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Gaina MA, Sbarcea SV, Popa BS, Stefanescu BV, Gaina AM, Szalontay AS, Bolos A, Stefanescu C. SAFEvR MentalVeRse.app: Development of a Free Immersive Virtual Reality Exposure Therapy for Acrophobia and Claustrophobia. Brain Sci 2024; 14:651. [PMID: 39061393 PMCID: PMC11274658 DOI: 10.3390/brainsci14070651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/13/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Specific phobias impact over 400 million people worldwide. Digitalizing mental health could alleviate the burden. Still, although the corporate-driven Metaverse is expanding rapidly, there needs to be more momentum in harnessing virtual reality exposure therapy uptake. Objective: This study aims to conceptualize, develop, and deploy a free Virtual Reality Exposure Therapy (VRET) application specifically designed for treating acrophobia and claustrophobia. This pilot study, which holds the promise of a future where mental health is more accessible and effective, explores the feasibility of leveraging transdisciplinary collaboration among specialists to create a safe, accessible, and effective VRET solution. Methods: We conducted a Delphi heuristic approach involving bioethicists, neuroscientists, and tech developers. Second, we reviewed the existing psychological theories and therapeutic strategies for addressing phobias in VR. Third, we conceptualized a thematic analysis-derived framework for a safe, adaptive-gamified free exposure to virtual reality acrophobia and claustrophobia (SAFEvR ACT). Finally, we provide an overview of the iterative improvements made during 12 workshops and 76 weekly briefings on developmental implementations. Results: We developed the SAFEvR ACT into a proof-of-concept application freely deployed on the MentalVerse app platform. Our safety-focused approach can benefit from prevalidation perspectives within future randomized control trials. Conclusions: The resulting application derived from the SAFEvR ACT framework represents a blueprint to counter the current lack of iVR mental health uptake by offering a free VRET alternative. Future research should aim towards developing similar free platforms to lessen mental health burdens and gather quantitative data. We conclude with a call to action to researchers to fine-tune our current approach and take a stand for free digital mental health within MentalVeRse.app.
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Affiliation(s)
- Marcel-Alexandru Gaina
- Psychiatry, Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.-S.S.); (A.B.); (C.S.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
- The Association of Integrative Psychotherapy and Clinical Psychology, 700469 Iasi, Romania
| | - Stefan-Vladimir Sbarcea
- Faculty of Computer Science, “Alexandru Ioan Cuza” University, 700483 Iasi, Romania; (S.-V.S.); (B.-S.P.)
| | - Bianca-Stefana Popa
- Faculty of Computer Science, “Alexandru Ioan Cuza” University, 700483 Iasi, Romania; (S.-V.S.); (B.-S.P.)
| | - Bogdan-Victor Stefanescu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” Iași, 700115 Iasi, Romania
| | - Alexandra-Maria Gaina
- PhD Department, University of Medicine and Pharmacy “Grigore T. Popa” Iași, 700115 Iasi, Romania;
| | - Andreea-Silvana Szalontay
- Psychiatry, Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.-S.S.); (A.B.); (C.S.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
| | - Alexandra Bolos
- Psychiatry, Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.-S.S.); (A.B.); (C.S.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
| | - Cristinel Stefanescu
- Psychiatry, Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.-S.S.); (A.B.); (C.S.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
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Russo S, Tibermacine IE, Tibermacine A, Chebana D, Nahili A, Starczewscki J, Napoli C. Analyzing EEG patterns in young adults exposed to different acrophobia levels: a VR study. Front Hum Neurosci 2024; 18:1348154. [PMID: 38770396 PMCID: PMC11102978 DOI: 10.3389/fnhum.2024.1348154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction The primary objective of this research is to examine acrophobia, a widely prevalent and highly severe phobia characterized by an overwhelming dread of heights, which has a substantial impact on a significant proportion of individuals worldwide. The objective of our study was to develop a real-time and precise instrument for evaluating levels of acrophobia by utilizing electroencephalogram (EEG) signals. Methods EEG data was gathered from a sample of 18 individuals diagnosed with acrophobia. Subsequently, a range of classifiers, namely Support Vector Classifier (SVC), K-nearest Neighbors (KNN), Random Forest (RF), Decision Tree (DT), Adaboost, Linear Discriminant Analysis (LDA), Convolutional Neural Network (CNN), and Artificial Neural Network (ANN), were employed in the analysis. These methodologies encompass both machine learning (ML) and deep learning (DL) techniques. Results The Convolutional Neural Network (CNN) and Artificial Neural Network (ANN) models demonstrated notable efficacy. The Convolutional Neural Network (CNN) model demonstrated a training accuracy of 96% and a testing accuracy of 99%, whereas the Artificial Neural Network (ANN) model attained a training accuracy of 96% and a testing accuracy of 97%. The findings of this study highlight the effectiveness of the proposed methodology in accurately categorizing real-time degrees of acrophobia using EEG data. Further investigation using correlation matrices for each level of acrophobia showed substantial EEG frequency band connections. Beta and Gamma mean values correlated strongly, suggesting cognitive arousal and acrophobic involvement could synchronize activity. Beta and Gamma activity correlated strongly with acrophobia, especially at higher levels. Discussion The results underscore the promise of this innovative approach as a dependable and sophisticated method for evaluating acrophobia. This methodology has the potential to make a substantial contribution toward the comprehension and assessment of acrophobia, hence facilitating the development of more individualized and efficacious therapeutic interventions.
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Affiliation(s)
- Samuele Russo
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Imad Eddine Tibermacine
- Department of Computer, Automation and Management Engineering, Sapienza University of Rome, Rome, Italy
| | - Ahmed Tibermacine
- Department of Computer Science, University of Biskra, Biskra, Algeria
| | - Dounia Chebana
- Department of Computer Science, University of Biskra, Biskra, Algeria
| | - Abdelhakim Nahili
- Department of Computer Science, University of Biskra, Biskra, Algeria
| | - Janusz Starczewscki
- Department of Computational Intelligence, Czestochowa University of Technology, Czestochowa, Poland
| | - Christian Napoli
- Department of Computer, Automation and Management Engineering, Sapienza University of Rome, Rome, Italy
- Department of Computational Intelligence, Czestochowa University of Technology, Czestochowa, Poland
- Institute for Systems Analysis and Computer Science, Italian National Research Council, Rome, Italy
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Shang W, Xie S, Feng W, Li Z, Jia J, Cao X, Shen Y, Li J, Shi H, Gu Y, Weng SJ, Lin L, Pan YH, Yuan XB. A non-image-forming visual circuit mediates the innate fear of heights in male mice. Nat Commun 2024; 15:3746. [PMID: 38702319 PMCID: PMC11068790 DOI: 10.1038/s41467-024-48147-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 04/19/2024] [Indexed: 05/06/2024] Open
Abstract
The neural basis of fear of heights remains largely unknown. In this study, we investigated the fear response to heights in male mice and observed characteristic aversive behaviors resembling human height vertigo. We identified visual input as a critical factor in mouse reactions to heights, while peripheral vestibular input was found to be nonessential for fear of heights. Unexpectedly, we found that fear of heights in naïve mice does not rely on image-forming visual processing by the primary visual cortex. Instead, a subset of neurons in the ventral lateral geniculate nucleus (vLGN), which connects to the lateral/ventrolateral periaqueductal gray (l/vlPAG), drives the expression of fear associated with heights. Additionally, we observed that a subcortical visual pathway linking the superior colliculus to the lateral posterior thalamic nucleus inhibits the defensive response to height threats. These findings highlight a rapid fear response to height threats through a subcortical visual and defensive pathway from the vLGN to the l/vlPAG.
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Affiliation(s)
- Wei Shang
- Key Laboratory of Brain Functional Genomics of Shanghai and Ministry of Education, Institute of Brain Functional Genomics, School of Life Science and the Collaborative Innovation Center for Brain Science, East China Normal University, Shanghai, 200062, China
| | - Shuangyi Xie
- Key Laboratory of Brain Functional Genomics of Shanghai and Ministry of Education, Institute of Brain Functional Genomics, School of Life Science and the Collaborative Innovation Center for Brain Science, East China Normal University, Shanghai, 200062, China
| | - Wenbo Feng
- Key Laboratory of Brain Functional Genomics of Shanghai and Ministry of Education, Institute of Brain Functional Genomics, School of Life Science and the Collaborative Innovation Center for Brain Science, East China Normal University, Shanghai, 200062, China
| | - Zhuangzhuang Li
- Department of Otolaryngology Head & Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, 200233, China
| | - Jingyan Jia
- Key Laboratory of Brain Functional Genomics of Shanghai and Ministry of Education, Institute of Brain Functional Genomics, School of Life Science and the Collaborative Innovation Center for Brain Science, East China Normal University, Shanghai, 200062, China
| | - Xiaoxiao Cao
- Key Laboratory of Brain Functional Genomics of Shanghai and Ministry of Education, Institute of Brain Functional Genomics, School of Life Science and the Collaborative Innovation Center for Brain Science, East China Normal University, Shanghai, 200062, China
| | - Yanting Shen
- Key Laboratory of Brain Functional Genomics of Shanghai and Ministry of Education, Institute of Brain Functional Genomics, School of Life Science and the Collaborative Innovation Center for Brain Science, East China Normal University, Shanghai, 200062, China
| | - Jing Li
- Key Laboratory of Brain Functional Genomics of Shanghai and Ministry of Education, Institute of Brain Functional Genomics, School of Life Science and the Collaborative Innovation Center for Brain Science, East China Normal University, Shanghai, 200062, China
| | - Haibo Shi
- Department of Otolaryngology Head & Neck Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, 200233, China
| | - Yiran Gu
- Key Laboratory of Brain Functional Genomics of Shanghai and Ministry of Education, Institute of Brain Functional Genomics, School of Life Science and the Collaborative Innovation Center for Brain Science, East China Normal University, Shanghai, 200062, China
| | - Shi-Jun Weng
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, 200032, China
| | - Longnian Lin
- Key Laboratory of Brain Functional Genomics of Shanghai and Ministry of Education, Institute of Brain Functional Genomics, School of Life Science and the Collaborative Innovation Center for Brain Science, East China Normal University, Shanghai, 200062, China
| | - Yi-Hsuan Pan
- Key Laboratory of Brain Functional Genomics of Shanghai and Ministry of Education, Institute of Brain Functional Genomics, School of Life Science and the Collaborative Innovation Center for Brain Science, East China Normal University, Shanghai, 200062, China.
| | - Xiao-Bing Yuan
- Key Laboratory of Brain Functional Genomics of Shanghai and Ministry of Education, Institute of Brain Functional Genomics, School of Life Science and the Collaborative Innovation Center for Brain Science, East China Normal University, Shanghai, 200062, China.
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Abstract
PURPOSE OF REVIEW The aim of this study was to illuminate the extent of the bilateral central vestibular network from brainstem and cerebellum to subcortical and cortical areas and its interrelation to higher cortical functions such as spatial cognition and anxiety. RECENT FINDINGS The conventional view that the main function of the vestibular system is the perception of self-motion and body orientation in space and the sensorimotor control of gaze and posture had to be developed further by a hierarchical organisation with bottom-up and top-down interconnections. Even the vestibulo-ocular and vestibulo-spinal reflexes are modified by perceptual cortical processes, assigned to higher vestibulo-cortical functions. A first comparative fMRI meta-analysis of vestibular stimulation and fear-conditioning studies in healthy participants disclosed widely distributed clusters of concordance, including the prefrontal cortex, anterior insula, temporal and inferior parietal lobe, thalamus, brainstem and cerebellum. In contrast, the cortical vestibular core region around the posterior insula was activated during vestibular stimulation but deactivated during fear conditioning. In recent years, there has been increasing evidence from studies in animals and humans that the central vestibular system has numerous connections related to spatial sensorimotor performance, memory, and emotion. The clinical implication of the complex interaction within various networks makes it difficult to assign some higher multisensory disorders to one particular modality, for example in spatial hemineglect or room-tilt illusion. SUMMARY Our understanding of higher cortical vestibular functions is still in its infancy. Different brain imaging techniques in animals and humans are one of the most promising methodological approaches for further structural and functional decoding of the vestibular and other intimately interconnected networks. The multisensory networking including cognition and emotion determines human behaviour in space.
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Affiliation(s)
- Marianne Dieterich
- German Center for Vertigo and Balance Disorders
- Department of Neurology, Ludwig-Maximilians University
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
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Wang D, Bargiotas I, Cao J, Vayatis N, Oudre L, Vidal PP. Heterogeneities of the perceptual-motor style during locomotion at height. Front Hum Neurosci 2024; 17:1228195. [PMID: 38283095 PMCID: PMC10810983 DOI: 10.3389/fnhum.2023.1228195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/21/2023] [Indexed: 01/30/2024] Open
Abstract
In a recent review, we summarized the characteristics of perceptual-motor style in humans. Style can vary from individual to individual, task to task and pathology to pathology, as sensorimotor transformations demonstrate considerable adaptability and plasticity. Although the behavioral evidence for individual styles is substantial, much remains to be done to understand the neural and mechanical substrates of inter-individual differences in sensorimotor performance. In this study, we aimed to investigate the modulation of perceptual-motor style during locomotion at height in 16 persons with no history of fear of heights or acrophobia. We used an inexpensive virtual reality (VR) video game. In this VR game, Richie's Plank, the person progresses on a narrow plank placed between two buildings at the height of the 30th floor. Our first finding was that the static markers (head, trunk and limb configurations relative to the gravitational vertical) and some dynamic markers (jerk, root mean square, sample entropy and two-thirds power law at head, trunk and limb level) we had previously identified to define perceptual motor style during locomotion could account for fear modulation during VR play. Our second surprising result was the heterogeneity of this modulation in the 16 young, healthy individuals exposed to moving at a height. Finally, 56% of participants showed a persistent change in at least one variable of their skeletal configuration and 61% in one variable of their dynamic control during ground locomotion after exposure to height.
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Affiliation(s)
- Danping Wang
- Plateforme d’Etude Sensorimotricité, Université Paris Cité, Paris, France
- Machine Learning and I-Health International Cooperation Base of Zhejiang Province, Hangzhou Dianzi University, Hangzhou, China
| | - Ioannis Bargiotas
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, France
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, France
| | - Jiuwen Cao
- Machine Learning and I-Health International Cooperation Base of Zhejiang Province, Hangzhou Dianzi University, Hangzhou, China
| | - Nicolas Vayatis
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, France
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, France
| | - Laurent Oudre
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, France
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, France
| | - Pierre-Paul Vidal
- Plateforme d’Etude Sensorimotricité, Université Paris Cité, Paris, France
- Machine Learning and I-Health International Cooperation Base of Zhejiang Province, Hangzhou Dianzi University, Hangzhou, China
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Cité, Université Paris Saclay, ENS Paris Saclay, Paris, France
- Centre Borelli, CNRS, SSA, INSERM, Université Paris Saclay, Université Paris Cité, ENS Paris Saclay, Gif-sur-Yvette, France
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Kodithuwakku Arachchige SNK, Chander H, Shojaei A, Knight AC, Brown C, Freeman HR, Burch V RF, Chen CC. Effects of virtual heights, dual-tasking, and training on static postural stability. APPLIED ERGONOMICS 2024; 114:104145. [PMID: 37837914 DOI: 10.1016/j.apergo.2023.104145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 09/13/2023] [Accepted: 09/27/2023] [Indexed: 10/16/2023]
Abstract
Working at altitudes, dual-tasking (DT), and lack of experience cause falls. This study aimed to investigate the impact of virtual heights, DT, and training on static postural stability. Twenty-eight volunteers' balance at seven virtual environments [VE; ground (G), altitude 1 (A1), edge 1 (E1), altitude 2 (A2), edge 2 (E2), altitude 3 (A3), and edge 3 (E3)] were recorded during single-tasking (ST) and DT over three days. Independent variables were analyzed using a 7 (VE) x 3 (DAY) x 2 (TASK) factorial repeated measures ANOVA. Greater postural sway was observed in A3 and E1, on DAY 1, and during DT. The study demonstrated static postural stability deteriorates at higher virtual altitudes and during DT and improves with training. The findings of the study suggest that virtual reality is a great altitude simulator, which could be used as a potential balance training tool in ergonomic settings.
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Affiliation(s)
- Sachini N K Kodithuwakku Arachchige
- Human Performance Laboratory, Department of Exercise and Nutrition Sciences, Weber State University, Dept 2805, 1435 Village Dr, Ogden, UT, 84408-5150, USA.
| | - Harish Chander
- Neuromechanics Laboratory, Department of Kinesiology, Mississippi State University, PO Box 6186 216, McCarthy Gym, Mississippi State, MS, 39762, USA; Human Factors & Athlete Engineering, Center for Advanced Vehicular Systems, Mississippi State University, 200 Research Blvd, Starkville, MS, 39759, USA.
| | - Alireza Shojaei
- Myers-Lawson School of Construction, Virginia Tech, 1345 Perry St, Blacksburg, VA, 24061, USA.
| | - Adam C Knight
- Neuromechanics Laboratory, Department of Kinesiology, Mississippi State University, PO Box 6186 216, McCarthy Gym, Mississippi State, MS, 39762, USA.
| | - Caitlyn Brown
- Neuromechanics Laboratory, Department of Kinesiology, Mississippi State University, PO Box 6186 216, McCarthy Gym, Mississippi State, MS, 39762, USA.
| | - Hannah R Freeman
- Department of Occupational Therapy, School of Health Professions, University of Alabama at Birmingham, 1716 9th Ave S, Birmingham, AL, 35233, USA.
| | - Reuben F Burch V
- Human Factors & Athlete Engineering, Center for Advanced Vehicular Systems, Mississippi State University, 200 Research Blvd, Starkville, MS, 39759, USA; Department of Industrial & Systems Engineering, Mississippi State University, 479-2 Hardy Road, 260McCain Hall, Box 9542, Mississippi State, MS, 39762, USA.
| | - Chih-Chia Chen
- Cognitive and Motor Control Laboratory, Department of Kinesiology, Mississippi State University, PO Box 6186, 216 McCarthy Gym, Mississippi State, MS, 39762, USA.
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Bzdúšková D, Marko M, Hirjaková Z, Riečanský I, Kimijanová J. Fear of heights shapes postural responses to vibration-induced balance perturbation at virtual height. Front Hum Neurosci 2023; 17:1229484. [PMID: 37771346 PMCID: PMC10523023 DOI: 10.3389/fnhum.2023.1229484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 08/21/2023] [Indexed: 09/30/2023] Open
Abstract
Introduction Standing upright at height is a challenging situation involving intense threat of balance loss and fall. The ability to maintain balance in such conditions requires properly resolving sensory conflicts and is influenced by fear. To get more insight on the role of fear in balance control at height, we explored the dynamics of postural behavior in the situation of enhanced threat of potential balance loss. Methods In 40 young individuals with varying fear of heights, we combined simulated exposure to height in a virtual reality environment with bilateral vibration of tibialis anterior muscles which evokes posture destabilization (the so-called vibration-induced falling). Results Under such condition of enhanced postural threat, individuals with intense fear of heights showed stronger stiffening of posture compared with individuals with low fear of heights who react more flexibly and adaptively to posture destabilization. This group difference was evident already at ground level but further increased during virtual height exposure. Discussion Our data show that fear of height significantly affects posture adaptation to balance-destabilizing events. Our findings demonstrate that the assessment of postural behavior during threatening situations in the virtual reality environment provides valuable insights into the mechanisms of balance control and may be used to develop novel strategies aimed at prevention of falls.
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Affiliation(s)
- Diana Bzdúšková
- Department of Behavioural Neuroscience, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Martin Marko
- Department of Behavioural Neuroscience, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
- Department of Applied Informatics, Faculty of Mathematics, Physics and Informatics, Comenius University in Bratislava, Bratislava, Slovakia
| | - Zuzana Hirjaková
- Department of Behavioural Neuroscience, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Igor Riečanský
- Department of Behavioural Neuroscience, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
- Department of Psychiatry, Faculty of Medicine, Slovak Medical University in Bratislava, Bratislava, Slovakia
| | - Jana Kimijanová
- Department of Behavioural Neuroscience, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
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Kodithuwakku Arachchige SN, Chander H, Turner AJ, Shojaei A, Knight AC, Griffith A, Burch RF, Chen CC. Physiological and Subjective Measures of Anxiety with Repeated Exposure to Virtual Construction Sites at Different Heights. Saf Health Work 2023; 14:303-308. [PMID: 37818213 PMCID: PMC10562126 DOI: 10.1016/j.shaw.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 07/11/2023] [Accepted: 07/24/2023] [Indexed: 10/12/2023] Open
Abstract
Background Occupational workers at altitudes are more prone to falls, leading to catastrophic outcomes. Acrophobia, height-related anxiety, and affected executive functions lead to postural instabilities, causing falls. This study investigated the effects of repeated virtual height exposure and training on cognitive processing and height-related anxiety. Methods Twenty-eight healthy volunteers (age 20.48 ± 1.26 years; mass 69.52 ± 13.78 kg) were recruited and tested in seven virtual environments (VE) [ground (G), 2-story altitude (A1), 2-story edge (E1), 4-story altitude (A2), 4-story edge (E2), 6-story altitude (A3), and 6-story edge (E3)] over three days. At each VE, participants identified occupational hazards present in the VE and completed an Attitude Towards Heights Questionnaire (ATHQ) and a modified State-Trait Anxiety Inventory Questionnaire (mSTAIQ). The number of hazards identified and the ATHQ and mSTAIQ scores were analyzed using a 7 (VE; G, A1, A2, A3, E1, E2, E3) x 3 (DAY; DAY 1, DAY 2, DAY 3) factorial repeated measures analysis of variance. Results The participants identified the lowest number of hazards at A3 and E3 VEs and on DAY 1 compared to other VEs and DAYs. ATHQ scores were lowest at G, A1, and E1 VEs. Conclusion Cognitive processing is negatively affected by virtual altitudes, while it improves with short-term training. The features of virtual reality, such as higher involvement, engagement, and reliability, make it a better training tool to be considered in ergonomic settings. The findings of this study will provide insights into cognitive dual-tasking at altitude and its challenges, which will aid in minimizing occupational falls.
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Affiliation(s)
| | - Harish Chander
- Department of Kinesiology, Mississippi State University, MS, USA
- Human Factors & Athlete Engineering, Center for Advanced Vehicular Systems, Mississippi State University, MS, USA
| | - Alana J. Turner
- Department of Kinesiology, Coastal Carolina University, Conway, SC, USA
| | - Alireza Shojaei
- Myers-Lawson School of Construction, Virginia Tech, Blacksburg, VA, USA
| | - Adam C. Knight
- Department of Kinesiology, Mississippi State University, MS, USA
| | - Aaron Griffith
- Department of Kinesiology, Mississippi State University, MS, USA
| | - Reuben F. Burch
- Human Factors & Athlete Engineering, Center for Advanced Vehicular Systems, Mississippi State University, MS, USA
- Department of Industrial & Systems Engineering, Mississippi State University, MS, USA
| | - Chih-Chia Chen
- Department of Kinesiology, Mississippi State University, MS, USA
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Gerb J, Brandt T, Huppert D. Historical descriptions of nystagmus and abnormal involuntary eye movements in various ancient cultures. Sci Prog 2023; 106:368504231191986. [PMID: 37642983 PMCID: PMC10469245 DOI: 10.1177/00368504231191986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Original texts and expert translations from various ancient cultures covering a time span from the 2nd millennium BC to the ninth century AD were searched for historical observations of involuntary eye movements. Abnormal, spontaneous eye movements are an easily recognisable neuro-ophthalmological symptom that can be both congenital and acquired. Ocular oscillations termed 'hippos' by Hippocrates (460-370BC) and Galenos (129-216AD) are synonymous with nystagmus, a term first introduced in the eighteenth century. The original description of hippos suggests an innate onset, which retrospectively can be related to either congenital (infantile) nystagmus or continuous involuntary eye movements of the blind. Other descriptions of abnormal involuntary eye movements with different beating directions, possibly associated with vertigo, seizures or ear symptoms and their impact on patients' quality of life (e.g. oscillopsia, blurred vision) are preserved in many fragmentary ancient documents including papyrus scrolls and stone tablets from Egypt, Mesopotamia, India, China, Greece, Rome and the Middle East. Although the sparse original descriptions of the direction and type of eye movements may inspire daring medical interpretations, caution is required when attempting to assign them to distinct nystagmus forms according to our current clinical classification of ocular motor disorders.
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Affiliation(s)
- Johannes Gerb
- Department of Neurology, Ludwig-Maximilians-Universität, Munich, Germany
- German Center for Vertigo and Balance Disorders-DSGZ, Ludwig-Maximilians-Universität, Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders-DSGZ, Ludwig-Maximilians-Universität, Munich, Germany
- Clinical Neuroscience, Ludwig-Maximilians-Universität, Munich, Germany
| | - Doreen Huppert
- Department of Neurology, Ludwig-Maximilians-Universität, Munich, Germany
- German Center for Vertigo and Balance Disorders-DSGZ, Ludwig-Maximilians-Universität, Munich, Germany
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Neumann N, Fullana MA, Radua J, Brandt T, Dieterich M, Lotze M. Common neural correlates of vestibular stimulation and fear learning: an fMRI meta-analysis. J Neurol 2023; 270:1843-1856. [PMID: 36723684 PMCID: PMC10025232 DOI: 10.1007/s00415-023-11568-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 01/11/2023] [Accepted: 01/11/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND A bidirectional functional link between vestibular and fear-related disorders has been previously suggested. OBJECTIVE To test a potential overlap of vestibular and fear systems with regard to their brain imaging representation maps. METHODS By use of voxel-based mapping permutation of subject images, we conducted a meta-analysis of earlier functional magnetic resonance imaging (fMRI) studies applying vestibular stimulation and fear conditioning in healthy volunteers. RESULTS Common clusters of concordance of vestibular stimulation and fear conditioning were found in the bilateral anterior insula cortex, ventrolateral prefrontal cortex and the right temporal pole, bilaterally in the adjacent ventrolateral prefrontal cortex, cingulate gyrus, secondary somatosensory cortex, superior temporal and intraparietal lobe, supplementary motor area and premotor cortex, as well as subcortical areas, such as the bilateral thalamus, mesencephalic brainstem including the collicular complex, pons, cerebellar vermis and bilateral cerebellar hemispheres. Peak areas of high concordance for activations during vestibular stimulation but deactivations during fear conditioning were centered on the posterior insula and S2. CONCLUSIONS The structural overlap of both networks allows the following functional interpretations: first, the amygdala, superior colliculi, and antero-medial thalamus might represent a release of preprogramed sensorimotor patterns of approach or avoidance. Second, the activation (vestibular system) and deactivation (fear system) of the bilateral posterior insula is compatible with the view that downregulation of the fear network by acute vestibular disorders or unfamiliar vestibular stimulation makes unpleasant perceived body accelerations less distressing. This also fits the clinical observation that patients with bilateral vestibular loss suffer from less vertigo-related anxiety.
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Affiliation(s)
- Nicola Neumann
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Functional Imaging Unit, Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Walther-Rathenau-Str. 46, 17475, Greifswald, Germany
| | - Miquel A Fullana
- Adult Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clinic, Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, University of Barcelona, Barcelona, Spain
| | - Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, University of Barcelona, Barcelona, Spain
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Marianne Dieterich
- German Center for Vertigo and Balance Disorders (DSGZ), University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- SyNergy-Munich Cluster for Systems Neurology, Munich, Germany
| | - Martin Lotze
- Functional Imaging Unit, Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Walther-Rathenau-Str. 46, 17475, Greifswald, Germany.
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Tang L, Jiang W, Wang X. New onset episodic vertigo as a presentation of vestibular neuritis. Front Neurol 2022; 13:984865. [PMID: 36313510 PMCID: PMC9596811 DOI: 10.3389/fneur.2022.984865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/08/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Vestibular neuritis (VN) is a common peripheral cause of acute vestibular syndrome, characterized by sustained vertigo and gait instability, persisting from 1 day to several weeks. With the widespread use of comprehensive vestibular function tests, patients with VN and non-sustained vertigo have drawn attention. In this study, we retrospectively analyzed the clinical presentation of patients with VN and episodic vertigo, aiming to expand the atypical clinical features of VN. Methods This retrospective study enrolled 58 patients with VN. Among them, 11 patients with more than 3 remissions per day, each lasting over 1 h were assigned to the episodic vertigo (EV) group, and 47 subjects without significant relief into the sustained vertigo (SV) group. Demographic information, clinical manifestations and data of supplementary examinations were collected and statistically analyzed. These patients were followed up 1 year after discharge to gather prognostic information. Results The incidence of spontaneous nystagmus (SN) and proportion of severe vertigo (Dizziness Handicap Inventory questionnaire score >60) in the SV group were significantly higher than those in the EV group. Spearman correlation showed that with a longer disease course, the velocity of overt saccade was smaller (p < 0.05, Rs = −0.263) in all patients with VN. Conclusion The non-sustained manifestations in VN overlap with a wider spectrum of other vestibular disorders and stroke-related vertigo, which add an additional layer of complexity to the differential diagnosis of new onset episodic vertigo. By retrospectively analyzing the clinical characteristics and vHIT parameters, our study has expounded on the atypical features and potential pathophysiological mechanism of episodic syndromes in VN. VOR gain and saccades measured by vHIT could be reliable indicators for vestibular rehabilitation process.
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12
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Hang Y, Zhong Y, Zhang G, Wu Z, Kong J, Wang Q, Ding H, Wu H, Yuan S, Wang C, Zhang N. Altered spontaneous neural activity in frontal and visual regions in patients with acrophobia. J Affect Disord 2022; 303:340-345. [PMID: 35151673 DOI: 10.1016/j.jad.2022.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Acrophobia is a prevalent type of specific phobia, which frequently leads to functional impairments and occupational limitations. However, the neural pathology of acrophobia is still largely unknown. METHODS 26 acrophobic patients and 30 healthy controls were enrolled in this study. All participants underwent a resting-state fMRI scan. Severity of symptoms was evaluated using self-report and behavioral measures. The regional homogeneity (ReHo) and seed-based functional connectivity (FC) were then examined. RESULTS Compared to controls, acrophobic patients demonstrated higher ReHo in the right fusiform gyrus and lower ReHo in the bilateral superior frontal gyrus. Lower FC of right fusiform gyrus-bilateral caudate, right fusiform gyrus-right parahippocampal gyrus, and left medial superior frontal gyrus-left cuneus was also found in the acrophobia group. Additionally, there were negative correlations between behavior avoidance scores and FC of right fusiform gyrus- right parahippocampal gyrus (r = -0.42, p = 0.04) and between scores of the 7-item generalized anxiety disorder scale and FC of left medial superior frontal gyrus- left cuneus (r = -0.40, p = 0.049) in the acrophobia group. LIMITATIONS Owing to the cross-sectional design, it was unclear whether the functional abnormalities found in the acrophobic patients were related to state or trait effects. CONCLUSIONS Preliminary results indicated that acrophobic patients revealed abnormal brain function in orbitofrontal cortex, medial prefrontal cortex, and visual regions. These abnormalities may be helpful in understanding the possible neurobiological mechanism of acrophobia and may serve as potential intervention and prevention targets.
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Affiliation(s)
- Yaming Hang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210029, China; School of Psychology, Nanjing Normal University, Nanjing, Jiangsu,210097, China
| | - Yuan Zhong
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu,210097, China
| | - Guojia Zhang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210029, China; School of Psychology, Nanjing Normal University, Nanjing, Jiangsu,210097, China
| | - Zhou Wu
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu,210097, China
| | - Jingya Kong
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu,210097, China
| | - Qiuyu Wang
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu,210097, China
| | - Huachen Ding
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Huiqin Wu
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Shiting Yuan
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210029, China
| | - Chun Wang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210029, China; School of Psychology, Nanjing Normal University, Nanjing, Jiangsu,210097, China; Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, 210029, China.
| | - Ning Zhang
- Nanjing Brain Hospital Affiliated to Nanjing Medical University, Nanjing, Jiangsu, 210029, China; Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, Jiangsu, 210029, China
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Bzdúšková D, Marko M, Hirjaková Z, Kimijanová J, Hlavačka F, Riečanský I. The Effects of Virtual Height Exposure on Postural Control and Psychophysiological Stress Are Moderated by Individual Height Intolerance. Front Hum Neurosci 2022; 15:773091. [PMID: 35095450 PMCID: PMC8789875 DOI: 10.3389/fnhum.2021.773091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/14/2021] [Indexed: 12/21/2022] Open
Abstract
Virtual reality (VR) enables individuals to be exposed to naturalistic environments in laboratory settings, offering new possibilities for research in human neuroscience and treatment of mental disorders. We used VR to study psychological, autonomic and postural reactions to heights in individuals with varying intensity of fear of heights. Study participants (N = 42) were immersed in a VR of an unprotected open-air elevator platform in an urban area, while standing on an unstable ground. Virtual elevation of the platform (up to 40 m above the ground level) elicited robust and reliable psychophysiological activation including increased distress, heart rate, and electrodermal activity, which was higher in individuals suffering from fear of heights. In these individuals, compared with individuals with low fear of heights, the VR height exposure resulted in higher velocity of postural movements as well as decreased low-frequency (<0.5 Hz) and increased high-frequency (>1 Hz) body sway oscillations. This indicates that individuals with strong fear of heights react to heights with maladaptive rigidity of posture due to increased weight of visual input for balance control, while the visual information is less reliable at heights. Our findings show that exposure to height in a naturalistic VR environment elicits a complex reaction involving correlated changes of the emotional state, autonomic activity, and postural balance, which are exaggerated in individuals with fear of heights.
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Affiliation(s)
- Diana Bzdúšková
- Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Martin Marko
- Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
- Department of Applied Informatics, Faculty of Mathematics, Physics and Informatics, Comenius University in Bratislava, Bratislava, Slovakia
| | - Zuzana Hirjaková
- Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Jana Kimijanová
- Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| | - František Hlavačka
- Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Igor Riečanský
- Department of Behavioural Neuroscience, Institute of Normal and Pathological Physiology, Centre of Experimental Medicine, Slovak Academy of Sciences, Bratislava, Slovakia
- Social, Cognitive and Affective Neuroscience Unit, Department of Cognition, Emotion, and Methods in Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
- Department of Psychiatry, Faculty of Medicine, Slovak Medical University in Bratislava, Bratislava, Slovakia
- *Correspondence: Igor Riečanský,
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Rimer E, Husby LV, Solem S. Virtual Reality Exposure Therapy for Fear of Heights: Clinicians' Attitudes Become More Positive After Trying VRET. Front Psychol 2021; 12:671871. [PMID: 34335386 PMCID: PMC8319686 DOI: 10.3389/fpsyg.2021.671871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/23/2021] [Indexed: 12/24/2022] Open
Abstract
Background Virtual reality exposure therapy (VRET) has the potential to solve logistic challenges when treating specific phobias. However, VRET has yet to see a large-scale implementation in clinical settings despite positive findings in treatment trials. This may partly be due to attitudes and lack of experience among clinicians, but also because of expensive and stationary VR solutions. Objective This study tested whether modern, wireless, commercially available VR equipment with controller-free hand tracking could induce and reduce discomfort using scenarios designed for fear of heights. Also, the study tested if clinicians’ attitudes toward using VR in therapy changed after trying it themselves. Method Attitudes to using VR in therapy and discomfort ratings were assessed for 74 clinicians before and after completing two VR scenarios. In addition, 54 non-clinicians completed the same scenarios. Participants were not diagnosed with acrophobia. Results The VR scenarios induced discomfort comparable to participants’ reported fear of heights in real life. Repeated training reduced discomfort. Positive attitudes toward use of VR in therapy was predicted by previous experience with VR, as well as positive attitudes toward novel technology and exposure therapy. Clinicians’ attitudes became more favorable after trying VRET themselves. Clinicians reported a range of possible advantages and disadvantages of using VR in therapy. Conclusion VRET for fear of heights was able to induce and reduce discomfort in clinicians and non-clinicians, and clinicians’ attitudes toward using VRET become more positive after trying VRET for themselves. The latest generation of VR solutions has potential to improve clinical availability and treatment options. Future research should explore how VRET can be implemented in clinical settings.
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Affiliation(s)
- Elise Rimer
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Vågsholm Husby
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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