A Literature Overview of Virtual Reality (VR) in Treatment of Psychiatric Disorders: Recent Advances and Limitations

The psychological and physiological effects of a virtual reality-based treatment program in female patients with fibromyalgia syndrome: A randomized controlled trial

The study aims to evaluate the effects of virtual reality (VR) programs on disease activity, central sensitization, kinesiophobia, body awareness, and pain catastrophizing in patients with fibromyalgia syndrome (FMS). Twenty-nine with FMS were randomized into the VR group or the control group (CG). FMS patients in the VR group were included in the VR-based relaxing treatment for 4 weeks, with one session per week. The progressive muscle relaxation technique and the breath-counting exercise were taught to participants in the CG. The Fibromyalgia Impact Questionnaire (FIQ), Central Sensitization Inventory Short-Form (CSI-SF), TAMPA, Pain Catastrophizing Scale (PCS), and Body Awareness Questionnaire (BAQ) were evaluated. Additionally, in the VR group, the Galvanic Skin Response (GSR), Simulator Sickness Questionnaire (SSQ), pain, stress, and exhaustion were assessed during each session. Post-treatment, the VR group showed significantly greater improvements than the CG in FIQ, CSI-SF, PCS, and BAQ (p < 0.05). Effect sizes in the VR group, except for TAMPA, ranged from large to very large (Cohen's d = 0.993-1.350). Although GSR scores decreased post-treatment, this reduction was not statistically significant (p > 0.05). Additionally, symptoms of SSQ, pain, stress, and exhaustion were notably reduced in the VR group. we recommend the widespread use of this innovative treatment approach in FMS patients.

Investigating Virtual Reality for Alleviating Human-Computer Interaction Fatigue: A Multimodal Assessment and Comparison with Flat Video

Studies have shown that prolonged Human-Computer Interaction (HCI) fatigue can increase the risk of mental illness and lead to a higher probability of errors and accidents during operations. Virtual Reality (VR) technology can simultaneously stimulate multiple senses such as visual, auditory, and tactile, providing an immersive experience that enhances cognition and understanding. Therefore, this study collects multimodal data to develop evaluation methods for HCI fatigue and further explores the fatigue-relieving effects of VR technology by comparing it with flat video. Using a modular design, electroencephalogram (EEG) and functional near-infrared spectroscopy (fNIRS) data in the resting, fatigue-induced, and recovery states, eye movement data in the resting and fatigue-induced states, as well as subjective scale results after each state were collected from the participants. Preprocessing and statistical analysis are performed through data flow architecture. After fatigue induction, it was found that the degree of activation of brain areas, especially the Theta band of prefrontal cortex, occurred significantly higher, the effective connectivity in the Alpha and Theta bands occurred significantly lower, the subjects' pupil diameters decreased, the blink frequency increased, and subjective questionnaire scores increased, which verified the validity of the multimodal data for assessing HCI fatigue. Analyzing fatigue relief through subgroups, it was found that when using the natural grassland scene with soothing music, both flat video and VR had the ability to alleviate fatigue, which was manifested as a significant decrease in the Alpha band in the LPFC brain area and a decrease in the questionnaire score. Moreover, during the recovery state, it was found that compared to the video group, the VR group had significantly higher activation in the Alpha and Theta bands of the prefrontal cortex, while the video group had significantly higher effective connectivity than the VR group in the Alpha band. This study delved deeply into the multidimensional characterization of fatigue and investigated new scenarios for the use of VR, which can help to promote the use of VR and can be migrated to scenarios that require fatigue management and productivity enhancement.

Examining a Telemedicine-Based Virtual Reality Clinic in Treating Adults With Specific Phobia: Protocol for a Feasibility Randomized Controlled Efficacy Trial

BACKGROUND

Virtual reality (VR) has strong potential to enhance the effectiveness of telemental health care (TMH) by providing accessible, personalized treatment from home. While there is ample research supporting VR for in-person treatment, there is only preliminary data on the efficacy of telemedicine-based VR. Furthermore, the majority of VR apps used in therapy are not designed for mental health care. VR has the potential to enhance TMH through innovative technology solutions designed specifically for the enhancement of remotely delivered evidence-based practices. This feasibility randomized controlled efficacy trial aims to fill both of these gaps by piloting a novel telemedicine-based VR app (Doxy.me VR) equipped with animal phobia exposure stimuli.

OBJECTIVE

This is a feasibility randomized controlled efficacy trial comparing exposure therapy via a telemedicine-based VR clinic versus standard TMH with adults with an intense fear of dogs, snakes, or spiders. The primary objective is to assess the feasibility of a fully powered trial. The secondary objective is to conduct a preliminary examination of clinical outcomes (eg, specific phobia symptoms).

METHODS

This single-site trial will enroll a minimum of 30 and a maximum of 60 adults with self-reported fear of dogs, snakes, or spiders. Potential participants will be recruited through clinical trial and research recruitment websites and posting flyers. All self-report assessments and homework will be partially automated using REDCap (Research Electronic Data Capture; Vanderbilt University) forms and surveys, but the baseline assessment of phobia symptoms and exposure intervention will be administered by the study therapist.

RESULTS

The feasibility of the proposed trial methodology will be assessed using enrollment, retention, assessment completion, and treatment protocol fidelity benchmarks. Between-group differences in specific phobia, anxiety, and depression symptoms while covarying for pretreatment scores, will be conducted using repeated measures ANOVA along with differences in therapeutic alliance and presence. Data obtained from these analyses will inform power analyses for a fully powered efficacy trial. In total, 54 participants were randomized between October 25, 2023, and July 26, 2024 (Doxy.me VR n=28 and TMH n=26). Data analysis will be completed and submitted by the end of the second quarter of 2025.

CONCLUSIONS

This feasibility randomized controlled trial comparing Doxy.me VR versus TMH aims to enhance the delivery of evidence-based treatments via telemedicine and reduce barriers to remotely delivered exposure therapy. This feasibility trial will be followed by a fully powered efficacy trial on telemedicine-based VR for animal phobias.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06302868; https://clinicaltrials.gov/study/NCT06302868.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/65770.

A superior colliculus-originating circuit prevents cocaine reinstatement via VR-based eye movement desensitization treatment

While Virtual Reality (VR) technology shows promise in the management of substance use disorders, the development of an effective VR-based extinction procedure remains lacking. In this study, we developed a VR-based eye movement desensitization and reprocessing extinction training program tailored for mice. We found that this VR treatment during cocaine extinction prevents reinstatement by suppressing the hyperactivation of glutamatergic excitatory neurons in the intermediate layers of the superior colliculus (SCiCaMKIIα) during exposure to environmental cues. Additionally, SCiCaMKIIα neurons innervate tyrosine hydroxylase-positive neurons in the locus coeruleus (LCTH). Environmental cues trigger stronger phasic activation of LCTH neurons through this SCiCaMKIIα→LCTH projection, leading to increased dopamine release onto the dorsal CA3 (dCA3) region, thereby facilitating reinstatement. Furthermore, we demonstrate that VR treatment effectively inhibits the neural circuitry involving SCiCaMKIIα→LCTH→dCA3 in response to environmental cues, thus preventing cocaine reinstatement. Our findings suggest that VR treatment may represent a promising strategy for achieving drug abstinence.

Effect of using virtual reality on fatigue and mental workload as key determinants of perceived stress in neonatal intensive care staff: A randomized controlled trial feasibility study and protocol

BACKGROUND

Health care professionals (HCPs) in neonatal intensive care units (NICUs) are prone to significant stress, leading to deleterious mental health effects. Recently, some studies have explored virtual reality (VR) immersion experience to mitigate these risks. However, these studies vary in clinical settings, design and mental health parameters.

AIM

To report on the safety and feasibility of VR immersion experience in busy tertiary NICU HCPs.

STUDY DESIGN

Ten eligible NICU HCPs without photosensitive epilepsy or cardiopulmonary disease participated. Participants underwent VR immersion (intervention arm; maximum of 15 min/session and 1 session/shift) during breaktimes in three consecutive shifts. They underwent a washout period, after which they completed 3 sessions as routine breaks (control arm) without VR experience. They completed pre-post break stress and survey questionnaires in both arms.

RESULTS

Analyses comprised data from 28 VR immersion and 27 control arm sessions (nine participants completed three sessions in both arms and one participant completed one session in intervention arm only). All VR immersion sessions were 'really liked' (60.7%) or 'liked' (39.3%). As far as the usage of VR devices were concerned, majority were deemed to be 'really easy' (25%) or 'easy' (57.14%). Quality of VR environments were reported to be 'Excellent' (28.6%) or 'good' (60.71%) in majority of sessions. Experience of chosen VR environments were 'really liked' (46.42%) or 'liked' (50%). Most importantly, the impact of VR experience on enhancing the break was deemed to be 'Yes, a lot' (46.42%) or 'Yes, a bit' (39.28%) in most sessions. Participants reported 'very minor' side effects in three VR sessions, none requiring any therapeutic interventions. Rest of the sessions reported 'no' side effects.

CONCLUSIONS

VR immersion experience is safe and feasible in busy HCPs in a tertiary NICU. Future recommendations would be to compare VR immersion experience with other well-being measures of staff.

RELEVANCE TO CLINICAL PRACTICE

Virtual reality immersion experience could be utilized for stress reduction in NICU HCPs.

Virtual reality exposure therapy for social anxiety disorders: a meta-analysis and meta-regression of randomized controlled trials

BACKGROUND AND OBJECTIVES

Virtual reality exposure therapy offers a unique opportunity to treat social anxiety disorder. This meta-analysis aims to evaluate the effectiveness of virtual reality exposure therapy compared to waitlist comparators or other interventions for individuals with social anxiety disorder in alleviating anxiety symptoms.

METHODS

A three-step comprehensive search for the randomized controlled trials of virtual reality exposure therapy was conducted from inception to 7 December 2023. The overall effect was measured using Hedges' g and determined using t-statistics at a significance level of p < 0.05. Sensitivity, subgroup, and meta-regression analyses were carried out.

RESULTS

A total of 17 randomized control trials were retrieved from nine electronic databases. Virtual reality exposure therapy has greater efficacy than waitlist comparators in reducing anxiety symptoms at post-intervention and follow-up assessment. Virtual reality exposure therapy demonstrates a similar effect to other interventions at post-intervention and follow-up assessment. We observed a greater effect for participants with symptomatic social anxiety when we combined the intervention with cognitive behavioral therapy compared to its counterpart. Meta-regression analyses found no significant covariate.

CONCLUSIONS

Overall, virtual reality exposure therapy can provide supplementary therapy for improving anxiety symptoms. Additional high-quality and large-scale trials with long-term follow-up are needed.

The limitations and challenges in the assessment of executive dysfunction associated with real-world functioning: The opportunity of serious games

Nowadays, there is a broad range of methods for detecting and evaluating executive dysfunction ranging from clinical interview to neuropsychological evaluation. Nevertheless, a critical issue of these assessments is the lack of correspondence of the neuropsychological test's results with real-world functioning. This paper proposes serious games as a new framework to improve the neuropsychological assessment of real-world functioning. We briefly discuss the contribution and limitations of current methods of evaluation of executive dysfunction (paper-and-pencil tests, naturalistic observation methods, and Information and Communications Technologies) to inform on daily life functioning. Then, we analyze what are the limitations of these methods to predict real-world performance: (1) A lack of appropriate instruments to investigate the complexity of real-world functioning, (2) the vast majority of neuropsychological tests assess well-structured tasks, and (3) measurement of behaviors are based on simplistic data collection and statistical analysis. This work shows how serious games offer an opportunity to develop more efficient tools to detect executive dysfunction in everyday life contexts. Serious games provide meaningful narrative stories and virtual or real environments that immerse the user in natural and social environments with social interactions. In those highly interactive game environments, the player needs to adapt his/her behavioral performance to novel and ill-structured tasks which are suited for collecting user interaction evidence. Serious games offer a novel opportunity to develop better tools to improve diagnosis of the executive dysfunction in everyday life contexts. However, more research is still needed to implement serious games in everyday clinical practice.

Effectiveness of virtual reality therapy in the treatment of anxiety disorders in adolescents and adults: a systematic review and meta-analysis of randomized controlled trials

Background

To evaluate the effect of virtual reality therapy on anxiety disorders in adolescents and adults by Meta-analysis.

Methods

A comprehensive literature search was conducted by PubMed, Web of Science, Embase, CINAHL, Scopus, Cochrane (from inception to November 2024). Two researchers independently performed literature screening, quality evaluation and data extraction, and Stata16.0 and Review Man 5.4 software were used for Meta-analysis.

Results

A total of 33 studies involving 3182 adolescents and adults with anxiety disorders were included. The results of Meta-analysis showed that compared with conventional interventions, virtual reality therapy significantly improved the symptoms and level of anxiety in patients with anxiety disorder [SMD = -0.95, 95%CI (-1.22,-0.69), Z = 7.05, P < 0.00001].

Conclusion

The current findings suggest that VR therapy interventions have a positive effect on improving the anxiety state of patients with anxiety disorders. The aforementioned research findings must be confirmed by more high-caliber studies due to the number and quality limitations of the contained literature.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display, identifier CRD42024574772.

The Efficacy and Patient Experience of Virtual Reality in Labor: An Integrative Review of Pain and Anxiety Management

BACKGROUND

Labor pain and anxiety are significant challenges in maternal healthcare, often managed through pharmacological interventions. Virtual Reality (VR), as a non- pharmacological method, has emerged as a potential tool for pain and anxiety relief in labor. This integrative review aims to synthesize evidence from randomized controlled trials (RCTs), qualitative studies, and mixed-methods research to evaluate the effectiveness of VR in labor pain and anxiety management and to understand patient experiences.

METHODS

Adhering to the PRISMA guidelines, a structured literature search was conducted across databases, including PsycINFO, CINAHL, and PubMed, yielding 1,227 studies. Following a meticulous screening and selection process by authors, 13 studies (10 RCTs, 2 qualitative, and 1 mixed methods) met the inclusion criteria. Data extraction focused on study design, population characteristics, VR interventions, outcomes measured, and key findings, with a content analysis approach employed for thematic synthesis.

RESULTS

The RCTs consistently showed VR's efficacy in reducing labor pain and, to some extent, anxiety. Qualitative studies highlighted VR's role in enhancing patient experiences, offering distraction, relaxation, and improved self-efficacy in pain management. The integration of findings from quantitative and qualitative studies provided a comprehensive understanding of VR's effectiveness and acceptability in labor. Notable themes included the importance of VR's immersive nature and its potential to reduce reliance on pharmacological interventions.

CONCLUSION

VR emerges as a promising tool for managing labor pain and anxiety, offering a non-invasive and patient-friendly alternative to traditional pain relief methods. Its implementation in clinical practice could enhance patient satisfaction and overall birthing experiences. However, further research is needed to standardize VR interventions, assess long-term effects, and determine cost-effectiveness. The findings encourage the consideration of VR as part of holistic maternal care, emphasizing the need to integrate patient-centered healthcare technologies.

The effectiveness of digital technology interventions for cognitive function in older adults: a systematic review and meta-analysis of randomized controlled trials

Digital technology interventions (DTIs) are seen as promising interventions to prevent or delay cognitive decline in older adults, yet evidence from reviews is not conclusive. The aim of this study is to explore the effectiveness of DTIs in improving older adults' cognitive function while taking study design and intervention characteristics as moderators. We searched the PubMed, Embase, CINAHL, PsycINFO, and Scopus databases up to May 26, 2023. Only randomized controlled trials examined the effects of DTIs on cognitive function were included in our study. Standardized mean difference (SMD) and 95% confidence interval for outcomes were applied in meta-analyses and subgroup analyses. A risk of bias assessment was also conducted. Overall, 23 eligible studies with a total sample size of 1454 participants were included. We found that DTIs significantly improved global cognitive function (SMD = 0.479), attention and processing speed (SMD = 0.488), executive function (SMD = 0.287), immediate recall (SMD = 0.266), and working memory (SMD = 0.307). Our subgroup analyses revealed that DTIs were more effective for cognitively impaired subjects, and DTIs with specific intervention characteristics, such as the inclusion of cognitive standard tasks, virtual reality-based interventions, specialized settings, professional guidance, low/medium-density training, > 24 sessions, and sessions lasting > 30 min, were more effective for different cognitive domains. This study supported the effectiveness of DTIs in improving cognitive function in older adults aged 60 years old and over, which may be influenced by study design and intervention characteristics. These findings have important implications for clinical dementia prevention and treatment strategies targeted at specific cognitive domains.

Investigating the effectiveness of ailurophobia treatment using virtual reality technique compared to metacognitive therapy: a randomized clinical trial

BACKGROUND

Fear of cats as a specific phobia disorder can cause disruption in some aspects of the affected people's lives. On the other hand, due to the fact that the two approaches of metacognitive treatment and behavioral therapy methods such as virtual reality are considered common treatment methods in anxiety disorders; It seems that it is necessary to examine the two approaches based on the effectiveness, durability and cost-benefit issue to present and introduce to therapists.

METHODS

The present study was a Randomized Clinical Trial study that was conducted on 28 patients with Ailurophobia. Based on simple random sampling, the participants were allocated in two groups: metacognitive intervention and virtual reality intervention. In order to collect data, demographic information questionnaire, cat anxiety questionnaire and researcher-made cat fear questionnaire were used. Data analysis was done with SPSS version 22 software and statistical tests of chi-square, t, analysis of variance. An alpha level of less than 0.05 was considered as a significant level.

RESULTS

The results of the study showed that there was a statistically significant difference between the average anxiety score in the two groups of virtual reality and metacognitive therapy (P˂0.001). So that in the virtual reality group, the anxiety score was significantly reduced. Also, other results of the study indicated that the mean score of the fear of cats scale was significantly lower in the virtual reality group than in the metacognitive therapy group (P˂0.001).

CONCLUSIONS

Although both treatment approaches based on virtual reality and metacognition are effective in reducing the level of anxiety and fear of cats in patients with Ailurophobia; However, the effectiveness and continuity of treatment in people receiving virtual reality treatment are more significant.

IRCT REGISTRATION NUMBER

IRCT20230105057057N1. Registration date: 2023-03-04.

REGISTRY

Iranian Registry of Clinical Trials.

Effects of immersive leisure-based virtual reality cognitive training on cognitive and physical function in community-based older adults: A randomized controlled trial

Background

Older adults are at risk of developing cognitive impairments, and cognitive training is commonly used to enhance cognitive function in this population. The effectiveness of cognitive training is further optimized with the integration of leisure-based activities, such as horticultural therapy. However, to the best of our knowledge, there is a lack of studies examining the effect of integrating virtual reality (VR) with leisure-based activities to provide real-world experiences and enhance cognitive outcomes in older adults. Furthermore, while immersive VR cognitive training has demonstrated effectiveness in enhancing multiple cognitive domains, methodological limitations-such as the absence of control groups or the use of passive controls-hinder the ability to draw conclusive conclusions regarding its comparative effectiveness.

Objective

This study conducted immersive leisure-based VR cognitive training in community-dwelling older adults to investigate its effectiveness on cognitive and physical functions. We employed an active control group in which participants received well-arranged leisure activities without focusing on cognitive components.

Methods

This cluster randomized controlled trial was conducted in the community facilities in northern Taiwan between 2022 and 2023. The VR cognitive training group received simulated gardening activities, such as planting, fertilizing, and harvesting, and tasks involving cognitive challenges, such as producing plant essential oils, for 60 min daily, 2 days per week, for 8 weeks. The control group received non-cognitive training. The outcomes evaluated were cognitive function assessed by Montreal Cognitive Assessment (MoCA), immediate memory assessed by Wechsler Memory Scale (WMS)-Word List, working memory and mental flexibility assessed by WMS-Digit Span Forward, WMS-Digit Span Backward, and WMG-Digit Span Sequencing (DSS), and physical function assessed by the Timed Up and Go (TUG) test.

Results

The study recruited 137 older adults. After VR cognitive training, higher significant improvements were seen in MoCA (p < 0.001), WMS-DSS (p = 0.015), and TUG (0.008*) compared with the control group.

Conclusions

This study is the first to examine the effects of fully immersive, leisure-based VR cognitive training on cognitive and physical function in community-dwelling older adults, highlighting its potential as a promising tool for promoting health compared to the non-cognitive training commonly used in community facilities.

Acceptance of Virtual Reality in Trainees Using a Technology Acceptance Model: Survey Study

Background

Virtual reality (VR) technologies have demonstrated therapeutic usefulness across a variety of health care settings. However, graduate medical education (GME) trainee perspectives on VR acceptability and usability are limited. The behavioral intentions of GME trainees with regard to VR as an anxiolytic tool have not been characterized through a theoretical framework of technology adoption.

Objective

The primary aim of this study was to apply a hybrid Technology Acceptance Model (TAM) and a United Theory of Acceptance and Use of Technology (UTAUT) model to evaluate factors that predict the behavioral intentions of GME trainees to use VR for patient anxiolysis. The secondary aim was to assess the reliability of the TAM-UTAUT.

Methods

Participants were surveyed in June 2023. GME trainees participated in a VR experience used to reduce perioperative anxiety. Participants then completed a survey evaluating demographics, perceptions, attitudes, environmental factors, and behavioral intentions that influence the adoption of new technologies.

Results

In total, 202 of 1540 GME trainees participated. Only 198 participants were included in the final analysis (12.9% participation rate). Perceptions of usefulness, ease of use, and enjoyment; social influence; and facilitating conditions predicted intention to use VR. Age, past use, price willing to pay, and curiosity were less strong predictors of intention to use. All confirmatory factor analysis models demonstrated a good fit. All domain measurements demonstrated acceptable reliability.

Conclusions

This TAM-UTAUT demonstrated validity and reliability for predicting the behavioral intentions of GME trainees to use VR as a therapeutic anxiolytic in clinical practice. Social influence and facilitating conditions are modifiable factors that present opportunities to advance VR adoption, such as fostering exposure to new technologies and offering relevant training and social encouragement. Future investigations should study the model's reliability within specialties in different geographic locations.

Craving induction through virtual reality cue-exposure for patients with alcohol dependence in rehabilitation treatment

New therapeutic approaches for alcohol dependence (AD) include virtual reality (VR)-based treatments offering scalable options for cue exposure (CE), a well-established strategy in cognitive behavioral therapy. This study aimed to evaluate the feasibility and tolerability of a new VR-CE paradigm. On an explorative basis, factors influencing the induction of craving were examined. This single-arm monocentric clinical study included n = 21 patients with AD in inpatient rehabilitation treatment, that completed one VR-CE session including confrontation with alcohol-associated stimuli. Measurements of subjective craving before, during and after exposure, affective states, VR side effects as cybersickness and the sense of presence in VR were conducted. Craving levels during and directly after VR-CE were significantly higher than before the intervention. Craving levels 20 min after VR-CE did not significantly differ compared to those before VR-CE. Patients described a pronounced sense of presence and only mild symptoms of cybersickness. Craving was significantly correlated with cybersickness. While positive affect decreased throughout the VR exposure, negative affect did not differ significantly in pre-post-comparisons. This study shows that craving induction through our VR-CE paradigm is feasible and well-tolerated by patients with AD in long-term rehabilitation. These results contribute to the development and future research of therapeutic VR-CE approaches.

Cognitive rehabilitation in schizophrenia research: a bibliometric and visualization analysis

Objective

Cognitive impairment is notably prevalent among schizophrenic individuals and is acknowledged as one of the core features of the disorder. Despite the proliferation of literature on cognitive rehabilitation treatments for schizophrenia in recent years, there remains a dearth of systematic reviews and selections of research in this area. From a bibliometric perspective, this study aims to analyze and discuss the current state, developmental trends, and potential research hotspots of cognitive rehabilitation in schizophrenia over the past two decades.

Methods

The Core database of Web of Science was utilized to retrieve articles on cognitive rehabilitation in Schizophrenia that were published from 2004 to 2024. Bibliometrics was applied to perform both quantitative and qualitative analyses of authors, institutions, countries, journals, references, and keywords, leveraging tools such as CiteSpace, VOSviewer, and the R software package Bibliometrix.

Results

A total of 2,413 articles were encompassed in this study, comprising 1,774 regular articles and 373 review articles. The United States emerged as the country with the highest productivity and citation counts, engaging in academic collaborations with over 40 nations. This was followed by the United Kingdom and Spain. King's College London stood out as the leading institution in the field. However, the article with the highest average citation rate was authored by Susan R. McGurk from the Dartmouth Centre for Psychiatric Research in the United States. Schizophrenia Research proved to be the most influential journal in this domain, with its articles being cited over 10,000 times.

Conclusion

This study provides a comprehensive review of research achievements in cognitive rehabilitation for schizophrenia spanning from 2004 to 2024, and outlines global research hotspots and trends with future projections. Currently, methods for cognitive rehabilitation in schizophrenia and neural plasticity in the brain represent the cutting-edge of research. The safety, efficacy, and standardization of virtual reality are poised to emerge as potential future hotspots and trends in research. Additionally, the neurobiological foundations of cognitive remediation therapy constitute an unexplored territory ripe for further investigation.

Impact of Cognitive VR vs. Traditional Training on Emotional Self-Efficacy and Cognitive Function in Patients with Multiple Sclerosis: A Retrospective Study Focusing on Gender Differences

BACKGROUND AND AIM

While conventional MS rehabilitation primarily addresses physical and cognitive symptoms, recent advances in VR technology offer immersive environments that facilitate both emotional and cognitive skill development. The purpose of this study is to evaluate the impact of VR-based training on emotional self-efficacy in multiple sclerosis (MS) patients and examine its association with cognitive function improvement. Additionally, this study aims to explore potential gender differences in these outcomes, hypothesizing that gender may influence the effectiveness of VR-based rehabilitation, which could inform more tailored approaches for emotional and cognitive rehabilitation in MS.

METHOD

The present retrospective study analyzed data from 43 MS patients undergoing cognitive and behavioral rehabilitation at the IRCCS Centro Neurolesi "Bonino Pulejo" in Italy, comparing a VR intervention group (VR-G) and a control group receiving traditional rehabilitation. Emotional self-efficacy, depression, and anxiety were assessed, alongside cognitive function pre- and post-intervention.

RESULTS

Findings indicate that the VR-G showed significant improvements in managing negative emotions, reduced depressive and anxiety symptoms, and enhanced cognitive performance, particularly in verbal learning and working memory. Gender-based analysis revealed a trend suggesting that females in the VR-G may exhibit greater improvements in positive emotional self-efficacy, although this difference did not reach statistical significance. Spearman's correlation highlighted associations between emotional self-efficacy and cognitive gains, supporting the potential of VR to foster both emotional and cognitive resilience.

CONCLUSIONS

These findings suggest that VR training may provide a tailored approach for MS rehabilitation, enhancing therapeutic outcomes by integrating emotional and cognitive training in an immersive setting. Further research should investigate long-term effects and neurophysiological correlates of VR training to optimize MS rehabilitation.

Non-Sleep Deep Rest Relaxation and Virtual Reality Therapy for Psychological Outcomes in Patients with Coronary Artery Disease: A Pilot Randomized Controlled Trial

Background: While cardiac rehabilitation (CR) primarily focuses on restoring physical strength, preventing relapse, and reducing rehospitalization rates, psychological interventions play a complementary role by supporting mental health, which is crucial for patients' long-term adherence and overall recovery. The effectiveness of psychological interventions in CR is debated, and while technologies like virtual reality (VR) therapy show promise, they have limitations for patients with coronary artery disease (CAD). Therefore, this study examines non-sleep deep rest (NSDR) relaxation, a novel and easily implementable technique, and compares its impact on depression, anxiety, and stress with VR therapy and standard care. Methods: Forty-five CAD patients undergoing CR in ambulatory conditions were divided into three groups: the NSDR group, which received eight sessions of NSDR relaxation as part of their rehabilitation; the VR group, which received eight sessions of VR therapy as part of their rehabilitation; and the control group, which received standard care including Schultz Autogenic Training (SAT). The outcomes were measured using the Hospital Anxiety and Depression Scale (HADS) and the Perception of Stress Questionnaire (PSQ). Results: Both NSDR relaxation and VR therapy were effective in reducing the HADS total score, anxiety levels, the PSQ general score, and emotional tension. No significant differences were observed between the two treatment approaches. However, SAT was found to be insufficient for effectively improving the mental state of cardiac patients. Conclusions: This study suggests that NSDR relaxation is an effective psychotherapeutic intervention in CR. NSDR and VR therapy showed similar benefits, offering promising alternatives to traditional methods. Integrating these techniques could enhance patient outcomes and adherence in CR. Further research is needed to refine these interventions and optimize their clinical application.

Dementia and Video Games: Systematic and Bibliographic Review

BACKGROUND/OBJECTIVES

This systematic and bibliographic review examines publications in the field of dementia and video game research from 2004 to 2023. The main objective is to assess developments and trends in video game technology for dementia care and detection.

METHODS

The PubMed database was the primary source for publications. PRISMA guidelines were applied to structure this review. Ten variables were defined, investigated, and split into three main categories: bibliographic, medical, and technical.

RESULTS

The results were synthesized using a quantitative approach to reduce bias through interpretation. Of 209 initial results, 77 publications have been included in the investigation. More studies focus on rehabilitation over assessment and detection of dementia. Clinical trials are typically conducted with limited participants. The most populated trials rarely enrol over 300 subjects. On average, around 38 subjects were enrolled in the trials. These studies are commonly supervised by a trainer or technology specialist, suggesting a technology gap in familiarity in the trial demographic.

CONCLUSIONS

Most interventions assessed were custom-designed applications with a specific outcome, focusing on physical activity and cognitive exercises. As the first of its kind, this publication focuses on the technical aspects of applied technologies and development methods. Using video games to treat and detect patients with cognitive impairments like dementia can benefit healthcare professionals, caretakers, and patients.

Controlling Virtual Reality With Brain Signals: State of the Art of Using VR-Based Feedback in Neurofeedback Applications

The rapid progress of commercial virtual reality (VR) technology, open access to VR development software as well as open-source instructions for creating brain-VR interfaces have increased the number of VR-based neurofeedback (NF) training studies. Controlling a VR environment with brain signals has potential advantages for NF applications. More entertaining, multimodal and adaptive virtual feedback modalities might positively affect subjective user experience and could consequently enhance NF training performance and outcome. Nevertheless, there are certain pitfalls and contraindications that make VR-based NF not suitable for everyone. In the present review, we summarize applications of VR-based NF and discuss positive effects of VR-based NF training as well as contraindications such as cybersickness in VR or age- and sex-related differences. The existing literature implies that VR-based feedback is a promising tool for the improvement of NF training performance. Users generally rate VR-based feedback more positively than traditional 2D feedback, albeit to draw meaningful conclusions and to rule out adverse effects of VR, more research on this topic is necessary. The pace in the development of brain-VR synchronization furthermore necessitates ethical considerations on these technologies.

Progress of research and application of non-pharmacologic intervention in Alzheimer's disease

Alzheimer's disease (AD) is a common neurodegenerative disease characterized by amyloid-β (Aβ) deposition and neurofibrillary tangles formed by high phosphorylation of tau protein. At present, drug therapy is the main strategy of AD treatment, but its effects are limited to delaying or alleviating AD. Recently, non-pharmacologic intervention has attracted more attention, and more studies have confirmed that non-pharmacologic intervention in AD can improve the patient's cognitive function and quality of life. This paper summarizes the current non-pharmacologic intervention in AD, to provide useful supplementary means for AD intervention.

The impact of immersive virtual reality meditation for depression and anxiety among inpatients with major depressive and generalized anxiety disorders

Background

Mindfulness-Based Cognitive Therapy (MBCT) is a non-pharmacological approach to alleviating depression and anxiety. While technology based MBCT is a standardized cost-effective approach, there have been concerns about its feasibility and effectiveness in clinical settings.

Aims

The purpose of this study was to investigate the longitudinal relationship between improved emotional regulation resulting from participation in Immersive Virtual Reality Meditation (IVRM) and Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) as monitored by electrocardiogram.

Methods

This study was a longitudinal single-arm clinical trial in which the intervention was conducted three times a week for 10 weeks at a behavioral health unit in a community hospital (n = 26). We measured Coherence Achievement Score (CAS), depression, and anxiety. The relationships between CAS, anxiety, depression, and covariates were analyzed using a Generalized Estimated Equation (GEE).

Results

The findings of our study provide evidence that the CAS scores indicative of emotional regulation function after IVRM participation were associated with a reduction in depression and anxiety.

Conclusion

Among the many technology-based complementary health care interventions that are available to reduce depression and anxiety, IVRM program use increases emotional regulatory function and decrease depression and anxiety.

Virtual stressors with real impact: what virtual reality-based biobehavioral research can teach us about typical and atypical stress responsivity

Stress contributes to transdiagnostic morbidity and mortality across a wide range of physical and mental health problems. VR tasks have been validated as stressors with robust effect sizes for VR-based stressors to evoke stress across the most common autonomic and adrenocortical stress biomarkers. However, meta-analytic validation of VR stressors have resulted in inconsistent logic: why should something that isn't real evoke a very real suite of stress responses? This review posits that conceptually addressing this question requires differentiating a cause, "stressor", from effects, "stress". Stress comprises a series of well-delineated perturbations in biological systems, such as autonomic and adrenocortical biomarkers in response to stressors. Despite their ubiquity, decades of literature have back-calculated stressor intensity based on the magnitude of a stress response. This causal directionality is not logical, yet remains pervasive because seemingly objective stress indices have generated a wealth of findings showing how stress gets under the skin and skull. This has created challenges for providing clear guidance and strategies to measure acute stressor intensity. Binary thinking about whether something is (not) real has stifled advances in understanding how to measure the dosage of a stressful environment. As a function of being programmed, individualizable, and titrated, virtual reality (VR) based stressors offer the field a platform for quantifying the dose of a stressor and generating reliable dose-response curves. This also raises the possibility to safely and ethically integrate psychosocial stressor administration into clinical and therapeutic settings. For example, Social Evaluative Threat experiments effectively trigger a stress response both in a laboratory setting and in built environments, while also upholding hard-fought trust and rapport with care providers. By focusing attention on the measurement of the stressor, VR paradigms can advance tangible understanding of stressors themselves and the pathways to the stress response.

Virtual reality improves sleep quality and associated symptoms in patients with chronic insomnia

PURPOSE

The present study aimed to explore the effectiveness of virtual reality (VR) therapy on sleep quality and associated symptoms, such as depression and anxiety, cognitive decline and autonomic nervous dysfunction, in chronic insomnia patients.

METHODS

Sixty-three chronic insomnia patients were randomly divided into VR group (n = 32) and control group (n = 20) based on a standard drug therapy. Patients were instructed to use VR at home once a day at evening for 6-week treatment. All participants received evaluations of subjective sleep quality measured with the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), and the Epworth Sleepiness Scale (ESS), depression and anxiety symptoms measured with the Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA), cognitive function, and objective sleep structure and autonomic nerve function examination measured with the sleep respiration monitoring device at baseline and after 6-week treatment. The main objective of this study was sleep quality assessment as the primary outcome.

RESULTS

After 6-week treatment, the decreases in PSQI score (-5.60 ± 2.37 vs -4.10 ± 1.80, P = 0.020) and ISI score (-8.81 ± 4.52 vs -6.35 ± 2.89, P = 0.038) of the VR group were significantly greater compared with the control group. The VR group showed more reduction in HAMD score (-9.96 ± 4.41 vs -7.50 ± 2.89, P = 0.035) and HAMA score (-8.96 ± 3.80 vs -6.80 ± 3.22, P = 0.046), and more increase in processing speed (0.54 ± 0.60 vs 0.00 ± 0.79, P = 0.011) than the control group. Moreover, the low-frequency coupling (-10.00 ± 17.40 vs. 8.25 ± 20.03, P = 0.001) was lowered and the high-frequency coupling (9.99 ± 17.40 vs. -8.24 ± 20.03, P = 0.001) was elevated in the VR group relative to the control group.

CONCLUSION

Our findings offered preliminary evidence that VR therapy enhanced sleep quality and also lessened depressive and anxious symptoms, and improved cognitive and autonomic functioning in patients with chronic insomnia.

Acute Augmented Effect of Virtual Reality (VR)-Integrated Relaxation and Mindfulness Exercising on Anxiety and Insomnia Symptoms: A Retrospective Analysis of 103 Anxiety Disorder Patients With Prominent Insomnia

BACKGROUND

Anxiety disorder is one of the most common mental disorders and often accompanied with sleep disturbance which can in turn exacerbate anxiety symptoms, creating a vicious cycle. In addition to psychopharmacological therapy, the effectiveness of psychotherapy as cognitive behavioral therapy (CBT) for treating anxiety disorders and insomnia has been well documented and widely accepted, but it is labor-intensive and costly. However, virtual reality (VR)-integrated CBT may improve this condition but needs more evidences to support its extensive application in routine clinical practice.

OBJECTIVES

This explorative study was aimed to conduct a retrospective analysis to evaluate the acute (2 weeks) augmented effect of VR-integrated relaxation and mindfulness exercising in improving anxiety and insomnia symptoms for patients who were diagnosed with anxiety disorders and concurrently with prominent insomnia symptoms and admitted to the Department of Psychiatry, The Affiliated Guangdong Second Provincial General Hospital of Jinan University during January 2021 to June 2021.

METHODS

All patients who were admitted to the department of psychiatry during January 1, 2021 to June 30, 2021 were screened with inclusion criteria and exclusion criteria, and the sociodemographic and clinical data of those included patients were collected from the electronic medical record system of the hospital using a self-designed case report form (CRF). Subjects who were administrated with medication alone were designated as conventional group, and those receiving treatment of medication combined with VR-integrated CBT (VR relaxation and mindfulness exercising) as VR group. The baseline and 2-week posttreatment data were compared between the two groups.

RESULTS

In total, there were 103 patients (70 female, 68%) included in the study. Among all, 68 (66.02%) were designated as the "VR group," and 35 (33.98%) as the "conventional group." The majority of patients (67%) were diagnosed with generalized anxiety disorder (GAD). Twenty-three (22.3%) patients had a comorbid diagnosis with primary insomnia, and insomnia was just one of the accompanying symptoms with anxiety for the rest 80 subjects. No statistically significant differences were found between VR and conventional groups in all baseline sociodemographic and clinical characteristics except for occupation. There were statistically significant differences for the remission rates of anxiety symptoms or insomnia symptoms and reduction of Hamilton Anxiety Rating Scale or Insomnia Severity Index total scores between conventional and VR groups. Greater remission rates or score reductions were found in VR group than in conventional group either for anxiety or for insomnia. Robust differences still existed when controlled for the variable "occupation."

CONCLUSIONS

Two-week augmented VR-integrated relaxation and mindfulness exercising is acutely beneficial for relieving both anxiety and insomnia symptoms and worth being recommended for routine clinical practice. Further prospective and randomized study compared to traditional CBT to explore its acute and long-term effect on anxiety and insomnia is needed.

Effects of motor imagery using virtual reality on pain sensitivity and affect in healthy individuals: a prospective randomized crossover study

OBJECTIVE

Exercise induces a hypoalgesic response and improves affect. However, some individuals are unable to exercise for various reasons. Motor imagery, involving kinesthetic and visual imagery without physical movement, activates brain regions associated with these benefits and could be an alternative for those unable to exercise. Virtual reality also enhances motor imagery performance because of its illusion and embodiment. Therefore, we examined the effects of motor imagery combined with virtual reality on pain sensitivity and affect in healthy individuals.

DESIGN

Randomized crossover study.

SETTING

Laboratory.

SUBJECTS

Thirty-six participants (women: 18) were included.

METHODS

Each participant completed three 10-min experimental sessions, comprising actual exercise, motor imagery only, and motor imagery combined with virtual reality. Hypoalgesic responses and affective improvement were assessed using the pressure-pain threshold and the Positive and Negative Affect Schedule, respectively.

RESULTS

All interventions significantly increased the pressure-pain threshold at the thigh (P < .001). Motor imagery combined with virtual reality increased the pressure-pain threshold more than motor imagery alone, but the threshold was similar to that of actual exercise (both P ≥ .05). All interventions significantly decreased the negative affect of the Positive and Negative Affect Schedule (all P < .05).

CONCLUSIONS

Motor imagery combined with virtual reality exerted hypoalgesic and affective-improvement effects similar to those of actual exercise.

CLINICAL TRIALS REGISTRATION

The study was enrolled in the UMIN Clinical Trials Registry (registration number: UMIN000046095). The website for registration information is https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000052614.

Metaverse and its impact on medical education and health care system: A narrative review

Background and Aims

The metaverse has enormous potential in health care, continuously developing and offering innovative solutions by combining artificial intelligence (AI), augmented reality (AR)/virtual reality (VR), Internet of Medical Devices, and quantum computing technologies. In addition to using virtual platforms to help and boost medical education, familiarity with this platform is necessary to strengthen medical skills and communication with patients in medical sciences in the future.

Methods

We conducted a comprehensive search using keywords and their MeSH synonyms, including "metaverse," "medical education," and "health care," across PubMed, Scopus, and Web of Science. After screening the results, relevant articles were selected to inform the writing of this manuscript.

Results

The metaverse is shaping the future of medical sciences, offering new opportunities for health education, advocacy training, and patient outcome improvement. The combination of real and virtual worlds may advance international relations, facilitate data sharing, increase medical care speed, and reduce infectious diseases. The metaverse, despite its benefits, has some limitations. Only 37% of 15-24-year-olds have internet access, and AR/VR glasses are expensive and may cause eye discomfort. It is also a potential risk for medical students, who may need help understanding the limitations of simulations and develop unrealistic expectations. Considering the metaverse as a supplement to clinical practice, not a replacement for supervised training, is crucial. Ethical concerns, data security, privacy, and lack of instructions for education are also issues. However, providing information about the metaverse can increase health care workers' attribution to use it for patient examinations, students' education, and tests.

Conclusion

This paper explores the impact of the metaverse on medical science education and underscores the need to integrate the metaverse into all areas of medical sciences as a supplement to existing evidence.

Treatment of Cognitive Impairment Associated with Schizophrenia Spectrum Disorders: New Evidence, Challenges, and Future Perspectives

Cognitive impairment associated with schizophrenia (CIAS) represents one of the core features of the disorder and has a significant impact on functional and rehabilitation outcomes of people living with schizophrenia spectrum disorders (SSD). The aim of this critical review is to highlight the most recent evidence on effective treatments available for CIAS, to discuss the current challenges in this field, and to present future perspectives that may help to overcome them. Concerning psychopharmacological approaches, among the most indicated strategies for the management and prevention of CIAS is to favor second-generation antipsychotic medications and avoid long-term and high-dose treatments with anticholinergic medications and benzodiazepines. Moreover, non-pharmacological approaches such as cognitive remediation and physical exercise-based programs represent evidence-based interventions in the treatment of CIAS that have shown reliable evidence of effectiveness on both cognitive and functional outcomes. These treatments, however, are still delivered to people accessing mental health services with a diagnosis of CIAS in an uneven manner, even in high-income countries. Academic and clinical partnership and collaboration, as well as advocacy from service users, families, carers, and stakeholders' organizations could help to reduce the bench to bedside gap in the treatment of CIAS. Future perspectives include the development of novel pharmacological agents that could be effective in the treatment of CIAS, the implementation of novel technologies such as telemedicine and virtual reality in the delivery of evidence-based interventions to improve accessibility and engagement, and further research in the field of non-invasive brain stimulation.

Application of virtual reality to enhance therapeutic Tai Chi for depression in elderly people

The battle against depression in the elderly is crucial due to its significant impact on their quality of life, physical and cognitive health, increased risk of social isolation and suicide, as well as the associated higher healthcare costs. This research investigates the effects of traditional and augmented reality Tai Chi, using the virtual environment "Managed Tai Chi," on depression in elderly individuals. The study involved 300 participants aged over 60 from the Beijing Medical Center, with an experimental period lasting six months and sessions held once a week. The Geriatric Depression Scale (GDS) was utilized as a diagnostic tool at the pre-test and post-test stages. The findings revealed that the VR group exhibited a more substantial reduction in depression compared to the traditional and control groups (p ≤ 0.05), indicating the enhanced efficacy of Tai Chi with VR augmentation in treating depression in the elderly.

The effects of exergames for cognitive function in older adults with mild cognitive impairment: a systematic review and metaanalysis

Purpose

Exergames are an innovative method that can promote neuroplasticity and improve the cognitive abilities of the elderly. This study aimed to compare the effects of single-task and multi-task exergames on the cognitive ability of the elderly with mild cognitive impairment (MCI).

Methods

Computerized literature search was performed using PubMed, Web of Science, EBSCO, Elsevier, ProQuest, China National Knowledge Infrastructure (CNKI), Wanfang and VIP database to identify relevant articles from the establishment of the database from inception to April 1, 2024. The inclusion criteria were: (i) participants aged 60 or older diagnosed with mild cognitive impairment, regardless of gender; (ii) use of randomized controlled trials (RCTs); (iii) interventions involving exergames with physical activity or as the primary variable; and (iv) outcome measures using standardized neuropsychological instruments to assess cognitive function, including statistical data on sample size, mean, and standard deviation. Finally, the included study comprised a total of 526 participants. Mean difference (MD) and 95% confidence interval (CI) were used to synthesize the effect size in the data.

Results

11 studies were included. Due to the differences in the intervention methods, subgroup analysis was performed on the included research. Compared with the control group assessed by the Montreal Cognitive Assessment Scale, the single-task intervention improved the cognitive ability of the elderly with MCI (MD 3.40, 95% CI 2.43-4.37), the Mini-Mental State Examination Scale (MD 2.38, 95% CI -2.03 to 2.72), the Trail Making Test (MD -3.89, 95% CI -6.45 to -1.33), and the Digit Span Forward test (MD 1.16, 95% CI 0.73-1.60).

Conclusion

This meta-analysis supports that exergames could be an effective cognitive rehabilitation method for MCI patients. Our study recommends that patients implement a customized exergames program and adhere to it for a long time. It is necessary to pay attention to the exercise guidelines and provide evidence from clinicians.

Strengths and limitations of this study

(1) This meta-analysis supports that exergames could be an effective cognitive rehabilitation method for MCI patients. Our study recommends that patients implement a customized exergames program and adhere to it for a long time. It is necessary to pay attention to the exercise guidelines and provide evidence from clinicians. (2) This research provides preliminary evidence for the clinical utility of VR tasks developed for mild cognitive impairment. (3) In this paper, only relevant studies in Chinese and English were searched, and no studies in other languages were searched.

Virtual reality in functional neurological disorder: a theoretical framework and research agenda for use in the real world

Functional neurological disorder (FND) is a common and disabling condition at the intersection of neurology and psychiatry. Despite remarkable progress over recent decades, the mechanisms of FND are still poorly understood and there are limited diagnostic tools and effective treatments. One potentially promising treatment modality for FND is virtual reality (VR), which has been increasingly applied to a broad range of conditions, including neuropsychiatric disorders. FND has unique features, many of which suggest the particular relevance for, and potential efficacy of, VR in both better understanding and managing the disorder. In this review, we describe how VR might be leveraged in the treatment and diagnosis of FND (with a primary focus on motor FND and persistent perceptual-postural dizziness given their prominence in the literature), as well as the elucidation of neurocognitive mechanisms and symptom phenomenology. First, we review what has been published to date on the applications of VR in FND and related neuropsychiatric disorders. We then discuss the hypothesised mechanism(s) underlying FND, focusing on the features that are most relevant to VR applications. Finally, we discuss the potential of VR in (1) advancing mechanistic understanding, focusing specifically on sense of agency, attention and suggestibility, (2) overcoming diagnostic challenges and (3) developing novel treatment modalities. This review aims to develop a theoretical foundation and research agenda for the use of VR in FND that might be applicable or adaptable to other related disorders.

Sex-related differences in young binge drinkers on the neurophysiological response to stress in virtual reality

Background

Stress is one of the main environmental factors involved in the onset of different psychopathologies. In youth, stressful life events can trigger inappropriate and health-damaging behaviors, such as binge drinking. This behavior, in turn, can lead to long-lasting changes in the neurophysiological response to stress and the development of psychological disorders late in life, e.g., alcohol use disorder. Our aim was to analyze the pattern of neurophysiological responses triggered with the exposition to a stressful virtual environment in young binge drinkers.

Methods

AUDIT-3 (third question from the full AUDIT) was used to detect binge drinking (BD) in our young sample (age 18-25 years). According to the score, participants were divided into control (CO) and BD group. Next, a standardized virtual reality (VR) scenario (Richie's Plank) was used for triggering the stress response while measuring the following neurophysiological variables: brain electrical activity by electroencephalogram (EEG) and cortisol levels through saliva samples both measurements registered before and after the stressful situation. Besides, heart rate (HR) with a pulsometer and electrodermal response (EDA) through electrodes placed on fingers were analyzed before, during and after the VR task.

Results

Regarding the behavior assessed during the VR task, BD group spent significantly less amount of time walking forward the table and a tendency toward more time walking backwards. There was no statistically significant difference between the BD and the CO group regarding time looking down, but when we controlled the variable sex, the BD women group displayed higher amount of time looking down than the rest of the groups. Neurophysiological measurements revealed that there was not any statistically significant difference between groups in any of the EEG registered measures, EDA response and cortisol levels. Sex-related differences were found in HR response to VR scenario, in which BD women displayed the highest peak of response to the stressor. Also, the change in heartbeat was higher in BD women than men.

Conclusion

Unveiling the neurophysiological alterations associated with BD can help us to prevent and detect early onset of alcohol use disorder. Also, from our data we conclude that participants' sex can modulate some stress responses, especially when unhealthy behaviors such as BD are present. Nevertheless, the moment of registration of the neurophysiological variables respect to the stressor seems to be a crucial variable.

Using virtual reality to improve verbal episodic memory in schizophrenia: A proof-of-concept trial

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.

A comprehensive review of deep learning in EEG-based emotion recognition: classifications, trends, and practical implications

Emotion recognition utilizing EEG signals has emerged as a pivotal component of human-computer interaction. In recent years, with the relentless advancement of deep learning techniques, using deep learning for analyzing EEG signals has assumed a prominent role in emotion recognition. Applying deep learning in the context of EEG-based emotion recognition carries profound practical implications. Although many model approaches and some review articles have scrutinized this domain, they have yet to undergo a comprehensive and precise classification and summarization process. The existing classifications are somewhat coarse, with insufficient attention given to the potential applications within this domain. Therefore, this article systematically classifies recent developments in EEG-based emotion recognition, providing researchers with a lucid understanding of this field's various trajectories and methodologies. Additionally, it elucidates why distinct directions necessitate distinct modeling approaches. In conclusion, this article synthesizes and dissects the practical significance of EEG signals in emotion recognition, emphasizing its promising avenues for future application.

Improving immersive experiences in virtual natural setting for public health and environmental design: A systematic review and meta-analysis of randomized controlled trials

In recent years, virtual reality (VR) technology has emerged as a powerful tool in the field of therapeutic landscapes. For hospitalized patients or individuals with limited mobility, VR provides highly personalized therapy by simulating authentic natural environments within a safe, convenient, and engaging setting. This study investigated the effectiveness of immersing patients in virtual natural environments for health recovery and compared the varying impacts of different types of landscapes on patients' recovery levels. The aim was to complement traditional medical approaches and enhance environmental design in the field of public health. Researchers systematically reviewed databases (January 2018 to August 2, 2023) to identify randomized controlled trials comparing the efficacy of virtual nature immersion with other treatments. The inclusion/exclusion criteria were established based on the population, intervention, comparison, outcomes, study design, and other aspects (expanded PICO) framework. The Cochrane tool was employed to assess the risk of bias. Meta-analysis was conducted by pooling the mean differences with a 95% confidence interval. Among 30 trials, a total of 2123 patients met the inclusion criteria, with 15 studies included in the meta-analysis. 30 trials met the criteria. Results show significant improvements in pain, anxiety, fear, and some physiological indicators with virtual nature-based treatments. On the other hand, natural scenes incorporating blue and green elements have been applied more extensively and have shown more significant effects. In comparison to conventional methods, this study strongly advocates that virtual reality environments are a crucial tool in bridging the gap between patients and nature, demonstrating their potential to reshape medical interventions and improve environmental design in the field of public health.

Examining the Efficacy of Extended Reality-Enhanced Behavioral Activation for Adults With Major Depressive Disorder: Randomized Controlled Trial

BACKGROUND

Major depressive disorder (MDD) is a global concern with increasing prevalence. While many evidence-based psychotherapies (EBPs) have been identified to treat MDD, there are numerous barriers to patients accessing them. Virtual reality (VR) has been used as a treatment enhancement for a variety of mental health disorders, but few studies have examined its clinical use in treating MDD. Behavioral activation (BA) is a simple yet effective and established first-line EBP for MDD that has the potential to be easily enhanced and adapted with VR technology. A previous report by our group explored the feasibility and acceptability of VR-enhanced BA in a small clinical proof-of-concept pilot. This study examines the clinical efficacy of a more immersive extended reality (XR)-enhanced BA (XR-BA) prototype. This is the first clinical efficacy test of an XR-BA protocol.

OBJECTIVE

This study examined whether XR-BA was feasible and efficacious in treating MDD in an ambulatory telemedicine clinic.

METHODS

A nonblinded between-subject randomized controlled trial compared XR-BA to traditional BA delivered via telehealth. The study used a previously established, brief 3-week, 4-session BA EBP intervention. The experimental XR-BA participants were directed to use a Meta Quest 2 (Reality Labs) VR headset to engage in simulated pleasant or mastery activities and were compared to a control arm, which used only real-life mastery or pleasant activities as between-session homework. The Patient Health Questionnaire (PHQ)-9 was the primary outcome measure. Independent-sample and paired-sample t tests (2-tailed) were used to determine statistical significance and confirmed using structural equation modeling.

RESULTS

Overall, 26 participants with MDD were randomized to receive either XR-BA (n=13, 50%) or traditional BA (n=13, 50%). The mean age of the 26 participants (n=6, 23% male; n=19, 73% female; n=1, 4% nonbinary or third gender) was 50.3 (SD 17.3) years. No adverse events were reported in either group, and no substantial differences in dropout rates or homework completion were observed. XR-BA was found to be statistically noninferior to traditional BA (t18.6=-0.28; P=.78). Both the XR-BA (t9=2.5; P=.04) and traditional BA (t10=2.3; P=.04) arms showed a statistically significant decrease in PHQ-9 and clinical severity from the beginning of session 1 to the beginning of session 4. There was a significant decrease in PHQ-8 to PHQ-9 scores between the phone intake and the beginning of session 1 for the XR-BA group (t11=2.6; P=.03) but not the traditional BA group (t11=1.4; P=.20).

CONCLUSIONS

This study confirmed previous findings that XR-BA may be a feasible, non-inferior, and acceptable enhancement to traditional BA. Additionally, there was evidence that supports the potential of XR to enhance expectation or placebo effects. Further research is needed to examine the potential of XR to improve access, outcomes, and barriers to MDD care.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05525390; https://clinicaltrials.gov/study/NCT05525390.

Soft Pneumatic Haptic Wearable to Create the Illusion of Human Touch

The ability to deliver sensations of human-like touch within virtual reality remains an important challenge to immersive, realistic experiences. Since conventional haptic actuators impart distinctively unnatural effects, we instead tackle this challenge through the design of a rendering mechanism using soft pneumatic actuators (SPA), embedded within a wearable jacket. The resulting system is then evaluated for its ability to mimic realistic touch gesture sensations of grab, touch, tap, and tickle as performed by human fingertips. The results of our experiments indicate that the stimuli produced by our design were reasonably effective in presenting realistic human-generated sensations.

An exploratory study of the effect of age and gender on face scanning during affect recognition in immersive virtual reality

A person with impaired emotion recognition is not able to correctly identify facial expressions represented by other individuals. The aim of the present study is to assess eyes gaze and facial emotion recognition in a healthy population using dynamic avatars in immersive virtual reality (IVR). For the first time, the viewing of each area of interest of the face in IVR is studied by gender and age. This work in healthy people is conducted to assess the future usefulness of IVR in patients with deficits in the recognition of facial expressions. Seventy-four healthy volunteers participated in the study. The materials used were a laptop computer, a game controller, and a head-mounted display. Dynamic virtual faces randomly representing the six basic emotions plus neutral expression were used as stimuli. After the virtual human represented an emotion, a response panel was displayed with the seven possible options. Besides storing the hits and misses, the software program internally divided the faces into different areas of interest (AOIs) and recorded how long participants looked at each AOI. As regards the overall accuracy of the participants' responses, hits decreased from the youngest to the middle-aged and older adults. Also, all three groups spent the highest percentage of time looking at the eyes, but younger adults had the highest percentage. It is also noteworthy that attention to the face compared to the background decreased with age. Moreover, the hits between women and men were remarkably similar and, in fact, there were no statistically significant differences between them. In general, men paid more attention to the eyes than women, but women paid more attention to the forehead and mouth. In contrast to previous work, our study indicates that there are no differences between men and women in facial emotion recognition. Moreover, in line with previous work, the percentage of face viewing time for younger adults is higher than for older adults. However, contrary to earlier studies, older adults look more at the eyes than at the mouth.Consistent with other studies, the eyes are the AOI with the highest percentage of viewing time. For men the most viewed AOI is the eyes for all emotions in both hits and misses. Women look more at the eyes for all emotions, except for joy, fear, and anger on hits. On misses, they look more into the eyes for almost all emotions except surprise and fear.

A Smartphone-Gamified Virtual Reality Exposure Therapy Augmented With Biofeedback for Ailurophobia: Development and Evaluation Study

BACKGROUND

To the best of our knowledge, no specialized research has been conducted to address ailurophobia (fear of cats) in Iran or globally. This has driven our project, along with the prevalence of ailurophobia and the absence of a gamified virtual reality exposure therapy (VRET) that incorporates affordable and easily accessible biofeedback (BF) tools. We hypothesize that a gamified VRET augmented with BF will yield more positive effects than a similar device lacking BF.

OBJECTIVE

This study primarily focuses on the development and preliminary evaluation of a smartphone-gamified VRET integrated with BF, targeting animal phobia, with a specific case study on ailurophobia. The secondary objectives are using affordable and readily available BF found in devices such as smart bands and smartwatches and creating a mobile virtual reality gamified app to improve patients' adherence to treatments while simultaneously enhancing the app's accessibility, scalability, and outreach.

METHODS

Evaluations encompassed 3 methods. First, we identified the tool's potential positive effects on phobia interventions, exploring 4 effects: intrinsic motivation, simulation of fearful situations, management of stressful circumstances without therapists' presence and mitigation of catastrophic thoughts, and preliminary effects on ailurophobia treatment. Participants were divided into BF and non-BF groups. Second, we gathered user preferences and opinions about the treatment. Third, we conducted heuristic evaluations using 44 heuristics from existing system usability scales assessing user interfaces, virtual reality platforms, and video games' playability. To interpret the data, mean scores; ANOVA, single factor; and ANOVA, 2-factor with replication were used. A total of 29 individuals were identified, of which 10 met the eligibility criteria or were accessible.

RESULTS

The smartphone-gamified VRET augmented with BF exhibited better results on the identified effects compared with the non-BF version and contributed to normalizing encounters with cats. Moreover, 41 of the 44 heuristics achieved a percentage above 62%, indicating its potential as a therapeutic product and its ability to enhance patient adherence to treatments. Patient preferences on the treatment and its strengths and weaknesses were provided for further improvement.

CONCLUSIONS

The tool has the potential to evolve into a comprehensive solution by incorporating various types of cats and their behaviors, simulating environments in which they are commonly found, and enhancing its appeal through an increased sense of adventure without inducing unrealistic fears. By adapting fear elements, the game can be tailored to treat various animal phobias. Phobia-focused games should avoid action and combat scenarios to prevent reinforcement of fear responses. After rigorous evaluation, further exploration is required to provide remote use beyond clinical settings.

Exploring the perceptions of former ICU patients and clinical staff on barriers and facilitators to the implementation of virtual reality exposure therapy: A qualitative study

BACKGROUND

Virtual reality (VR) as a digital technology has developed rapidly, becoming more realistic, portable, sensory and easier to navigate. Although studies have found VR to be effective for many clinical applications, patients and clinicians have described several barriers to the successful implementation of this technology. To remove barriers for implementation of VR in health care, a greater understanding is needed of how VR can integrate into clinical environments, particularly complex settings such as an intensive care unit.

AIM

This study aimed to explore the perceived barriers and facilitators for the implementation of VR exposure therapy for intensive care patients and clinical staff.

STUDY DESIGN

A qualitative study using an Interpretative Description approach was undertaken. Semi-structured focus groups were conducted with 13 participants: nine patients and four health care professionals. Focus groups explored barriers and facilitators of using virtual reality (VR) exposure therapy in intensive care. Thematic analysis was employed to produce codes and themes.

RESULTS

In total, eight themes describing the perceived barriers and facilitators to implementing VR exposure therapy were identified. Four themes related to the perceived barriers of implementing VR exposure therapy in intensive care were identified: psychological, sensory, environmental and staff competency and confidence. There were a further four themes related to the perceived facilitators to the implementation of VR exposure therapy: staff training, patient capacity, orientation to technology and support during the intervention.

CONCLUSIONS

This study identified novel barriers and facilitators that could be expected when implementing VR exposure therapy for patients' post-intensive care unit stay. The findings suggest that psychological barriers of fear and apprehension were expected to provoke patient avoidance of exposure therapy. Perceived barriers for staff focused on preparedness to deliver the VR exposure therapy and a lack of technological competence. Both patients and staff stated that a comprehensive induction, orientation and training could facilitate VR exposure therapy, improving engagement.

RELEVANCE TO CLINICAL PRACTICE

This study has identified that with appropriate staff training, resources, and integration into current patient care pathways, VR exposure therapy may be a valuable intervention to support patient recovery following critical illness. Prior to undertaking VR exposure therapy, patients often need reassurance that side-effects can be managed, and that they can easily control their virtual exposure experience.

Immersive experiences in museums for elderly with cognitive disorders: a user-centered design approach

In the context of global aging, to explore the design needs of elderly with dementia in museum environments, to establish a user cognitive psychological model based on immersion theory, and to enhance the satisfaction of cognitively impaired dementia with the museum service experience. Using literature research, surveys, questionnaires, interviews, and focus groups, we analyze the experience design from the psychological demands of elderly with dementia, build a method of mining user needs by combining the KANO model with the analytic hierarchy process (AHP) method, and establish a model for evaluating the excellence of the experience of the museum environment. The conclusion shows that displaying museum virtual scenes or old objects can effectively increase the subjective well-being of people suffering from various health conditions. The method can accurately tap the attributes of the needs of elderly with dementia, break through the drawbacks of the traditional museum experience design which is dominated by the designer's subjective consciousness, and allow the audience to better experience the museum immersive experience, which provides a new idea and method for the effectiveness of cognitive interventions for elderly with cognitive disorders.

Evolution of anxiety management in prostate biopsy under local anesthesia: a narrative review

INTRODUCTION AND METHODS

Prostate biopsy (PB) is an essential step in the diagnosis and active surveillance of prostate cancer (PCa). Transperineal PB (TP-PB) is now the recommended approach and is mostly conducted under local anesthesia. However, this procedure can potentially cause anxiety for patients, given the oncological context and the fear of peri-procedural pain and complications. The objective of this narrative review is to summarize the currently available tools for the management of peri-interventional anxiety during TP-PB, with a particular emphasis on the potential role of virtual reality (VR) in this setting.

RESULTS

In TP-PB, preoperative anxiety can lead to increased pain perception, longer procedure time, and decreased patient satisfaction. Pharmacological and non-pharmacological approaches have been explored to reduce anxiety, such as premedication, deep sedation, education, relaxation techniques, hypnosis, and music therapy, albeit with mixed results. VR has recently emerged in the technological armamentarium for managing pain and anxiety, and the efficiency of this technology has been evaluated in various medical fields, including pediatrics, gastroenterology, urology, gynecology, and psychiatry.

CONCLUSION

Despite the paucity of available data, VR appears to be a safe and effective technique in reducing anxiety in many procedures, even in frail patients. No studies have evaluated the role of VR in TP-PB. Future research should thus explore the optimal way to implement VR technology and any potential benefits for TP-PB patients.

Virtual reality interventions designed to support parents during and throughout the first year after birth: A scoping review

Objective

Virtual reality (VR) has become increasingly popular in clinical and health settings where it has been used for a wide range of purposes. A recent scoping review explored VR applications to assist pregnant women and found that VR was a useful method to be used for a range of different purposes in both pregnancy and labour. However, no such review exists for the period after birth.

Method

We aimed to search for studies that used VR to support parents during birth and in the first year postpartum (Population) in different settings (Context), and finally provided data on the characteristics, reported effectiveness and experience of VR interventions (Concept). Two hundred and fifty-one studies were identified, of which ten were eligible. Two authors independently extracted data including study design, participants and results.

Results

Findings indicate that VR has been used effectively in this context to alleviate depression anxiety, and multiple domains of pain and to improve childbirth satisfaction. The majority of the studies explored the use of VR technology on outcomes such as pain and anxiety during labour and birth. The studies included used a broad range of VR hardware and software. All of the studies reported positive experiences of using VR.

Conclusions

Across these studies, VR was found to be effective in terms of both physiological and psychological outcomes. There are many unexplored maternal and infant focused applications of VR which warrant further investigation as emerging evidence indicates this is becoming an increasingly accessible method to improve maternal and infant health outcomes from pregnancy through to parenthood.

Virtual reality efficiency as exposure therapy for alcohol use: A systematic literature review

Virtual reality is an immersive technology that can be used as a tool in the treatment of disorders linked to substance use disorders, such as alcohol use disorder. This systematic review of the literature examines the effectiveness of virtual reality as exposure therapy for heavy social drinkers, defined as people who regularly consume alcohol in a variety of social contexts, with or without a diagnosis of alcohol use disorder. The current review includes ten studies with a total of 377 participants. Most participants were adult men (61.03%), with an age average of 44.1 years [± 7.42] and alcohol use ranging from light to heavy. Although studies show heterogeneous results, the use of virtual reality cue exposure therapies has shown greater improvement in terms of craving reduction for patients suffering from alcohol use disorder. Studies have also shown that the realism of the virtual environment can influence levels of craving and anxiety, both in heavy social drinkers. In addition, the use of virtual reality has proven to increase feeling of self-efficacy and decrease the tendency to engage in automatic drinking behaviors. However, the review also mentions the necessity of larger research to determine the efficiency of virtual reality as a therapeutic treatment for alcohol use disorder, whilst considering comorbidities and treatment background, especially for resistant patients.

Acceptability, feasibility, and user satisfaction of a virtual reality relaxation intervention in a psychiatric outpatient setting during the COVID-19 pandemic

Background

The COVID-19 pandemic was particularly difficult for individuals with mental disorders. Due to governmental restrictions, face-to-face offers for psychiatric outpatients like therapies, psychoeducational groups or relaxation courses were limited. Virtual reality (VR) might be a new possibility to support these patients by providing them with a home-based relaxation tool.

Objective

The aim of this study was to evaluate the acceptability, feasibility, and user satisfaction of a supportive therapy-accompanying, relaxation VR intervention in psychiatric outpatients during the COVID-19 pandemic in Germany.

Methods

The four-weeks VR intervention consisted of regular watching of relaxing videos in the participants' home environment. Sociodemographics, feasibility (frequency of use, user-friendliness), satisfaction (Client Satisfaction Questionnaire-8), depressive symptoms (Patient Health Questionnaire-9), quality of life (abbreviated World Health Organization Quality of Life assessment), and credibility and expectancy (Credibility Expectancy Questionnaire-8) were measured in an intention-to-treat (ITT) analysis and a per-protocol (PP) analysis of completers.

Results

In total, N = 40 patients participated in the study. Most of the participants in the ITT analysis (n = 30, 75.0%) used the VR device three or 4 weeks. A majority of the N = 29 completers (PP: n = 18, 62.1%) used it all 4 weeks. Most participants used the device two or more times a week (ITT: n = 30, 83.3%; PP: n = 26, 89.7%) and described the user-friendliness as rather or very easy (ITT: n = 33, 91.7%; PP: n = 26, 89.7%). User satisfaction was high (ITT: 19.42, SD = 4.08; PP: M = 20.00, SD = 4.19) and did not correlate with participants' sex or age (all p < 0.05). Depressive symptoms and psychological quality of life improved significantly from pre-to post-intervention (ITT and PP, all p < 0.05). Higher pre-intervention credibility significantly correlated with a better outcome of satisfaction (ITT and PP), depressive symptoms, physical, psychological, and social quality of life (PP; all p < 0.05).

Conclusion

A supportive therapy-accompanying VR relaxation intervention is feasible and acceptable in a psychiatric outpatient setting. Due to the high satisfaction and user-friendliness, VR can be an easy to implement relaxation tool to support psychiatric outpatients.

Clinical trial registration

https://clinicaltrials.gov/, DRKS00027911.

Study protocol for virtual leisure investigating the effect of virtual reality-delivered stress reduction, entertainment and distraction on the use of coercion and need-based medication and patient satisfaction at a closed psychiatric intensive care unit - a mixed-methods pilot clinical trial

INTRODUCTION

The environment at a psychiatric inpatient ward can lead to emotional distress and behavioural deviations in vulnerable individuals potentially resulting in conflicts, increased use of need-based medication and coercive actions, along with low satisfaction with treatment. To accommodate these challenges, recreational and entertaining interventions are recommended. The tested interventions have, however, shown varying effects and demand a high degree of planning and staff involvement while being difficult to adapt to individual needs. Virtual reality (VR) may help overcome these challenges.

METHODS AND ANALYSIS

The study is a mixed-methods clinical trial with a target sample of 124 patients hospitalised at a closed psychiatric ward in the capital region of Denmark. Outcomes (eg, coercion, need-based medication and perceived stress) for a 12-month period where all patients are offered VR-based recreational experiences during their hospitalisation will be compared with outcomes for a 12-month period where VR is not offered. Feasibility and acceptability will be explored with qualitative interviews supplemented with non-participant observations and focus groups. The study began on 1 January 2023, and we expect to complete data collection by 31 December 2024.

ETHICS AND DISSEMINATION

The study is registered at Danish Data Protection Agency (j.no P-2022-466) and is approved by the Committee on Health Research Ethics of the capital region of Denmark (j.no 22013313). All patients will be required to provide informed consent. Results from this study will be disseminated via peer-reviewed journals and congress/consortium presentations.

TRIAL REGISTRATION NUMBER

NCT05654740.

Effectiveness of Social Virtual Reality Training in Enhancing Social Interaction Skills in Children With Attention-Deficit/Hyperactivity Disorder: Protocol for a Three-Arm Pilot Randomized Controlled Trial

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders among children. Children with ADHD have challenges in understanding social cues and behavioral problems when entering a social setting. Virtual reality (VR) has been applied to improve cognitive behaviors in children with ADHD. Previous studies have not adopted VR to improve social interaction competence and appropriateness in children with ADHD. VR offers a more effective alternative to therapeutic strategies for children with ADHD.

OBJECTIVE

This study aims to examine the feasibility and effectiveness of social VR training in enhancing social interaction skills compared to traditional social skills training in children with ADHD. We hypothesize that participants in the social VR training group are likely to perform better on social interaction skills than those in the traditional social skills training group.

METHODS

In this nonblinded, 3-arm randomized controlled trial (RCT), 90 participants with ADHD recruited from the community will be randomized 1:1:1 to the social VR intervention group, traditional social skills training group, or waitlist control group. The child psychiatrist will conduct assessments for each participant at baseline and after the intervention. The Social Skills Rating Scale-Parent will be used to assess the social interaction skills of the participants before and after the intervention. Participants in the social VR intervention group and traditional social skills training group will receive twelve 20-minute training sessions for 3 weeks. The participants in the waitlist control group will receive no training. The primary outcome measure is training acceptability and compliance. The secondary outcome measures are the child psychiatrist's assessment and the Social Skills Rating Scale-Parent before and after the intervention. Another outcome measure is the Behavior Rating Inventory of Executive Function and Attention. Differences in the scale scores will be examined using a t test and an F test.

RESULTS

This study is set to commence in the fourth quarter of 2023. It is anticipated that participants in the social VR intervention group will exhibit superior social interaction skills than those in the traditional social skills training group.

CONCLUSIONS

To our knowledge, this RCT is the first study examining the feasibility and effectiveness of a social VR-based intervention for enhancing the social interaction skills of children with ADHD in Hong Kong. The VR-based social skills training is expected to provide a safer and more effective environment for children with ADHD to learn than the traditional approach. This study can lead to a full-scale RCT.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05778526; https://clinicaltrials.gov/study/NCT05778526.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/48208.

Counseling Psychological Understanding and Considerations of the Metaverse: A Theoretical Review

The COVID-19 pandemic has triggered the interest in and demand for online platforms that can replace traditional face-to-face activities. Accordingly, metaverses have been increasingly used across society, especially in the Mental health field. This broad use of metaverses is now recognized as a major trend that will drive various industries across healthcare and society. In response to this societal change, this study provides a theoretical framework for understanding and applying metaverses as therapeutic spaces in mental health fields through a conceptualization and characterization of metaverses for a range of technologies and services. The value of metaverses as a human-centered "field of experience" was identified and proposed based on the essential aspect of the user, the human being, rather than from the technology used. According to existing psychotherapeutic theories, four therapeutic concepts for the metaverse were proposed: metaverse as an "average expectable environment" in the developmental and therapeutic categories of the self, a transitional stage for adaptation to reality, a creative space for memory and communication for the self, and an expanded or "surplus" reality. This work is expected to be a useful basis for expanding new psychotherapeutic strategies and methods as therapeutic spaces for maintaining mental health through the metaverse.

Sensory stimulations potentializing digital therapeutics pain control

For the past two decades, using Digital Therapeutics (DTx) to counter painful symptoms has emerged as a novel pain relief strategy. Several studies report that DTx significantly diminish pain while compensating for the limitations of pharmacological analgesics (e.g., addiction, side effects). Virtual reality (VR) is a major component of the most effective DTx for pain reduction. Notably, various stimuli (e.g., auditory, visual) appear to be frequently associated with VR in DTx. This review aims to compare the hypoalgesic power of specific stimuli with or without a VR environment. First, this review will briefly describe VR technology and known elements related to its hypoalgesic effect. Second, it will non-exhaustively list various stimuli known to have a hypoalgesic effect on pain independent of the immersive environment. Finally, this review will focus on studies that investigate a possible potentialized effect on pain reduction of these stimuli in a VR environment.

Computer assisted skull base surgery: a contemporary review

Skull base surgery has evolved significantly since Harvey Cushing's first descriptions in the early 1900s. Computer aided surgery (CAS) applications continue to expand; they include virtual surgical planning, augmented and virtual reality, 3D printing of models/cutting guides/implants, surgical navigation, and intraoperative imaging. The authors will review the current skull base CAS literature and propose a computer aided surgical workflow categorizing these applications into 3 phases: 1) Virtual planning, 2) Surgical execution, 3) Intraoperative verification.