldwide. Although the body of intervention studies is expanding, there is a lack of reviews that summarise recent progress and discuss the challenges and direction of research in this area. Hence, this rapid review seeks to systematically evaluate the available evidence in the last five years in the treatment of specific phobias in adults. Studies published between January 2014 to December 2019 were identified through searches on the electronic databases of Medline and PsychINFO. In total, 33 studies were included. Evidence indicates that psychotherapy, and in particular cognitive behaviour therapy, when implemented independently or as an adjunctive, is a superior intervention with large effect sizes. Technology-assisted therapies seem to have a beneficial effect on alleviating fears and are described to be more tolerable than
in vivo exposure therapy. Pharmacological agents are investigated solely as adjuncts to exposure therapy, but the effects are inconsistent; propranolol and glucocorticoid may be promising. A handful of cognitive-based therapies designed to alter fear arousal and activation pathways of phobias have presented preliminary, positive outcomes. Challenges remain with the inherent heterogeneity of specific phobia as a disorder and the accompanying variability in outcome measures and intervention approaches to warrant a clear conclusion on efficacy.
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Affiliation(s)
- Christabel E W Thng
- Department of Developmental Psychiatry, Institute of Mental Health, 10 Buangkok View, 539747, Singapore
| | - Nikki S J Lim-Ashworth
- Department of Developmental Psychiatry, Institute of Mental Health, 10 Buangkok View, 539747, Singapore
| | - Brian Z Q Poh
- Department of Developmental Psychiatry, Institute of Mental Health, 10 Buangkok View, 539747, Singapore
| | - Choon Guan Lim
- Department of Developmental Psychiatry, Institute of Mental Health, 10 Buangkok View, 539747, Singapore
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46
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Aboujaoude E, Gega L, Parish MB, Hilty DM. Editorial: Digital Interventions in Mental Health: Current Status and Future Directions. Front Psychiatry 2020; 11:111. [PMID: 32174858 PMCID: PMC7056878 DOI: 10.3389/fpsyt.2020.00111] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 02/10/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Elias Aboujaoude
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Lina Gega
- Department of Health Sciences & Hull York Medicine School, University of York, York, United Kingdom
| | - Michelle B. Parish
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, CA, United States
| | - Donald M. Hilty
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Davis, CA, United States
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47
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Kim S, Kim E. The Use of Virtual Reality in Psychiatry: A Review. Soa Chongsonyon Chongsin Uihak 2020; 31:26-32. [PMID: 32612410 PMCID: PMC7324842 DOI: 10.5765/jkacap.190037] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/15/2019] [Accepted: 11/19/2019] [Indexed: 12/26/2022] Open
Abstract
With the advancement in modern information technology, virtual reality (VR) is being increasingly used for the diagnosis, assessment, and treatment of mental disorders. Recently, a VR-based cognitive behavioral therapy for social phobia has been recognized as a new medical technology in South Korea. This might lead to an increase in the use of VR in the field of psychiatry. The present review provides an overview of the status of VR therapies in various psychiatric conditions such as anxiety disorder, post-traumatic stress disorder, psychosis, addiction, and eating disorder. Besides, it summarizes the role of VR therapy in the management of disorders associated with child and adolescence psychiatry as well as various other clinical applications. Additionally, we discuss the merits and limitations of VR therapy, which might serve as a useful reference for researchers. In the current environment wherein novel medical models consisting of a combination of digital devices and medicine are being developed; understanding new technologies such as VR could open new doors to mental health treatments.
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Affiliation(s)
- Suji Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Eunjoo Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Psychiatry, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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48
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MacLeod JS, MacLeod C, Dondzilo L, Bell J. The Role of Fear of Fatness and Avoidance of Fatness in Predicting Eating Restraint. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10052-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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49
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Colombo D, Fernández-Álvarez J, García Palacios A, Cipresso P, Botella C, Riva G. New Technologies for the Understanding, Assessment, and Intervention of Emotion Regulation. Front Psychol 2019; 10:1261. [PMID: 31275191 PMCID: PMC6591314 DOI: 10.3389/fpsyg.2019.01261] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 05/13/2019] [Indexed: 01/10/2023] Open
Abstract
In the last decades, emotion regulation (ER) received increasing attention and became one of the most studied topics within the psychological field. Nevertheless, this construct has not been fully updated with the latest technological advancements. In this perspective, we will show how diverse technologies, such as virtual reality (VR), wearable biosensors, smartphones, or biofeedback techniques, can be applied to the understanding, assessment, and intervention of ER. After providing a brief overview of the currently available technological developments, we will discuss the benefits of incorporating new technologies in ER field, including ecological validity, intervention personalization, and the integration of understudied facets of ER, such as the implicit and interpersonal dimension.
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Affiliation(s)
- Desirée Colombo
- Department of Basic Psychology, Clinical and Psychobiology, Jaume I University, Castellón de la Plana, Spain
| | | | - Azucena García Palacios
- Department of Basic Psychology, Clinical and Psychobiology, Jaume I University, Castellón de la Plana, Spain
- CIBER of Physiopathology of Obesity and Nutrition, Madrid, Spain
| | - Pietro Cipresso
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano (IRCCS), Milan, Italy
| | - Cristina Botella
- Department of Basic Psychology, Clinical and Psychobiology, Jaume I University, Castellón de la Plana, Spain
- CIBER of Physiopathology of Obesity and Nutrition, Madrid, Spain
| | - Giuseppe Riva
- Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy
- Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano (IRCCS), Milan, Italy
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50
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