Within- and Between-Session Prefrontal Cortex Response to Virtual Reality Exposure Therapy for Acrophobia

Assessing multilingual speakers' language processing through functional near-infrared spectroscopy (fNIRS)

Multilinguals' navigation through three or more language systems utilizing one cognitive system is a phenomenon of recent interest. Few functional near-infrared spectroscopy (fNIRS) studies have focused on brain activations concerning multilinguals. The present study uses picture-naming and fNIRS technique to explore the prefrontal brain activations amongst neurotypical multilinguals belonging to four major provinces of Pakistan. The 26 right-handed participants utilize their native language (Punjabi, Pushto, Sindhi or Balochi), first language (Urdu) and second language (English) distinctively in the experiment. Brain imaging results demonstrate a significant activation of the right prefrontal cortex among the multilingual adults along with left laterality. Moreover, results indicate significant activation of channels demonstrating heavier cognitive load with English in comparison to first or native language(s). The paper suggests that right dorsolateral prefrontal cortex and right medial prefrontal cortex play a significant role in language processing alongside the left prefrontal cortex, exemplifying that peripheral activation during word retrieval, processing and production is a possibility.

EEG microstate in people with different degrees of fear of heights during virtual high-altitude exposure

Previous neuroimaging studies based on electroencephalography (EEG) microstate analysis have identified abnormal neural electric activity in patients with psychiatric diseases. However, the microstate information in individuals with different degrees of fear of heights (FoH) remains unknown so far. The aim of the study was therefore to explore the changes of EEG microstate characteristics in different FoH individuals when exposed to high-altitude stimulated by virtual reality (VR). First, acrophobia questionnaire (AQ) before the experiment and 32-channel EEG signals under the virtual high-altitude exposure were collected from 69 subjects. Second, each subject was divided into one of three levels of FoH including no-FoH, mild or moderate FoH (m-FoH) and severe FoH (s-FoH) groups according to their AQ scores. Third, using microstate analysis, we transformed EEG data into sequences of characteristic topographic maps and computed EEG microstate features including microstate basic parameters, microstate sequences complexity and microstate energy. Finally, the extracted features as inputs were sent to train and test an support vector machine (SVM) for classifying different FoH groups. The results demonstrated that five types of microstates (labeled as A, B, C, D and F) were identified across all subjects, of which microstates A-D resembled the four typical microstate classes and microstate F was a non-canonical microstate. Significantly decreased occurrence, coverage and duration of microstate F and transition probabilities from other microstates to microstate F in m-FoH and s-FoH groups were observed compared to no-FoH group. It was also demonstrated that both m-FoH and s-FoH groups showed a notable reduction in sample entropy and Lempel-Ziv complexity. Moreover, energies of microstate D for m-FoH group and microstate B for s-FoH group in right parietal, parietooccipital and occipital regions exhibited prominent decreases as comparison to people without FoH. But, no significant differences were found between m-FoH and s-FoH groups. Additionally, the results indicated that AQ-anxiety scores were negatively correlated with microstate basic metrics as well as microstate energy. For classification, the performance of SVM reached a relatively high accuracy of 89 % for distinguishing no-FoH from m-FoH. In summary, the findings highlight the alterations of EEG microstates in people with fear of heights induced by virtual high-altitude, reflecting potentially underlying abnormalities in the allocation of neural assemblies. Therefore, the combination of EEG microstate analysis and VR may be a potential valuable approach for the diagnosis of fear of heights.

When virtual reality becomes psychoneuroendocrine reality: A stress(or) review

This review article was awarded the Dirk Hellhammer award from ISPNE in 2023. It explores the dynamic relationship between stressors and stress from a historical view as well as a vision towards the future of stress research via virtual reality (VR). We introduce the concept of a "syncytium," a permeable boundary that blurs the distinction between stress and stressor, in order to understand why the field of stress biology continues to inadequately measure stress alone as a proxy for the force of external stressors. Using Virtual Reality (VR) as an illustrative example to explicate the black box of stressors, we examine the distinction between 'immersion' and 'presence' as analogous terms for stressor and stress, respectively. We argue that the conventional psychological approaches to stress measurement and appraisal theory unfortunately fall short in quantifying the force of the stressor, leading to reverse causality fallacies. Further, the concept of affordances is introduced as an ecological or holistic tool to measure and design a stressor's force, bridging the gap between the external environment and an individual's physiological response to stress. Affordances also serve to ameliorate shortcomings in stress appraisal by integrating ecological interdependencies. By combining VR and psychobiological measures, this paper aims to unravel the complexity of the stressor-stress syncytium, highlighting the necessity of assessing both the internal and external facets to gain a holistic understanding of stress physiology and shift away from reverse causality reasoning. We find that the utility of VR extends beyond presence to include affordance-based measures of immersion, which can effectively model stressor force. Future research should prioritize the development of tools that can measure both immersion and presence, thereby providing a more comprehensive understanding of how external stressors interact with individual psychological states.

iVR-fNIRS: studying brain functions in a fully immersive virtual environment

Immersive virtual reality (iVR) employs head-mounted displays or cave-like environments to create a sensory-rich virtual experience that simulates the physical presence of a user in a digital space. The technology holds immense promise in neuroscience research and therapy. In particular, virtual reality (VR) technologies facilitate the development of diverse tasks and scenarios closely mirroring real-life situations to stimulate the brain within a controlled and secure setting. It also offers a cost-effective solution in providing a similar sense of interaction to users when conventional stimulation methods are limited or unfeasible. Although combining iVR with traditional brain imaging techniques may be difficult due to signal interference or instrumental issues, recent work has proposed the use of functional near infrared spectroscopy (fNIRS) in conjunction with iVR for versatile brain stimulation paradigms and flexible examination of brain responses. We present a comprehensive review of current research studies employing an iVR-fNIRS setup, covering device types, stimulation approaches, data analysis methods, and major scientific findings. The literature demonstrates a high potential for iVR-fNIRS to explore various types of cognitive, behavioral, and motor functions in a fully immersive VR (iVR) environment. Such studies should set a foundation for adaptive iVR programs for both training (e.g., in novel environments) and clinical therapeutics (e.g., pain, motor and sensory disorders and other psychiatric conditions).

Adjunctive cognitive training with exposure enhances fear and neural outcomes in social anxiety

Exposure-based cognitive behavioral therapy (CBT) is the gold standard for treating social anxiety disorder (SAD), yet response is not universal. CBT is thought to operate via extinction-related learning during exposure, which in turn relies on cognitive processes such as working memory. The present proof-of-concept study investigates the potential for training working memory to improve anxiety related outcomes following exposure. Thirty-three adults with elevated social anxiety were randomized to complete a working memory training or sham training condition. Post-training, participants completed a working memory assessment, speech exposure session, and two fMRI tasks. Participants who received working memory training demonstrated lower distress ratings by the end of the speech exposures and better performance on the fMRI working memory task than those in sham. Working memory training completers had greater neural activation in frontoparietal regions during an in-scanner working memory task and exhibited less neural activation in the fusiform gyrus in response to an emotional face processing task than those in sham. Adding working memory training to exposure procedures could strengthen functioning of frontoparietal regions and alter emotional processing - key mechanisms implicated in extinction learning. Findings provide preliminary evidence that training working memory in conjunction with exposure may enhance exposure success.

Altered brain function in patients with acrophobia: A voxel-wise degree centrality analysis

AIM

To explore the local spontaneous neural activity and whole-brain functional connectivity patterns in the resting brain of acrophobia patients.

METHODS

50 patients with acrophobia and 47 healthy controls were selected for this study. All participants underwent resting-state MRI scans after enrollment. The imaging data were then analyzed using a voxel-based degree centrality (DC) method, and seed-based functional connectivity (FC) correlation analysis was used to explore the correlation between abnormal functional connectivity and clinical symptom scales in acrophobia. The severity of symptoms was evaluated using self-report and behavioral measures.

RESULTS

Compared to controls, acrophobia patients showed higher DC in the right cuneus and left middle occipital gyrus and significantly lower DC in the right cerebellum and left orbitofrontal cortex (p < 0.01, GRF corrected). Additionally, there were negative correlations between the acrophobia questionnaire avoidance (AQ- Avoidance) scores and right cerebellum-left perirhinal cortex FC (r = -0.317, p = 0.025) and between scores of the 7-item generalized anxiety disorder scale and left middle occipital gyrus-right cuneus FC (r = -0.379, p = 0.007). In the acrophobia group, there was a positive correlation between behavioral avoidance scale and right cerebellum-right cuneus FC (r = 0.377, p = 0.007).

CONCLUSIONS

The findings indicated that there are local abnormalities in spontaneous neural activity and functional connectivity in the visual cortex, cerebellum, and orbitofrontal cortex in patients with acrophobia.

Use of Virtual Reality Techniques to Rehabilitate Military Veterans with Post-Traumatic Stress Disorder (Review)

Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder developing after a traumatic event like participation in combat activities. Objective diagnosis of combat PTSD and effective rehabilitation of war veterans is a current multifaceted problem with particularly high social costs. This review aims to evaluate the potential of virtual reality technique used as exposure therapy tool (VRET) to rehabilitate combat veterans and service members with PTSD. The review was written following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The final analysis includes 75 articles published in 2017-2022. VRET therapeutic effect mechanisms were examined along with protocols and scenarios of VRET combined with other interventions influencing PTSD treatment like pharmacotherapy, motion-assisted multi-modular memory desensitization and reconsolidation (3MDR), transcranial magnetic stimulation. The necessity is substantiated of psychophysiological measurements for objectification of PTSD clinical criteria and its dynamics during treatment. It was shown that inclusion of VRET to the package of PTSD rehabilitation interventions positively affects the results due to the enhanced effect of presence and greater experience personalization. Thus, VRET may be an effective, controlled, and cost-effective alternative for PTSD treatment in combatants, including those not responding to conventional therapy.

Differences in Brain Activity and Body Movements Between Virtual Reality and Offline Exercise: Randomized Crossover Trial

BACKGROUND

Virtual reality (VR) has been suggested to be effective at enhancing physical exercises because of its immersive characteristics. However, few studies have quantitatively assessed the range of motion and brain activity during VR exercises.

OBJECTIVE

We hypothesized that 3D immersive VR could stimulate body movement and brain activity more effectively than standard exercises and that the increased range of motions during 3D immersive VR exercises would be associated with orbitofrontal activation.

METHODS

A randomized crossover trial was conducted to compare exercises with and without VR. A total of 24 healthy males performed the same motions when exercising with and without 3D immersive VR, and the recorded videos were used for motion analysis. Hemodynamic changes in the prefrontal cortex were assessed using functional near-infrared spectroscopy.

RESULTS

There were significant differences in the total angle (z=-2.31; P=.02), length (z=-2.78; P=.005), calorie consumption (z=-3.04; P=.002), and change in accumulated oxygenated hemoglobin within the right orbitofrontal cortex (F^1,94=9.36; P=.003) between the VR and offline trials. Hemodynamic changes in the right orbitofrontal cortex were positively correlated with the total angle (r=0.45; P=.001) and length (r=0.38; P=.007) in the VR exercise; however, there was no significant correlation in the offline trial.

CONCLUSIONS

The results of this study suggest that 3D immersive VR exercise effectively increases the range of motion in healthy individuals in relation to orbitofrontal activation.

TRIAL REGISTRATION

Clinical Research Information Service KCT0008021; https://cris.nih.go.kr/cris/search/detailSearch.do/23671.

Neural correlates of fear conditioning are associated with treatment-outcomes to behavioral exposure in spider phobia - Evidence from magnetoencephalography

•

Magnetoencephalographic effects of fear conditioning predict exposure outcomes.

•

No associations between fear ratings of conditioned stimuli and exposure outcomes.

•

Prefrontal correlates of safety processing and/or fear inhibition are treatment-relevant.

•

Individual neural differences might be a promising predictor of exposure success.

Background

Models of anxiety disorders and the rationale of exposure therapy (ET) are grounded on classical fear conditioning. Yet, it is unclear whether lower fear ratings of conditioned safety versus threat cues and corresponding neural markers of safety-learning and/or fear inhibition assessed before treatment would predict better outcomes of behavioral exposure.

Methods

Sixty-six patients with spider phobia completed pre-treatment clinical and experimental fear conditioning assessments, one session of virtual reality ET, a post-treatment clinical assessment, and a 6-month follow-up assessment. Tilted Gabor gratings served as conditioned stimuli (CS) that were either paired (CS+) or remained unpaired (CS-) with an aversive phobia-related and phobia-unrelated unconditioned stimulus (UCS). CS+/CS- differences in fear ratings and magnetoencephalographic event-related fields (ERFs) were related to percentual symptom reductions from pre- to post-treatment, as assessed via spider phobia questionnaire (SPQ), behavioral avoidance test (BAT), and remission status at 6-month follow-up.

Results

We observed no associations between pre-treatment CS+/CS- differences in fear ratings and any treatment outcome. CS+/CS- differences in source estimations of ERFs revealed that higher CS- activity in bilateral dorsolateral prefrontal cortex (dlPFC) was related with SPQ- and BAT-reductions. Associations between CS+/CS- differences and treatment outcomes were also observed in left ventromedial prefrontal cortex (vmPFC) regions, which additionally revealed associations with the follow-up remission status.

Conclusions

Results provide initial evidence that neural pre-treatment CS+/CS- differences may hold predictive information regarding outcomes of behavioral exposure. Our findings highlight a key role of neural responses to safety cues with potentially inhibitory effects on affect-generating structures during fear conditioning.

Altered spontaneous neural activity in frontal and visual regions in patients with acrophobia

BACKGROUND

Acrophobia is a prevalent type of specific phobia, which frequently leads to functional impairments and occupational limitations. However, the neural pathology of acrophobia is still largely unknown.

METHODS

26 acrophobic patients and 30 healthy controls were enrolled in this study. All participants underwent a resting-state fMRI scan. Severity of symptoms was evaluated using self-report and behavioral measures. The regional homogeneity (ReHo) and seed-based functional connectivity (FC) were then examined.

RESULTS

Compared to controls, acrophobic patients demonstrated higher ReHo in the right fusiform gyrus and lower ReHo in the bilateral superior frontal gyrus. Lower FC of right fusiform gyrus-bilateral caudate, right fusiform gyrus-right parahippocampal gyrus, and left medial superior frontal gyrus-left cuneus was also found in the acrophobia group. Additionally, there were negative correlations between behavior avoidance scores and FC of right fusiform gyrus- right parahippocampal gyrus (r = -0.42, p = 0.04) and between scores of the 7-item generalized anxiety disorder scale and FC of left medial superior frontal gyrus- left cuneus (r = -0.40, p = 0.049) in the acrophobia group.

LIMITATIONS

Owing to the cross-sectional design, it was unclear whether the functional abnormalities found in the acrophobic patients were related to state or trait effects.

CONCLUSIONS

Preliminary results indicated that acrophobic patients revealed abnormal brain function in orbitofrontal cortex, medial prefrontal cortex, and visual regions. These abnormalities may be helpful in understanding the possible neurobiological mechanism of acrophobia and may serve as potential intervention and prevention targets.

The efficacy and acceptability of exposure therapy for the treatment of post-traumatic stress disorder in children and adolescents: a systematic review and meta-analysis

BACKGROUND

Posttraumatic stress disorder (PTSD) is common among children and adolescents who have experienced traumatic events. Exposure therapy (ET) has been shown to be effective in treating PTSD in adults. However, its efficacy remains uncertain in children and adolescents.

AIMS

To evaluate the efficacy and acceptability of ET in children and adolescents with PTSD.

METHOD

We searched PubMed, EMBASE, Cochrane, Web of Science, PsycINFO, CINAHL, ProQuest, LILACS, and international trial registries for randomized controlled trials (RCTs) assessed ET in children and adolescents (aged ≤18 years) with PTSD up to August 31, 2020. The primary outcomes were efficacy (the endpoint score from PTSD symptom severity rating scales) and acceptability (all-cause discontinuation), secondary outcomes included efficacy at follow-up (score from PTSD scales at the longest point of follow-up), depressive symptoms (end-point score on depressive symptom severity rating scales) and quality of life/social functioning (end-point score on quality of life/social functioning rating scales). This study was registered with PROSPERO (CRD42020150859).

RESULT

A total of 6 RCTs (278 patients) were included. The results showed that ET was statistically more efficacious than control groups (standardized mean differences [SMD]: - 0.47, 95% confidence interval [CI]: - 0.91 to - 0.03). In subgroup analysis, exposure therapy was more efficacious for patients with single type of trauma (SMD: - 1.04, 95%CI: - 1.43 to - 0.65). Patients with an average age of 14 years and older, ET was more effective than the control groups (SMD: - 1.04, 95%CI: - 1.43 to - 0.65), and the intervention using prolonged exposure therapy (PE) (SMD: - 1.04, 95%CI: - 1.43 to - 0.65) was superior than control groups. Results for secondary outcomes of efficacy at follow-up (SMD: - 0.64, 95%CI: - 1.17 to - 0.10) and depressive symptoms (SMD: - 0.58, 95%CI: - 0.93 to - 0.22) were similar to the previous findings for efficacy outcome. No statistically significant effects for acceptability and quality of life/social functioning were found.

CONCLUSION

ET showed superiority in efficacy at post-treatment/follow-up and depressive symptoms improvement in children and adolescents with PTSD. Patients with single type of trauma may benefit more from ET. And ET is more effective in patients 14 years or older. Moreover, PE could be a better choice.

Virtual Reality Aided Therapy towards Health 4.0: A Two-Decade Bibliometric Analysis

Health 4.0 aligns with Industry 4.0 and encourages the application of the latest technologies to healthcare. Virtual reality (VR) is a potentially significant component of the Health 4.0 vision. Though VR in health care is a popular topic, there is little knowledge of VR-aided therapy from a macro perspective. Therefore, this paper was aimed to explore the research of VR in aiding therapy, thus providing a potential guideline for futures application of therapeutic VR in healthcare towards Health 4.0. A mixed research method was adopted for this research, which comprised the use of a bibliometric analysis (a quantitative method) to conduct a macro overview of VR-aided therapy, the identification of significant research structures and topics, and a qualitative review of the literature to reveal deeper insights. Four major research areas of VR-aided therapy were identified and investigated, i.e., post-traumatic stress disorder (PTSD), anxiety and fear related disorder (A&F), diseases of the nervous system (DNS), and pain management, including related medical conditions, therapies, methods, and outcomes. This study is the first to use VOSviewer, a commonly used software tool for constructing and visualizing bibliometric networks and developed by Center for Science and Technology Studies, Leiden University, the Netherlands, to conduct bibliometric analyses on VR-aided therapy from the perspective of Web of Science core collection (WoSc), which objectively and visually shows research structures and topics, therefore offering instructive insights for health care stakeholders (particularly researchers and service providers) such as including integrating more innovative therapies, emphasizing psychological benefits, using game elements, and introducing design research. The results of this paper facilitate with achieving the vision of Health 4.0 and illustrating a two-decade (2000 to year 2020) map of pre-life of the Health Metaverse.

Detecting Fear of Heights Response to a Virtual Reality Environment Using Functional Near-Infrared Spectroscopy

To enable virtual reality exposure therapy (VRET) that treats anxiety disorders by gradually exposing the patient to fear using virtual reality (VR), it is important to monitor the patient's fear levels during the exposure. Despite the evidence of a fear circuit in the brain as reflected by functional near-infrared spectroscopy (fNIRS), the measurement of fear response in highly immersive VR using fNIRS is limited, especially in combination with a head-mounted display (HMD). In particular, it is unclear to what extent fNIRS can differentiate users with and without anxiety disorders and detect fear response in a highly ecological setting using an HMD. In this study, we investigated fNIRS signals captured from participants with and without a fear of height response. To examine the extent to which fNIRS signals of both groups differ, we conducted an experiment during which participants with moderate fear of heights and participants without it were exposed to VR scenarios involving heights and no heights. The between-group statistical analysis shows that the fNIRS data of the control group and the experimental group are significantly different only in the channel located close to right frontotemporal lobe, where the grand average oxygenated hemoglobin Δ[HbO] contrast signal of the experimental group exceeds that of the control group. The within-group statistical analysis shows significant differences between the grand average Δ[HbO] contrast values during fear responses and those during no-fear responses, where the Δ[HbO] contrast values of the fear responses were significantly higher than those of the no-fear responses in the channels located towards the frontal part of the prefrontal cortex. Also, the channel located close to frontocentral lobe was found to show significant difference for the grand average deoxygenated hemoglobin contrast signals. Support vector machine-based classifier could detect fear responses at an accuracy up to 70% and 74% in subject-dependent and subject-independent classifications, respectively. The results demonstrate that cortical hemodynamic responses of a control group and an experimental group are different to a considerable extent, exhibiting the feasibility and ecological validity of the combination of VR-HMD and fNIRS to elicit and detect fear responses. This research thus paves a way toward the a brain-computer interface to effectively manipulate and control VRET.

In search of a naturalistic neuroimaging approach: Exploration of general feasibility through the case of VR-fMRI and application in the domain of episodic memory

Virtual Reality (VR) is an increasingly widespread tool for research as it allows the creation of experiments taking place in multimodal and daily-life-like environments, while keeping a strong experimental control. Adding neuroimaging to VR leads to a better understanding of the underlying brain networks activated during a naturalistic task, whether for research purposes or rehabilitation. The present paper focuses on the specific use of concurrent VR and fMRI and its technical challenges and feasibility, with a brief examination of the general existing solutions. Following the PRISMA guidelines, the review investigates the particular case of how VR-fMRI has explored episodic memory so far, with a comparison of object- and place-based episodic memory. This review confirms the involvement of cerebral regions well-known to be implicated in episodic memory and unravels other regions devoted to bodily and narrative aspects of the self, promoting new avenues of research in the domain of naturalistic episodic memory. Future studies should develop more immersive and interactive virtual neuroimaging features to increase ecological and embodied neurocognition aspects.

Clinical predictors of treatment response towards exposure therapy in virtuo in spider phobia: A machine learning and external cross-validation approach

While being highly effective on average, exposure-based treatments are not equally effective in all patients. The a priori identification of patients with a poor prognosis may enable the application of more personalized psychotherapeutic interventions. We aimed at identifying sociodemographic and clinical pre-treatment predictors for treatment response in spider phobia (SP). N = 174 patients with SP underwent a highly standardized virtual reality exposure therapy (VRET) at two independent sites. Analyses on group-level were used to test the efficacy. We applied a state-of-the-art machine learning protocol (Random Forests) to evaluate the predictive utility of clinical and sociodemographic predictors for a priori identification of individual treatment response assessed directly after treatment and at 6-month follow-up. The reliability and generalizability of predictive models was tested via external cross-validation. Our study shows that one session of VRET is highly effective on a group-level and is among the first to reveal long-term stability of this treatment effect. Individual short-term symptom reductions could be predicted above chance, but accuracies dropped to non-significance in our between-site prediction and for predictions of long-term outcomes. With performance metrics hardly exceeding chance level and the lack of generalizability in the employed between-site replication approach, our study suggests limited clinical utility of clinical and sociodemographic predictors. Predictive models including multimodal predictors may be more promising.

Behavioral and Magnetoencephalographic Correlates of Fear Generalization are Associated with Responses to Later Virtual Reality Exposure Therapy in Spider Phobia

BACKGROUND

As overgeneralization of fear is a pathogenic marker of anxiety disorders, we investigated whether pre-treatment levels of fear generalization in spider-phobic patients are related to their response to exposure-based treatment, in order to identify pre-treatment moderators of treatment success.

METHODS

Ninety patients with spider phobia completed pre-treatment clinical and magnetoencephalography (MEG) assessments, one session of virtual reality exposure therapy, and a post-treatment clinical assessment. Based on the primary outcome (30% symptom reduction in self-reported symptoms) they were categorized as responders or non-responders. In a pre-treatment MEG fear generalization paradigm involving fear conditioning with two unconditioned stimuli (UCS), we obtained fear ratings, UCS-expectancy ratings, and event-related fields to conditioned stimuli (CS-, CS+) and 7 different generalization stimuli (GS) on a perceptual continuum from CS- to CS+.

RESULTS

Prior to treatment, non-responders showed behavioral overgeneralization indicated by more linear generalization gradients in fear ratings. Analyses of MEG source estimations revealed that non-responders showed a decline of their (inhibitory) frontal activations to safety-signaling CS- and GS compared to CS+ over time, while responders maintained these activations at early (<300ms) and late processing stages.

CONCLUSIONS

Results provide initial evidence that pre-treatment differences of behavioral and neural markers of fear generalization may act as moderators of later responses to behavioral exposure. Stimulating further research on fear generalization as a potential predictive marker, our findings are an important first step in the attempt to identify patients who may not profit from ET, and to personalize and optimize treatment strategies for this vulnerable patient group.

Application of Near-Infrared Spectroscopy for Evidence-Based Psychotherapy

This perspective article discusses the importance of evidence-based psychotherapy and highlights the usefulness of near-infrared spectroscopy (NIRS) in assessing the effects of psychotherapeutic interventions as a future direction of clinical psychology. NIRS is a safe and non-invasive neuroimaging technique that can be implemented in a clinical setting to measure brain activity via a simple procedure. This article discusses the possible benefits and challenges of applying NIRS for this purpose, and the available methodology based on previous studies that used NIRS to evaluate psychotherapeutic effects. Furthermore, this perspective article suggests alternative methodologies that may be useful, namely, the single- and multi-session evaluations using immediate pre- and post-intervention measurements. These methods can be used to evaluate state changes in brain activity, which can be derived from a single session of psychotherapeutic interventions. This article provides a conceptual schema important in actualizing NIRS application for evidence-base psychotherapy.

Neuronal Correlates of Small Animal Phobia in Human Subjects through fMRI: The Role of the Number and Proximity of Stimuli

Brain regions involved in small-animal phobia include subcortical and cortical areas. The present study explored the neuronal correlates of small-animal phobia through fMRI data to determine whether a manipulation of number and proximity parameters affects the neurobiology of the processing of feared stimuli. The participants were 40 individuals with phobia and 40 individuals without phobia (28.7% male and 71.3% female). They watched videos of real and virtual images of spiders, cockroaches and lizards in motion presented more or less nearby with one or three stimuli in the different conditions. The results suggested a differential brain activity between participants with and without phobia depending on the proximity and number of phobic stimuli. Proximity activated the motor response marked by the precentral gyrus and the cingulate gyrus. By contrast, the number of stimuli was associated with significant sensory activity in the postcentral gyrus and ventromedial prefrontal cortex. We also observed a greater activity in the occipital cortex when exploring the number compared to the proximity factor. Threatening stimuli presented nearby and those presented in greater numbers generated an intense phobic response, suggesting a different emotion regulation strategy. Based on these findings, exposure therapies might consider including proximity to the threat and number of stimuli as key factors in treatment.

Acrophobia Quantified by EEG Based on CNN Incorporating Granger Causality

The aim of this study is to quantify acrophobia and provide safety advices for high-altitude workers. Considering that acrophobia is a fuzzy quantity that cannot be accurately evaluated by conventional detection methods, we propose a comprehensive solution to quantify acrophobia. Specifically, this study simulates a virtual reality environment called High-altitude Plank Walking Challenge, which provides a safe and controlled experimental environment for subjects. Besides, a method named Granger Causality Convolutional Neural Network (GCCNN) combining convolutional neural network and Granger causality functional brain network is proposed to analyze the subjects' noninvasive scalp EEG signals. Here, the GCCNN method is used to distinguish the subjects with severe acrophobia, moderate acrophobia, and no acrophobia in a three-class classification task or no acrophobia and acrophobia in a two-class classification task. Compared with the mainstream methods, the GCCNN method achieves better classification performance, with an accuracy of 98.74% for the two-class classification task (no acrophobia versus acrophobia) and of 98.47% for the three-class classification task (no acrophobia versus moderate acrophobia versus severe acrophobia). Consequently, our proposed GCCNN method can provide more accurate quantitative results than the comparative methods, making it to be more competitive in further practical applications.

Will virtual rehabilitation replace clinicians: a contemporary debate about technological versus human obsolescence

This article is inspired by a pseudo Oxford-style debate, which was held in Tel Aviv University, Israel at the International Conference on Virtual Rehabilitation (ICVR) 2019, which is the official conference of the International Society for Virtual Rehabilitation. The debate, between two 2-person teams with a moderator, was organized by the ICVR Program committee to address the question "Will virtual rehabilitation replace clinicians?" It brought together five academics with technical, research, and/or clinical backgrounds-Gerry Fluet, Tal Krasovsky, Anat Lubetzky, Philippe Archambault, W. Geoffrey Wright-to debate the pros and cons of using virtual reality (VR) and related technologies to help assess, diagnose, treat, and track recovery, and more specifically investigate the likelihood that advanced technology will ultimately replace human clinicians. Both teams were assigned a side to defend, whether it represented their own viewpoint or not, and to take whatever positions necessary to make a persuasive argument and win the debate. In this paper we present a recapitulation of the arguments presented by both sides, and further include an in-depth consideration of the question. We attempt to judiciously lay out a number of arguments that fall along a spectrum from moderate to extreme; the most extreme and/or indefensible positions are presented for rhetorical and demonstrative purposes. Although there may not be a clear answer today, this paper raises questions which are related to the basic nature of the rehabilitation profession, and to the current and potential role of technology within it.

Virtual Reality and Psychedelics for the Treatment of Psychiatric Disease: A Systematic Literature Review

OBJECTIVE

Hallucinogenic substances or psychedelic drugs have been historically used by humans worldwide for centuries, and interest grows around them because of the therapeutic potential that they pose for mental disease. Virtual Reality (VR), has been highly developed and improved in the last decade, and it is also gaining importance due to their potential as therapeutic tools. In this article, the most recent and relevant information regarding the medical applications of both VR and psychedelics was highlighted, and diverse potential therapeutic uses were explored in hope to set the ground for further research on this topic.

METHOD

A systematic literature review using the PRISMA methods was conducted in PubMed, Medline, Embase, Cochrane Library, Scopus and Web of Science, including only peer-reviewed clinical trials or case studies written in English, that address the use of psychedelics and/or VR for the treatment of psychiatric disorders and that measure the success of the therapies. A final selection of 23 manuscripts were used in this systematic review.

RESULTS

VR showed security and significant efficacy in the management of special cases of phobias (social, motion pain and spiders), eating disorder, post-traumatic stress disorder (PTSD), gambling disorder, preoperative anxiety and schizophrenia.

CONCLUSIONS

The hallucinogenic drugs evaluated exhibited positive effects in treatment of depressive and anxiety disorders, alcohol dependence and PTSD. More research is needed in order to test the effectiveness of these therapies (alone or together) in different mental illnesses and different populations.

Neuronal correlates of spider phobia in a combined fNIRS-EEG study

Specific phobia is associated with aberrant brain activation in confrontation paradigms with phobic stimuli. In previous EEG research enhanced event-related potentials (ERPs) in the late-positive potential (LPP) window have been observed. Further, studies with functional near-infrared spectroscopy (fNIRS) and fMRI suggest that spider phobia is associated with enhanced activation within cortical and subcortical areas. In the current study we investigated the neuronal correlates of spider phobia in a combined fNIRS-EEG study. To this end, 37 spider phobic patients (PP) and 32 healthy controls (HC) underwent a symptom provocation paradigm during which subjects watched video clips of spiders and domestic animals (confrontation phase) after being primed on the content of the video (anticipation phase). Simultaneously, fNIRS, EEG, electromyography (EMG), electrocardiography and behavioral measures were assessed. Results showed increased LPP amplitudes, increased hemodynamic responses in the cognitive control network, and increased EMG activity and heart rate during spider conditions in PP in comparison to HC. Furthermore, in behavioral ratings PP showed higher emotional distress and avoidance. Behavioral ratings, fNIRS and EEG data showed positive correlations on a between-subject as well as on a within-subject level. Our results merge the existing data on neurophysiological correlates of phobic stimulus processing in hemodynamic and electrophysiological research and extend those of static visual material (pictures) to dynamic visual material (videos).

Exposure Therapy for Post-Traumatic Stress Disorder: Factors of Limited Success and Possible Alternative Treatment

Recent research indicates that there is mixed success in using exposure therapies on patients with post-traumatic stress disorder (PTSD). Our study argues that there are two major reasons for this: The first is that there are nonassociative aspects of PTSD, such as hyperactive amygdala activity, that cannot be attenuated using the exposure therapy; The second is that exposure therapy is conceptualized from the theoretical framework of Pavlovian fear extinction, which we know is heavily context dependent. Thus, reducing fear response in a therapist's office does not guarantee reduced response in other situations. This study also discusses work relating to the role of the hippocampus in context encoding, and how these findings can be beneficial for improving exposure therapies.

Cortical oxygenation during exposure therapy - in situ fNIRS measurements in arachnophobia

•

This is the first study that assessed cortical hemodynamic reactions during exposure therapy in situ.

•

During exposure patients showed increased activity in the cognitive control network (CCN) compared to a control condition.

•

CCN activity deceased during the session.

•

Further, CCN activity was associated with fear ratings at the beginning of the session and this relationship decreased from session to session.

Exposure therapy is a well-studied and highly efficacious treatment for phobic disorders. Although the neurobiological model of fear is well underpinned by various studies, the mechanisms of exposure therapy are still under discussion. Partly, this is due to the fact that most neurophysiological methods like fMRI are not able to be used in the natural therapeutic settings.

The current study used in situ measurements of cortical blood oxygenation (O₂Hb) during exposure therapy by means of functional near-infrared spectroscopy. 37 subjects (N = 30 completers) underwent exposure therapy during 5 adapted sessions in which subjects were exposed to Tegenaria Domestica (domestic house spider – experimental condition) and Dendrobaena Veneta/ Eisenaia hortensis (red earthworm – control condition).

Compared to the control condition, patients showed higher O₂Hb levels in the anticipation and exposure phase of spider exposure in areas of the cognitive control network (CCN). Further, significant decreases in O₂Hb were observed during the session accompanied by reductions in fear related symptoms. However, while symptoms decreased in a linear quadratic manner, with higher reductions in the beginning of the session, CCN activity decreased linearly. Further, higher anxiety at the beginning of session one was associated with increased O₂Hb in the CCN. This association decreased within the following sessions.

The current study sheds light on the neuronal mechanisms of exposure therapy. The results are discussed in light of a phase model of exposure therapy that posits a role of cognitive control in the beginning and routine learning at the end of the therapy session.