Effectiveness of a smartphone-based, augmented reality exposure app to reduce fear of spiders in real-life: A randomized controlled trial

Augmented Reality as an Aid to Behavior Therapy for Anxiety Disorders: A Narrative Review

Anxiety disorders are among the most common mental disorders worldwide. These conditions are characterized by excessive anxiety that is difficult to control. In most anxiety disorders, symptoms are triggered by exposure to specific objects or situations. This leads sufferers to avoid such exposures, leading to impaired social and occupational functioning and reduced quality of life. Therapies based on behavioral principles, either alone or in combination with cognitive techniques, are the most effective psychological interventions for anxiety disorders. However, the effectiveness of these therapies may be limited due to a lack of generalization from clinic to real-world settings. Augmented reality (AR) is a technology that provides an interactive experience by superimposing computer-generated content, often in multiple sensory modalities, on the real world. Emerging evidence suggests that AR may be useful in treating a broad range of mental disorders, including anxiety disorders. This review examines the evidence for the use of AR-based techniques as an aid to behavioral or cognitive-behavioral therapies for anxiety disorders. The available evidence suggests that this method may offer significant advantages over conventional therapies, particularly in the case of specific phobias, but also in social anxiety disorder. AR can also be combined with other novel technologies to monitor psychophysiological markers of anxiety and its reduction over the course of treatment. The advantages of AR could be related to its combination of real and simulated content, allowing for better generalization of the benefits of conventional exposure-based therapy. Though the safety, efficacy, and cost-effectiveness of this method need to be confirmed in larger samples, it could lead to a paradigm shift in the way behavioral therapies for anxiety disorders are conceptualized and delivered.

The efficacy of augmented reality exposure therapy in the treatment of spider phobia-a randomized controlled trial

The evidence for the use of Augmented Reality (AR) in treating specific phobias has been growing. However, issues of accessibility persist, especially in developing countries. The current study examined a novel, but relatively simple therapist guided smartphone-based AR Exposure Treatment (ARET) of spider phobia. Participants who reported symptoms of Arachnophobia were randomized into one of three comparison groups: ARET (n = 20), traditional in vivo exposure therapy (IVET; n = 18) and a waitlist control group (n = 17). Behavioral approach, subjective symptom measures, and galvanic skin response were assessed pre- and post-treatment. The study was concluded with a one-month follow up assessment. Results indicated that both treatment groups showed statistically significant and clinically meaningful improvements in behavioral approach at post-test that were maintained at 1 month follow- up, compared to the wait-listed group. Moreover, the treatment groups demonstrated significant improvements in subjective symptom report at 1-month follow up. Given its utility and potential accessibility, our findings suggest that future AR evaluation research could be conducted in therapy settings with minimal resources.

The Efficacy and Therapeutic Alliance of Augmented Reality Exposure Therapy in Treating Adults With Phobic Disorders: Systematic Review

BACKGROUND

Phobic disorders are characterized by excessive fear of a stimulus that can affect the quality of a patient's life. The lifetime prevalence in adults is 7.7% to 12.5%. The current literature provides evidence-based inferences about the effectiveness of in-vivo exposure therapy (IVET) in treating phobia. However, this method can put the therapist and the client in danger, with high drop out and refusal rates. A newer approach for exposure therapy using augmented reality technology is under assessment.

OBJECTIVE

This systematic review investigated the novel technology's efficacy, cost-efficacy, and therapeutic alliance in treating adults with phobia.

METHODS

An extensive search was conducted using 4 major databases (MEDLINE, PsycINFO, Embase, and Scopus) using a comprehensive list of synonyms for augmented reality exposure therapy (ARET) and phobic disorders. The search targeted any randomized control trial testing ARET in adults with phobic disorders up to August 8, 2022.

RESULTS

A total of 6 studies were included, with 208 participants providing results. Studies investigating the efficacy of ARET compared to no intervention showed significant results (P<.05) in the ARET group improvement. Head-to-head comparative studies comparing ARET to IVET showed no significant difference (P>.05) in the effectiveness and therapeutic alliance between both therapies. Further, the results demonstrated that the ARET group had a better long-term effect than IVET, with the ability to put the patients in more situations to face the feared object.

CONCLUSIONS

The current data suggest clinically significant efficacy and a promising therapeutic alliance of ARET. However, no data are available investigating the cost-effectiveness of ARET. Further research is warranted to ascertain ARET's cost-effectiveness and examine its efficacy in other populations and anxiety conditions.

Mixed results for exposure and response prevention therapy in mixed reality for patients with contamination-related obsessive-compulsive disorder: A randomized controlled pilot study

INTRODUCTION

Technology-supported exposure and response prevention (ERP) for patients with obsessive-compulsive disorder (OCD) as tested in clinical research, holds promise but also has limitations. The present study aims to overcome these limitations by using mixed reality for ERP (MERP). The objectives of this pilot study were to evaluate the safety, feasibility, and acceptance of MERP and to identify possible obstacles.

METHODS

Twenty inpatients with contamination-related OCD were recruited and randomized to two conditions: MERP (six sessions in 3 weeks) and care as usual treatment. Patients were assessed before treatment (baseline), after the 3-week intervention period (post), as well as 3 months after post assessment (follow-up) regarding symptomatology (Y-BOCS).

RESULTS

Results showed a similar reduction in symptomatology in both groups from baseline to post. Regarding safety, no clinically significant deterioration was detected in the MERP group. Patients' evaluation of the MERP was heterogeneous. The qualitative feedback provided helpful indications for further development of the software. Sense of presence was below the midpoint of the scales.

CONCLUSION

This is the first study evaluating a MERP for patients with OCD that shows cautious evidence for the acceptance and safety of MERP. The results of the subjective evaluation suggest revisions of the software.

Use of augmented reality in mental health-related conditions: A systematic review

Objective

Augmented reality (AR) is a relatively new technology that merges virtual and physical environments, augmenting one's perception of reality. AR creates a computer-generated environment that evokes a unique perception of reality, where real and virtual objects are registered with one another, which operates interactively and in real time. Recently, the medical application of AR technology has dramatically increased with other assisted technologies, from training to clinical practice. The ability to manipulate the real environment extensively has given AR interventions an advantage over traditional approaches. In this study, we aim to conduct a systematic review of the use of AR to have a better understanding of how the use of AR may affect patients with mental health-related conditions when combined with gamification.

Method

This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines by searching Pubmed and Web of Science databases.

Results and Conclusion

We identified 48 relevant studies that fulfill the criteria. The studies were grouped into four categories: Neurodevelopmental disorders, anxiety and phobia, psychoeducation & well-being, and procedural & pain management. Our results revealed the effectiveness of AR in mental health-related conditions. However, the heterogeneity and small sample sizes demonstrate the need for further research with larger sample sizes and high-quality study designs.

Augmented reality as a novel approach for addiction treatment: development of a smoking cessation app

OBJECTIVE

Augmented reality (AR) is a rapidly developing technology that has substantial potential as a novel approach for addiction treatment, including tobacco use. AR can facilitate the delivery of cue exposure therapy (CET) such that individuals can experience the treatment in their natural environments as viewed via a smartphone screen, addressing the limited generalizbility of extinction learning. Previously, our team developed a basic AR app for smoking cessation and demonstrated the necessary mechanisms for CET. Specifically, we showed that the AR smoking cues, compared to neutral cues, elicited substantial cue reactivity (i.e. increased urge) and that repeated exposure to the AR smoking cues reduced urge (i.e. extinction) in a laboratory setting. Here we report the next step in the systematic development of the AR app, in which we assessed the usability and acceptability of the app among daily smokers in their natural environments.

METHOD

Daily smokers (N = 23, 78.3% female, Mean Age = 43.4, Mean Cigarettes/Day = 14.9), not actively quitting, were instructed to use the AR app in locations and situations where they smoke (e.g. home, bar) at least 5 times per day over one week. The study is registered in clinicaltrials.gov (NCT04101422).

RESULTS

Results indicated high usability and acceptability. Most of the participants (73.9%) used the AR app on at least 5 days. Participants found the AR cues realistic and well-integrated in their natural environments. The AR app was perceived as easy to use (Mean = 4.1/5) and learn (mean of 2 days to learn). Overall satisfaction with the app was also high. Secondary analyses found that 56.5% reported reduced smoking, with an average 26% reduction in cigarettes per day at follow-up.

CONCLUSIONS

These findings set the stage for a randomized controlled trial testing the AR app as an adjuvant therapy for treating tobacco dependence, with potential applicability to other substances. KEY MESSAGEThis study found that the augmented reality (AR) smartphone application that utlized cue exposure treatment for smoking cessation was perceived as easy to use and learn in the natural, day-to-day environment of daily smokers. Findings set the stage for a larger clinical trial testing the AR app as an adjuvant therapy for treating tobacco dependence, with potential applicability to other addictive behaviors.

Extended reality for mental health: Current trends and future challenges

Virtual and augmented reality have been used to diagnose and treat several mental health disorders for decades. Technological advances in these fields have facilitated the availability of commercial solutions for end customers and practitioners. However, there are still some barriers and limitations that prevent these technologies from being widely used by professionals on a daily basis. In addition, the COVID-19 pandemic has exposed a variety of new scenarios in which these technologies could play an essential role, like providing remote treatment. Disorders that traditionally had received less attention are also getting in the spotlight, such as depression or obsessive-compulsive disorder. Improvements in equipment and hardware, like Mixed Reality Head Mounted Displays, could help open new opportunities in the mental health field. Extended reality (XR) is an umbrella term meant to comprise Virtual reality (VR), mixed reality (MR), and augmented reality (AR). While XR applications are eminently visual, other senses are being explored in literature around multisensory interactions, such as auditory, olfactory, or haptic feedback. Applying such stimuli within XR experiences around mental disorders is still under-explored and could greatly enrich the therapeutic experience. This manuscript reviews recent research regarding the use of XR for mental health scenarios, highlighting trends, and potential applications as well as areas for improvement. It also discusses future challenges and research areas in upcoming topics such as the use of wearables, multisensory, and multimodal interaction. The main goal of this paper is to unpack how these technologies could be applied to XR scenarios for mental health to exploit their full potential and follow the path of other health technologies by promoting personalized medicine.

Automated app-based augmented reality cognitive behavioral therapy for spider phobia: Study protocol for a randomized controlled trial

Background

Fear of spiders, or Arachnophobia, is one of the most common specific phobias. The gold standard treatment, in vivo exposure therapy, is effective, but comes with significant limitations, including restricted availability, high costs, and high refusal rates. Novel technologies, such as augmented reality, may help to overcome these limitations and make Exposure Therapy more accessible by using mobile devices.

Objective

This study will use a Randomized Controlled Trial design to investigate whether ZeroPhobia: Arachnophobia, a 6-week Augmented Reality Exposure Therapy smartphone self-help application, can effectively reduce spider phobia symptoms. Additionally, we will examine user-friendliness of the application and the effect of usage intensity and presence on treatment outcome.

Methods

This study is registered in the Netherlands Trial Registry under NL70238.029.19 (Trial NL9221). Ethical approval was received on October 11, 2019. One-hundred-twelve participants (age 18–64, score ≥ 59) on the Fear of Spiders Questionnaire [FSQ] will be recruited from the general Dutch population and randomly assigned to a treatment or waitlist control group. The ZeroPhobia application can be accessed on users’ smartphone. Baseline, post-test (i.e., at six weeks), 3- and 12-month follow-up assessments will be done, each including the Fear of Spiders Questionnaire as the main outcome measure as well as additional measures of anxiety, depression, user-friendliness, and presence as secondary measures and covariates.

Results

The study was funded on September 25, 2018. Data collection started in September 2021 and the study is expected to run until September 2022.

Conclusions

Our study will improve our understanding of the efficacy and feasibility of providing Exposure Therapy for spider phobia using an Augmented Reality self-help application, with the intention of making mental health care more accessible.

Augmented Reality and Virtual Reality in Dentistry: Highlights from the Current Research

Many modern advancements have taken place in dentistry that have exponentially impacted the progress and practice of dentistry. Augmented reality (AR) and virtual reality (VR) are becoming the trend in the practice of modern dentistry because of their impact on changing the patient’s experience. The use of AR and VR has been beneficial in different fields of science, but their use in dentistry is yet to be thoroughly explored, and conventional ways of dentistry are still practiced at large. Over the past few years, dental treatment has been significantly reshaped by technological advancements. In dentistry, the use of AR and VR systems has not become widespread, but their different uses should be explored. Therefore, the aim of this review was to provide an update on the contemporary knowledge, to report on the ongoing progress of AR and VR in various fields of dental medicine and education, and to identify the further research required to achieve their translation into clinical practice. A literature search was performed in PubMed, Scopus, Web of Science, and Google Scholar for articles in peer-reviewed English-language journals published in the last 10 years up to 31 March 2021, with the help of specific keywords related to AR and VR in various dental fields. Of the total of 101 articles found in the literature search, 68 abstracts were considered suitable and further evaluated, and consequently, 33 full-texts were identified. Finally, a total of 13 full-texts were excluded from further analysis, resulting in 20 articles for final inclusion. The overall number of studies included in this review was low; thus, at this point in time, scientifically-proven recommendations could not be stated. AR and VR have been found to be beneficial tools for clinical practice and for enhancing the learning experiences of students during their pre-clinical education and training sessions. Clinicians can use VR technology to show their patients the expected outcomes before the undergo dental procedures. Additionally, AR and VR can be implemented to overcome dental phobia, which is commonly experienced by pediatric patients. Future studies should focus on forming technological standards with high-quality data and developing scientifically-proven AR/VR gadgets for dental practice.