Recent Progress in Virtual Reality Exposure Therapy for Phobias: A Systematic Review

Occupational therapy in the Fourth Industrial Revolution

Background.

While occupational therapy’s inception was from the Arts and Crafts movement and the moral treatment movement with war veterans, the profession has evolved to requiring a professional entry-level master’s degree to practice, and involves complex relationships with clients across the life span. Throughout history, a consistent impact of each industrial revolution has been the loss of jobs to automation. This consequence is even more profound today with the exponential growth of innovations and automation.

Purpose.

The objectives of this article are to (a) set the context by reviewing the evolution, or five eras, of occupational therapy in Canada; (b) present what is meant by the “Fourth Industrial Revolution”; and (c) examine the technological innovations faced by occupational therapists and our clients as we enter the “sixth” era of occupational therapy in Canada.

Key Issues.

Although occupational therapy, as a profession, has low risk for automation, a great number of our clients will not be able to reskill fast enough to keep up with job market requirements. Telerehabilitation, the Internet of Things, virtual reality, 3-D printing, robotics, artificial intelligence, and autonomous vehicles are challenging ways occupational therapists provide services to clients.

Implications.

It is recommended that occupational therapists engage with disciplines beyond current typical connections, as our expertise is called upon to advocate for ourselves and our clients who are end users of these technologies.

The Past, Present, and Future of Virtual and Augmented Reality Research: A Network and Cluster Analysis of the Literature

The recent appearance of low cost virtual reality (VR) technologies - like the Oculus Rift, the HTC Vive and the Sony PlayStation VR - and Mixed Reality Interfaces (MRITF) - like the Hololens - is attracting the attention of users and researchers suggesting it may be the next largest stepping stone in technological innovation. However, the history of VR technology is longer than it may seem: the concept of VR was formulated in the 1960s and the first commercial VR tools appeared in the late 1980s. For this reason, during the last 20 years, 100s of researchers explored the processes, effects, and applications of this technology producing 1000s of scientific papers. What is the outcome of this significant research work? This paper wants to provide an answer to this question by exploring, using advanced scientometric techniques, the existing research corpus in the field. We collected all the existent articles about VR in the Web of Science Core Collection scientific database, and the resultant dataset contained 21,667 records for VR and 9,944 for augmented reality (AR). The bibliographic record contained various fields, such as author, title, abstract, country, and all the references (needed for the citation analysis). The network and cluster analysis of the literature showed a composite panorama characterized by changes and evolutions over the time. Indeed, whether until 5 years ago, the main publication media on VR concerned both conference proceeding and journals, more recently journals constitute the main medium of communication. Similarly, if at first computer science was the leading research field, nowadays clinical areas have increased, as well as the number of countries involved in VR research. The present work discusses the evolution and changes over the time of the use of VR in the main areas of application with an emphasis on the future expected VR's capacities, increases and challenges. We conclude considering the disruptive contribution that VR/AR/MRITF will be able to get in scientific fields, as well in human communication and interaction, as already happened with the advent of mobile phones by increasing the use and the development of scientific applications (e.g., in clinical areas) and by modifying the social communication and interaction among people.

L’ergothérapie à l’ère de la quatrième révolution industrielle

Description.

Bien que l’ergothérapie soit issue du mouvement Arts and Crafts et du traitement du moral des anciens combattants, la profession a évolué vers l’adoption de la maîtrise préalable à l’entrée en exercice de la pratique et elle fait appel à l’établissement de relations complexes avec les clients tout au long de la vie. À travers l’histoire, chacune des révolutions industrielles a eu un impact systématique, soit une perte massive d’emplois en raison de l’automatisation des processus. Cette conséquence est encore plus profonde aujourd’hui avec la croissance exponentielle des innovations et de l’automatisation.

But.

Les objectifs de cet article sont (a) de faire une mise en contexte en examinant l’évolution ou les cinq ères de l’ergothérapie au Canada, (b) de définir ce que l’on entend par « quatrième révolution industrielle », et (c) d’examiner les innovations technologiques qui auront une influence sur les ergothérapeutes et leurs clients alors que nous entrons dans la « sixième » ère de l’ergothérapie au Canada.

Questions clés.

Bien que le risque d’automatisation de la profession d’ergothérapeute soit faible, un grand nombre de nos clients seront incapables d’acquérir assez rapidement les nouvelles compétences qui seront requises pour répondre aux exigences du marché de l’emploi. La téléréadaptation, l’Internet des objets, la réalité virtuelle, l’impression 3D, la robotique, l’intelligence artificielle et les véhicules autonomes sont en train de transformer la façon dont les ergothérapeutes offrent des services aux clients.

Conséquences.

Il serait judicieux pour les ergothérapeutes de s’allier à des disciplines différentes de celles avec lesquelles ils collaborent habituellement, car leur expertise sera sollicitée pour défendre leurs propres intérêts et ceux de leurs clients, qui sont les utilisateurs finaux de ces technologies.

Neuroscience of Virtual Reality: From Virtual Exposure to Embodied Medicine

Is virtual reality (VR) already a reality in behavioral health? To answer this question, a meta-review was conducted to assess the meta-analyses and systematic and narrative reviews published in this field in the last twenty-two months. Twenty-five different articles demonstrated the clinical potential of this technology in both the diagnosis and the treatment of mental health disorders: VR compares favorably to existing treatments in anxiety disorders, eating and weight disorders, and pain management, with long-term effects that generalize to the real world. But why is VR so effective? Here, the following answer is suggested: VR shares with the brain the same basic mechanism: embodied simulations. According to neuroscience, to regulate and control the body in the world effectively, the brain creates an embodied simulation of the body in the world used to represent and predict actions, concepts, and emotions. VR works in a similar way: the VR experience tries to predict the sensory consequences of an individual's movements, providing to him/her the same scene he/she will see in the real world. To achieve this, the VR system, like the brain, maintains a model (simulation) of the body and the space around it. If the presence in the body is the outcome of different embodied simulations, concepts are embodied simulations, and VR is an embodied technology, this suggests a new clinical approach discussed in this article: the possibility of altering the experience of the body and facilitating cognitive modeling/change by designing targeted virtual environments able to simulate both the external and the internal world/body.

Internet Versus Virtual Reality Settings for Genomics Information Provision

Current models of genomic information provision will be unable to handle large-scale clinical integration of genomic information, as may occur in primary care settings. Therefore, adoption of digital tools for genetic and genomic information provision is anticipated, primarily using Internet-based, distributed approaches. The emerging consumer communication platform of virtual reality (VR) is another potential intermediate approach between face-to-face and distributed Internet platforms to engage in genomics education and information provision. This exploratory study assessed whether provision of genomics information about body weight in a simulated, VR-based consultation (relative to a distributed, Internet platform) would be associated with differences in health behavior-related attitudes and beliefs, and interpersonal reactions to the avatar-physician. We also assessed whether outcomes differed depending upon whether genomic versus lifestyle-oriented information was conveyed. There were significant differences between communication platforms for all health behavior-oriented outcomes. Following communication in the VR setting, participants reported greater self-efficacy, dietary behavioral intentions, and exercise behavioral intentions than in the Internet-based setting. There were no differences in trust of the physician by setting, and no interaction between setting effects and the content of the information. This study was a first attempt to examine the potential capabilities of a VR-based communication setting for conveying genomic content in the context of weight management. There may be benefits to use of VR settings for communication about genomics, as well as more traditional health information, when it comes to influencing the attitudes and beliefs that underlie healthy lifestyle behaviors.

Users' Opinion About a Virtual Reality System as an Adjunct to Psychological Treatment for Stress-Related Disorders: A Quantitative and Qualitative Mixed-Methods Study

This study aims to explore patients' and therapists' attitudes about the psychological treatment they received (patients) or applied (therapists). The treatments were standard CBT protocols for post-traumatic stress disorder (PTSD), complicated grief (CG), or adjustment disorders (ADs), depending on each patient diagnosis. The treatments were delivered following a traditional format or supported by a virtual reality (VR) system "EMMA's WORLD" designed for the treatment of stress-related disorders. "EMMA's WORLD" is a VR application in which patients can explore negative experiences using different virtual elements that can be customized to make them more meaningful to the user. The sample was composed of two groups: the "professionals" (N = 10) were all clinical psychologists who applied the same psychological treatment in both the traditional format ("traditional condition") and using the VR system ("EMMA" condition). The second group consisted of a sample of patients (N = 50) who met the criteria for at least one of three different diagnoses: PTSD (N = 15), CG (N = 15), or AD (N = 20). 25 patients received treatment in the traditional format and 25 supported by the VR system. The patients were asked about their expectations (before treatment) and satisfaction (after treatment) with the treatment they received. All the therapists were asked their opinions about both treatment conditions. A mixed-methods approach using quantitative and qualitative methodologies was used. In both conditions, high scores were observed, and the patient's opinions were even better when they have already received the treatments. A more pronounced pre-test-post-test change in the EMMA therapy group than in the traditional group was observed. EMMA's World was well-accepted by both patients and therapists, and it helped to foster motivation in patients, while helping the therapist to apply the treatment. Thus, VR can be useful as an adjunct tool to enhance the treatment.

Running for extinction? Aerobic exercise as an augmentation of exposure therapy in panic disorder with agoraphobia

Exposure-based Cognitive Behavioral Therapy (eb-CBT) represents the most evidence-based psychotherapeutic approach in anxiety disorders. However, its efficacy may be limited by a delay in onset of action and a substantial number of patients does not respond sufficiently to treatment. In this context, aerobic exercise was found to be effective in reducing clinical anxiety as well as to improve (elements of) disorder-specific CBT in some mental disorders. We therefore investigated the effect of aerobic exercise supplementary to an eb-CBT in panic disorder and agoraphobia (PD/AG). 77 patients with PD/AG performed a 30 min treadmill task with moderate or low intensity (70% or 30% of the maximal oxygen uptake [VO_2max]) prior to five exposure sessions within a standardized seven-week CBT. At baseline, after completing the treatment period (post) and six month after post (follow-up), several measures of (un)specific psychopathology (Hamilton Anxiety Rating Scale [Ham-A], Mobility Inventory [MI], Panic and Agoraphobia Scale [PAS], Agoraphobic Cognitions Questionnaire [ACQ], Body Sensations Questionnaire [BSQ]) were established to assess for clinical changes. All patients experienced a significant improvement of symptoms from baseline to post (for all measures p < .001) but repeated-measures analyses of variance found a trend towards a significant time × group interaction in the Ham-A in favor for the moderate intense exercise group (f[1, 74] = 4.15, p = .045, α=.025). This trend, however, disappeared at follow-up since the low-intense exercise group further improved significantly in Ham-A after post. Our findings therefore might point to an accelerating effect of moderate-intense exercise within an exposure-based CBT for AG/PD.