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Miegel F, Lohse L, Jelinek L, Scheunemann J, Gabbert T, Schauenburg G, Bittner L, Mostajeran F, Kühn S, Gallinat J, Yassari A. Digital nature: Unveiling the impact and safety of FlowVR group intervention for depression in a feasibility trial. Acta Psychiatr Scand 2024. [PMID: 39049561 DOI: 10.1111/acps.13731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/17/2024] [Accepted: 06/29/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE This study addresses the limitations of existing interventions for depression, such as a deficit-oriented focus, overlooking the utilization of positive elements such as nature, and neglecting the incorporation of group effects. The present feasibility study examines FlowVR, a resource-oriented, nature-inspired virtual reality (VR)-based group therapy. Previously tested individually in a pilot study for non-clinical participants, FlowVR has demonstrated positive effects on depressive symptoms. This study assesses the impact and safety of FlowVR in a group setting within a clinical sample using a one-armed study design. METHOD Forty-two inpatients and day patients with depression were recruited. Before and after the FlowVR intervention period of 4 weeks (two sessions per week), depressive symptoms were assessed (Beck Depression Inventory-II; BDI). Symptomatology (i.e., depressive symptoms), depression-associated variables (i.e., self-efficacy), intervention-specific variables (feeling of flow), and VR-specific variables (simulator sickness) were assessed before and after each session. RESULTS Linear mixed effect models showed that symptomatology (depression, negative affect, current anxiety), depression-associated constructs (self-efficacy, motivation), and intervention-specific variables (flow) improved over the course of the sessions. No variable deteriorated more in one session compared to any other session. The lasso regression identified five potential predictors for the change in depression (BDI-II), yet these could not be validated in a subsequent linear regression analysis. CONCLUSION To conclude, FlowVR had the hypothesized positive impact over the course of the sessions, showing, for example, improvements in symptomatology. The sessions have demonstrated safety with no notable deteriorations. Therefore, FlowVR is deemed safe for clinical patients and group settings. However, further research is needed to explore predictors for the change in depression.
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Affiliation(s)
- Franziska Miegel
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Luzie Lohse
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Scheunemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tana Gabbert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gesche Schauenburg
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Bittner
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Human-Computer Interaction Group, Department of Informatics, Universität Hamburg, Hamburg, Germany
| | - Fariba Mostajeran
- Human-Computer Interaction Group, Department of Informatics, Universität Hamburg, Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Environmental Neuroscience, Max Planck Institute for Human Development, Berlin, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Amir Yassari
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Jackson RW, Cao-Nasalga A, Chieng A, Pirkl A, Jagielo AD, Xu C, Goldenhersch E, Rosencovich N, Waitman C, Prochaska JJ. Adding Virtual Reality Mindful Exposure Therapy to a Cancer Center's Tobacco Treatment Offerings: Feasibility and Acceptability Single-Group Pilot Study. JMIR Form Res 2024; 8:e54817. [PMID: 39042439 DOI: 10.2196/54817] [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: 11/22/2023] [Revised: 04/25/2024] [Accepted: 05/29/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Smoking contributes to 1 in 3 cancer deaths. At the Stanford Cancer Center, tobacco cessation medication management and counseling are provided as a covered benefit. Patients charted as using tobacco are contacted by a tobacco treatment specialist and offered cessation services. As a novel addition, this study examined the acceptability of a virtual reality (VR) mindful exposure therapy app for quitting smoking called MindCotine. OBJECTIVE The objective of this study was to determine the feasibility and acceptability of offering 6 weeks of MindCotine treatment as a part of Stanford's Tobacco Treatment Services for patients seen for cancer care. METHODS As part of a single-group pilot study, the MindCotine VR program was offered to English- or Spanish-speaking patients interested in quitting smoking. Given the visual interface, epilepsy was a medical exclusion. Viewed from a smartphone with an attachable VR headset, MindCotine provides a digital environment with audiovisual content guiding mindfulness exercises (eg, breathing techniques, body awareness, and thought recognition), text-based coaching, and cognitive behavioral therapy-based self-reflections for quitting smoking. Interested patients providing informed consent were mailed a MindCotine headset and asked to use the app for 10+ minutes a day. At the end of 6 weeks, participants completed a feedback survey. RESULTS Of the 357 patients reached by the tobacco treatment specialist, 62 (17.3%) were ineligible, 190 (53.2%) were not interested in tobacco treatment services, and 78 (21.8%) preferred other tobacco treatment services. Among the 105 eligible and interested in assistance with quitting, 27 (25.7%) were interested in MindCotine, of whom 20 completed the informed consent, 9 used the program, and 8 completed their end-of-treatment survey. Participants using MindCotine completed, on average, 13 (SD 20.2) program activities, 19 (SD 26) journal records, and 11 (SD 12.3) coaching engagements. Of the 9 participants who used MindCotine, 4 (44%) reported some dizziness with app use that resolved and 7 (78%) would recommend MindCotine to a friend. In total, 2 participants quit tobacco (22.2% reporting, 10% overall), 2 others reduced their smoking by 50% or more, and 2 quit for 24 hours and then relapsed. CONCLUSIONS In a feasibility and acceptability pilot study of a novel VR tobacco treatment app offered to patients at a cancer center, 4 of 9 (44%) reporting and 4 of 20 (20%) overall substantially reduced or quit using tobacco after 6 weeks and most would recommend the app to others. Further testing on a larger sample is warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT05220254; https://clinicaltrials.gov/study/NCT05220254.
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Affiliation(s)
| | - Ann Cao-Nasalga
- Health Education, Engagement and Promotion, Stanford Health Care, Stanford, CA, United States
| | - Amy Chieng
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Palo Alto, CA, United States
| | - Amy Pirkl
- Health Education, Engagement and Promotion, Stanford Health Care, Stanford, CA, United States
| | - Annemarie D Jagielo
- PGSP-Stanford PsyD Consortium, Palo Alto University, Palo Alto, CA, United States
| | - Cindy Xu
- Health Education, Engagement and Promotion, Stanford Health Care, Stanford, CA, United States
| | - Emilio Goldenhersch
- Laboratorio de Investigación en Neurociencia y Ciencias Sociales, Universidad de Flores, Buenos Aires, Argentina
| | - Nicolas Rosencovich
- Escuela de Ingeniería Biomédica, Universidad Nacional de Córdoba, Córdoba, Argentina
| | | | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Palo Alto, CA, United States
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Banakou D, Johnston T, Beacco A, Senel G, Slater M. Desensitizing Anxiety Through Imperceptible Change: Feasibility Study on a Paradigm for Single-Session Exposure Therapy for Fear of Public Speaking. JMIR Form Res 2024; 8:e52212. [PMID: 39037760 DOI: 10.2196/52212] [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: 08/26/2023] [Revised: 04/29/2024] [Accepted: 05/08/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND Exposure therapy (ET) for anxiety disorders involves introducing the participant to an anxiety-provoking situation over several treatment sessions. Each time, the participant is exposed to a higher anxiety-provoking stimulus; for example, in the case of fear of heights, the participant would successively experience being at a greater height. ET is effective, and its counterpart, virtual reality (VR) exposure therapy (VRET), where VR substitutes real-world exposure, is equally so. However, ET is time-consuming, requiring several sessions. OBJECTIVE This study aimed to compare the results of single-session exposure with those of traditional VRET with regard to reducing public speaking anxiety. METHODS We introduced a paradigm concerned with public speaking anxiety where the VR exposure occurred in a single session while the participant interacted with a virtual therapist. Over time, the therapist transformed into an entire audience with almost imperceptible changes. We carried out a feasibility study with 45 participants, comparing 3 conditions: single-session exposure (n=16, 36%); conventional multiple-session exposure (n=14, 31%), where the same content was delivered in successive segments over 5 sessions; and a control group (n=15, 33%), who interacted with a single virtual character to talk about everyday matters. A week later, the participants were required to speak on a stage in front of a large audience in VR. RESULTS Across most of the series of conventional public speaking anxiety measures, the single-session exposure was at least as effective in reducing anxiety as the multiple-session exposure, and both these conditions were better than the control condition. The 12-item Personal Report of Confidence as a Speaker was used to measure public speaking anxiety levels, where higher values indicated more anxiety. Using a Bayesian model, the posterior probabilities of improvement compared to a high baseline were at least 1.7 times greater for single- and multiple-session exposures compared to the control group. The State Perceived Index of Competence was used as a measure of anticipatory anxiety for speaking on a stage in front of a large audience, where lower values indicated higher anxiety. The probabilities of improvement were just over 4 times greater for single- and multiple-session exposures compared to the control group for a low baseline and 489 (single) and 53 (multiple) times greater for a middle baseline. CONCLUSIONS Overall, the results of this feasibility study show that for moderate public speaking anxiety, the paradigm of gradual change in a single session is worth following up with further studies with more severe levels of anxiety and a larger sample size, first with a randomized controlled trial with nonpatients and subsequently, if the outcomes follow those that we have found, with a full clinical trial with patients.
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Affiliation(s)
- Domna Banakou
- Event Lab, Department of Clinical Psychology and Psychobiology, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Tania Johnston
- Systems Neuroscience, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | - Alejandro Beacco
- Event Lab, Department of Clinical Psychology and Psychobiology, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Gizem Senel
- Event Lab, Department of Clinical Psychology and Psychobiology, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Mel Slater
- Event Lab, Department of Clinical Psychology and Psychobiology, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
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Vasdev N, Gupta T, Pawar B, Bain A, Kumar Tekade R. Navigating the future of health care with AI-driven digital therapeutics. Drug Discov Today 2024:104110. [PMID: 39034025 DOI: 10.1016/j.drudis.2024.104110] [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: 03/10/2024] [Revised: 07/01/2024] [Accepted: 07/16/2024] [Indexed: 07/23/2024]
Abstract
Digital therapeutics (DTx) is a recently conceived idea in health care that aims to cure ailments and modify patient behavior by employing a range of digital technologies. Notably, when traditional medication is not entirely efficacious, DTx offers an innovative avenue for treatments linked to dysfunctional behaviors and lifestyle management. DTx involves extremely adaptable therapeutic devices that empower greater patient engagement in treating illness, using algorithms to collect, transfer and analyze the patient's data. Efficient clinical monitoring and supervision at the individual level by remote access and algorithms for a range of diseases is made possible by integrating machine learning and artificial intelligence with DTx. There is a potentially large worldwide market for DTx owing to its convenient, personalized therapies.
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Affiliation(s)
- Nupur Vasdev
- National Institute of Pharmaceutical Education and Research (NIPER) Ahmedabad, An Institute of National Importance, Government of India, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Palaj, Opp. Air Force Station, Gandhinagar, 382355, Gujarat, India
| | - Tanisha Gupta
- National Institute of Pharmaceutical Education and Research (NIPER) Ahmedabad, An Institute of National Importance, Government of India, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Palaj, Opp. Air Force Station, Gandhinagar, 382355, Gujarat, India
| | - Bhakti Pawar
- National Institute of Pharmaceutical Education and Research (NIPER) Ahmedabad, An Institute of National Importance, Government of India, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Palaj, Opp. Air Force Station, Gandhinagar, 382355, Gujarat, India
| | - Anoothi Bain
- National Institute of Pharmaceutical Education and Research (NIPER) Ahmedabad, An Institute of National Importance, Government of India, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Palaj, Opp. Air Force Station, Gandhinagar, 382355, Gujarat, India
| | - Rakesh Kumar Tekade
- National Institute of Pharmaceutical Education and Research (NIPER) Ahmedabad, An Institute of National Importance, Government of India, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Palaj, Opp. Air Force Station, Gandhinagar, 382355, Gujarat, India.
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Ng WHD, Ang WHD, Fukahori H, Goh YS, Lim WS, Siah CJR, Seah B, Liaw SY. Virtual reality-based reminiscence therapy for older adults to improve psychological well-being and cognition: A systematic review. J Clin Nurs 2024. [PMID: 39020507 DOI: 10.1111/jocn.17375] [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: 02/02/2024] [Revised: 05/12/2024] [Accepted: 07/04/2024] [Indexed: 07/19/2024]
Abstract
BACKGROUND Virtual reality-reminiscence therapy (VR-RT) has increasingly been applied to older adults to improve psychological well-being and cognition. OBJECTIVE This review aims to identify (1) the design characteristics of conducting a VR-RT and (2) the effects of VR-RT on the user experience, cognitive outcomes and psychological well-being. DESIGN Systematic review. METHODS Eligible studies were sourced across nine electronic databases, trial registries, grey literature and hand-searching of the reference list. A narrative synthesis was conducted. Twenty-two studies were included, and most were appraised as high quality. Most of the VR-RTs were highly immersive and personalised, with participants having the autonomy of control. VR-RT has the potential to improve anxiety and depression, and cognitive outcomes for older adults. Overall, VR-RT was reported to be an enjoyable experience for older adults. CONCLUSIONS VR-RT is a promising innovation that can improve older adults' psychological well-being and cognition without significant side effects, including cybersickness and with the potential for scalability across various settings. More randomised controlled studies are needed to evaluate the effectiveness of VR-RT and its features and treatment dosage. These studies could also examine the effectiveness of VR-RT as an intervention to promote independence in activities of daily living and physical rehabilitation. RELEVANCE TO CLINICAL PRACTICE VR-RT is a promising intervention for older adults in community settings to enhance psychological well-being and cognition. VR's versatility enables personalised experiences within dynamic virtual environments, possibly enhancing engagement and therapeutic outcomes. NO PATIENT OR PUBLIC CONTRIBUTION This systematic review did not directly involve patient or public contribution to the manuscript.
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Affiliation(s)
- Wai Hung Daniel Ng
- National Cancer Centre Singapore, Singapore Health Services, Singapore, Singapore
| | - Wei How Darryl Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hiroki Fukahori
- Faculty of Nursing and Medical Care, Keio University, Fujisawa-City, Japan
| | - Yong Shian Goh
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chiew Jiat Rosalind Siah
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Nursing, Singapore General Hospital, Singapore, Singapore
| | - Betsy Seah
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sok Ying Liaw
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Hignett R, Curran R, Fisher HL, Riches S. Psychologists' experience of working with people who hear voices and their views on the idea of voice simulation training: A qualitative study. Psychol Psychother 2024. [PMID: 38970412 DOI: 10.1111/papt.12540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 06/19/2024] [Indexed: 07/08/2024]
Abstract
OBJECTIVES Research indicates psychologists typically lack subjective understanding of voice hearing. Voice hearing simulation training has potential to improve understanding, empathy and confidence among clinicians, but psychologists have had limited input into its development. This study investigated psychologists' and a psychotherapist's clinical experience of working with people who hear voices and their views and recommendations for voice hearing simulation training. DESIGN This was a qualitative study. METHODS Clinical psychologists and one psychotherapist (N = 17) participated in semi-structured interviews. Thematic analysis was used to analyse transcribed data. RESULTS The Clinical Experience theme comprised of subthemes Barriers to engagement, Diversity of voice hearing experiences, Lack of subjective understanding, Curiosity about voice hearing, Empathy for voice hearers, Using personal experiences to relate to voices, Clinical experience increases knowledge, Importance of supervision and colleague's support, Benefits of experiential training, Limited training in non-psychosis settings and Clinical experience increases confidence. The Views on Voice Hearing Simulation Training theme comprised of subthemes Improves subjective understanding, Concern about distress, Discomfort as a strength of voice hearing simulations, Artificiality of simulation, Increases empathy and Over-estimation of understanding. The Recommendations theme comprised of subthemes Discuss artificiality, Co-production, Promote voice diversity, Support staff and Maximise inclusivity. CONCLUSIONS Findings indicate that clinical experience improves psychologists' confidence and knowledge, yet participants reported a lack of subjective understanding of voice hearing. Co-produced simulation training between individuals who hear voices and clinicians was anticipated to improve subjective understanding, empathy and therapeutic relationships, which could support a range of staff and improve quality of care delivered.
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Affiliation(s)
- Rebecca Hignett
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Rebecca Curran
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Helen L Fisher
- Social, Genetic & Developmental Psychiatry Centre, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Simon Riches
- Social, Genetic & Developmental Psychiatry Centre, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Kent, UK
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Brouwer D, Morrin H, Nicholson TR, Terhune DB, Schrijnemaekers M, Edwards MJ, Gelauff J, Shotbolt P. Virtual reality in functional neurological disorder: a theoretical framework and research agenda for use in the real world. BMJ Neurol Open 2024; 6:e000622. [PMID: 38979395 PMCID: PMC11227774 DOI: 10.1136/bmjno-2023-000622] [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: 12/22/2023] [Accepted: 04/01/2024] [Indexed: 07/10/2024] Open
Abstract
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.
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Affiliation(s)
- David Brouwer
- Department of Neurology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Hamilton Morrin
- Neuropsychiatry Research and Education Group, King's College London Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Timothy R Nicholson
- Neuropsychiatry Research and Education Group, King's College London Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Devin B Terhune
- Neuropsychiatry Research and Education Group, King's College London Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Department of Psychology, King's College London Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | | | - Mark J Edwards
- Neuropsychiatry Research and Education Group, King's College London Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Jeannette Gelauff
- Department of Neurology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
| | - Paul Shotbolt
- Neuropsychiatry Research and Education Group, King's College London Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, King's College London Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Belger J, Blume M, Akbal M, Chojecki P, de Mooij J, Gaebler M, Klotzsche F, Krohn S, Lafci MT, Quinque E, Tromp J, Villringer A, Finke C, Thöne-Otto A. The immersive virtual memory task: Assessing object-location memory in neurological patients using immersive virtual reality. Neuropsychol Rehabil 2024; 34:870-898. [PMID: 37728961 DOI: 10.1080/09602011.2023.2256957] [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] [Received: 03/30/2022] [Accepted: 09/02/2023] [Indexed: 09/22/2023]
Abstract
TRIAL REGISTRATION German Clinical Trials Register identifier: DRKS00024005.
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Affiliation(s)
- Julia Belger
- Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Marie Blume
- Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Mert Akbal
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Paul Chojecki
- Fraunhofer Institute for Telecommunications, Heinrich-Hertz Institute, Berlin, Germany
| | - Jeroen de Mooij
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Michael Gaebler
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Felix Klotzsche
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Stephan Krohn
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mustafa Tevfik Lafci
- Fraunhofer Institute for Telecommunications, Heinrich-Hertz Institute, Berlin, Germany
| | - Eva Quinque
- Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Johanne Tromp
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Arno Villringer
- Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Carsten Finke
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Angelika Thöne-Otto
- Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
- Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
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Blanco D, Roberts RM, Gannoni A, Cook S. Assessment and treatment of mental health conditions in children and adolescents: A systematic scoping review of how virtual reality environments have been used. Clin Child Psychol Psychiatry 2024; 29:1070-1086. [PMID: 37738029 PMCID: PMC11188554 DOI: 10.1177/13591045231204082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
BACKGROUND There is growing interest in the use of virtual reality environments (VREs) in psychological treatment and assessment. Most research has focused on the application of VREs in adult psychological disorders with fewer studies focusing on its applicability with children and adolescents. A systematic scoping review was undertaken of research assessing how VREs have been used in the treatment and assessment of childhood mental health disorders to provide an overview of the current state of the literature and identify future research directions. METHOD Systematic searches of online databases were conducted in PsycInfo, PubMed, Embase, Scopus, and Web of Science. RESULTS Eleven studies met eligibility criteria and were included in this review, with the majority focusing on VRE interventions for anxiety-related disorders. There is also emerging support for VRE deep breathing training for anxiety, VRE assisted treatment of internet gaming disorder and anorexia nervosa, and VRE assessment of body image evaluation in anorexia nervosa. Most studies were pilot and feasibility studies with only three randomised-controlled trials (RCT). CONCLUSIONS The current literature shows some promise for the use of VRE assessments and interventions of childhood mental health problems, particularly for anxiety-related disorders such as social anxiety and specific phobias. However, high-quality RCTs are now needed to establish effectiveness of VREs in this population, and how it compares to existing evidence-based approaches, given its promise to improve both engagement and outcomes.
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Affiliation(s)
- Dana Blanco
- School of Psychology, University of Adelaide, Australia
| | | | - Anne Gannoni
- Child & Adolescent Mental Health Services, Women’s & Children’s Health Network, Australia
| | - Steve Cook
- School of Humanities, University of Adelaide, Australia
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Amonoo HL, Newcomb R, Lorenz KA, Psenka R, Holmbeck K, Farnam EJ, Tse A, Desai S, Vassev N, Waldman LP, El-Jawahri A. A novel psychosocial virtual reality intervention (BMT-VR) for patients undergoing hematopoietic stem cell transplantation: Pilot randomized clinical trial design and methods. Contemp Clin Trials 2024; 142:107550. [PMID: 38685401 PMCID: PMC11180582 DOI: 10.1016/j.cct.2024.107550] [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: 01/03/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Although patients undergoing hematopoietic stem cell transplantation (HSCT) must cope with psychological distress and isolation during an extended transplant hospitalization, psychosocial interventions to address these unmet needs are lacking. Virtual reality offers an innovative modality to deliver a patient-centered psychosocial intervention to address psychosocial needs of patients undergoing HSCT. However, there are currently no supportive care interventions leveraging virtual reality in patients undergoing HSCT. OBJECTIVE To describe the methods of a randomized clinical trial (RCT) to assess the feasibility and preliminary efficacy of a self-administered, virtual reality-delivered psychosocial intervention (BMT-VR) to improve psychological distress and quality of life (QOL) for patients hospitalized for HSCT. METHODS This study entails a single-center RCT of BMT-VR compared to usual transplant care in 80 patients hospitalized for HSCT. Adult patients with hematologic malignancies hospitalized for autologous or allogeneic HSCT are eligible. BMT-VR includes psychoeducation about the HSCT process, psychosocial skill building to promote effective coping and acceptance, and self-care and positive psychology skills to promote post-HSCT recovery. The primary aim is to assess the feasibility defined a priori as ≥60% of eligible patients enrolling in the study, and of those enrolled and randomized to the BMT-VR, ≥ 60% completing 4/6 BMT-VR modules. Secondary objectives include assessing the preliminary effects on psychological distress and QOL. DISCUSSION This is the first RCT of a virtual reality-delivered psychosocial intervention for the HSCT population. If deemed feasible, a future larger multi-site clinical trial can evaluate the efficacy of BMT-VR on outcomes for patients hospitalized for HSCT.
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Affiliation(s)
- Hermioni L Amonoo
- Department of Psychosocial Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Richard Newcomb
- Harvard Medical School, Boston, MA, USA; Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Karl A Lorenz
- Division of Primary Care and Population Health, Section of Palliative Care, Palo Alto VA Health Care System, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Riley Psenka
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Katherine Holmbeck
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Emelia J Farnam
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Alexandra Tse
- Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Lauren P Waldman
- Harvard Medical School, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Areej El-Jawahri
- Harvard Medical School, Boston, MA, USA; Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
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Marques JM, Figueiredo CPM, Scanavino MDT. A review of published studies on virtual reality in sexuality research. Sex Med Rev 2024; 12:371-386. [PMID: 38705842 DOI: 10.1093/sxmrev/qeae024] [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] [Received: 11/20/2023] [Revised: 03/14/2024] [Accepted: 03/29/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Virtual reality (VR) technology contributes to greater approach of methodological safety to make ecological validity more feasible and a growing interest in sexuality behaviors. OBJECTIVES The aim of this study was to show VR in the sexuality area by a comprehensive review of outcomes, offer a synthesis of the studies, and make a methodological quality assessment of finding results. A secondary goal was to investigate the effect of immersion on diverse sexual responses outcomes. METHODS We designed a review based on a systematic review strategy describing types of studies, participants, data collection and outcomes; searched in 4 electronic databases (PubMed, EMBASE, PsycINFO, and SciELO), and made a full-text screening process. RESULTS The study found 18 articles that met research criteria synthesized within 3 outcome groups: erection measures, level of immersion, and biomarker studies. Synthesis shows a lack of methodological aspects that impair results, such as description of methods from bias protection, randomization, or concealment. The literature still needs to improve its methodology, even though it already shows relevant data for intervention in sexual dysfunction, forensic psychiatry, sexual attraction, orientation, and use of pornography. CONCLUSION Current methodological issues need better design to highlight relevant issues in sexuality with stronger quality of design, opening boundaries to new diagnostic or interventional technologies to sexual health.
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Affiliation(s)
- João Miguel Marques
- Excessive Sexual Drive and Prevention of Negative Outcome Associated to Sexual Behavior Outpatient Unit, Institute of Psyquiatry (IPq) Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Caio Petrus Monteiro Figueiredo
- Institute of Psyquiatry (IPq) Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Marco D T Scanavino
- Excessive Sexual Drive and Prevention of Negative Outcome Associated to Sexual Behavior Outpatient Unit, Institute of Psyquiatry (IPq) Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Experimental Pathophysiology Post Graduation Program, Institute of Psyquiatry (IPq) Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
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Li Y, Muschalla B. Virtual Reality Mental Health Interventions in Geriatric Care for Functional or Well-being Enhancement - A Scoping Review. DIE REHABILITATION 2024. [PMID: 38885655 DOI: 10.1055/a-2316-6541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
PURPOSE It has become common to use Virtual Reality (VR) for mental health interventions; however, its use in care of the elederly is limited, especially regarding mood and well-being. In this review, we summarize the results of current VR-based mental health interventions for this population. METHODS Peer-reviewed journal articles on immersive VR mental health intervention in seniors, published until 2022, were included. RESULTS There were 2697 results found in the database search, of which 40 articles met the inclusion criteria and were included in the final analysis. Most studies did not use an experimental design with randomized controlled trials and follow-up sessions. Function-oriented and entertainment-oriented intervention studies were categorized. VR-based geriatric mental interventions have grown rapidly since 2018, especially the number of interventions that promote wellbeing. The function-oriented intervention used active interactions with varied devices. Entertainment-oriented interaction was primarily passive, seldomly using hand controllers for moving activities. Generally, VR interventions improved the mental health of older adults. CONCLUSION Geriatric rehabilitation can benefit from this innovative technology to maintain cognitive functions and to improve the well-being of seniors. They have potential for use in aging care and in retirement homes. Future VR intervention may also involve promoting social interaction to combat loneliness among seniors.
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Li Q, Yang Z, Liu X, Zhang Q, Li M, Hu R, Huang L, Yu Q, Dai M. Perioperative use of immersive head-mounted virtual reality display enhances patient satisfaction in great saphenous vein surgery: a single-center clinical observation study. Am J Transl Res 2024; 16:2445-2452. [PMID: 39006251 PMCID: PMC11236645 DOI: 10.62347/kose3119] [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: 03/05/2024] [Accepted: 05/24/2024] [Indexed: 07/16/2024]
Abstract
OBJECTIVE To explore the application effect of head-mounted virtual reality display immersive experience in improving the perioperative satisfaction of patients undergoing great saphenous vein surgery. METHODS A total of 158 patients undergoing saphenous vein surgery at the First Affiliated Hospital, Jiangxi Medical College, Nanchang University from January 2020 to January 2023 were randomly divided into an observation group and a control group in a 1:1 ratio, with 79 cases in each group. The observation group received head-mounted display virtual reality immersive experience, whereas the control group received midazolam. The study compared the perioperative satisfaction, changes in preoperative and postoperative anxiety and depression scores, intraoperative blood pressure and heart rate, postoperative visual analog scale (VAS) score, and the incidence of postoperative nausea and vomiting between the two groups. Additionally, the satisfaction of patients, anesthesiologists, and chief surgeons was compared. RESULTS All surgeries were completed successfully. Patients in the observation group exhibited higher perioperative satisfaction compared to those in the control group (P<0.001). There were no significant differences in anxiety or depression scores between the two groups before surgery (P>0.05). However, both groups showed a reduction in anxiety and depression scores postoperatively, with the observation group demonstrating lower scores than the control group (both P<0.05). The observation group also had lower intraoperative blood pressure, heart rate, postoperative VAS scores, and incidence of nausea and vomiting compared to the control group (all P<0.05). Furthermore, the satisfaction levels of the anesthesiologists and chief surgeons were higher in the observation group than in the control group (P=0.043, 0.012). CONCLUSION Head-mounted display virtual reality immersive experience can enhance perioperative satisfaction among patients undergoing great saphenous vein surgery, reduce anxiety and depression scores, and contribute to the stabilization of hemodynamics during surgery, thereby decreasing postoperative nausea and vomiting.
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Affiliation(s)
- Qianqian Li
- Department of Anesthesiology and Operative Medicine, Medical Center of Anesthesiology and Pain, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University Nanchang 330052, Jiangxi, China
| | - Zichang Yang
- Department of The First Clinical Medical College, Jiangxi Medical College, Nanchang University Nanchang 330052, Jiangxi, China
| | - Xuyang Liu
- Department of The First Clinical Medical College, Jiangxi Medical College, Nanchang University Nanchang 330052, Jiangxi, China
| | - Qin Zhang
- Department of Anesthesiology and Operative Medicine, Medical Center of Anesthesiology and Pain, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University Nanchang 330052, Jiangxi, China
| | - Mengyuan Li
- Department of Anesthesiology and Operative Medicine, Medical Center of Anesthesiology and Pain, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University Nanchang 330052, Jiangxi, China
| | - Ruilin Hu
- Department of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University Nanchang 330052, Jiangxi, China
| | - Lianghui Huang
- Department of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University Nanchang 330052, Jiangxi, China
| | - Qi Yu
- Department of Anesthesiology and Operative Medicine, Medical Center of Anesthesiology and Pain, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University Nanchang 330052, Jiangxi, China
| | - Min Dai
- Department of General Surgery, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University Nanchang 330052, Jiangxi, China
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Wang Y, Sun J, Yu K, Liu X, Liu L, Miao H, Li T. Virtual reality exposure reduce acute postoperative pain in female patients undergoing laparoscopic gynecology surgery: A Randomized Control Trial (RCT) study. J Clin Anesth 2024; 97:111525. [PMID: 38870701 DOI: 10.1016/j.jclinane.2024.111525] [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: 03/15/2023] [Revised: 04/28/2024] [Accepted: 06/08/2024] [Indexed: 06/15/2024]
Abstract
STUDY OBJECTIVE Few studies have focused on the effect of virtual reality (VR) exposure on postoperative acute pain in adult female patients undergoing gynecology surgery. DESIGN A randomized control trial (RCT) study. SETTING At Beijing Fuxing Hospital. PATIENTS 115 patients aged between 20 and 60 years, American Society of Anesthesiologists (ASA) physical status I - II were consecutively enrolled and randomly divided into VR group (n = 58) or control group (n = 57). INTERVENTIONS Patients in the VR group received 15 min of VR video viewing before surgery. MEASUREMENTS The primary outcome was acute postoperative pain at 8 h which was measured by the Visual Analogue Scale (VAS) scores. The secondary outcomes including the use of analgesic drugs, the incidence of moderate pain and postoperative recovery which were recorded 24 h after surgery. The Hospital Anxiety and Depression Scale (HADS) was also used to evaluate patients' emotional status before surgery. MAIN RESULTS The VAS scores at 30 min [2 (1,2) vs. 3 (2,3)], 2 h [2 (2,3) vs. 4 (3,4)], 4 h [3 (2,4) vs. 4 (4,5)], 8 h [3 (2,4) vs. 4 (4,5)], 12 h [2 (2,3) vs. 4 (3,4)], 24 h [1 (1,2) vs. 3 (2,3)] after surgery. Generalized estimation equation (GEE) indicated that VR intervention was negatively correlated with postoperative VAS values (β = -0.830, S.E = 0.199, 95%CI (-1.220,-0.439), Wald χ2 = 17.359, p<0.05), in the meanwhile, VR also lower the incidence of moderate pain (VAS > 4) at 8 h postoperatively (12.1% vs 31.0%, p = 0.013). However, the 24 h tramadol usage remained unchanged. Patients in the VR group had better sleep quality (6.33 ± 2.3 vs. 4.12 ± 2.5, p < 0.001) and lower incidence of nausea (43.1% vs. 63.2%, p < 0.05), dizziness (0% vs. 14.0%, p < 0.05), and headache (12.1% vs. 29.8%, p < 0.05). VR could reduce the median HADS scores (9.81 ± 6.1 vs 3.14 ± 3.9, p < 0.001) and blood pressure preoperatively. CONCLUSIONS VR intervention can reduce acute postoperative pain with better postoperative recovery and lower preoperative anxiety level in adult female patients undergoing laparoscopic gynecology surgery.
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Affiliation(s)
- Ying Wang
- Department of anesthesiology, Beijing Fuxing Hospital, Capital Medical University, Beijing 100038, China
| | - Jian Sun
- Department of anesthesiology, Beijing Fuxing Hospital, Capital Medical University, Beijing 100038, China
| | - Kang Yu
- Department of anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Xiao Liu
- Department of anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Lei Liu
- Department of Science and Technology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
| | - Huihui Miao
- Department of anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
| | - Tianzuo Li
- Department of anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.
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Schroeder PA, Collantoni E, Lohmann J, Butz MV, Plewnia C. Virtual reality assessment of a high-calorie food bias: Replication and food-specificity in healthy participants. Behav Brain Res 2024; 471:115096. [PMID: 38849007 DOI: 10.1016/j.bbr.2024.115096] [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: 09/04/2023] [Revised: 05/07/2024] [Accepted: 06/04/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Theoretical models and behavioural studies indicate faster approach behaviour for high-calorie food (approach bias) among healthy participants. A previous study with Virtual Reality (VR) and online motion-capture quantified this approach bias towards food and non-food cues in a controlled VR environment with hand movements. The aim of this study was to test the specificity of a manual approach bias for high-calorie food in grasp movements compared to low-calorie food and neutral objects of different complexity, namely, simple balls and geometrically more complex office tools. METHODS In a VR setting, healthy participants (N = 27) repeatedly grasped or pushed high-calorie food, low-calorie food, balls and office tools in randomized order with 30 item repetitions. All objects were rated for valence and arousal. RESULTS High-calorie food was less attractive and more arousing in subjective ratings than low-calorie food and neutral objects. Movement onset was faster for high-calorie food in push-trials, but overall push responses were comparable. In contrast, responses to high-calorie food relative to low-calorie food and to control objects were faster in grasp trials for later stages of interaction (grasp and collect). Non-parametric tests confirmed an approach bias for high-calorie food. CONCLUSION A behavioural bias for food was specific to high-calorie food objects. The results confirm the presence of bottom-up advantages in motor-cognitive behaviour for high-calorie food in a non-clinical population. More systematic variations of object fidelity and in clinical populations are outstanding. The utility of VR in assessing approach behaviour is confirmed in this study by exploring manual interactions in a controlled environment.
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Affiliation(s)
- Philipp A Schroeder
- Department of Psychology, University of Tübingen, Schleichstr. 4, Tübingen 72076, Germany; German Center for Mental Health (DZPG), Germany.
| | - Enrico Collantoni
- Department of Neuroscience, University of Padova, Italy; Padova Neuroscience Center, University of Padova, Italy
| | - Johannes Lohmann
- Cognitive Modeling, Department of Computer Science, University of Tübingen, Sand 14, Tübingen 72076, Germany
| | - Martin V Butz
- Department of Psychology, University of Tübingen, Schleichstr. 4, Tübingen 72076, Germany; Cognitive Modeling, Department of Computer Science, University of Tübingen, Sand 14, Tübingen 72076, Germany
| | - Christian Plewnia
- German Center for Mental Health (DZPG), Germany; Department of Psychiatry and Psychotherapy, Neurophysiology & Interventional Neuropsychiatry, University of Tübingen, Calwerstr. 14, Tübingen 72076, Germany
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Firth J, Torous J, López-Gil JF, Linardon J, Milton A, Lambert J, Smith L, Jarić I, Fabian H, Vancampfort D, Onyeaka H, Schuch FB, Firth JA. From "online brains" to "online lives": understanding the individualized impacts of Internet use across psychological, cognitive and social dimensions. World Psychiatry 2024; 23:176-190. [PMID: 38727074 PMCID: PMC11083903 DOI: 10.1002/wps.21188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2024] Open
Abstract
In response to the mass adoption and extensive usage of Internet-enabled devices across the world, a major review published in this journal in 2019 examined the impact of Internet on human cognition, discussing the concepts and ideas behind the "online brain". Since then, the online world has become further entwined with the fabric of society, and the extent to which we use such technologies has continued to grow. Furthermore, the research evidence on the ways in which Internet usage affects the human mind has advanced considerably. In this paper, we sought to draw upon the latest data from large-scale epidemiological studies and systematic reviews, along with randomized controlled trials and qualitative research recently emerging on this topic, in order to now provide a multi-dimensional overview of the impacts of Internet usage across psychological, cognitive and societal outcomes. Within this, we detail the empirical evidence on how effects differ according to various factors such as age, gender, and usage types. We also draw from new research examining more experiential aspects of individuals' online lives, to understand how the specifics of their interactions with the Internet, and the impact on their lifestyle, determine the benefits or drawbacks of online time. Additionally, we explore how the nascent but intriguing areas of culturomics, artificial intelligence, virtual reality, and augmented reality are changing our understanding of how the Internet can interact with brain and behavior. Overall, the importance of taking an individualized and multi-dimensional approach to how the Internet affects mental health, cognition and social functioning is clear. Furthermore, we emphasize the need for guidelines, policies and initiatives around Internet usage to make full use of the evidence available from neuroscientific, behavioral and societal levels of research presented herein.
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Affiliation(s)
- Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - John Torous
- Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - José Francisco López-Gil
- One Health Research Group, Universidad de las Americas, Quito, Ecuador
- Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Jake Linardon
- School of Psychology, Deakin University, Geelong, VIC, Australia
| | - Alyssa Milton
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Australian Research Council, Centre of Excellence for Children and Families over the Life Course, Sydney, NSW, Australia
| | | | - Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Ivan Jarić
- Laboratoire Ecologie, Systématique et Evolution, Université Paris-Saclay, Gif-sur-Yvette, France
- Biology Centre, Czech Academy of Sciences, České Budějovice, Czech Republic
| | - Hannah Fabian
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
- University Psychiatric Center, KU Leuven, Leuven, Belgium
| | - Henry Onyeaka
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Felipe B Schuch
- Department of Sports Methods and Techniques, Federal University of Santa Maria, Santa Maria, Brazil
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Institute of Health Sciences, Universidad Autônoma de Chile, Providência, Chile
| | - Josh A Firth
- Department of Biology, University of Oxford, Oxford, UK
- School of Biology, University of Leeds, Leeds, UK
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Yan C, Eno A, Wagler A. Mitigating Identity-Related Anxiety through Humor and Immersive Storytelling with 360-Degree Video in Virtual Reality: A Study on Microaggressions' Mental Health Effects. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:713. [PMID: 38928959 PMCID: PMC11203420 DOI: 10.3390/ijerph21060713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/28/2024]
Abstract
Background: Microaggressions are subtle slights that can cause significant psychological distress among marginalized groups. Few studies have explored interventions that might mitigate these effects. Objective: This study aimed to investigate if and how humor-infused immersive storytelling via virtual reality (VR) could reduce identity-related psychological distress caused by microaggressions. Methods: Using a community-based participatory research approach, we developed a 7-min 360-degree VR film depicting scenarios of microaggressions across various identities. Forty-six college students participated in a controlled study where they were exposed to this immersive VR experience. We measured identity-related psychological anxiety, character identification, perceived humor, and perceived psychological presence. Results: The findings demonstrated a significant anxiety reduction following the VR intervention, supporting the efficacy of humor-infused storytelling in alleviating the impact of microaggressions. Character identification significantly predicted anxiety reduction, while perceived humor and psychological presence did not directly influence anxiety reduction but indirectly contributed through enhanced character identification. Conclusions: Humor-infused immersive storytelling, facilitated by VR, effectively reduces identity-related psychological distress primarily through character identification. The structural equation modeling results emphasize the importance of integrating humor and psychological presence to enhance character connection, advocating for a balanced approach that combines traditional narrative elements with technological innovations in health interventions aimed at combating the adverse psychological effects of microaggressions.
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Affiliation(s)
- Changmin Yan
- College of Journalism and Mass Communications, University of Nebraska-Lincoln, Lincoln, NE 68588, USA; (A.E.); (A.W.)
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Selaskowski B, Wiebe A, Kannen K, Asché L, Pakos J, Philipsen A, Braun N. Clinical adoption of virtual reality in mental health is challenged by lack of high-quality research. NPJ MENTAL HEALTH RESEARCH 2024; 3:24. [PMID: 38755289 PMCID: PMC11099044 DOI: 10.1038/s44184-024-00069-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Affiliation(s)
- Benjamin Selaskowski
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, Bonn, Germany.
| | - Annika Wiebe
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Kyra Kannen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Laura Asché
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Julian Pakos
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Niclas Braun
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, Bonn, Germany
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De Jaegere E, van Heeringen K, Emmery P, Mommerency G, Portzky G. Effects of a Serious Game for Adolescent Mental Health on Cognitive Vulnerability: Pilot Usability Study. JMIR Serious Games 2024; 12:e47513. [PMID: 38725223 PMCID: PMC11097755 DOI: 10.2196/47513] [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: 03/22/2023] [Revised: 03/08/2024] [Accepted: 03/24/2024] [Indexed: 05/18/2024] Open
Abstract
Background Adolescent mental health is of utmost importance. E-mental health interventions, and serious games in particular, are appealing to adolescents and can have beneficial effects on their mental health. A serious game aimed at improving cognitive vulnerability (ie, beliefs or attitudes), which can predispose an individual to mental health problems, can contribute to the prevention of these problems in adolescents. Objective This study aimed to assess the feasibility of the prototype of a serious game called "Silver." Methods The prototype of the serious game was developed using a user-centered participatory design. The prototype of Silver focused on 1 aspect of a serious game for improving cognitive vulnerability in adolescents, that is, the recognition and identification of cognitive distortions. Through the game, players were required to identify and classify the character's thoughts as helpful or unhelpful. Upon successful advancement to the next level, the task becomes more challenging, as players must also identify specific types of cognitive distortions. A pre- and posttest uncontrolled design was used to evaluate the game, with a 1-week intervention phase in which participants were asked to play the game. Participants aged 12-16 years were recruited in schools. The outcomes of interest were the recognition of cognitive distortions and presence of participants' cognitive distortions. The game was also evaluated on its effects, content, and usefulness. Results A total of 630 adolescents played Silver and completed the assessments. Adolescents were significantly better at recognizing cognitive distortions at the pretest (mean 13.09, SD 4.08) compared to the posttest (mean 13.82, SD 5.09; t629=-4.00, P<.001). Furthermore, their cognitive distortions decreased significantly at the posttest (mean 38.73, SD 12.79) compared to the pretest (mean 41.43, SD 10.90; t629=7.98, P<.001). Participants also indicated that the game helped them recognize cognitive distortions. Many participants considered the game appealing (294/610, 48.2%) but boring (317/610, 52%) and preferred a more comprehensive game (299/610, 49%). Conclusions Findings from this study suggest that a serious game may be an effective tool for improving cognitive vulnerability in adolescents. The development of such a serious game, based on the prototype, is recommended. It may be an important and innovative tool for the universal prevention of mental health problems in adolescents. Future research on the effects of the game is warranted.
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Affiliation(s)
- Eva De Jaegere
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Kees van Heeringen
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Peter Emmery
- University Psychiatric Centre KU Leuven, KU Leuven, Leuven, Belgium
| | - Gijs Mommerency
- Department of Child and Adolescent Psychiatry, Ghent University Hospital, Ghent, Belgium
| | - Gwendolyn Portzky
- Department of Head and Skin, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Martin J, Rueda A, Lee GH, Tassone VK, Park H, Ivanov M, Darnell BC, Beavers L, Campbell DM, Nguyen B, Torres A, Jung H, Lou W, Nazarov A, Ashbaugh A, Kapralos B, Litz B, Jetly R, Dubrowski A, Strudwick G, Krishnan S, Bhat V. Digital Interventions to Understand and Mitigate Stress Response: Protocol for Process and Content Evaluation of a Cohort Study. JMIR Res Protoc 2024; 13:e54180. [PMID: 38709554 PMCID: PMC11106701 DOI: 10.2196/54180] [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] [Received: 12/01/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Staffing and resource shortages, especially during the COVID-19 pandemic, have increased stress levels among health care workers. Many health care workers have reported feeling unable to maintain the quality of care expected within their profession, which, at times, may lead to moral distress and moral injury. Currently, interventions for moral distress and moral injury are limited. OBJECTIVE This study has the following aims: (1) to characterize and reduce stress and moral distress related to decision-making in morally complex situations using a virtual reality (VR) scenario and a didactic intervention; (2) to identify features contributing to mental health outcomes using wearable, physiological, and self-reported questionnaire data; and (3) to create a personal digital phenotype profile that characterizes stress and moral distress at the individual level. METHODS This will be a single cohort, pre- and posttest study of 100 nursing professionals in Ontario, Canada. Participants will undergo a VR simulation that requires them to make morally complex decisions related to patient care, which will be administered before and after an educational video on techniques to mitigate distress. During the VR session, participants will complete questionnaires measuring their distress and moral distress, and physiological data (electrocardiogram, electrodermal activity, plethysmography, and respiration) will be collected to assess their stress response. In a subsequent 12-week follow-up period, participants will complete regular assessments measuring clinical outcomes, including distress, moral distress, anxiety, depression, and loneliness. A wearable device will also be used to collect continuous data for 2 weeks before, throughout, and for 12 weeks after the VR session. A pre-post comparison will be conducted to analyze the effects of the VR intervention, and machine learning will be used to create a personal digital phenotype profile for each participant using the physiological, wearable, and self-reported data. Finally, thematic analysis of post-VR debriefing sessions and exit interviews will examine reoccurring codes and overarching themes expressed across participants' experiences. RESULTS The study was funded in 2022 and received research ethics board approval in April 2023. The study is ongoing. CONCLUSIONS It is expected that the VR scenario will elicit stress and moral distress. Additionally, the didactic intervention is anticipated to improve understanding of and decrease feelings of stress and moral distress. Models of digital phenotypes developed and integrated with wearables could allow for the prediction of risk and the assessment of treatment responses in individuals experiencing moral distress in real-time and naturalistic contexts. This paradigm could also be used in other populations prone to moral distress and injury, such as military and public safety personnel. TRIAL REGISTRATION ClinicalTrials.gov NCT05923398; https://clinicaltrials.gov/study/NCT05923398. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54180.
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Affiliation(s)
- Josh Martin
- Interventional Psychiatry Program, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Alice Rueda
- Interventional Psychiatry Program, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Gyu Hee Lee
- Interventional Psychiatry Program, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Vanessa K Tassone
- Interventional Psychiatry Program, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Haley Park
- Interventional Psychiatry Program, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Martin Ivanov
- Department of Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, ON, Canada
| | - Benjamin C Darnell
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
| | - Lindsay Beavers
- Allan Waters Family Simulation Program, Unity Health Toronto, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Douglas M Campbell
- Allan Waters Family Simulation Program, Unity Health Toronto, Toronto, ON, Canada
- Neonatal Intensive Care Unit, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Binh Nguyen
- Department of Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, ON, Canada
| | - Andrei Torres
- maxSIMhealth Group, Ontario Tech University, Oshawa, ON, Canada
| | - Hyejung Jung
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Anthony Nazarov
- MacDonald Franklin OSI Research Centre, Lawson Health Research Institute, London, ON, Canada
| | - Andrea Ashbaugh
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Bill Kapralos
- maxSIMhealth Group, Ontario Tech University, Oshawa, ON, Canada
| | - Brett Litz
- Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, MA, United States
- Department of Psychiatry, Boston University Chobanian and Avedisian School of Medicine, Boston, MA, United States
| | - Rakesh Jetly
- Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada
| | - Adam Dubrowski
- maxSIMhealth Group, Ontario Tech University, Oshawa, ON, Canada
| | - Gillian Strudwick
- Centre For Addiction & Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Sridhar Krishnan
- Department of Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, ON, Canada
| | - Venkat Bhat
- Interventional Psychiatry Program, St Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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21
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Macchi G, De Pisapia N. Virtual reality, face-to-face, and 2D video conferencing differently impact fatigue, creativity, flow, and decision-making in workplace dynamics. Sci Rep 2024; 14:10260. [PMID: 38704442 PMCID: PMC11069516 DOI: 10.1038/s41598-024-60942-6] [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] [Received: 10/05/2023] [Accepted: 04/29/2024] [Indexed: 05/06/2024] Open
Abstract
Digital communication technologies are rapidly evolving, and understanding their impact on group dynamics and cognitive performance in professional settings becomes central. This study investigates the psychological impact of different interaction settings-two-dimensional Video Conferencing (VC), Face-To-Face (FTF), and Virtual Reality (VR)-on group dynamics, cognitive performance, and aspects of well-being in a professional context. Utilizing a sample of 40 participants from a large Italian electricity transmission company, the study employs a within-subjects design to explore various metrics, including flow, creativity, fatigue and aspects of interaction. The results indicate that FTF interactions are optimal for idea generation and task absorption. VR, although initially more fatiguing for first-time users, fosters a more collaborative and peaceful environment, encouraging participants to engage more openly with each other. VC was found to be the least fatiguing, but also the least engaging in terms of task absorption and idea generation. Additionally, age-related differences were observed, particularly in the perception of motivational and emotional fatigue in the VR setting. The study provides empirical evidence supporting the integration of VR in professional settings for specific types of meetings, while also highlighting the limitations and areas for future research. These findings have implications for organizational well-being, cognitive ergonomics, and the evolving landscape of remote work technologies.
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Affiliation(s)
- Gregorio Macchi
- Department of Psychology and Cognitive Science (DIPSCO), University of Trento, Corso Bettini 31, 38068, Rovereto, TN, Italy
| | - Nicola De Pisapia
- Department of Psychology and Cognitive Science (DIPSCO), University of Trento, Corso Bettini 31, 38068, Rovereto, TN, Italy.
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22
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Lafortune D, Dubé S, Lapointe V, Bonneau J, Champoux C, Sigouin N. Virtual Reality Could Help Assess Sexual Aversion Disorder. JOURNAL OF SEX RESEARCH 2024; 61:588-602. [PMID: 37556729 DOI: 10.1080/00224499.2023.2241860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Virtual reality (VR) may improve our understanding of sexual dysfunctions' manifestations, although research in this area remains limited. This study assessed the potential use of a VR Behavior Avoidance Test (VR-BAT) as a tool for examining the clinical features of Sexual Aversion Disorder (SAD): the experience of fear, disgust, and avoidance when facing sexual cues/contexts. A sample of 55 adults (≥ 18y) with (n = 27) and without SAD (n = 28) completed a self-report measure of sexual avoidance. Their anxiety, disgust, electrodermal activity, heart rate, and visual and behavioral avoidance were then examined during two VR-BATs involving sexual or non-sexual stimuli. Mixed repeated measures ANOVAs, t-tests, and correlational analyses were performed. Results showed that individuals in the SAD group reported greater anxiety and disgust compared to their non-SAD counterparts during the sexual stimuli condition. Sexual avoidance scores were largely positively related to anxiety and disgust during the VR sexual condition, and moderately negatively related to the time spent touching the virtual character's genitals. This study is important given the prevalence of sexual difficulties, such as SAD, and the new research avenues offered by emerging technologies, like VR.
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Affiliation(s)
- D Lafortune
- Department of Sexology, Université du Québec à Montréal
| | - S Dubé
- Department of Psychology, Concordia University
| | - V Lapointe
- Department of Psychology, Université du Québec à Montréal
| | - J Bonneau
- School of Media, Université du Québec à Montréal
| | - C Champoux
- School of Media, Université du Québec à Montréal
| | - N Sigouin
- School of Media, Université du Québec à Montréal
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23
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Kim YG, Lee JH, Shim JW, Rhee W, Kim BS, Yoon D, Kim MJ, Park JW, Jeong CW, Yang HK, Cho M, Kim S. A multimodal virtual vision platform as a next-generation vision system for a surgical robot. Med Biol Eng Comput 2024; 62:1535-1548. [PMID: 38305815 PMCID: PMC11021270 DOI: 10.1007/s11517-024-03030-1] [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: 08/19/2023] [Accepted: 01/19/2024] [Indexed: 02/03/2024]
Abstract
Robot-assisted surgery platforms are utilized globally thanks to their stereoscopic vision systems and enhanced functional assistance. However, the necessity of ergonomic improvement for their use by surgeons has been increased. In surgical robots, issues with chronic fatigue exist owing to the fixed posture of the conventional stereo viewer (SV) vision system. A head-mounted display was adopted to alleviate the inconvenience, and a virtual vision platform (VVP) is proposed in this study. The VVP can provide various critical data, including medical images, vital signs, and patient records, in three-dimensional virtual reality space so that users can access medical information simultaneously. An availability of the VVP was investigated based on various user evaluations by surgeons and novices, who executed the given tasks and answered questionnaires. The performances of the SV and VVP were not significantly different; however, the craniovertebral angle of the VVP was 16.35° higher on average than that of the SV. Survey results regarding the VVP were positive; participants indicated that the optimal number of displays was six, preferring the 2 × 3 array. Reflecting the tendencies, the VVP can be a neoconceptual candidate to be customized for medical use, which opens a new prospect in a next-generation surgical robot.
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Affiliation(s)
- Young Gyun Kim
- Interdisciplinary Program in Bioengineering, Seoul National University, 1 Gwanak-Ro, Gwanak-Gu, Seoul, 08826, Republic of Korea
| | - Jong Hyeon Lee
- Interdisciplinary Program in Bioengineering, Seoul National University, 1 Gwanak-Ro, Gwanak-Gu, Seoul, 08826, Republic of Korea
| | - Jae Woo Shim
- Interdisciplinary Program in Bioengineering, Seoul National University, 1 Gwanak-Ro, Gwanak-Gu, Seoul, 08826, Republic of Korea
| | - Wounsuk Rhee
- Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Byeong Soo Kim
- Interdisciplinary Program in Bioengineering, Seoul National University, 1 Gwanak-Ro, Gwanak-Gu, Seoul, 08826, Republic of Korea
| | - Dan Yoon
- Interdisciplinary Program in Bioengineering, Seoul National University, 1 Gwanak-Ro, Gwanak-Gu, Seoul, 08826, Republic of Korea
| | - Min Jung Kim
- Department of Surgery, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Ji Won Park
- Department of Surgery, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Han-Kwang Yang
- Department of Surgery, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Minwoo Cho
- Department of Transdisciplinary Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
- Department of Medicine, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
| | - Sungwan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
- Artificial Intelligence Institute, Seoul National University, 1 Gwanak-Ro, Gwanak-Gu, Seoul, 08826, Republic of Korea.
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24
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Colombo V, Mondellini M, Fumagalli A, Aliverti A, Sacco M. A virtual reality-based endurance training program for COPD patients: acceptability and user experience. Disabil Rehabil Assist Technol 2024; 19:1590-1599. [PMID: 37272556 DOI: 10.1080/17483107.2023.2219699] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/25/2023] [Indexed: 06/06/2023]
Abstract
PURPOSE To investigate the acceptability and user experience of an in-hospital endurance training program based on the Virtual Park, a semi-immersive Virtual Reality (VR) system for patients with Chronic Obstructive Pulmonary Disease (COPD).Materials and methodsPatients performed 20 min of cycling two times/day for around ten days. The evaluation included adherence, exercise capacity, physical performance, and user experience. RESULTS Fourteen patients (6 F/8 M; age = 71.29 ± 6.93 years) with mild/moderate COPD participated. The adherence rate was satisfying: 85.71% of patients attended the program without adverse events; the individual attendance rate (86.85% ± 27.43) was also high. The exercise capacity assessed before and after the training significantly improved in our group (6MWT pre-post: t(11)= -5.040, p < 0.05), as happens in standard PR programs. The physical performance metrics of each session indicate that all participants could sustain the proposed training protocol over the whole period. Patients judged the VR experience positively (User Experience Questionnaire = 1.84 ± 0.22) and were highly engaged in the activity for the whole period (Short Flow State Scale pre-post: 4.61 ± 0.27/4.40 ± 0.36). CONCLUSIONS Our preliminary results open the possibility for further investigations on long-term motivation and clinical effectiveness of more immersive VR interventions for COPD.
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Affiliation(s)
- Vera Colombo
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing (STIIMA), National Research Council (CNR), Lecco, Italy
- Department of Electronics, Information, and Bioengineering (DEIB), Politecnico di Milano, Milano, Italy
| | - Marta Mondellini
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing (STIIMA), National Research Council (CNR), Lecco, Italy
| | | | - Andrea Aliverti
- Department of Electronics, Information, and Bioengineering (DEIB), Politecnico di Milano, Milano, Italy
| | - Marco Sacco
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing (STIIMA), National Research Council (CNR), Lecco, Italy
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25
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Blanc J, Scaramutti C, Carrasco M, Dimanche S, Hollimon L, Moore J, Moise R, Gabbay V, Seixas A. I am Lifted Above the World: utilizing VR for stress reduction among perinatal women of color. Front Psychiatry 2024; 15:1377978. [PMID: 38716116 PMCID: PMC11075633 DOI: 10.3389/fpsyt.2024.1377978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/25/2024] [Indexed: 07/03/2024] Open
Abstract
Background Perinatal mental health conditions affect 800,000 individuals annually in the United States and are a leading cause of complications in pregnancy and childbirth. However, the impact of these conditions varies across racial and ethnic groups. Portable digital solutions, such as mobile apps, have been developed for maternal mental health, but they often do not adequately cater to the needs of women of color. To ensure the effectiveness and equity of these interventions, it is crucial to consider the unique experiences of perinatal women from diverse racial backgrounds. This qualitative study aims to explore the complex aspects of motherhood, maternal mental well-being, and resilience among perinatal women of color. It also investigates the factors that either hinder or facilitate the use of Virtual Reality (VR) for stress management in this specific demographic. Methods This research involves two focus groups comprising perinatal women, primarily identifying as Black or Latina, enrolled in the ongoing Nurturing Moms study at the University of Miami Miller School of Medicine. Additionally, feedback is collected from five different participants. The study assesses Nurture VR™, a VR-based program integrating mindfulness techniques, relaxation exercises, and guided imagery for pregnancy and postpartum. Results Qualitative analysis uncovers five primary themes and 19 sub-themes, addressing the complexities of motherhood, maternal mental health, attitudes towards VR therapy, postpartum care, and the perception of resilience. Participants share challenges related to household management, caregiving, financial stress, breastfeeding, relaxation, sleep, and the significance of social support. Their preferences and reservations regarding VR therapy are also expressed. Conclusion This study sheds light on the diverse struggles and obstacles faced by women of color during and after pregnancy, with potential repercussions for their mental and sleep health. It underscores the need for mental health screening and analysis of maternal stress-related sleep issues, in addition to the facilitation of social support in maternal health programs. Additionally, it highlights the promise of culturally responsive behavioral treatments, including VR interventions, in offering timely and tailored mental health support to perinatal women, taking into account their intersectional identities.
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Affiliation(s)
- Judite Blanc
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Carolina Scaramutti
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Mary Carrasco
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Stacyca Dimanche
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Laronda Hollimon
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jesse Moore
- Department of Psychology & the Learning Research Development Center, University of Pittsburgh, Pittsburgh, PA, United States
| | - Rhoda Moise
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Vilma Gabbay
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Azizi Seixas
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States
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26
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Abensur Vuillaume L, Goffoy J, Dubois N, Almoyner N, Bardet C, Dubreucq E, Klenkenberg S, Donneau AF, Dib C, Ghuysen A. Collaborative virtual reality environment in disaster medicine: moving from single player to multiple learners. BMC MEDICAL EDUCATION 2024; 24:422. [PMID: 38641770 PMCID: PMC11031920 DOI: 10.1186/s12909-024-05429-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND The use of virtual reality (VR) in healthcare education is on the increase. In disaster medicine, it could be a solution to the cost and logistic constraints for a "full-scale" scenarios. However, VR is mainly designed for single players, which is not appropriate for the objectives pursued in disaster medicine. We decided to evaluate the educational value of using individual VR simulation in disaster medicine on a group of learners. METHODS The VR scenario used was a reproduction of a major train crash, with 21 victims and whose objectives were START triage and first aid techniques. The sessions were carried out in multi-participant groups with different roles (active and immersed with headset, paper triage without headset, and active for communications not immersed in the headset). Their perceived self-efficacy was assessed before (T0), after (T1) and 2 months (T2) after the training. Satisfaction and confidence in learning were also measured. RESULTS The median levels of satisfaction and confidence in learning were of 21/25 and 32/40 respectively. Their perceived self-efficacy increased significantly between T0 and T1 (p < 0.001), and remained stable until T2. The different roles of participant showed no difference in terms of satisfaction, confidence in learning or changes in perceived self-efficacy. One third of the participants agreed that the number of participants had interfered with their learning. A significant negative correlation (rS = -0.51, p = 0.002) was found between satisfaction and the fact of having been hindered by the number of participants. Around 90% of participants found the activity entertaining and found the new technologies appropriate for learning technical skills. CONCLUSIONS This first experience of VR in a group setting is satisfactory and shows its positive effects. The limitations highlighted here will enable areas of improvement to be identified for the use of VR in disaster medicine, pending the development of multi-player tools. It would now be appropriate to analyse the impact of this type of simulation on learning and its retention over time.
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Affiliation(s)
| | - Jonathan Goffoy
- Medical Simulation Center, Department of Public Health, Liège University, Liege, Belgium
| | - Nadège Dubois
- Medical Simulation Center, Department of Public Health, Liège University, Liege, Belgium
| | - Nathacha Almoyner
- Service d'Accueil Des Urgences, Hôpital Saint Louis, La Rochelle, France
| | - Cécile Bardet
- Service d'Accueil Des Urgences, Centre Hospitalier de Niort, Niort, France
| | - Evelyne Dubreucq
- Service d'Accueil Des Urgences, Hôpital TENON, APHP, Paris, France
| | - Sophie Klenkenberg
- Biostatistics and Research Methods Center (B-STAT), Liège University, Liege, Belgium
| | | | - Camille Dib
- SAMU 57, Service d'Accueil Des Urgences, CHR Metz-Thionville, Metz, France
| | - Alexandre Ghuysen
- Medical Simulation Center, Department of Public Health, Liège University, Liege, Belgium
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27
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Moreau S, Thérond A, Cerda IH, Studer K, Pan A, Tharpe J, Crowther JE, Abd-Elsayed A, Gilligan C, Tolba R, Ashina S, Schatman ME, Kaye AD, Yong RJ, Robinson CL. Virtual Reality in Acute and Chronic Pain Medicine: An Updated Review. Curr Pain Headache Rep 2024:10.1007/s11916-024-01246-2. [PMID: 38587725 DOI: 10.1007/s11916-024-01246-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE OF REVIEW This review critically analyzes the recent literature on virtual reality's (VR) use in acute and chronic pain management, offering insights into its efficacy, applications, and limitations. RECENT FINDINGS Recent studies, including meta-analyses and randomized controlled trials, have demonstrated VR's effectiveness in reducing pain intensity in various acute pain scenarios, such as procedural/acute pain and in chronic pain conditions. The role of factors such as immersion and presence in enhancing VR's efficacy has been emphasized. Further benefits have been identified in the use of VR for assessment as well as symptom gathering through conversational avatars. However, studies are limited, and strong conclusions will require further investigation. VR is emerging as a promising non-pharmacological intervention in pain management for acute and chronic pain. However, its long-term efficacy, particularly in chronic pain management, remains an area requiring further research. Key findings highlight that VR programs vary in efficacy depending on the specificity of the origin of pain.
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Affiliation(s)
- Sacha Moreau
- Massachusetts Institute of Technology, Boston, MA, USA
| | - Alexandra Thérond
- Department of Psychology, Université du Québec a Montréal, 100 Sherbrooke St W, Montréal, QC, H2X 3P2, Canada.
| | - Ivo H Cerda
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kachina Studer
- Department of Earth and Planetary Science, Harvard University, Cambridge, MA, USA
- Department Mechanical Engineering, Massachusetts Institute of Technology (MIT), Cambridge, MA, USA
| | - Alicia Pan
- Northeastern University, Boston, MA, USA
| | - Jacob Tharpe
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts, Worcester, MA, USA
| | - Jason E Crowther
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts, Worcester, MA, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | | | - Reda Tolba
- Pain Management Department in the Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Sait Ashina
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health-Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | | | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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28
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Anastasiadou D, Herrero P, Garcia-Royo P, Vázquez-De Sebastián J, Slater M, Spanlang B, Álvarez de la Campa E, Ciudin A, Comas M, Ramos-Quiroga JA, Lusilla-Palacios P. Assessing the Clinical Efficacy of a Virtual Reality Tool for the Treatment of Obesity: Randomized Controlled Trial. J Med Internet Res 2024; 26:e51558. [PMID: 38578667 PMCID: PMC11031704 DOI: 10.2196/51558] [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] [Received: 08/03/2023] [Revised: 01/12/2024] [Accepted: 01/30/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Virtual reality (VR) interventions, based on cognitive behavioral therapy principles, have been proven effective as complementary tools in managing obesity and have been associated with promoting healthy behaviors and addressing body image concerns. However, they have not fully addressed certain underlying causes of obesity, such as a lack of motivation to change, low self-efficacy, and the impact of weight stigma interiorization, which often impede treatment adherence and long-term lifestyle habit changes. To tackle these concerns, this study introduces the VR self-counseling paradigm, which incorporates embodiment and body-swapping techniques, along with motivational strategies, to help people living with obesity effectively address some of the root causes of their condition. OBJECTIVE This study aims to assess the clinical efficacy of ConVRself (Virtual Reality self-talk), a VR platform that allows participants to engage in motivational self-conversations. METHODS A randomized controlled trial was conducted with 68 participants from the bariatric surgery waiting list from the obesity unit of the Vall d'Hebron University Hospital in Barcelona, Spain. Participants were assigned to 1 of 3 groups: a control group (CG), which only received treatment as usual from the obesity unit; experimental group 1 (EG1), which, after intensive motivational interviewing training, engaged in 4 sessions of VR-based self-conversations with ConVRself, and underwent embodiment and body-swapping techniques; and experimental group 2 (EG2), which engaged in 4 VR-based sessions led by a virtual counselor with a prerecorded discourse, and only underwent the embodiment technique. In the case of both EG1 and EG2, the VR interventions were assisted by a clinical researcher. Readiness to change habits, eating habits, and psychological variables, as well as adherence and satisfaction with ConVRself were measured at baseline, after the intervention, 1 week after the intervention, and 4 weeks after the intervention. RESULTS Regarding the primary outcomes, EG1 (24/68, 35%) and EG2 (22/68, 32%) showed significant improvements in confidence to lose weight compared to the CG (22/68, 32%) at all assessment points (β=-.16; P=.02). Similarly, EG1 demonstrated a significant increase after the intervention in readiness to exercise more compared to the CG (β=-.17; P=.03). Regarding the secondary outcomes, EG1 participants showed a significant reduction in uncontrolled eating (β=.71; P=.01) and emotional eating (β=.29; P=.03) compared to the CG participants, as well as in their anxiety levels compared to EG2 and CG participants (β=.65; P=.01). In addition, participants from the experimental groups reported high adherence and satisfaction with the VR platform (EG1: mean 59.82, SD 4.00; EG2: mean 58.43, SD 5.22; d=0.30, 95% CI -0.30 to 0.89). CONCLUSIONS This study revealed that using VR self-conversations, based on motivational interviewing principles, may have benefits in helping people with obesity to enhance their readiness to change habits and self-efficacy, as well as reduce dysfunctional eating behaviors and anxiety. TRIAL REGISTRATION ClinicalTrials.gov NCT05094557; https://www.clinicaltrials.gov/study/NCT05094557.
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Affiliation(s)
- Dimitra Anastasiadou
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
- Psychiatry, Mental Health and Addictions Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Pol Herrero
- Psychiatry, Mental Health and Addictions Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Paula Garcia-Royo
- Psychiatry, Mental Health and Addictions Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
| | - Julia Vázquez-De Sebastián
- Psychiatry, Mental Health and Addictions Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
- RE-FiT Barcelona Research Group, Vall d'Hebron Research Institute & Parc Sanitari Pere Virgili, Barcelona, Spain
| | - Mel Slater
- Virtual Bodyworks S.L., Barcelona, Spain
- The Institute of Neurosciences, Universitat de Barcelona, Barcelona, Spain
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Andreea Ciudin
- Endocrinology and Nutrition Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Comas
- Endocrinology and Nutrition Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Antoni Ramos-Quiroga
- Psychiatry, Mental Health and Addictions Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
- Psychiatry Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
| | - Pilar Lusilla-Palacios
- Psychiatry, Mental Health and Addictions Research Group, Vall d´Hebron Research Institute, Barcelona, Spain
- Psychiatry Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain
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van Wolffelaar BR, van Horn JE, Hoogsteder LM. Treatment of aggression regulation problems with virtual reality: study protocol for a randomized controlled trial. Front Psychol 2024; 15:1324644. [PMID: 38638522 PMCID: PMC11024330 DOI: 10.3389/fpsyg.2024.1324644] [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: 10/19/2023] [Accepted: 03/22/2024] [Indexed: 04/20/2024] Open
Abstract
Background Aggressive conduct among delinquents presents a pervasive issue, bearing substantial implications for not only society at large but also for the victims and the individuals displaying the aggression. Traditional approaches to treating aggression regulation deficiencies generally employ Cognitive Behavioral Therapy (CBT) in conjunction with analog role-playing exercises. A body of research supports the efficacy of various therapeutic models for aggression regulation, including Responsive Aggression Regulation Therapy (Re-ART). Role-playing within a therapeutic context has been shown to contribute significantly to reductions in violent reoffending. However, the practical application of these skills in real-world settings remains challenging due to the inherent risk of aggressive outbreaks. Additionally, the conventional role-playing scenarios, often conducted in a therapy room, lack contextual realism and may induce role confusion between the patient and the therapist. Virtual Reality (VR) technology could offer a viable solution to these limitations by allowing for skill training in both behavioral and cognitive domains within a realistic yet safe and controlled setting. The technology also facilitates real-time awareness of emotional states and tension levels in the patient. This paper describes the study protocol of a randomized controlled trial in which Re-ART offered in a virtual environment (Re-ART VR) is compared to Re-ART offered as treatment as usual. Methods and analysis Adult forensic outpatients with aggression regulation problems are randomly assigned to either Re-ART VR or Re-ART. The Controlling Skills, Influence of Thinking and Handling Conflicts modules will be offered to both groups during 3-6 months. Pre- and post-intervention measurements are performed. The primary outcome measurement is the degree of aggression regulation, while secondary outcome measurements include impulsivity and cognitive biases. Additionally, patient motivation and therapist motivation are expected to act as moderating factors. Discussion To date, scarcely previous research has been done on the effectiveness of VR in treatment of aggression regulation problems in forensic outpatients. Forensic outpatients who do not benefit sufficiently from mainly CBT-based interventions may benefit more from experiential learning. The unique capabilities of VR in this regard have the potential to enhance the treatment effect.Clinical trial registration: [https://clinicaltrials.gov/], identifier [NL78265.018.21].
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Affiliation(s)
| | | | - Larissa M. Hoogsteder
- De Forensische Zorgspecialisten, de Waag, Utrecht, Netherlands
- Program Group: Forensic Child and Youth Care, University of Amsterdam, Amsterdam, Netherlands
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Clay F, Hunt R, Obiefuna N, Solly JE, Watson E, Wilkinson A, Chohan R, Hatfield C, Fletcher PC, Underwood BR. The Use of Immersive Virtual Reality in Sensory Sessions on a Specialist Dementia Unit: Service Evaluation of Feasibility and Acceptability. Occup Ther Health Care 2024; 38:317-330. [PMID: 37933866 DOI: 10.1080/07380577.2023.2270052] [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] [Received: 02/03/2023] [Accepted: 10/08/2023] [Indexed: 11/08/2023]
Abstract
This service evaluation reviewed inclusion of Immersive Virtual Reality (iVR) relaxation activities as part of routine occupational therapy sensory sessions on a specialist dementia unit. Twenty-five sessions were completed over 13 wk with 14 participants. Nine participants chose to engage in multiple sessions. Feasibility was assessed through participant engagement and tolerability. Modal first session length was in the range 30 s to 2 min. This increased to over 2 min on second sessions. There was a lack of significant adverse effects measured by direct questioning, neuropsychiatric assessment before vs. after sessions and adverse incident reporting. Acceptability was assessed via structured review of user and staff feedback which noted positive experiences such as relaxation, openness to discussion, reminiscence, wider engagement and interest in future use. Further work is required to explore efficacy and use in other settings.
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Affiliation(s)
- Felix Clay
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
| | - Rachel Hunt
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
| | - Neche Obiefuna
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
- University of East Anglia, Norwich, UK
| | - Jeremy E Solly
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Emily Watson
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
| | - Alison Wilkinson
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
| | - Raminder Chohan
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
| | | | - Paul C Fletcher
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Benjamin R Underwood
- Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn, UK
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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31
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Li Y, Wilke C, Shiyanov I, Muschalla B. Impact of Virtual Reality-Based Group Activities on Activity Level and Well-Being Among Older Adults in Nursing Homes: Longitudinal Exploratory Study. JMIR Serious Games 2024; 12:e50796. [PMID: 38551635 PMCID: PMC11015370 DOI: 10.2196/50796] [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: 07/12/2023] [Revised: 10/27/2023] [Accepted: 02/02/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND In addition to illness, inactivity is a risk factor for high mortality in nursing homes. Using innovative technology, such as virtual reality (VR), for meaningful group activities could provide new opportunities for solving this problem. VR interventions have already been approved as a promising method for enhancing the health of older adults. OBJECTIVE In this study, we examined whether VR-based group activities can have a positive impact on activity level and group interaction among older adults living in nursing homes. METHODS We conducted a longitudinal study and provided VR interventions as a group activity once a week for 4 consecutive weeks in nursing homes. Participants were recruited based on the experience of the nursing staff members and the natural decisions of the older adults. Within a virtual cottage, designed according to the needs of the target group, older adults were able to perform daily tasks that they were no longer able to do in real life, such as gardening and making pizza. Overall, 2 psychologists measured the psychosocial capacities, activities of daily life, and well-being before and after the interventions using standardized instruments. RESULTS The results focus on a total of 84 older adults from 14 nursing homes who completed at least 3 VR interventions. The results indicate that several psychosocial capacities among the older adults improved, including adherence to regulations (P<.001; η²=0.122), flexibility (P<.001; η²=0.109), and group integration (P<.001; η²=0.141). Problems related to competence also showed a slight decrease (P=.04; η²=0.039). In addition, the VR intervention promoted their proactivity (P<.001; η²=0.104) and mobility (P=.04; η²=0.039). During the VR group intervention, older adults' well-being could be maintained at a high level. The results highlight the beneficial effects of VR intervention as a meaningful activity in nursing homes, showcasing the potential of VR applications in this setting. CONCLUSIONS This study provides a novel and naturalistic perspective, offering new insights into the use of VR in nursing homes. The VR intervention was well accepted and fulfilled the aim of enhancing capacity and well-being. It could be a meaningful group activity in nursing homes to improve social group interaction. To provide stronger evidence, randomized controlled trials are necessary.
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Affiliation(s)
- Yijun Li
- Department of Psychotherapy and Diagnostics, Technische Universität Braunschweig, Institute of Psychology, Braunschweig, Germany
| | - Carlotta Wilke
- Department of Psychotherapy and Diagnostics, Technische Universität Braunschweig, Institute of Psychology, Braunschweig, Germany
| | | | - Beate Muschalla
- Department of Psychotherapy and Diagnostics, Technische Universität Braunschweig, Institute of Psychology, Braunschweig, Germany
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Alhammad SA. Advocating for Action: Exploring the Potential of Virtual Reality in Breathing Exercise - A Review of The Clinical Applications. Patient Prefer Adherence 2024; 18:695-707. [PMID: 38524197 PMCID: PMC10960537 DOI: 10.2147/ppa.s451609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/13/2024] [Indexed: 03/26/2024] Open
Abstract
The emergence of virtual reality (VR) technologies is currently shaping the healthcare system and is now being employed in various healthcare interventions. Pulmonary rehabilitation remains one such area in which VR is currently thriving to ensure overall health and well-being. While the importance of these novel technologies is being primarily researched in pulmonary rehabilitation, especially over passive conventional breathing exercise training, there seems to be a limited number of studies that have comprehensively put together these findings. This study utilizes a scoping review methodology to review VR exercises in clinical settings related to pulmonary rehabilitation. To achieve this objective, three electronic databases (Web of Science, PubMed, and Cochrane Library) were searched using a formulated search string related to the research objective. Following the database search, a total of 236 references were retrieved and managed using the reference manager. The screening of references was conducted according to the PRISMA 2020 screening process, and their quality was assessed using the JBI checklist. Ultimately, a total of eight publications of high quality were selected for inclusion in the scoping review. The results of the synthesis validate the importance of utilizing VR in the context of breathing exercise in rehabilitation. The effectiveness and rapid development of VR breathing exercises are primarily attributed to the engaging and immersive experience they provide. The use of biofeedback and self-regulation techniques into VR exercise systems was also seen to have a notable impact on the effectiveness of the breathing exercise system.
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Affiliation(s)
- Saad A Alhammad
- Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
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33
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Simoncini G, Borghesi F, Mancuso V, Pedroli E, Cipresso P. Assessing alexithymia: the proposal of a psychometric tool based on spheric videos. Front Hum Neurosci 2024; 18:1375342. [PMID: 38562229 PMCID: PMC10982385 DOI: 10.3389/fnhum.2024.1375342] [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: 01/23/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
The present perspective introduces a novel psychometric tool designed to enhance the evaluation of alexithymia. Alexithymia, a condition marked by difficulties in recognizing and expressing emotions, along with a propensity to direct attention outside rather than toward one's own interior experiences, is commonly investigated through self-report questionnaires. These instruments assume that individuals have sufficient self-awareness and abstraction capabilities, which restricts the understanding of the underlying mechanisms of emotional recognition in individuals who do not possess these capacities. To address this lack, emerging technologies like virtual reality (VR) and 360° videos facilitate the recreation of immersive contexts, enabling subjects to engage with scenarios even remotely. Our innovative tool employs spherical video technology to recreate social and non-social scenarios that elicit emotions. Psychophysiological measures are collected during video observation; then, questions are asked to investigate how the subject consciously processes the emotions they experienced. This multimodal approach aims to capture both implicit and explicit emotion processing, providing a comprehensive assessment. Overall, the proposed psychometric tool offers the potential for a more nuanced understanding of alexithymic traits and their real-life impact, empowering clinicians to tailor treatment processes to individual needs based on a richer set of information.
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Affiliation(s)
| | | | | | - Elisa Pedroli
- Faculty of Psychology, eCampus University, Novedrate, Italy
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Albert L, Potheegadoo J, Herbelin B, Bernasconi F, Blanke O. Numerosity estimation of virtual humans as a digital-robotic marker for hallucinations in Parkinson's disease. Nat Commun 2024; 15:1905. [PMID: 38472203 DOI: 10.1038/s41467-024-45912-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 02/07/2024] [Indexed: 03/14/2024] Open
Abstract
Hallucinations are frequent non-motor symptoms in Parkinson's disease (PD) associated with dementia and higher mortality. Despite their high clinical relevance, current assessments of hallucinations are based on verbal self-reports and interviews that are limited by important biases. Here, we used virtual reality (VR), robotics, and digital online technology to quantify presence hallucination (vivid sensations that another person is nearby when no one is actually present and can neither be seen nor heard) in laboratory and home-based settings. We establish that elevated numerosity estimation of virtual human agents in VR is a digital marker for experimentally induced presence hallucinations in healthy participants, as confirmed across several control conditions and analyses. We translated the digital marker (numerosity estimation) to an online procedure that 170 PD patients carried out remotely at their homes, revealing that PD patients with disease-related presence hallucinations (but not control PD patients) showed higher numerosity estimation. Numerosity estimation enables quantitative monitoring of hallucinations, is an easy-to-use unobtrusive online method, reaching people far away from medical centers, translating neuroscientific findings using robotics and VR, to patients' homes without specific equipment or trained staff.
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Affiliation(s)
- Louis Albert
- Laboratory of Cognitive Neuroscience, Neuro-X Institute, Faculty of Life Sciences, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
| | - Jevita Potheegadoo
- Laboratory of Cognitive Neuroscience, Neuro-X Institute, Faculty of Life Sciences, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
| | - Bruno Herbelin
- Laboratory of Cognitive Neuroscience, Neuro-X Institute, Faculty of Life Sciences, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
| | - Fosco Bernasconi
- Laboratory of Cognitive Neuroscience, Neuro-X Institute, Faculty of Life Sciences, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, Neuro-X Institute, Faculty of Life Sciences, Swiss Federal Institute of Technology (EPFL), Geneva, Switzerland.
- Department of Clinical Neurosciences, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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35
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González-Gualda LM, Vicente-Querol MA, García AS, Molina JP, Latorre JM, Fernández-Sotos P, Fernández-Caballero A. An exploratory study of the effect of age and gender on face scanning during affect recognition in immersive virtual reality. Sci Rep 2024; 14:5553. [PMID: 38448515 PMCID: PMC10918108 DOI: 10.1038/s41598-024-55774-3] [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: 01/01/2023] [Accepted: 02/26/2024] [Indexed: 03/08/2024] Open
Abstract
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.
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Affiliation(s)
- Luz M González-Gualda
- Servicio de Salud de Castilla-La Mancha, Complejo Hospitalario Universitario de Albacete, Servicio de Salud Mental, 02004, Albacete, Spain
| | - Miguel A Vicente-Querol
- Neurocognition and Emotion Unit, Instituto de Investigación en Informática de Albacete, 02071, Albacete, Spain
| | - Arturo S García
- Neurocognition and Emotion Unit, Instituto de Investigación en Informática de Albacete, 02071, Albacete, Spain
- Departmento de Sistemas Informáticos, Universidad de Castilla-La Mancha, 02071, Albacete, Spain
| | - José P Molina
- Neurocognition and Emotion Unit, Instituto de Investigación en Informática de Albacete, 02071, Albacete, Spain
- Departmento de Sistemas Informáticos, Universidad de Castilla-La Mancha, 02071, Albacete, Spain
| | - José M Latorre
- Departmento de Psicología, Universidad de Castilla-La Mancha, 02071, Albacete, Spain
| | - Patricia Fernández-Sotos
- Servicio de Salud de Castilla-La Mancha, Complejo Hospitalario Universitario de Albacete, Servicio de Salud Mental, 02004, Albacete, Spain
- CIBERSAM-ISCIII (Biomedical Research Networking Centre in Mental Health, Instituto de Salud Carlos III), 28016, Madrid, Spain
| | - Antonio Fernández-Caballero
- Neurocognition and Emotion Unit, Instituto de Investigación en Informática de Albacete, 02071, Albacete, Spain.
- Departmento de Sistemas Informáticos, Universidad de Castilla-La Mancha, 02071, Albacete, Spain.
- CIBERSAM-ISCIII (Biomedical Research Networking Centre in Mental Health, Instituto de Salud Carlos III), 28016, Madrid, Spain.
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Borelle C, Forner E. Reality check. The issue of social plausibility in Virtual reality therapy with addiction patients. Soc Sci Med 2024; 344:116653. [PMID: 38354480 DOI: 10.1016/j.socscimed.2024.116653] [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] [Received: 09/15/2023] [Revised: 01/25/2024] [Accepted: 02/02/2024] [Indexed: 02/16/2024]
Abstract
In France, virtual reality has been experimented since 2016 to address addictive behaviors. The existing literature insists on the "immersive" dimension of the technology as a significant factor in the efficacy of exposure. An ethnographic approach, however, suggests that the realism criterion should be reassessed. Based on a fieldwork conducted in the addictology department of a French hospital that made use of Virtual reality therapy (VRT), the article shows that it is a form of technical reiteration designed to develop reflexivity about one's actions, provoking the craving so that it can be domesticated. The patient's engagement in "as if" mode is facilitated by the therapist's work in mapping the patient's addictive practices, personalizing the exposure situations, and elaborating the simulation as being part of a practical experiment. While the question of graphic realism does not seem especially problematic, the question of social plausibility can put the simulation operation under strain.
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Affiliation(s)
- Céline Borelle
- CEMS (EHESS-CNRS-INSERM), France; SENSE (Orange), France.
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Kaup B, Ulrich R, Bausenhart KM, Bryce D, Butz MV, Dignath D, Dudschig C, Franz VH, Friedrich C, Gawrilow C, Heller J, Huff M, Hütter M, Janczyk M, Leuthold H, Mallot H, Nürk HC, Ramscar M, Said N, Svaldi J, Wong HY. Modal and amodal cognition: an overarching principle in various domains of psychology. PSYCHOLOGICAL RESEARCH 2024; 88:307-337. [PMID: 37847268 PMCID: PMC10857976 DOI: 10.1007/s00426-023-01878-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/17/2023] [Indexed: 10/18/2023]
Abstract
Accounting for how the human mind represents the internal and external world is a crucial feature of many theories of human cognition. Central to this question is the distinction between modal as opposed to amodal representational formats. It has often been assumed that one but not both of these two types of representations underlie processing in specific domains of cognition (e.g., perception, mental imagery, and language). However, in this paper, we suggest that both formats play a major role in most cognitive domains. We believe that a comprehensive theory of cognition requires a solid understanding of these representational formats and their functional roles within and across different domains of cognition, the developmental trajectory of these representational formats, and their role in dysfunctional behavior. Here we sketch such an overarching perspective that brings together research from diverse subdisciplines of psychology on modal and amodal representational formats so as to unravel their functional principles and their interactions.
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Affiliation(s)
- Barbara Kaup
- Department of Psychology, Fachbereich Psychologie, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany.
| | - Rolf Ulrich
- Department of Psychology, Fachbereich Psychologie, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany.
| | - Karin M Bausenhart
- Department of Psychology, Fachbereich Psychologie, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
| | - Donna Bryce
- Department of Psychology, Fachbereich Psychologie, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
- Department of Psychology, University of Augsburg, Augsburg, Germany
| | - Martin V Butz
- Department of Psychology, Fachbereich Psychologie, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
- Department of Computer Science, University of Tübingen, Sand 14, 72076, Tübingen, Germany
| | - David Dignath
- Department of Psychology, Fachbereich Psychologie, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
| | - Carolin Dudschig
- Department of Psychology, Fachbereich Psychologie, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
| | - Volker H Franz
- Department of Computer Science, University of Tübingen, Sand 14, 72076, Tübingen, Germany
| | - Claudia Friedrich
- Department of Psychology, Fachbereich Psychologie, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
| | - Caterina Gawrilow
- Department of Psychology, Fachbereich Psychologie, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
| | - Jürgen Heller
- Department of Psychology, Fachbereich Psychologie, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
| | - Markus Huff
- Department of Psychology, Fachbereich Psychologie, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
- Leibniz-Institut für Wissensmedien, Tübingen, Germany
| | - Mandy Hütter
- Department of Psychology, Fachbereich Psychologie, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
| | - Markus Janczyk
- Department of Psychology, University of Bremen, Bremen, Germany
| | - Hartmut Leuthold
- Department of Psychology, Fachbereich Psychologie, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
| | - Hanspeter Mallot
- Department of Biology, University of Tübingen, Auf der Morgenstelle 28, 72076, Tübingen, Germany
| | - Hans-Christoph Nürk
- Department of Psychology, Fachbereich Psychologie, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
| | - Michael Ramscar
- Department of Psychology, Fachbereich Psychologie, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
| | - Nadia Said
- Department of Psychology, Fachbereich Psychologie, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
| | - Jennifer Svaldi
- Department of Psychology, Fachbereich Psychologie, University of Tübingen, Schleichstr. 4, 72076, Tübingen, Germany
- German Center for Mental Health (DZPG), partner site, Tübingen, Germany
| | - Hong Yu Wong
- Department of Philosophy, University of Tübingen, Tübingen, Germany
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Micheluzzi V, Casu G, Sanna GD, Canu A, Iovino P, Caggianelli G, Vellone E. Improving adherence to rehabilitation for heart failure patients through immersive virtual reality (VIRTUAL-HF): A protocol for a randomized controlled trial. Contemp Clin Trials 2024; 138:107463. [PMID: 38302011 DOI: 10.1016/j.cct.2024.107463] [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] [Received: 11/04/2023] [Revised: 01/02/2024] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND To improve symptoms and reduce poor outcomes related to heart failure (HF), international guidelines recommend cardiac rehabilitation (CR), particularly for those with a reduced ejection fraction. Unfortunately, patient adherence to rehabilitation programs remains suboptimal, with dropouts ranging from 15.4 to 63.3%. An innovative and promising intervention that could improve adherence to rehabilitation is virtual reality (VR). This study aims to evaluate the effects of VR in patients with HF who undergo CR using this technology in terms of adherence (primary outcome), functional capacity, perceived exertion, angina, quality of life, heart rate, oxygen saturation, blood pressure, maximum oxygen uptake, minute ventilation/carbon dioxide production slope, oxygen pulse, blood values of NT-proBNP and HF related rehospitalization rates (secondary outcomes). METHODS A randomized controlled trial will be conducted in a sample of 80 patients referred to CR. Participants will be enrolled in a cardiological rehabilitation unit of a large university hospital in Italy and randomized (1:1) to the experimental intervention consisting of CR performed with high-quality immersive VR with PICO 4® Head Mounted Display headset and TREADMILL XR® software (Arm 1) or standard CR (Arm 2). Patients, according to guidelines, will perform 30-min of CR sessions with moderate intensity, twice a week for one month. RESULTS Significant improvements in primary and secondary outcomes are expected in patients in the intervention group. CONCLUSIONS If proven to be effective, VR could be an innovative, safe, and easy digital health intervention to improve adherence to CR in patients with HF, as well as important clinical outcomes.
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Affiliation(s)
- Valentina Micheluzzi
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy; Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Gavino Casu
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy; Department of Medicine, and Pharmacy, University of Sassari, Sassari, Italy
| | | | - Antonella Canu
- Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | - Paolo Iovino
- Health Sciences Department, University of Florence, Florence, Italy
| | | | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; Department of Nursing and Obstetrics, Wroclaw Medical University, Wrocław, Poland
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Holsteg S, Askeridis JM, Krajewski J, Mildner P, Freitag S, Müller T, Schnieder S, Gieselmann A, Karger A. Virtual reality roleplays for patients with depression: A user experience evaluation. Internet Interv 2024; 35:100713. [PMID: 38318087 PMCID: PMC10840098 DOI: 10.1016/j.invent.2024.100713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 12/31/2023] [Accepted: 01/15/2024] [Indexed: 02/07/2024] Open
Abstract
Background Virtual reality (VR) has been used successfully and effectively in psychotherapy for a variety of disorders. In the field of depression, there are only a few VR interventions and approaches. Although simple social interactions have been successfully modeled in VR for several mental disorders, there has been no transfer to the field of depression therapy. VR may be employed for psychodynamic psychotherapy to work on interpersonal conflict patterns. In this study, we developed and evaluated a VR intervention for the simulation of roleplay situations in the context of supportive-expressive therapy. Methods We conducted a clinical user experience (UX) study at a psychotherapeutic clinic in Düsseldorf, Germany. Eight inpatients with depression and four therapists were included. Semi-structured interviews and qualitative content analysis were used to identify UX issues of the developed VR intervention. Usability questionnaires and technical usage data were also considered. The VR intervention consisted of two therapist-controlled roleplay scenarios designed to support work on the core conflictual relationship theme by allowing patients to interact in typical problematic social situations. Recorded VR roleplays allow for therapeutic debriefing with a change of perspective. Therapists were given the option of using the roleplay in multiple sessions. Results All therapists conducted one session per patient with the VR intervention. From the patient interviews, 26 UX issues were extracted, of which one technical malfunction and two unclarities in the interaction with the VR agent were rated as major problems. From the therapist interviews, 14 UX issues were extracted, of which five were rated as major problems related to the interface in the dialog control or the complex system setup. Conclusion The main problem was designing a dialog structure that allows both complex conversational flows and a clear control interface. In principle, VR roleplays could be integrated well and safely into therapy. The VR intervention shows promise for providing an emotional experience of interpersonal conflict patterns in the context of psychotherapy. Additionally, other roleplay situations involving various social problem areas must be created and evaluated in terms of the fit to the patients' core conflictual relationship themes.
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Affiliation(s)
- Steffen Holsteg
- Clinical Institute of Psychosomatic Medicine and Psychotherapy, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstrasse 5, D-40225 Düsseldorf, Germany
| | - Johanna M. Askeridis
- Clinical Institute of Psychosomatic Medicine and Psychotherapy, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstrasse 5, D-40225 Düsseldorf, Germany
| | - Jarek Krajewski
- Institute of Experimental Psychophysiology GmbH, Gustav-Poensgen-Strasse 29, D-40215 Düsseldorf, Germany
| | - Philip Mildner
- Nuromedia GmbH, Schaafenstrasse 25, D-50676 Cologne, Germany
| | | | - Tobias Müller
- Clinical Institute of Psychosomatic Medicine and Psychotherapy, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstrasse 5, D-40225 Düsseldorf, Germany
| | - Sebastian Schnieder
- Institute of Experimental Psychophysiology GmbH, Gustav-Poensgen-Strasse 29, D-40215 Düsseldorf, Germany
| | - Annika Gieselmann
- Department of Clinical Psychology, Heinrich Heine University Düsseldorf, Universitätsstrasse 1, D-40225 Düsseldorf, Germany
| | - André Karger
- Clinical Institute of Psychosomatic Medicine and Psychotherapy, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstrasse 5, D-40225 Düsseldorf, Germany
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Jabir AI, Lin X, Martinengo L, Sharp G, Theng YL, Tudor Car L. Attrition in Conversational Agent-Delivered Mental Health Interventions: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e48168. [PMID: 38412023 PMCID: PMC10933752 DOI: 10.2196/48168] [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] [Received: 04/25/2023] [Revised: 09/21/2023] [Accepted: 12/04/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Conversational agents (CAs) or chatbots are computer programs that mimic human conversation. They have the potential to improve access to mental health interventions through automated, scalable, and personalized delivery of psychotherapeutic content. However, digital health interventions, including those delivered by CAs, often have high attrition rates. Identifying the factors associated with attrition is critical to improving future clinical trials. OBJECTIVE This review aims to estimate the overall and differential rates of attrition in CA-delivered mental health interventions (CA interventions), evaluate the impact of study design and intervention-related aspects on attrition, and describe study design features aimed at reducing or mitigating study attrition. METHODS We searched PubMed, Embase (Ovid), PsycINFO (Ovid), Cochrane Central Register of Controlled Trials, and Web of Science, and conducted a gray literature search on Google Scholar in June 2022. We included randomized controlled trials that compared CA interventions against control groups and excluded studies that lasted for 1 session only and used Wizard of Oz interventions. We also assessed the risk of bias in the included studies using the Cochrane Risk of Bias Tool 2.0. Random-effects proportional meta-analysis was applied to calculate the pooled dropout rates in the intervention groups. Random-effects meta-analysis was used to compare the attrition rate in the intervention groups with that in the control groups. We used a narrative review to summarize the findings. RESULTS The systematic search retrieved 4566 records from peer-reviewed databases and citation searches, of which 41 (0.90%) randomized controlled trials met the inclusion criteria. The meta-analytic overall attrition rate in the intervention group was 21.84% (95% CI 16.74%-27.36%; I2=94%). Short-term studies that lasted ≤8 weeks showed a lower attrition rate (18.05%, 95% CI 9.91%- 27.76%; I2=94.6%) than long-term studies that lasted >8 weeks (26.59%, 95% CI 20.09%-33.63%; I2=93.89%). Intervention group participants were more likely to attrit than control group participants for short-term (log odds ratio 1.22, 95% CI 0.99-1.50; I2=21.89%) and long-term studies (log odds ratio 1.33, 95% CI 1.08-1.65; I2=49.43%). Intervention-related characteristics associated with higher attrition include stand-alone CA interventions without human support, not having a symptom tracker feature, no visual representation of the CA, and comparing CA interventions with waitlist controls. No participant-level factor reliably predicted attrition. CONCLUSIONS Our results indicated that approximately one-fifth of the participants will drop out from CA interventions in short-term studies. High heterogeneities made it difficult to generalize the findings. Our results suggested that future CA interventions should adopt a blended design with human support, use symptom tracking, compare CA intervention groups against active controls rather than waitlist controls, and include a visual representation of the CA to reduce the attrition rate. TRIAL REGISTRATION PROSPERO International Prospective Register of Systematic Reviews CRD42022341415; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022341415.
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Affiliation(s)
- Ahmad Ishqi Jabir
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Future Health Technologies, Singapore-ETH Centre, Campus for Research Excellence And Technological Enterprise, Singapore, Singapore
| | - Xiaowen Lin
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Laura Martinengo
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Gemma Sharp
- Department of Neuroscience, Monash University, Melbourne, Australia
| | - Yin-Leng Theng
- Centre for Healthy and Sustainable Cities, Wee Kim Wee School of Communication and Information, Nanyang Technological University Singapore, Singapore, Singapore
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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Thaysen-Petersen D, Hammerum SK, Vissing AC, Oestrich IH, Nordentoft M, Düring SW, Fink-Jensen A. Virtual reality-assisted cognitive behavioral therapy for patients with alcohol use disorder: a randomized feasibility study. Front Psychiatry 2024; 15:1337898. [PMID: 38419905 PMCID: PMC10899342 DOI: 10.3389/fpsyt.2024.1337898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Cognitive behavioral therapy (CBT) is an evidence-based treatment for alcohol use disorder (AUD). Exposure to high-risk situations in virtual reality (VR) has been suggested to have a potential therapeutical benefit, but no previous study has combined VR and CBT for AUD. We aimed to investigate the feasibility of using VR-simulated high-risk environments in CBT-based treatment of AUD. Methods We randomized ten treatment-seeking AUD-diagnosed individuals to three sessions of conventional CBT or VR-assisted CBT performed at two outpatient clinics in Denmark. In each session, patients randomized to VR-CBT were exposed to VR-simulations from a restaurant to induce authentic thoughts, emotions, physiological reactions, and craving for CBT purposes. The primary outcome measure was feasibility: Drop-out rate, psychological reactions, and simulator sickness. Secondary outcomes were assessment of preliminary short-term changes in alcohol consumption and craving from baseline to one-week and one-month follow-up. In addition, the study was conducted for training in operationalization of VR equipment, treatment manuals, and research questionnaires. Results The majority of patients completed all study visits (90%). VR induced authentic high-risk related thoughts, emotions, and physiological reactions that were considered relevant for CBT by patients and therapists. Four of five patients randomized to VR-CBT experienced cravings during VR simulations, and most of these patients (3/5) experienced mild simulator sickness during VR exposure. The preliminary data showed that patients receiving VR-CBT had more reduction in alcohol consumption than patients receiving conventional CBT at one week- (median 94% vs. 72%) and one-month follow-up (median 98% vs. 55%). Similar results were found regarding changes in cravings. Conclusion We demonstrated VR-CBT to be a feasible intervention for patients with AUD which supports continued investigations in a larger randomized clinical trial evaluating the efficacy of VR-CBT. Clinical trial registration https://www.clinicaltrials.gov/study/NCT04990765?cond=addiction%20CRAVR&rank=2, identifier NCT05042180.
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Affiliation(s)
- Daniel Thaysen-Petersen
- Mental Health Centre Copenhagen, Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Sigurd Krogh Hammerum
- Mental Health Centre Copenhagen, Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Anne-Cathrine Vissing
- Mental Health Centre Copenhagen, Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Irene Henriette Oestrich
- Mental Health Centre Sct. Hans, Roskilde, Mental Health Services, Capital Region of Denmark, Roskilde, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Signe Wegmann Düring
- Mental Health Centre Sct. Hans, Roskilde, Mental Health Services, Capital Region of Denmark, Roskilde, Denmark
- Outpatient Clinics, Novavi Foundation, Frederiksberg, Denmark
- Psychiatric Center Amager, Mental Health Services, Capitol Region Hospitals, Amager, Denmark
| | - Anders Fink-Jensen
- Mental Health Centre Copenhagen, Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Shen FX, Baum ML, Martinez-Martin N, Miner AS, Abraham M, Brownstein CA, Cortez N, Evans BJ, Germine LT, Glahn DC, Grady C, Holm IA, Hurley EA, Kimble S, Lázaro-Muñoz G, Leary K, Marks M, Monette PJ, Jukka-Pekka O, O’Rourke PP, Rauch SL, Shachar C, Sen S, Vahia I, Vassy JL, Baker JT, Bierer BE, Silverman BC. Returning Individual Research Results from Digital Phenotyping in Psychiatry. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:69-90. [PMID: 37155651 PMCID: PMC10630534 DOI: 10.1080/15265161.2023.2180109] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Psychiatry is rapidly adopting digital phenotyping and artificial intelligence/machine learning tools to study mental illness based on tracking participants' locations, online activity, phone and text message usage, heart rate, sleep, physical activity, and more. Existing ethical frameworks for return of individual research results (IRRs) are inadequate to guide researchers for when, if, and how to return this unprecedented number of potentially sensitive results about each participant's real-world behavior. To address this gap, we convened an interdisciplinary expert working group, supported by a National Institute of Mental Health grant. Building on established guidelines and the emerging norm of returning results in participant-centered research, we present a novel framework specific to the ethical, legal, and social implications of returning IRRs in digital phenotyping research. Our framework offers researchers, clinicians, and Institutional Review Boards (IRBs) urgently needed guidance, and the principles developed here in the context of psychiatry will be readily adaptable to other therapeutic areas.
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Affiliation(s)
- Francis X. Shen
- Harvard Medical School
- Massachusetts General Hospital
- Harvard Law School
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mason Marks
- Harvard Law School
- Florida State University College of Law
- Yale Law School
| | | | | | | | - Scott L. Rauch
- Harvard Medical School
- McLean Hospital
- Mass General Brigham
| | | | | | | | - Jason L. Vassy
- Harvard Medical School
- Brigham and Women’s Hospital
- VA Boston Healthcare System
| | | | - Barbara E. Bierer
- Harvard Medical School
- Brigham and Women’s Hospital
- Multi-Regional Clinical Trials Center of Brigham and Women’s Hospital and Harvard
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Quaglieri A, Pizzo A, Cricenti C, Tagliaferri G, Frisari FV, Burrai J, Mari E, Lausi G, Giannini AM, Zivi P. Gambling and virtual reality: unraveling the illusion of near-misses effect. Front Psychiatry 2024; 15:1322631. [PMID: 38362030 PMCID: PMC10867214 DOI: 10.3389/fpsyt.2024.1322631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/10/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction Studying gambling behavior is a crucial element in reducing the impact of problem gambling. Nevertheless, most current research is carried out in controlled laboratory settings rather than real-life situations, which raises concerns about how applicable the findings are in the broader context. Virtual reality (VR) has proven to be a valuable tool and has been utilized in various experimental scenarios. A limited number of studies have employed VR to investigate gambling behaviors, and few have explored them in an older adolescent context. Methods This study examined the behavioral and physiological effects of gambling behavior, including problem gambling, gaming addiction, and risk-taking decision-making in a sample of 36 high-school students aged between 18 to 20 years using an ad-hoc constructed VR scenario designed to simulate a slot-machine platform. Results The behavioral results highlighted that participants reporting more problem gambling were sensitive to near-misses: i.e., they bet more after near-misses than after losses. This result may reflect the false belief that gamblers, after near-misses, are closer to winning. Physiological data showed that participants exhibited heart rate deceleration during the anticipation of the outcome, which has been suggested to represent a marker of feedback anticipation processing and hyposensitivity to losses. Discussion Overall, this study provides evidence for a new VR tool to assess gambling behaviors and new insights into gambling-related behavioral and physiological factors. Implications for the treatment of problem gambling are discussed.
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Affiliation(s)
| | - Alessandra Pizzo
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | | | | | - Francesca Valeria Frisari
- Department of Psychology of Development and Socialization Processes, Sapienza University of Rome, Rome, Italy
| | - Jessica Burrai
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Emanuela Mari
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | - Giulia Lausi
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Pierpaolo Zivi
- Department of Psychology, Sapienza University of Rome, Rome, Italy
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Rong XJ, Ning Z. Practical effect of different teaching modes in teaching gastrointestinal surgery nursing. World J Gastrointest Surg 2024; 16:166-172. [PMID: 38328328 PMCID: PMC10845283 DOI: 10.4240/wjgs.v16.i1.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND With the continuous development and progress of medical technology, the position of surgical nursing in the field of clinical medicine is becoming increasingly prominent. As an important branch of the surgical field, the nursing requirements and difficulty of gastrointestinal surgery are also increasing. In order to improve the teaching quality of nursing care in gastrointestinal surgery, many educators and researchers are actively exploring new teaching methods. Among them, the teaching method case-based learning (CBL), scene-simulated learning (SSL), task-based learning (TBL), combining self-evaluation and training mode is considered as an effective method. This method aims to help students to better master knowledge and skills and improve their comprehensive quality by cultivating their self-evaluation ability. AIM To explore the practical effect of CBL-SSL-TBL combined with training mode and student self-assessment in nursing teaching of gastrointestinal surgery. METHODS Seventy-one nursing interns in our hospital from December 2020 to December 2021 were selected. According to different teaching modes, they were divided into observation group CBL-SSL-TBL combined with training mode combined with student self-assessment and control group (conventional teaching mode), of which 36 were in observation group and 35 were in control group. The results of operational skills, theoretical knowledge, nursing students' satisfaction, learning effectiveness questionnaire and teaching effect were compared between the two groups. RESULTS Compared between the two groups, the operational skills and theoretical knowledge scores of the observation group were higher than those of the control group, and the difference was statistically significant (P < 0.05). Compared between the two groups, the total satisfaction ratio of the observation group was higher than that of the control group, the difference was statistically significant (P < 0.05). Compared between the two groups, the observation group was lower than the control group in the questionnaire results of learning efficacy, and the difference was statistically significant (P < 0.05). Compared between the two groups, the proportion of thinking ability, subjective initiative and understanding of theoretical knowledge in the observation group was higher than that in the control group, the difference was statistically significant (P < 0.05). CONCLUSION The use of CBL-SSL-TBL combined with training mode and student self-assessment in gastrointestinal surgery nursing teaching can improve the operational skills of nursing interns, theoretical knowledge and satisfaction scores of nursing students, improve the results of learning efficiency questionnaire and teaching effect, which can be popularized in clinical teaching.
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Affiliation(s)
- Xiao-Juan Rong
- Department of Nursing, Medical College in Jiangxi University of Technology, Nanchang 330098, Jiangxi Province, China
| | - Zhen Ning
- Department of Nursing, Medical College in Jiangxi University of Technology, Nanchang 330098, Jiangxi Province, China
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Le Roy B, Martin-Krumm C, Poupon C, Richieri R, Malbos E, Barthélémy F, Guedj E, Trousselard M. Virtual Exercise in Medicine: A Proof of Concept in a Healthy Population. JMIR Form Res 2024; 8:e45637. [PMID: 38252484 PMCID: PMC10845022 DOI: 10.2196/45637] [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: 01/10/2023] [Revised: 05/19/2023] [Accepted: 08/31/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Science is beginning to establish the benefits of the use of virtual reality (VR) in health care. This therapeutic approach may be an appropriate complementary treatment for some mental illnesses. It could prevent high levels of morbidity and improve the physical health of patients. For many years, the literature has shown the health benefits of physical exercise. Physical exercise in a VR environment may improve the management of mild to moderate mental health conditions. In this context, we developed a virtual environment combined with an ergocycle (the augmented physical training for isolated and confined environments [APTICE] system). OBJECTIVE This study aims to investigate the impact of physical exercise in a VR environment. METHODS A total of 14 healthy participants (11 men and 3 women; mean age 43.28, SD 10.60 years) undertook 15 minutes of immersive physical exercise using the system. Measures included mindfulness and immersion disposition, subjective perceptions of sensory information, user experience, and VR experience (ie, psychological state, flow, and presence). RESULTS First, the APTICE system appears to be a useful tool because the user experience is positive (subscales in the AttrakDiff questionnaire: pragmatic quality=0.99; hedonic quality-stimulation=1.90; hedonic quality-identification=0.67; attractiveness=1.58). Second, the system can induce a positive psychological state (negative emotion, P=.06) and an experience of flow and presence (P values ranging from <.001 to .04). Third, individual immersive and mindful disposition plays a role in the VR experience (P values ranging from <.02 to .04). Finally, our findings suggest that there is a link between the subjective perception of sensory information and the VR experience (P values ranging from <.02 to .04). CONCLUSIONS These results indicate that the device is well accepted with positive psychological and exteroceptive outcomes. Overall, the APTICE system could be a proof of concept to explore the benefits of virtual physical exercise in clinical medicine.
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Affiliation(s)
- Barbara Le Roy
- Unité neurophysiologie du stress, Institut de recherche biomédicale des armées, Brétigny-sur-Orge, France
- Adaptation, mesure et évaluation en santé. Approches interdisciplinaires, Metz, France
| | - Charles Martin-Krumm
- Unité neurophysiologie du stress, Institut de recherche biomédicale des armées, Brétigny-sur-Orge, France
- Adaptation, mesure et évaluation en santé. Approches interdisciplinaires, Metz, France
- Vulnérabilité, capabilité, rétablissement, Unité religion, culture et société, Ecole des psychologues praticiens, Paris, France
| | - Charlotte Poupon
- École nationale supérieure de création industrielle, Paris, France
| | - Raphaëlle Richieri
- Département psychiatrie, Hôpital de la Conception, Institut Fresnel, Marseille, France
| | - Eric Malbos
- Département psychiatrie, Hôpital de la Conception, Institut Fresnel, Marseille, France
| | - Fanny Barthélémy
- Département de médecine nucléaire, Centre européen de recherche en imagerie médicale, Institut Fresnel, Marseille, France
| | - Eric Guedj
- Département de médecine nucléaire, Centre européen de recherche en imagerie médicale, Institut Fresnel, Marseille, France
| | - Marion Trousselard
- Unité neurophysiologie du stress, Institut de recherche biomédicale des armées, Brétigny-sur-Orge, France
- Adaptation, mesure et évaluation en santé. Approches interdisciplinaires, Metz, France
- Service de santé des armées, Paris, France
- Réseau ABC des Psychotraumas, Montpellier, France
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Armstrong A, Oetinger K, Weimer K, Hönig K. Digital psychosocial interventions for individuals with spinal cord injury: a scoping review. Front Psychiatry 2024; 15:1289138. [PMID: 38317764 PMCID: PMC10838963 DOI: 10.3389/fpsyt.2024.1289138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/05/2024] [Indexed: 02/07/2024] Open
Abstract
Objective To provide an overview of the digital mental health care landscape for individuals with spinal cord injury (SCI). Methods PubMed, PsycInfo, and PSYNDEX were searched for articles meeting the following criteria: (1) article written in English or German; (2) digital psychosocial intervention; (3) SCI only; (4) treatment of individuals with SCI and not their relatives or caregivers. Records were screened by title and abstract and records meeting the inclusion criteria were obtained for full text screening. The references of identified articles were screened to find further relevant articles. The literature search was updated before submission. Risk of Bias was assessed by using the Cochrane risk-of-bias tool for randomized trials (RoB 2) and a narrative synthesis was conducted. Results Ten randomized-controlled trials (RCT) and ten non-randomized-controlled trials were identified and compared in this review, evaluating twelve internet- and mobile-based interventions, five smartphone apps, and three virtual reality applications. The interventions were primarily used as stand-alone aftercare programs. While some were not based on any theory, cognitive behavioral therapy mostly served as the theoretical basis for the online interventions. The extent of human support also varied greatly between the studies. The number of intervention modules ranged between 2 and 72. There were also major differences in outcome variables and effects. A meta-analytical evaluation of the data was not conducted due to heterogeneity of studies. Conclusion Digital applications to promote the psychosocial health of individuals with SCI are an emerging field of research with many treatment approaches still to come. First high quality RCT studies report promising results. Unfortunately, not all studies are of high quality or the interventions have been insufficiently adapted to the needs of people with SCI. Therefore, more research is needed to further develop applications, and to generalize and test the effects found in the long term.
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Affiliation(s)
| | - Katja Oetinger
- Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Centre, Ulm, Germany
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Sommer JL, Reynolds K, Hebbard P, Smith MSD, Mota N, Mutch WAC, Maples-Keller J, Roos L, El-Gabalawy R. Preoperative Virtual Reality to Expose Patients With Breast Cancer to the Operating Room Environment: Feasibility and Pilot Case Series Study. JMIR Form Res 2024; 8:e46367. [PMID: 38231570 PMCID: PMC10831694 DOI: 10.2196/46367] [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: 02/08/2023] [Revised: 11/16/2023] [Accepted: 12/04/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Clinically elevated preoperative distress and anxiety are common among patients undergoing cancer surgery. Preoperative interventions have been developed to mitigate this distress and anxiety but are inconsistent in efficacy and feasibility for broad implementation. OBJECTIVE This preliminary pilot study aims to assess the feasibility and utility of a newly developed virtual reality (VR) intervention to expose patients awaiting breast cancer surgery to the operating room environment and a simulation of anesthetic induction. METHODS Patients undergoing breast cancer surgery (N=7) were assigned to the VR intervention or control (treatment as usual) group and completed self-report measures of distress and anxiety before surgery, on the day of surgery, and after surgery (5 and 30 d postoperatively). Those in the intervention group trialed the VR simulation 1 to 2 weeks preoperatively and provided qualitative and quantitative feedback. We assessed the feasibility of recruitment capability and study design and evaluated participants' impressions of the intervention using self-report rating scales and open-ended questions. We also descriptively examined distress and anxiety levels throughout the duration of the study. RESULTS Recruitment occurred between December 2021 and December 2022 and progressed slowly (rate: 1 participant/7 wk on average; some hesitancy because of stress and being overwhelmed). All participants who consented to participate completed the entire study. All participants were female and aged 56 (SD 10.56) years on average. In total, 57% (4/7) of the participants were assigned to the intervention group. On average, intervention participants spent 12 minutes engaged in the VR simulation. In general, the intervention was rated favorably (eg, clear information, enjoyable, and attractive presentation; mean% agreement 95.00-96.25, SD 4.79-10.00) and as helpful (mean% agreement 87.50, SD 25.00). Participants described the intervention as realistic (eg, "It was realistic to my past surgical experiences"), impacting their degree of preparedness and expectations for surgery (eg, "The sounds and sights and procedures give you a test run; they prepare you for the actual day"), and having a calming or relaxing effect (eg, "You feel more relaxed for the surgery"). CONCLUSIONS This preoperative VR intervention demonstrated preliminary feasibility among a sample of patients undergoing breast cancer surgery. Results and participant feedback will inform modifications to the VR intervention and the study design of a large-scale randomized controlled trial to examine the efficacy of this intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT04544618; https://clinicaltrials.gov/study/NCT04544618.
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Affiliation(s)
- Jordana L Sommer
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Kristin Reynolds
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Pamela Hebbard
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba, Winnipeg, MB, Canada
| | | | - Natalie Mota
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - W Alan C Mutch
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jessica Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States
| | - Leslie Roos
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Renée El-Gabalawy
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
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Mizuta R, Maeda N, Tashiro T, Suzuki Y, Kuroda S, Ishida A, Oda S, Watanabe T, Tamura Y, Komiya M, Urabe Y. Effectiveness of Metaverse Space-Based Exercise Video Distribution in Young Adults: Randomized Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e46397. [PMID: 38227355 PMCID: PMC10828949 DOI: 10.2196/46397] [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] [Received: 02/10/2023] [Revised: 09/04/2023] [Accepted: 11/28/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND In response to the serious lack of physical activity among young adults, recent attempts have been made to encourage young people to exercise through exercise video distribution. However, merely distributing videos does not lead to improved physical activity levels. Metaverse space, which enables web-based interaction through avatars, allows users to watch exercise videos in the same space as other avatars. OBJECTIVE This study explored whether exercise video distribution using metaverse space is effective in improving physical activity levels, along with mental health and locomotive function, among young people. METHODS In this parallel-group randomized controlled trial participants were recruited using printed poster displays. A total of 48 young adults aged between 18 and 30 years were assigned to 3 groups of 16 each: the metaverse, YouTube, and control group. To encourage exercise, the metaverse group was given an exercise video each week with a load of around 4-8 metabolic equivalents of tasks (METs) for 8 videos delivered in the metaverse space. The YouTube group was sent a URL on YouTube every week to view exercise videos with the same content as the metaverse group. The control group was given no special instructions. The intervention period was 8 weeks. Pre- and postintervention physical activity, well-being, locomotive syndrome risk tests, and social capital were measured. Although this study was not blinded to the participants, the measurers did not know to which group the participants belonged. Mixed model repeated-measures analyses and a post hoc Wilcoxon signed rank sum test were performed to detect the effects of the intervention in all groups. RESULTS The results of the mixed model repeated-measures analyses showed a significant interaction between groups and before and after the intervention for total physical activity (metaverse group: pre 737.1, SD 609.5 METs/week, post 1575.4, SD 1071.8 METs/week; YouTube group: pre 661.7, SD 710.7 METs/week, post 911.9, SD 1103.3 METs/week; and control group: pre 930.6, SD 665.1 METs/week, post 844.7, SD 701.8 METs/week; P=.04) but none for the indicators of well-being (P=.40), locomotive function scale (P=.17), and social capital (P=.23). A post hoc test showed a significant increase in physical activity in the metaverse group before and after the intervention (P=.006). CONCLUSIONS This study is the first to show that delivering exercise videos through metaverse space can increase physical activity in young adults by providing a gathering space for individuals similarly motivated for exercise practice. This way, the sense of isolation during exercise is reduced compared with merely distributing videos on YouTube. The use of metaverse space in health promotion is likely to spread, and this study provides a useful reference for its exploration. TRIAL REGISTRATION ClinicalTrials.gov NCT06019156; https://ichgcp.net/clinical-trials-registry/NCT06019156.
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Affiliation(s)
- Rami Mizuta
- Department of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Noriaki Maeda
- Department of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tsubasa Tashiro
- Department of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuta Suzuki
- Department of Physical Therapy, Faculty of Rehabilitation, Kyushu Nutrition Welfare University, Fukuoka, Japan
| | - Sayo Kuroda
- Department of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ayano Ishida
- Department of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Sakura Oda
- Department of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tomoya Watanabe
- Department of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yuki Tamura
- Department of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Makoto Komiya
- Department of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukio Urabe
- Department of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Espinola CW, Nguyen B, Torres A, Sim W, Rueda A, Beavers L, Campbell DM, Jung H, Lou W, Kapralos B, Peter E, Dubrowski A, Krishnan S, Bhat V. Digital Interventions for Stress Among Frontline Health Care Workers: Results From a Pilot Feasibility Cohort Trial. JMIR Serious Games 2024; 12:e42813. [PMID: 38194247 PMCID: PMC10783335 DOI: 10.2196/42813] [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: 09/21/2022] [Revised: 08/03/2023] [Accepted: 09/30/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has challenged the mental health of health care workers, increasing the rates of stress, moral distress (MD), and moral injury (MI). Virtual reality (VR) is a useful tool for studying MD and MI because it can effectively elicit psychophysiological responses, is customizable, and permits the controlled study of participants in real time. OBJECTIVE This study aims to investigate the feasibility of using an intervention comprising a VR scenario and an educational video to examine MD among health care workers during the COVID-19 pandemic and to use our mobile app for longitudinal monitoring of stress, MD, and MI after the intervention. METHODS We recruited 15 participants for a compound intervention consisting of a VR scenario followed by an educational video and a repetition of the VR scenario. The scenario portrayed a morally challenging situation related to a shortage of life-saving equipment. Physiological signals and scores of the Moral Injury Outcome Scale (MIOS) and Perceived Stress Scale (PSS) were collected. Participants underwent a debriefing session to provide their impressions of the intervention, and content analysis was performed on the sessions. Participants were also instructed to use a mobile app for 8 weeks after the intervention to monitor stress, MD, and mental health symptoms. We conducted Wilcoxon signed rank tests on the PSS and MIOS scores to investigate whether the VR scenario could induce stress and MD. We also evaluated user experience and the sense of presence after the intervention through semi-open-ended feedback and the Igroup Presence Questionnaire, respectively. Qualitative feedback was summarized and categorized to offer an experiential perspective. RESULTS All participants completed the intervention. Mean pre- and postintervention scores were respectively 10.4 (SD 9.9) and 13.5 (SD 9.1) for the MIOS and 17.3 (SD 7.5) and 19.1 (SD 8.1) for the PSS. Statistical analyses revealed no significant pre- to postintervention difference in the MIOS and PSS scores (P=.11 and P=.22, respectively), suggesting that the experiment did not acutely induce significant levels of stress or MD. However, content analysis revealed feelings of guilt, shame, and betrayal, which relate to the experience of MD. On the basis of the Igroup Presence Questionnaire results, the VR scenario achieved an above-average degree of overall presence, spatial presence, and involvement, and slightly below-average realism. Of the 15 participants, 8 (53%) did not answer symptom surveys on the mobile app. CONCLUSIONS Our study demonstrated VR to be a feasible method to simulate morally challenging situations and elicit genuine responses associated with MD with high acceptability and tolerability. Future research could better define the efficacy of VR in examining stress, MD, and MI both acutely and in the longer term. An improved participant strategy for mobile data capture is needed for future studies. TRIAL REGISTRATION ClinicalTrails.gov NCT05001542; https://clinicaltrials.gov/study/NCT05001542. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/32240.
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Affiliation(s)
- Caroline W Espinola
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Interventional Psychiatry Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Binh Nguyen
- Department of Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, ON, Canada
| | - Andrei Torres
- maxSIMhealth Group, Ontario Tech University, Oshawa, ON, Canada
| | - Walter Sim
- Interventional Psychiatry Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Alice Rueda
- Interventional Psychiatry Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Lindsay Beavers
- Allan Waters Family Simulation Program, Unity Health Toronto, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Douglas M Campbell
- Allan Waters Family Simulation Program, Unity Health Toronto, Toronto, ON, Canada
- Neonatal Intensive Care Unit, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hyejung Jung
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wendy Lou
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Bill Kapralos
- maxSIMhealth Group, Ontario Tech University, Oshawa, ON, Canada
| | - Elizabeth Peter
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Adam Dubrowski
- maxSIMhealth Group, Ontario Tech University, Oshawa, ON, Canada
| | - Sridhar Krishnan
- Department of Electrical, Computer, and Biomedical Engineering, Toronto Metropolitan University, Toronto, ON, Canada
| | - Venkat Bhat
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Interventional Psychiatry Program, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
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50
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Sigurvinsdottir R, Skúladóttir H, Antonsdóttir HF, Cardenas P, Georgsdóttir MT, Írisardóttir Þórisdóttir M, Jónsdóttir EK, Konop M, Valdimarsdóttir HB, Vilhjálmsson HH, Ásgeirsdóttir BB. A Virtual Reality Courtroom for Survivors of Sexual Violence: A Mixed-Method Pilot Study on Application Possibilities. Violence Against Women 2024; 30:249-274. [PMID: 37801610 DOI: 10.1177/10778012231205589] [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: 10/08/2023]
Abstract
This mixed-method pilot study examined the application possibilities of a virtual courtroom to support survivors of sexual violence who may experience courtroom-associated distress. Female sexual violence survivors (n = 13) who had testified in court following victimization entered an interactive virtual courtroom replica. Their reactions were measured quantitatively and qualitatively. The virtual courtroom evoked both subjective and physiological stress. Participants perceived the virtual reality environment as similar to the real-life courtroom. Most reported negative experiences from interacting with the criminal justice system. The virtual courtroom is a possible future strategy to support survivors when reporting violence to the justice system.
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Affiliation(s)
| | | | | | - Paola Cardenas
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | | | | | | | - Magdalena Konop
- Department of Psychotherapy, Jagiellonian University Medical College, Krakow, Poland
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