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Ye T, Elliott R, McFarquhar M, Mansell W. The impact of audience dynamics on public speaking anxiety in virtual scenarios: An online survey. J Affect Disord 2024; 363:S0165-0327(24)01120-0. [PMID: 39067529 DOI: 10.1016/j.jad.2024.07.061] [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: 11/28/2023] [Revised: 06/29/2024] [Accepted: 07/14/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Public speaking is one of the most commonly feared situations reported in both community and university samples. Despite extensive theoretical models and empirical studies aimed at delineating the underlying factors of Public Speaking Anxiety (PSA), the specific variables contributing to its onset remain incompletely characterised. METHODS The research involved 297 participants from an AmazonTurk survey, engaging with virtual public speaking scenarios differentiated by audience size, engagement levels, and room spatial dimensions. Participants' anticipated anxiety levels were quantitatively assessed across these scenarios, enabling a comprehensive exploration of the interaction between situational variables and PSA, thereby providing a framework to explore the influence of audience size, engagement, and spatial dimensions on PSA. RESULTS The mixed-effect model revealed a significant interaction among audience size, audience engagement, and room spatial dimensions. Further analyses using principal axis factoring and multiple regression identified three main factors: F1 (Engagement in a Large Audience), F2 (Confinement or Evaluation Anxiety), and F3 (Audience Disengagement). These factors significantly predict PSA scores. CONCLUSIONS This study reveals that PSA is influenced by a complex interplay of audience size, room dimensions, and audience engagement. The finding underscores the viable way to incorporate these situational variables in both empirical investigations and therapeutic interventions. Specifically, it introduces a novel framework for standardising audience size relative to room capacity.
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Affiliation(s)
- Tingjun Ye
- Division of Neuroscience and Experimental Psychology, Stopford Building, University of Manchester, UK.
| | - Rebecca Elliott
- Division of Neuroscience and Experimental Psychology, Stopford Building, University of Manchester, UK
| | - Martyn McFarquhar
- Division of Neuroscience and Experimental Psychology, Zochonis Building, University of Manchester, UK
| | - Warren Mansell
- Division of Psychology and Mental Health, Zochonis Building, University of Manchester, UK
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Maymon CN, Crawford MT, Blackburne K, Botes A, Carnegie K, Mehr SA, Meier J, Murphy J, Miles NL, Robinson K, Tooley M, Grimshaw GM. The presence of fear: How subjective fear, not physiological changes, shapes the experience of presence. J Exp Psychol Gen 2024; 153:1500-1516. [PMID: 38635168 PMCID: PMC11182719 DOI: 10.1037/xge0001576] [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] [Indexed: 04/19/2024]
Abstract
When we become engrossed in novels, films, games, or even our own wandering thoughts, we can feel present in a reality distinct from the real world. Although this subjective sense of presence is, presumably, a ubiquitous aspect of conscious experience, the mechanisms that produce it are unknown. Correlational studies conducted in virtual reality have shown that we feel more present when we are afraid, motivating claims that physiological changes contribute to presence; however, such causal claims remain to be evaluated. Here, we report two experiments that test the causal role of subjective and physiological components of fear (i.e., activation of the sympathetic nervous system) in generating presence. In Study 1, we validated a virtual reality simulation capable of inducing fear. Participants rated their emotions while they crossed a wooden plank that appeared to be suspended above a city street; at the same time, we recorded heart rate and skin conductance levels. Height exposure increased ratings of fear, presence, and both measures of sympathetic activation. Although presence and fear ratings were correlated during height exposure, presence and sympathetic activation were unrelated. In Study 2, we manipulated whether the plank appeared at height or at ground level. We also captured participants' movements, which revealed that alongside increases in subjective fear, presence, and sympathetic activation, participants also moved more slowly at height relative to controls. Using a mediational approach, we found that the relationship between height exposure and presence on the plank was fully mediated by self-reported fear, and not by sympathetic activation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | | | | | - André Botes
- University of Auckland, Auckland, New Zealand
| | | | - Samuel A. Mehr
- University of Auckland, Auckland, New Zealand
- Yale Child Study Center, New Haven, USA
| | | | - Justin Murphy
- Victoria University of Wellington, Wellington, New Zealand
| | | | - Kealagh Robinson
- Victoria University of Wellington, Wellington, New Zealand
- Massey University, Palmerston North, New Zealand
| | - Michael Tooley
- Victoria University of Wellington, Wellington, New Zealand
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3
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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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Ribé-Viñes JM, Gutiérrez-Maldonado J, Zabolipour Z, Ferrer-Garcia M. Virtual reality exposure with vibrotactile stimulation for the treatment of fear of flying: A pilot study. J Behav Ther Exp Psychiatry 2024; 82:101915. [PMID: 37862878 DOI: 10.1016/j.jbtep.2023.101915] [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] [Received: 07/21/2022] [Revised: 08/30/2023] [Accepted: 09/28/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Virtual reality (VR) interventions are becoming more prevalent in treating fear of flying (FoF). Since multisensory stimulation can enhance the sense of presence in a virtual environment, the present study compared virtual reality exposure with and without vibrotactile cues to determine its contribution to the realism of the virtual experience. METHODS A repeated measures design was used. Thirty-one participants were exposed to two experimental conditions with a minimum of a one-week interval between them: one in which participants were exposed to the virtual environment with vibrotactile cues (smart chair, SC), and another in which participants were exposed to the virtual environment without vibrotactile cues (ordinary chair, OC). The administration order of both conditions was counterbalanced to avoid possible order effects. RESULTS Participants felt higher levels of sense of presence when using the SC than the OC. However, the addition of vibrotactile stimulation partially influenced experienced anxiety. Some personality traits were also associated with participants' sense of presence and anxiety responses during the exposure. LIMITATIONS The sample size was smaller than required. Moreover, only self-reported measures were used. Finally, a roller coaster instead of an airplane scenario was used for the exposure, which might not have been suitable enough for provoking anxiety in participants with FoF. CONCLUSIONS Vibrotactile cues enhanced the sense of presence. However, the addition of vibrotactile stimulation did not have a consistent effect on anxiety experienced during exposure. Therefore, the benefits of incorporating vibrotactile cues in virtual reality environments for exposure therapy are not clear.
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Affiliation(s)
- J M Ribé-Viñes
- Department of Clinical Psychology and Psychobiology. Universitat de Barcelona, Barcelona, Spain.
| | - J Gutiérrez-Maldonado
- Department of Clinical Psychology and Psychobiology. Universitat de Barcelona, Barcelona, Spain; Neuroscience Institute. Universitat de Barcelona, Barcelona, Spain
| | - Zahra Zabolipour
- Department of Clinical Psychology and Psychobiology. Universitat de Barcelona, Barcelona, Spain
| | - M Ferrer-Garcia
- Department of Clinical Psychology and Psychobiology. Universitat de Barcelona, Barcelona, Spain; Neuroscience Institute. Universitat de Barcelona, Barcelona, Spain.
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Woicik K, Geraets CNW, Klein Tuente S, Masthoff E, Veling W. Virtual reality aggression prevention treatment in a Dutch prison-based population: a pilot study. Front Psychol 2023; 14:1235808. [PMID: 38034305 PMCID: PMC10683795 DOI: 10.3389/fpsyg.2023.1235808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/25/2023] [Indexed: 12/02/2023] Open
Abstract
Background Treating violent behavior in prisons comes with challenges, such as the inability to practice safely with triggering situations and motivational issues. A solution may be the use of Virtual Reality (VR). With VR, specific conditions or needs can be tailored for individual practice, it can enhance motivation and VR has proven to be a safe and effective tool in mental health treatment. Objective A pilot study was conducted to test the acceptability, feasibility, and preliminary effects of VR Aggression Prevention Treatment (VRAPT) in a prison-based population. Methods In total 17 detainees with aggressive behavior were included in this single-group pilot study. Acceptability and feasibility were assessed using qualitative measures for participants and therapists. Preliminary treatment effects were measured with self-report and observational measures on aggression, anger, emotion regulation, and impulsiveness. Results Participants and therapists were predominantly positive about VRAPT. Participants rated the sessions with an average satisfaction score of 9.2 out of 10 (SD = 0.3). Qualitative data showed that participants reported having learned to respond more adequately to aggressive behavior and gained insights into their own and others' triggers and tension. The combination of VR and theory was experienced as a strength of the treatment, as well as the ability to trigger aggression in VR which provided insights into aggression. However, the theoretical framework was found to be too complex, and more aggressive and personal scenarios should be incorporated into the sessions. Self-reported aggression, anger, provocation, emotion regulation, and observed verbal aggression decreased and seemed to stabilize after the treatment ended, with small to medium effect sizes. Conclusion VRAPT proved feasible and acceptable for most participants and therapists. An adapted treatment protocol called Virtual Reality Treatment for Aggression Control (VR-TrAC), will be used in a future RCT to investigate the effects of the treatment in a prison-based population.
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Affiliation(s)
- Kasja Woicik
- Penitentiary Institution Vught, Vught, Netherlands
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Chris N. W. Geraets
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Lund Clinical Research on Externalizing and Developmental Psychopathology, Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Stéphanie Klein Tuente
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Erik Masthoff
- Fivoor Science and Treatment Innovation, Rotterdam, Netherlands
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands
| | - Wim Veling
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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Brown NB, Milani S, Jabs F, Kingstone A, Brotto LA. Exploring Women's State-Level Anxiety in Response to Virtual Reality Erotica. JOURNAL OF SEX & MARITAL THERAPY 2023; 50:137-151. [PMID: 37807833 DOI: 10.1080/0092623x.2023.2265924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Virtual Reality (VR)-based treatments for anxiety disorders are efficacious but there is a lack of research examining anxious responses to VR erotica, which could innovate treatments for sexual difficulties. We examined erotica features that elicited anxiety and sexual presence in women. Thirty-eight women viewed erotic videos from different modalities (2D, VR) and points of view (1st, 3rd person) and completed anxiety and sexual presence measures before and after each video. Women experienced greater anxiety for VR than 2D films and reported the most anxiety for VR 1st person films. Sexual presence was affected by modality and point of view.
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Affiliation(s)
- Natalie B Brown
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Sonia Milani
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Faith Jabs
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Alan Kingstone
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Lori A Brotto
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada
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Miegel F, Jelinek L, Moritz S, Lohse L, Yassari AH, Bücker L. Mixed results for exposure and response prevention therapy in mixed reality for patients with contamination-related obsessive-compulsive disorder: A randomized controlled pilot study. J Clin Psychol 2023; 79:2317-2336. [PMID: 37317567 DOI: 10.1002/jclp.23550] [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: 12/22/2022] [Revised: 03/22/2023] [Accepted: 05/28/2023] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Technology-supported exposure and response prevention (ERP) for patients with obsessive-compulsive disorder (OCD) as tested in clinical research, holds promise but also has limitations. The present study aims to overcome these limitations by using mixed reality for ERP (MERP). The objectives of this pilot study were to evaluate the safety, feasibility, and acceptance of MERP and to identify possible obstacles. METHODS Twenty inpatients with contamination-related OCD were recruited and randomized to two conditions: MERP (six sessions in 3 weeks) and care as usual treatment. Patients were assessed before treatment (baseline), after the 3-week intervention period (post), as well as 3 months after post assessment (follow-up) regarding symptomatology (Y-BOCS). RESULTS Results showed a similar reduction in symptomatology in both groups from baseline to post. Regarding safety, no clinically significant deterioration was detected in the MERP group. Patients' evaluation of the MERP was heterogeneous. The qualitative feedback provided helpful indications for further development of the software. Sense of presence was below the midpoint of the scales. CONCLUSION This is the first study evaluating a MERP for patients with OCD that shows cautious evidence for the acceptance and safety of MERP. The results of the subjective evaluation suggest revisions of the software.
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Affiliation(s)
- Franziska Miegel
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany
| | - Luzie Lohse
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany
| | - Amir H Yassari
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany
| | - Lara Bücker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany
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Jeanningros A, Baillot A, Corno G, Rivard MC, Aimé A, Bouchard S. Validation of a Virtual Environment to Induce State Social Physique Anxiety in Women with Obesity and Social Physique Anxiety. J Clin Med 2023; 12:6065. [PMID: 37763006 PMCID: PMC10531808 DOI: 10.3390/jcm12186065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/09/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
State Social Physique Anxiety (SPA), in contrast to Trait SPA, is triggered by specific situations that elicit SPA. To date, no research has used virtual reality (VR) to recreate a situation that may elicit State SPA. The purpose of this study is to validate a virtual environment (VE) that simulates an anxiogenic situation to induce State SPA in women with obesity and high SPA. The high SPA group consisted of 25 self-identified women living with obesity and high Trait SPA. The low SPA group consisted of 20 self-identified women with low SPA. All participants were immersed in a virtual swimming pool environment for 10 min using a virtual reality headset. After the immersion, State SPA and fear of being negatively judged felt during immersion were measured with self-report questionnaires. A questionnaire assessing unwanted negative side effects was administered before and after the immersion. Using an ANCOVA with Trait SPA as covariate, State SPA was found to be significantly higher in the high SPA group. Fear of being judged negatively was also significantly higher in the high SPA group. Unwanted negative side effects scores did not increase post-immersion in either group. This study documents the validity of a novel VE for inducing State SPA in women with obesity and high SPA.
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Affiliation(s)
- Alice Jeanningros
- Psychoeducation and Psychology Department, Université du Québec en Outaouais (UQO), Gatineau, QC J8X 3X7, Canada
| | - Aurélie Baillot
- Interdisciplinary Health School, Université du Québec en Outaouais (UQO), 283 Boul. Alexandre-Taché, Gatineau, QC J8X 3X7, Canada
- Psychosocial Medicine Research Center, Centre Intégré de Santé et Services Sociaux de l’Outaouais (CISSSO), Gatineau, QC J8T 4J3, Canada
- Institut du Savoir de Montfort-Research Hospital, Ottawa, ON K1K 0T2, Canada
| | - Giulia Corno
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal IUSMM, Montreal, QC H1N 3V2, Canada
| | - Marie-Christine Rivard
- Cyberpsychology Laboratory, Université du Québec en Outaouais (UQO), Gatineau, QC J8X 3X7, Canada
| | - Annie Aimé
- Psychoeducation and Psychology Department, Université du Québec en Outaouais (UQO), Gatineau, QC J8X 3X7, Canada
| | - Stéphane Bouchard
- Psychoeducation and Psychology Department, Université du Québec en Outaouais (UQO), Gatineau, QC J8X 3X7, Canada
- Psychosocial Medicine Research Center, Centre Intégré de Santé et Services Sociaux de l’Outaouais (CISSSO), Gatineau, QC J8T 4J3, Canada
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Lohse L, Jelinek L, Moritz S, Blömer J, Bücker L, Miegel F. Efficacy of exposure and response prevention therapy in mixed reality for patients with obsessive-compulsive disorder: study protocol for a randomized controlled trial. BMC Psychol 2023; 11:113. [PMID: 37055854 PMCID: PMC10100604 DOI: 10.1186/s40359-023-01116-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/07/2023] [Indexed: 04/15/2023] Open
Abstract
Many patients with obsessive-compulsive disorder (OCD) do not receive cognitive behavioral therapy with exposure and response prevention (first line treatment for OCD), for example, due to patients' fear of the exposure and reservations of the therapists. Technology-supported exposure (e.g., exposure therapy with response prevention in mixed reality [MERP]) for patients with OCD may help to overcome this obstacle. Building upon findings of our pilot study objectives of this study are to evaluate the efficacy, expectations of treatment success, feasibility, and acceptance of MERP as well as to identify possible limitations. In total, 64 outpatients with contamination-related OCD will be recruited and randomized to one of two conditions: MERP (six sessions in six weeks) and self-guided exposure therapy (six exercises in six weeks). Participants will be assessed before (baseline), after the six-week intervention period (post), as well as three months after post assessment (follow-up) regarding symptomatology (Yale-Brown Obsessive Compulsive Scale; Y-BOCS), their subjective evaluation of MERP (acceptance) and sense of presence. The planned study is the first to investigate MERP in patients with OCD.
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Affiliation(s)
- Luzie Lohse
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jannik Blömer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Lara Bücker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Franziska Miegel
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Evoked sensory stimulation of the eating environment, impacts feeling of presence and food desires in an online environment. Food Res Int 2023; 167:112645. [PMID: 37087236 DOI: 10.1016/j.foodres.2023.112645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/15/2023] [Accepted: 02/21/2023] [Indexed: 02/27/2023]
Abstract
Online food choices are often made outside a regular food environment and suffer from sensory deprivation. The present study investigated if evoked multi-sensory stimulation can drive context specific food desires in an online environment. In a randomised between subject design, participants expressed their food desire on a visual analogue scale and feeling of presence (e.g., did you feel present on a beach) on a Likert scale, whilst looking online at a picture and reading a neutral description of a sensory laboratory (control condition), looking at a photo of a beach and reading a neutral description (beach condition), or looking at a photo of a beach and reading a sensory based description (beach + ). Participants (n = 725 participants, 622 females) who saw the beach photo increased their desire for cold, but not neutral foods (p < 0.05), those who were exposed to the sensory description in addition to the photo showed a higher desire for cold foods compared to those who just saw the beach photo (p < 0.001). These effects were modulated by an increased feeling of presence and how often participants visited the beach. Participants with a higher feeling of presence showed a higher desire for cold foods (p < 0.05). Food desires of those who visited the beach often were more impacted by the evoked sensory stimulation than food desires of those who visited the beach rarely. Food desires created in an online environment can be influenced by visual, and text based evoked sensory stimulation as long as consumers' feeling of presence in is high. The results can inform public health professionals how to impact healthy food choices in an online environment.
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Maples-Keller JL, Sherrill A, Reddi P, Norrholm SD, Rothbaum BO. Extinction-Based Exposure Therapies Using Virtual Reality. Curr Top Behav Neurosci 2023; 64:335-352. [PMID: 37566312 DOI: 10.1007/7854_2023_437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
The focus of this chapter is an overview of integrating virtual reality (VR) technology within the context of exposure therapy for anxiety disorders, a gold standard treatment, with a focus on how VR can help facilitate extinction learning processes integral to these interventions. The chapter will include an overview of advantages of incorporating VR within exposure therapy, and benefits specifically within an inhibitory learning approach for extinction training. A review of the empirical literature on the effectiveness of VR exposure therapy for specific phobia and PTSD will be provided, as well as practical overview of how to effectively incorporate VR within exposure therapy.
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Affiliation(s)
- Jessica L Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA.
| | - Andrew Sherrill
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Preethi Reddi
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Seth D Norrholm
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Barbara O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Condition notification assisted by virtual reality technology reduces the anxiety levels of parents of children with simple CHD: a prospective randomised controlled study. Cardiol Young 2022; 32:1801-1806. [PMID: 34991769 DOI: 10.1017/s104795112100500x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
PURPOSE This study explored the effects of condition notification based on virtual reality technology on the anxiety levels of parents of children with simple CHD. METHODS The subjects of the study were the parents of 60 children with simple CHD who were treated in our centre. The state anxiety scale was used to assess the anxiety status of the parents of the children before and after the condition notification in different ways (based on virtual reality explanations and written explanations). RESULTS In this study, a total of 55 parents of children with CHD successfully completed the survey. At the time of admission, there was no significant difference in the state anxiety scale scores of the parents between the two groups. The anxiety status of the virtual reality group was relieved after the condition notification assisted by virtual reality technology, and there was a significant difference compared with the control group. CONCLUSION Condition notification based on virtual reality technology can effectively alleviate the anxiety of parents of children with simple CHD, which is worthy of clinical application.
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Azimisefat P, de Jongh A, Rajabi S, Kanske P, Jamshidi F. Efficacy of virtual reality exposure therapy and eye movement desensitization and reprocessing therapy on symptoms of acrophobia and anxiety sensitivity in adolescent girls: A randomized controlled trial. Front Psychol 2022; 13:919148. [PMID: 36186313 PMCID: PMC9521642 DOI: 10.3389/fpsyg.2022.919148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAcrophobia is a specific phobia characterized by a severe fear of heights. The purpose of the present study was to investigate the efficacy of two therapies that may ameliorate symptoms of acrophobia and anxiety sensitivity, i.e., virtual reality exposure therapy (VRET) and eye movement desensitization and reprocessing (EMDR) therapy with a Waiting List Control Condition (WLCC).MethodsWe applied a three-armed randomized controlled pre-post-test design with 45 female adolescent students. Students who met DSM-5 criteria for acrophobia were randomly assigned to either VRET (N = 15; Mage = 17.26; SD = 1.32), EMDR (N = 15; Mage = 17.15; SD = 1.57), or a WLCC (N = 15; Mage = 17.50; SD = 1.26). The study groups were evaluated one week before the intervention and one week after the last intervention session regarding symptoms of acrophobia (Severity Measure for Acrophobia) and anxiety sensitivity (Anxiety Sensitivity Index).ResultsThe data showed that both the application of VRET and EMDR therapy were associated with significantly reduced symptoms of acrophobia (d = 1.03 for VRET and d = 1.08 for EMDR) and anxiety sensitivity (d = 1.15 for VRET and d = 1.13 for EMDR) in comparison to the Waiting List.LimitationsThe sample consisted only of adolescent women. Due to the recognizable differences between the two interventions, the therapists and the participants were not blind to the conditions.ConclusionThe results suggest that both VRET and EMDR are interventions that can significantly improve symptoms of acrophobia and anxiety sensitivity in female adolescents.Clinical Trial Registrationhttps://www.irct.ir/trial/57391, identifier: IRCT20210213050343N1.
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Affiliation(s)
| | - Ad de Jongh
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands
| | - Soran Rajabi
- Department of Psychology, Persian Gulf University, Bushehr, Iran
- *Correspondence: Soran Rajabi,
| | - Philipp Kanske
- Clinical Psychology and Behavioural Neuroscience, Faculty of Psychology, Technische Universität Dresden, Dresden, Germany
| | - Fatemeh Jamshidi
- Department of Psychology, Persian Gulf University, Bushehr, Iran
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Miegel F, Bücker L, Kühn S, Mostajeran F, Moritz S, Baumeister A, Lohse L, Blömer J, Grzella K, Jelinek L. Exposure and Response Prevention in Virtual Reality for Patients with Contamination-Related Obsessive-Compulsive Disorder: a Case Series. Psychiatr Q 2022; 93:861-882. [PMID: 35779165 DOI: 10.1007/s11126-022-09992-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2022] [Indexed: 11/27/2022]
Abstract
Exposure therapy in virtual reality is successful in treating anxiety disorders. Studies on exposure and response prevention in virtual reality (VERP) in obsessive-compulsive disorder (OCD) are rare, and it is unclear whether distress associated with other emotions than anxiety (e.g., disgust) can be evoked. The present study aimed to investigate whether distress can be induced during VERP in patients with contamination-related OCD (C-OCD) and a primary feeling of disgust. We treated eight female patients with C-OCD with the primary emotion of disgust over six weeks with VERP and assessed their OC symptoms before and after the intervention period with the Y-BOCS. We measured subjective units of distress (SUD), heart rate and skin conductivity (arousal), sense of presence, and simulator sickness during four consecutive exposure sessions. VERP was able to induce distress and arousal. The qualitative feedback was heterogeneous and sense of presence moderate. Patients' OC symptoms reduced over the treatment period with medium to large effect sizes, but only two patients were considered responders; two patients discontinued treatment due to lack of treatment success. Although VERP was able to induce distress and arousal associated with disgust and evoked a moderate sense of presence, the low rate of symptom reduction diminishes the positive results. Possible reasons for the heterogeneous results and implications are discussed. Trial registration: German Registry for Clinical Studies (DRKS00016929), 10.04.2019.
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Affiliation(s)
- Franziska Miegel
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Lara Bücker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Lentzeallee 94, 14195, Berlin, Germany
| | - Fariba Mostajeran
- Department of Informatics, University of Hamburg, Vogt-Kölln-Strasse 30, 22527, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Anna Baumeister
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Luzie Lohse
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jannik Blömer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Karsten Grzella
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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15
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Wang Z, Li Y, An J, Dong W, Li H, Ma H, Wang J, Wu J, Jiang T, Wang G. Effects of Restorative Environment and Presence on Anxiety and Depression Based on Interactive Virtual Reality Scenarios. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137878. [PMID: 35805535 PMCID: PMC9266120 DOI: 10.3390/ijerph19137878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 02/01/2023]
Abstract
Anxiety and depression have been growing global mental health problems. The following studies explored the effect of interactive VR scenarios to find a low-cost and high-efficiency solution. Study 1 designed a 2 (anxiety and depression state) × 4 (interactive VR scenarios) experiment, the results of 20 participants showed that the designed scenarios had good restoration and presence, assisting to improve depression mood for people with mild to moderate anxiety and depression. Study 2 further investigated the intervention effects of two environment types (urban and park) and four interactive activities (automatic viewing, free-roaming, fishing, and watering plants in the park environment), based on data from a 10-minute experiment conducted by 195 participants with mild to moderate anxiety and depression. The subjective scales, EEG and EMG, and scenario experience were analyzed and the results showed that: (1) the restorative and present VR scenarios were beneficial in alleviating state anxiety and depression; (2) the restorative environment and presence were significantly and positively related to the reduction of anxiety and depression respectively, moreover, presence mediated the restorative environment on the recovery from anxiety and depression; (3) the environmental settings, the complexity of interaction, human factors, and maturity of VR devices and technology were also key factors that influenced the effects of interactive VR scenario experience and intervention. These studies revealed VR psychological intervention scenarios could be designed with comprehensive factors. Moreover, they might help pave the way for future study in exploring the physiology and psychology mode in virtual and real spaces, enhancing intervention effectiveness.
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Affiliation(s)
- Zhimeng Wang
- Department of Psychology, School of Humanities and Social Sciences, Beijing Forestry University, Beijing 100083, China; (Z.W.); (Y.L.); (W.D.); (H.L.); (H.M.); (J.W.); (G.W.)
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China; (J.A.); (T.J.)
| | - Yue Li
- Department of Psychology, School of Humanities and Social Sciences, Beijing Forestry University, Beijing 100083, China; (Z.W.); (Y.L.); (W.D.); (H.L.); (H.M.); (J.W.); (G.W.)
- Department of Psychology, Lund University, 22100 Lund, Sweden
| | - Jingchen An
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China; (J.A.); (T.J.)
| | - Wenyi Dong
- Department of Psychology, School of Humanities and Social Sciences, Beijing Forestry University, Beijing 100083, China; (Z.W.); (Y.L.); (W.D.); (H.L.); (H.M.); (J.W.); (G.W.)
| | - Hongqidi Li
- Department of Psychology, School of Humanities and Social Sciences, Beijing Forestry University, Beijing 100083, China; (Z.W.); (Y.L.); (W.D.); (H.L.); (H.M.); (J.W.); (G.W.)
| | - Huirui Ma
- Department of Psychology, School of Humanities and Social Sciences, Beijing Forestry University, Beijing 100083, China; (Z.W.); (Y.L.); (W.D.); (H.L.); (H.M.); (J.W.); (G.W.)
| | - Junhui Wang
- Department of Psychology, School of Humanities and Social Sciences, Beijing Forestry University, Beijing 100083, China; (Z.W.); (Y.L.); (W.D.); (H.L.); (H.M.); (J.W.); (G.W.)
| | - Jianping Wu
- Department of Psychology, School of Humanities and Social Sciences, Beijing Forestry University, Beijing 100083, China; (Z.W.); (Y.L.); (W.D.); (H.L.); (H.M.); (J.W.); (G.W.)
- Correspondence:
| | - Ting Jiang
- Faculty of Psychology, Beijing Normal University, Beijing 100875, China; (J.A.); (T.J.)
| | - Guangxin Wang
- Department of Psychology, School of Humanities and Social Sciences, Beijing Forestry University, Beijing 100083, China; (Z.W.); (Y.L.); (W.D.); (H.L.); (H.M.); (J.W.); (G.W.)
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16
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Scientific Landscape of Embodied Experience in the Virtual Environment: A Bibliometric Analysis. BUILDINGS 2022. [DOI: 10.3390/buildings12060844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The realm of architecture has been influenced by the expansion in virtual environments (VEs), along with Industry 4.0 technologies transforming human–VE interactions. Despite increasing scholarly interest in embodied experience-integrated VE, there have been few comprehensive literature reviews undertaken on VEs from a holistic experience perspective. Therefore, this article reviews the literature on the embodied experiential dimension of VEs that has become necessary to adapt theories and methodologies in a way that enhances the user experience in a VE. This study employs a bibliometric analysis to review research performance and undertake a science mapping of the literature. The 969 pieces of data retrieved from Web of Science were subjected to a performance analysis, and VOSviewer was used to visualize the intellectual structure and research themes. The results of this study emphasize the strength and growing interest in VEs from the embodied experience perspective. Another significant finding is that VE experience studies are mostly based on embodied technologies. In this paper, the results of analyses are discussed in terms of productivity, collaboration, and research themes for future. This study contributes to the literature by providing a significant theoretical reference for the potential of the embodied experience in VE research, which will mostly attract the interest of architectural design researchers.
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17
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Philippe TJ, Sikder N, Jackson A, Koblanski ME, Liow E, Pilarinos A, Vasarhelyi K. Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review. JMIR Ment Health 2022; 9:e35159. [PMID: 35551058 PMCID: PMC9109782 DOI: 10.2196/35159] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of mental health conditions. OBJECTIVE To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions. METHODS We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care. RESULTS Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52%) of research involved the treatment of substance use disorders, 29% focused on mood, anxiety, and traumatic stress disorders, and >5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence. CONCLUSIONS Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions.
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Affiliation(s)
- Tristan J Philippe
- Department of Cellular & Physiological Sciences, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | | | - Anna Jackson
- School of Social Work, The University of British Columbia, Vancouver, BC, Canada
| | - Maya E Koblanski
- Department of Cellular & Physiological Sciences, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Eric Liow
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Andreas Pilarinos
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Krisztina Vasarhelyi
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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18
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Quezada-Scholz VE, Laborda MA, San Martín C, Miguez G, Alfaro F, Mallea J, Díaz F. Cued fear conditioning in humans using immersive Virtual Reality. LEARNING AND MOTIVATION 2022. [DOI: 10.1016/j.lmot.2022.101803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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19
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Schuster L, Friedrich AS, Kothgassner OD, Zemp M. Virtual Reality als Trainingstool in der Klinischen und Gesundheitspsychologie. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2022. [DOI: 10.1026/1616-3443/a000662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Hintergrund: Virtual Reality (VR) wird zunehmend als Hilfsmittel für psychologische Interventionen eingesetzt. Auch für sozial-emotionale Fähigkeiten kann VR realitätsnahe Übungsszenarien kreieren. Fragestellung: Dieses systematische Review gibt einen Überblick über den aktuellen Forschungsstand zu VR-Trainings sozial-emotionaler Fähigkeiten. Methode: Die systematische Literaturrecherche erfolgte in PSYNDEX, PsycINFO, Scopus, PubMed und Web of Science und orientierte sich an den PRISMA-Richtlinien. Eingeschlossen wurden deutsch- und englischsprachige empirische Studien zu VR-basierten Trainings sozial-emotionaler Fähigkeiten für gesunde oder psychisch beeinträchtigte Personen aller Altersstufen. Ergebnisse: Elf Studien wurden eingeschlossen. Die Mehrheit untersuchte klinische Stichproben. Die methodische Qualität wurde bei zehn Studien positiv beurteilt. Schlussfolgerungen: Insgesamt spricht das Review für die Nützlichkeit VR-basierter Trainings sozial-emotionaler Fähigkeiten, aber der aktuelle Forschungsstand erlaubt noch keine eindeutigen Schlussfolgerungen bezüglich ihrer Wirksamkeit.
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Affiliation(s)
- Laura Schuster
- Institut für Klinische und Gesundheitspsychologie, Universität Wien, Österreich
| | | | - Oswald D. Kothgassner
- Universitätsklinik für Kinder- und Jugendpsychiatrie, Medizinische Universität Wien, Österreich
| | - Martina Zemp
- Institut für Klinische und Gesundheitspsychologie, Universität Wien, Österreich
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20
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Chard I, van Zalk N. Virtual Reality Exposure Therapy for Treating Social Anxiety: A Scoping Review of Treatment Designs and Adaptation to Stuttering. Front Digit Health 2022; 4:842460. [PMID: 35281220 PMCID: PMC8913509 DOI: 10.3389/fdgth.2022.842460] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/28/2022] [Indexed: 12/16/2022] Open
Abstract
Virtual Reality Exposure Therapy (VRET) has been shown to be an effective technique for reducing social anxiety. People who stutter are at greater risk of developing heightened social anxiety. Cognitive behavior therapy protocols have shown promise in reducing social anxiety in people who stutter, but no studies have investigated VRET targeting social anxiety associated with stuttering. The aim of the current review is to provide an overview of VRET techniques used to treat social anxiety and insights into how these techniques might be adopted in the case of comorbid stuttering and social anxiety. Twelve studies were reviewed to understand key distinctions in VRET protocols used to treat social anxiety. Distinctions include exercises targeting public speaking vs. general social anxiety, computer-generated virtual environments vs. 360° video, and therapist guided vs. automated VRET. Based on the review findings, we propose how certain features could be applied in the case of stuttering. Virtual therapists, inhibitory learning techniques and integration into speech therapy may be suitable ways to tailor VRET. Regardless of these different techniques, VRET should consider the situations and cognitive-behavioral processes that underlie the experience of social anxiety amongst people who stutter.
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Affiliation(s)
- Ian Chard
- Design Psychology Lab, Dyson School of Design Engineering, Imperial College London, London, United Kingdom
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21
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Mor S, Botella C, Campos D, Carlbring P, Tur C, Quero S. An internet-based treatment for flying phobia using 360° images: A feasibility pilot study. Internet Interv 2022; 28:100510. [PMID: 35242593 PMCID: PMC8866141 DOI: 10.1016/j.invent.2022.100510] [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: 12/06/2021] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND More research is needed in the field of Internet-delivered Cognitive Behavioral Treatments (ICBTs) for specific phobia in order to understand which characteristics are important in online exposure scenarios. The aim of the present work was to conduct a feasibility pilot study to explore participants' opinions, preferences, and acceptability ratings of two types of images (still images vs 360° navigable images) in an ICBT for Flying Phobia (FP). A secondary aim was to test the potential effectiveness of the two active treatment arms compared to a waiting list control group. An exploratory aim was to compare the role of navigable images vs. still images in the level of sense of presence and reality judgment and explore their possible mediation in treatment effectiveness. METHODS Participants were randomly allocated to three conditions: NO-FEAR Airlines with still images (n = 26), NO-FEAR Airlines with still and navigable images (n = 26), and a waiting list group (n = 26). Primary outcome measures were participants' opinions, preferences, satisfaction, and acceptance regarding the images used in the exposure scenarios. Secondary outcome measures included FP symptomatology outcomes and measures of sense of presence and reality judgment. RESULTS Participants in the study preferred navigable images over still images before and after treatment (over 84%), and they considered them more effective and logical for the treatment of their problem. However, adherence in the experimental conditions was low (42.3% dropout rate), and more participants withdrew from the group that included navigable images compared to the group that only included still images (14 vs. 8), with no statistical differences in attrition between the two conditions. NO-FEAR Airlines proved to be effective in reducing FP symptomatology compared to the control group, with large between-group effect sizes on all FP measures (ranging from 0.76 to 2.79). No significant mediation effect was found for sense of presence or reality judgment in treatment effectiveness. DISCUSSION The results of the current study suggest that participants prefer more immersive images in exposure scenarios, providing data that can help to design useful exposure scenarios to treat specific phobias in the future. They also provide evidence supporting the effectiveness of an ICBT for FP. TRIAL REGISTRATION Registered at Clinicaltrials.gov (NCT03900559) on April 9, 2019. Retrospectively registered.
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Affiliation(s)
- Sonia Mor
- Universitat Jaume I, Castellón, Spain
| | - Cristina Botella
- Universitat Jaume I, Castellón, Spain,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain
| | - Daniel Campos
- Department of Psychology and Sociology, University of Zaragoza, Huesca, Spain,Instituto de Investigación Sanitaria Aragón (IISAragon), Zaragoza, Spain
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Soledad Quero
- Universitat Jaume I, Castellón, Spain,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain,Corresponding author at: Universitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain.
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22
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van Loenen I, Scholten W, Muntingh A, Smit J, Batelaan N. The Effectiveness of Virtual Reality Exposure-Based Cognitive Behavioral Therapy for Severe Anxiety Disorders, Obsessive-Compulsive Disorder, and Posttraumatic Stress Disorder: Meta-analysis. J Med Internet Res 2022; 24:e26736. [PMID: 35142632 PMCID: PMC8874794 DOI: 10.2196/26736] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/22/2021] [Accepted: 12/06/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In recent years, virtual reality exposure-based cognitive behavioral therapy (VRE-CBT) has shown good treatment results in (subclinical) anxiety disorders and seems to be a good alternative to exposure in vivo in regular cognitive behavioral therapy (CBT). However, previous meta-analyses on the efficacy of VRE-CBT on anxiety disorders have included studies on specific phobias and subthreshold anxiety; therefore, these results may not be generalizable to patients with more severe and disabling anxiety disorders. OBJECTIVE The objective of our study is to determine the efficacy of VRE-CBT on more severe anxiety disorders, excluding specific phobias and subthreshold anxiety disorders. Meta-analyses will be conducted to examine the efficacy of VRE-CBT versus waitlist and regular CBT. Our secondary objectives are to examine whether the efficacy differs according to the type of anxiety disorder, type of recruitment, and type of VRE-CBT (virtual reality exposure either with or without regular CBT). Furthermore, attrition in VRE-CBT and CBT will be compared. METHODS Studies published until August 20, 2020, were retrieved through systematic literature searches in PubMed, PsycINFO, and Embase. We calculated the effect sizes (Hedges g) for the difference between the conditions and their 95% CIs for posttest and follow-up measurements in a random effects model. A separate meta-analysis was performed to compare attrition between the VRE-CBT and CBT conditions. RESULTS A total of 16 trials with 817 participants were included. We identified 10 comparisons between VRE-CBT and a waitlist condition and 13 comparisons between VRE-CBT and a CBT condition. With regard to risk of bias, information on random sequence generation, allocation concealment, and risk of bias for selective outcome reporting was often absent or unclear. The mean effect size of VRE-CBT compared with waitlist (nco=10) was medium and significant, favoring VRE-CBT (Hedges g=-0.490, 95% CI -0.82 to -0.16; P=.003). The mean effect size of VRE-CBT compared with CBT (nco=13) was small and nonsignificant, favoring CBT (Hedges g=0.083, 95% CI -0.13 to 0.30; P=.45). The dropout rates between VRE-CBT and CBT (nco=10) showed no significant difference (odds ratio 0.79, 95% CI 0.49-1.27; P=.32). There were no indications of small study effects or publication bias. CONCLUSIONS The results of our study show that VRE-CBT is more effective than waitlist and as effective as CBT in the treatment of more severe anxiety disorders. Therefore, VRE-CBT may be considered a promising alternative to CBT for patients with more severe anxiety disorders. Higher-quality randomized controlled trials are needed to verify the robustness of these findings.
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Affiliation(s)
- Inge van Loenen
- GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Willemijn Scholten
- GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Anna Muntingh
- GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Johannes Smit
- GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Neeltje Batelaan
- GGZ inGeest Specialized Mental Health Care, Amsterdam, Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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23
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Arnfred B, Bang P, Hjorthøj C, Christensen CW, Stengaard Moeller K, Hvenegaard M, Agerskov L, Krog Gausboel U, Soe D, Wiborg P, Smith CIS, Rosenberg N, Nordentoft M. Group cognitive behavioural therapy with virtual reality exposure versus group cognitive behavioural therapy with in vivo exposure for social anxiety disorder and agoraphobia: a protocol for a randomised clinical trial. BMJ Open 2022; 12:e051147. [PMID: 35110313 PMCID: PMC8811551 DOI: 10.1136/bmjopen-2021-051147] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Anxiety disorders have a high lifetime prevalence, early-onset and long duration or chronicity. Exposure therapy is considered one of the most effective elements in cognitive behavioural therapy (CBT) for anxiety, but in vivo exposure can be challenging to access and control, and is sometimes rejected by patients because they consider it too aversive. Virtual reality allows flexible and controlled exposure to challenging situations in an immersive and protected environment. AIM The SoREAL-trial aims to investigate the effect of group cognitive behavioural therapy (CBT-in vivo) versus group CBT with virtual reality exposure (CBT-in virtuo) for patients diagnosed with social anxiety disorder and/or agoraphobia, in mixed groups. METHODS AND ANALYSIS The design is an investigator-initiated randomised, assessor-blinded, parallel-group and superiority-designed clinical trial. Three hundred two patients diagnosed with social anxiety disorder and/or agoraphobia will be included from the regional mental health centres of Copenhagen and North Sealand and the Northern Region of Denmark. All patients will be offered a manual-based 14-week cognitive behavioural group treatment programme, including eight sessions with exposure therapy. Therapy groups will be centrally randomised with concealed allocation sequence to either CBT-in virtuo or CBT-in vivo. Patients will be assessed at baseline, post-treatment and 1-year follow-up by treatment blinded researchers and research assistants. The primary outcome will be diagnosis-specific symptoms measured with the Liebowitz Social Anxiety Scale for patients with social anxiety disorder and the Mobility Inventory for Agoraphobia for patients with agoraphobia. Secondary outcome measures will include depression symptoms, social functioning and patient satisfaction. Exploratory outcomes will be substance and alcohol use, working alliance and quality of life. ETHICS AND DISSEMINATION The trial has been approved by the research ethics committee in the Capital Region of Denmark. All results, positive, negative as well as inconclusive, will be published as quickly as possible and still in concordance with Danish law on the protection of confidentially and personal information. Results will be presented at national and international scientific conferences. The trial has obtained approval by the Regional Ethics Committee of Zealand (H-6-2013-015) and the Danish Data Protection Agency (RHP-2014-009-02670). The trial is registered at ClinicalTrial.gov as NCT03845101. The patients will receive information on the trial both verbally and in written form. Written informed consent will be obtained from each patient before inclusion in the trial. The consent form will be scanned and stored in the database system and the physical copy will be destroyed. It is emphasised that participation in the trial is voluntary and that the patient can withdraw his or her consent at any time without consequences for further and continued treatment. TRIAL REGISTRATION NUMBER NCT03845101.
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Affiliation(s)
- Benjamin Arnfred
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Bang
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Biomedical and Clinical Sciences, Linköping University, Linkoping, Sweden
| | - Carsten Hjorthøj
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Clas Winding Christensen
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Kirsten Stengaard Moeller
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Morten Hvenegaard
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lone Agerskov
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ulrik Krog Gausboel
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ditte Soe
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Wiborg
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christopher Ian Schøler Smith
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicole Rosenberg
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
- Department for Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Copenhagen, Denmark
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Virtual Reality Aided Therapy towards Health 4.0: A Two-Decade Bibliometric Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031525. [PMID: 35162546 PMCID: PMC8834834 DOI: 10.3390/ijerph19031525] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 12/12/2022]
Abstract
Health 4.0 aligns with Industry 4.0 and encourages the application of the latest technologies to healthcare. Virtual reality (VR) is a potentially significant component of the Health 4.0 vision. Though VR in health care is a popular topic, there is little knowledge of VR-aided therapy from a macro perspective. Therefore, this paper was aimed to explore the research of VR in aiding therapy, thus providing a potential guideline for futures application of therapeutic VR in healthcare towards Health 4.0. A mixed research method was adopted for this research, which comprised the use of a bibliometric analysis (a quantitative method) to conduct a macro overview of VR-aided therapy, the identification of significant research structures and topics, and a qualitative review of the literature to reveal deeper insights. Four major research areas of VR-aided therapy were identified and investigated, i.e., post-traumatic stress disorder (PTSD), anxiety and fear related disorder (A&F), diseases of the nervous system (DNS), and pain management, including related medical conditions, therapies, methods, and outcomes. This study is the first to use VOSviewer, a commonly used software tool for constructing and visualizing bibliometric networks and developed by Center for Science and Technology Studies, Leiden University, the Netherlands, to conduct bibliometric analyses on VR-aided therapy from the perspective of Web of Science core collection (WoSc), which objectively and visually shows research structures and topics, therefore offering instructive insights for health care stakeholders (particularly researchers and service providers) such as including integrating more innovative therapies, emphasizing psychological benefits, using game elements, and introducing design research. The results of this paper facilitate with achieving the vision of Health 4.0 and illustrating a two-decade (2000 to year 2020) map of pre-life of the Health Metaverse.
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Chung OS, Johnson AM, Dowling NL, Robinson T, Ng CH, Yücel M, Segrave RA. Are Australian Mental Health Services Ready for Therapeutic Virtual Reality? An Investigation of Knowledge, Attitudes, Implementation Barriers and Enablers. Front Psychiatry 2022; 13:792663. [PMID: 35185649 PMCID: PMC8854652 DOI: 10.3389/fpsyt.2022.792663] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 01/14/2022] [Indexed: 12/18/2022] Open
Abstract
Therapeutic virtual reality (VR) has the potential to address the challenges of equitable delivery of evidence-based psychological treatment. However, little is known about therapeutic VR regarding the perspectives and needs of real-world service providers. This exploratory study aimed to assess the acceptability, appropriateness, and feasibility of therapeutic VR among clinicians, managers, and service staff working in mental healthcare and explore potential implementation barriers and enablers. Eighty-one staff from a network of private psychiatric hospitals in Victoria, Australia (aged M + SD: 41.88 + 12.01 years, 71.6% female; 64% clinical staff) completed an online survey, which included the Acceptability of Intervention Measure (AIM), Appropriateness of Intervention Measure (IAM), and Feasibility of Intervention Measure (FIM). While 91% of participants had heard about VR technology, only 40% of participants had heard of therapeutic VR being used in mental healthcare, and none had used therapeutic VR in a clinical setting. Most participants perceived VR to be acceptable (84%), appropriate (69%), and feasible (59%) to implement within their role or service and envisioned a range of possible applications. However, participants expressed concerns regarding safety, efficacy, and logistical challenges across clinical settings. Findings suggest a strong interest for therapeutic VR among Australian mental health providers working in the private system. However, dissemination efforts should focus on addressing identified barriers to ensure mental health providers are adequately informed and empowered to make implementation decisions.
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Affiliation(s)
- Olivia S Chung
- BrainPark, Turner Institute for Brain and Mental Health and Monash Biomedical Imaging Facility, Monash University, Melbourne, VIC, Australia
| | - Alisha M Johnson
- BrainPark, Turner Institute for Brain and Mental Health and Monash Biomedical Imaging Facility, Monash University, Melbourne, VIC, Australia
| | - Nathan L Dowling
- Professorial Unit, Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, VIC, Australia
| | - Tracy Robinson
- School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Bathurst, NSW, Australia
| | - Chee H Ng
- Professorial Unit, Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, VIC, Australia
| | - Murat Yücel
- BrainPark, Turner Institute for Brain and Mental Health and Monash Biomedical Imaging Facility, Monash University, Melbourne, VIC, Australia
| | - Rebecca A Segrave
- BrainPark, Turner Institute for Brain and Mental Health and Monash Biomedical Imaging Facility, Monash University, Melbourne, VIC, Australia
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Rowland DP, Casey LM, Ganapathy A, Cassimatis M, Clough BA. A Decade in Review: A Systematic Review of Virtual Reality Interventions for Emotional Disorders. PSYCHOSOCIAL INTERVENTION = INTERVENCION PSICOSOCIAL 2022; 31:1-20. [PMID: 37362616 PMCID: PMC10268557 DOI: 10.5093/pi2021a8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/22/2021] [Indexed: 06/28/2023]
Abstract
Research is increasingly demonstrating the therapeutic benefits of virtual reality interventions for various mental health conditions, though these rarely translate from research to application in clinical settings. This systematic review aims to examine the efficacy of current virtual reality interventions for emotional disorders, with a focus on clinical and technological features that influence translation of treatments from research to clinical practice. A comprehensive systematic literature search was conducted following PRISMA guidelines, for studies including the application of a virtual reality intervention to a clinical population of adults with an emotional disorder. Thirty-seven eligible studies were identified, appraised, and assessed for bias. Treatment effects were typically large across studies, with virtual reality being considered an efficacious treatment modality for various anxiety disorders and post-traumatic stress disorder. Virtual reality interventions were typically used for delivering exposure in cognitive behavioural therapy approaches. Considerable variability was seen in cost, technological specifications, degree of therapist involvement, delivery format, dosage, duration, and frequency of treatment. Suboptimal methodological rigour was identified in some studies. Remote use of virtual reality was rare, despite increasing options for in home use. Virtual reality interventions have the potential to overcome barriers to care and better meet the needs of consumers. Future research should examine the efficacy of virtual reality for treatment of depressive disorders and obsesive compulsive disorder. Improved methodological reporting and development of transdiagnostic and remotely delivered virtual reality interventions, will likely increase the translation of this treatment modality.
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Affiliation(s)
- Dale P. Rowland
- Griffith UniversityQueenslandAustraliaGriffith University, Queensland, Australia
- Menzies Health InstituteQueenslandAustraliaMenzies Health Institute Queensland, Australia
| | - Leanne M. Casey
- Griffith UniversityQueenslandAustraliaGriffith University, Queensland, Australia
- Menzies Health InstituteQueenslandAustraliaMenzies Health Institute Queensland, Australia
| | - Aarthi Ganapathy
- Griffith UniversityQueenslandAustraliaGriffith University, Queensland, Australia
- Menzies Health InstituteQueenslandAustraliaMenzies Health Institute Queensland, Australia
| | - Mandy Cassimatis
- Griffith UniversityQueenslandAustraliaGriffith University, Queensland, Australia
- Menzies Health InstituteQueenslandAustraliaMenzies Health Institute Queensland, Australia
| | - Bonnie A. Clough
- Griffith UniversityQueenslandAustraliaGriffith University, Queensland, Australia
- Menzies Health InstituteQueenslandAustraliaMenzies Health Institute Queensland, Australia
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Zainal NH, Chan WW, Saxena AP, Taylor CB, Newman MG. Pilot randomized trial of self-guided virtual reality exposure therapy for social anxiety disorder. Behav Res Ther 2021; 147:103984. [PMID: 34740099 DOI: 10.1016/j.brat.2021.103984] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 09/14/2021] [Accepted: 10/04/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Virtual reality exposure therapy (VRE) has shown promising efficacy for the treatment of social anxiety disorder (SAD) and related comorbidities. However, most trials conducted to date were therapist-led, and little is known about the efficacy of self-guided VRE. Therefore, this randomized controlled trial (RCT) aimed to determine the efficacy of a self-directed VRE for SAD. METHOD Forty-four community-dwelling or undergraduate adults diagnosed with SAD based on the Mini International Neuropsychiatric Interview were randomly assigned to VRE designed to last four sessions or more (n = 26) or waitlist (WL; n = 18). Self-reported SAD severity (Social Phobia Diagnostic Questionnaire and Social Interaction Anxiety Scale), job interview anxiety (Measure of Anxiety in Selection Interviews), trait worry (Penn State Worry Questionnaire), and depression symptoms (Patient Health Questionnaire-9) were administered at baseline, post-treatment, 3-month-follow-up (3MFU), and 6-month-follow-up (6MFU). Piecewise multilevel modeling analyses were conducted to manage clustering in the data. RESULTS VRE vs. WL resulted in greater reductions in SAD symptom severity, job interview fear, and trait worry, with moderate-to-large effect sizes (Hedge's g = -0.54 to -1.11) from pre-to-post treatment. Although significant between-group differences did not emerge for change in depression, VRE led to change in depression, whereas waitlist did not. These gains were also maintained at 3MFU and 6MFU. Further, facets of presence increased during the course of VRE (g = 0.36-0.45), whereas cybersickness decreased (g = -0.43). DISCUSSION Brief, self-guided VRE might ameliorate SAD and comorbid worry, for young-to-middle-aged adults with SAD. Other theoretical and practical implications were also discussed.
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Reeves R, Elliott A, Curran D, Dyer K, Hanna D. 360° Video virtual reality exposure therapy for public speaking anxiety: A randomized controlled trial. J Anxiety Disord 2021; 83:102451. [PMID: 34304028 DOI: 10.1016/j.janxdis.2021.102451] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 05/20/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
Public speaking anxiety (PSA) is a prevalent condition which is highly interrelated with social anxiety. PSA can be effectively treated with exposure therapy. Virtual reality exposure therapy (VRET) is increasingly being explored as a novel and cost-effective mode of treatment. No previous randomized controlled trial has examined whether stand-alone 360° video VRET is an effective intervention for treating PSA and interrelated disorder relevant fears. Further, studies have not explored whether 360° video content influences VRET outcomes. Participants with high PSA (n = 51) were randomly allocated to: 360° video VRET incorporating stimuli of audiences (360°Audience) (n = 17), 360° video VRET incorporating stimuli of empty rooms (360°Empty) (n = 16) and no treatment control (n = 18). Outcomes were measured over five time-points. Mixed ANOVA revealed a significant interaction between time and intervention group for PSA, social anxiety and fear of negative evaluation (FNE). Within-group analysis demonstrated there was a significant pre-intervention to post-intervention reduction across measures for both 360° video VRET groups: PSA 360°Audience (ηp2 = .90, p<.001), 360°Empty (ηp2 = .71, p < .001); social anxiety 360°Audience (ηp2 = .49, p=.002), 360°Empty (ηp2 = .39, p = .009); FNE 360°Audience (ηp2 = .59, p<.001), 360°Empty (ηp2 = .43, p = .006). Active intervention participants showed significant improvement from pre-intervention to 10-week follow-up on all measures. Findings illustrate that 360° video VRET is an efficacious way to significantly reduce PSA, social anxiety and FNE.
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Affiliation(s)
| | - Adam Elliott
- Northern Health and Social Care Trust, United Kingdom
| | | | - Kevin Dyer
- Northern Health and Social Care Trust, United Kingdom
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Skeva R, Gregg L, Jay C, Pettifer S. Assessment of virtual environments for alcohol Relapse Prevention in a less immersive and cost-effective setup: A qualitative study. COMPUTERS IN HUMAN BEHAVIOR REPORTS 2021. [DOI: 10.1016/j.chbr.2021.100120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Rimer E, Husby LV, Solem S. Virtual Reality Exposure Therapy for Fear of Heights: Clinicians' Attitudes Become More Positive After Trying VRET. Front Psychol 2021; 12:671871. [PMID: 34335386 PMCID: PMC8319686 DOI: 10.3389/fpsyg.2021.671871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/23/2021] [Indexed: 12/24/2022] Open
Abstract
Background Virtual reality exposure therapy (VRET) has the potential to solve logistic challenges when treating specific phobias. However, VRET has yet to see a large-scale implementation in clinical settings despite positive findings in treatment trials. This may partly be due to attitudes and lack of experience among clinicians, but also because of expensive and stationary VR solutions. Objective This study tested whether modern, wireless, commercially available VR equipment with controller-free hand tracking could induce and reduce discomfort using scenarios designed for fear of heights. Also, the study tested if clinicians’ attitudes toward using VR in therapy changed after trying it themselves. Method Attitudes to using VR in therapy and discomfort ratings were assessed for 74 clinicians before and after completing two VR scenarios. In addition, 54 non-clinicians completed the same scenarios. Participants were not diagnosed with acrophobia. Results The VR scenarios induced discomfort comparable to participants’ reported fear of heights in real life. Repeated training reduced discomfort. Positive attitudes toward use of VR in therapy was predicted by previous experience with VR, as well as positive attitudes toward novel technology and exposure therapy. Clinicians’ attitudes became more favorable after trying VRET themselves. Clinicians reported a range of possible advantages and disadvantages of using VR in therapy. Conclusion VRET for fear of heights was able to induce and reduce discomfort in clinicians and non-clinicians, and clinicians’ attitudes toward using VRET become more positive after trying VRET for themselves. The latest generation of VR solutions has potential to improve clinical availability and treatment options. Future research should explore how VRET can be implemented in clinical settings.
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Affiliation(s)
- Elise Rimer
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Vågsholm Husby
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Considerations and practical protocols for using virtual reality in psychological research and practice, as evidenced through exposure-based therapy. Behav Res Methods 2021; 53:2725-2742. [PMID: 34080173 DOI: 10.3758/s13428-021-01543-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 12/12/2022]
Abstract
Everyday client stressors are often challenging to replicate in clinical and research environments, which hinders the ability to reliably reproduce clinical outcomes. To overcome this obstacle, tools that can bridge the inherent disconnect between these settings and the real-world experiences of clients are urgently needed. Virtual reality (VR) promises to provide immersive experiences within controlled laboratory or clinical settings. While the potential opportunities and challenges of VR applications have been scientifically reviewed, clinical adoptions into psychology are hampered by a paucity of practical and methodological publications. This paper intends to address that gap, by providing a four-step process for decision-making considerations, including practical recommendations and an applied case study of developing an exposure-based system for obsessive-compulsive disorder. We provide a framework to make VR accessible for clinician-researchers to create similar systems that realise the promise while encouraging ongoing scientific rigour.
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Development of a Virtual Ecological Environment for Learning the Taipei Tree Frog. SUSTAINABILITY 2021. [DOI: 10.3390/su13115911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The learning objectives of environmental education emphasize investigation in real life to enhance students’ skills and experiences in solving practical problems. This study used the virtual reality (VR) technology to develop a virtual ecological environment for learning about the Taipei tree frog, supported by situated learning and game-based learning design to enhance students’ learning interest and motivation. Users can wear the head-mounted display (HMD) to explore the virtual environment for learning the Taipei tree frog’s ecological behavior, such as foraging and mating as well as its habitats and predators. A teaching experiment was conducted to investigate students’ learning effectiveness and the senses of presence and anxiety after using the virtual ecological environment. The experimental group (wearing the HMD) contained 40 students, the control group (using the desktop VR) contained 40 students, and both groups were used as samples to learn about the Taipei tree frog. The results indicated that using HMD VR and desktop VR could both enhance learning achievements, but the learning effectiveness of the former was significantly higher than that of the latter. The levels of anxiety for both groups were about the same, but the level of presence for the experimental group was higher than that of the control group because the HMD VR provided a more immersive experience than the desktop VR. The virtual ecological environment can save the time and effort of travelling to the natural habitat for observing the Taipei tree frog, and the design of role-playing game (RPG) can enhance learners’ interest and motivation. Therefore, it is a useful tool for promoting environmental education.
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Fehribach JR, Toffolo MBJ, Cornelisz I, van Klaveren C, van Straten A, van Gelder JL, Donker T. Virtual Reality Self-help Treatment for Aviophobia: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e22008. [PMID: 33843605 PMCID: PMC8076993 DOI: 10.2196/22008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 12/10/2020] [Accepted: 02/16/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Aviophobia (the fear of flying) can greatly impact the daily life functioning of people with the condition. Traditional exposure-based treatment is hampered by the limited availability of airplane practice situations, which is a result of economical and practical concerns. Easily accessible and low-cost virtual reality exposure therapy may address these challenges. OBJECTIVE The purpose of our study is to investigate the effectiveness of ZeroPhobia: Aviophobia (a self-help mobile app-based treatment) in reducing flight anxiety symptoms and depressive and anxiety symptoms. We will also investigate the effects of usage intensity, the sense of immersion, inherent absorption ability, and perceived user-friendliness on the treatment effect. METHODS Participants (N=114) who are aged 18-64 years and experience at least mild symptoms of aviophobia will be recruited from the general Dutch population and randomized into a treatment group or waitlist control group. By using their own phones and rudimentary mobile virtual reality headsets, participants will receive six modules of psychoeducation and cognitive behavioral therapy, which will include six levels of virtual reality exposure therapy over a period of 6 weeks. Assessments will be conducted at baseline, posttest (ie, after 6 weeks), and 3- and 12-month follow-ups. The primary outcome measure of our study is the Flight Anxiety Situations Questionnaire. The secondary outcome measures include anxiety and depression measures and additional covariates (including usage intensity, the degree of immersion, etc). We will test treatment effectiveness by conducting an intention-to-treat analysis and estimating average treatment effects on the treated. The mechanisms of treatment effect will also be explored. RESULTS The study was funded on September 25, 2018. Ethical approval was received on October 11, 2019. Recruitment closed on May 7, 2020. CONCLUSIONS Our study will further the scientific understanding and clinical implications of technology's current ability to aid in providing effective, accessible treatment for the fear of flying. TRIAL REGISTRATION Netherlands Trial Registry NL70238.029.19; https://www.trialregister.nl/trial/8257. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/22008.
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Affiliation(s)
- Jamie Rhiannon Fehribach
- Clinical Psychology, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Marieke Bianca Jolien Toffolo
- Clinical Psychology, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ilja Cornelisz
- Methods and Statistics, Department of Education Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Center for Learning Analytics, Amsterdam, Netherlands
| | - Chris van Klaveren
- Methods and Statistics, Department of Education Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Center for Learning Analytics, Amsterdam, Netherlands
| | - Annemieke van Straten
- Clinical Psychology, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Jean-Louis van Gelder
- Department of Criminology, Max Planck Institute for the Study of Crime, Security and Law, Freiburg, Germany
- Institute of Education and Child Studies, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands
| | - Tara Donker
- Clinical Psychology, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands
- Laboratory of Biological and Personality Psychology, Department of Psychology, Albert Ludwigs-University of Freiburg, Freiburg, Germany
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Litleskare S. The relationship between postural stability and cybersickness: It's complicated - An experimental trial assessing practical implications of cybersickness etiology. Physiol Behav 2021; 236:113422. [PMID: 33839164 DOI: 10.1016/j.physbeh.2021.113422] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 11/25/2022]
Abstract
Virtual reality (VR) is known to cause cybersickness, and studies report that deteriorations of postural stability coincides with the onset cybersickness. It is unclear whether these deteriorations are the cause or a consequence of cybersickness. Thus, it is also unclear whether measures of postural stability may either predict susceptibility (cause) or objectively measure (consequence) the malaise. To examine whether deteriorations of postural stability can either predict or objectively measure cybersickness, healthy active adults (n = 50) were exposed to one of two different 10 min 360˚ VR videos. Postural stability was assessed, using a force platform, before exposure with eyes open (baseline) and eyes closed, during the first and last minute of exposure, and approximately 10 min after exposure. The deterioration of postural stability from baseline to the first minute of exposure was larger in participants who reported cybersickness, compared to those who did not, for both total trace length (p = 0.017) and standard deviation velocity (p = 0.008). However, there was substantial individual variation and overlap between sick and well participants. Deteriorations of postural stability from baseline to the eyes closed condition did not differ between sick and well participants (trace length, p = 0.270; standard deviation velocity, p = 0.112). There was a significant correlation between the severity of cybersickness and the change of postural stability from the first to the last minute of VR exposure for trace length (rs=0.32, p = 0.027), but not standard deviation velocity (rs=0.20, p = 0.187). The deteriorations had returned to baseline levels 10 min after exposure. These findings suggest that deteriorations of postural stability was both a predictor and objective measure at a group level. However, the large individual variation, substantial overlap between sick and well participants, and the limited strength of correlations suggest that deterioration of postural stability has limited practical value as both a predictor and objective measure. These findings emphasize the complicated nature of the relationship between cybersickness and postural stability.
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Affiliation(s)
- Sigbjørn Litleskare
- Department of Public Health and Sport Sciences, Inland Norway University of Applied Sciences, Terningen Arena, Hamarveien 112, 2406 Elverum, Norway.
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Brito H, Pham T, Vicente B. Effect of sensorimotor rehabilitation based on an immersive virtual reality model on mental health. Int J Geriatr Psychiatry 2021; 37. [PMID: 33797806 DOI: 10.1002/gps.5541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The aim of this study was to determine the immersive virtual reality-based sensorimotor rehabilitation (IVR-SRB) effect on mental health (global mental health, depression, anxiety and well-being) in older adults. METHODS This study was experimental, with a sample of 111 older adults (control-experimental), considering an application of IVR-SRB in four different virtual settings with exteroceptive synchronization, proprioceptive and vestibular stimuli, for 6 weeks. OUTCOME VARIABLES symptoms associated with depression and anxiety; positive mental health (psychological well-being). A descriptive and inferential approach was used to analyze the data, and the ANCOVA test was used to compare the post-intervention groups, controlled by the baseline; In case of baseline moderation, a linear regression model was applied to identify the level of moderation and a region of significance analysis. RESULTS An IVR-SRB positive net effect was found in the reduction of symptoms of global mental health (p < 0.0001) and depression (p < 0.0001), without baseline moderation. The anxiety scores showed moderation at the beginning (p < 0.0001; b = -0.53), identifying that the greater the presence of anxiety symptoms, the greater the effect of IVR-SRB in reducing these symptoms; its effect is present from scores of 2.9 (Goldberg-12). There were no changes in well-being. CONCLUSION IVR-SRB is recognized as a great intervention tool among elderly population, showing its multidimensional approach capacity, properly responding to the reduction of symptoms associated with mental disorders.
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Affiliation(s)
- Héctor Brito
- Department of Psychiatry and Mental Health, Faculty of Medicine, Universidad de Concepción, Concepcion, Chile
- Physiotherapy Department, Faculty of Health Sciences, Health Rehabilitation Sciences Research Unit (I-CIRESA), Universidad Autónoma de Chile, Chile
| | - Trung Pham
- Department of Computer Sciences & Cyberworx, US Air Force Academy, Colorado, USA
| | - Benjamín Vicente
- Department of Psychiatry and Mental Health, Faculty of Medicine, Universidad de Concepción, Concepcion, Chile
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Mor S, Botella C, Campos D, Tur C, Castilla D, Soler C, Quero S. An Internet-based treatment for Flying Phobia using 360° images: Study protocol for a feasibility pilot study. Internet Interv 2021; 24:100387. [PMID: 33936953 PMCID: PMC8076687 DOI: 10.1016/j.invent.2021.100387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 03/15/2021] [Accepted: 03/24/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Flying Phobia (FP) is a prevalent disorder that can cause serious interference in a person's life. ICBT interventions have already shown their efficacy in several studies, but studies in the field of specific phobias are still scarce. Moreover, few studies have investigated the feasibility of using different types of images in exposure scenarios in ICBTs and no studies have been carried out on the role of sense of presence and reality judgement. The aim of the present study is to explore the feasibility of an ICBT for FP (NO-FEAR Airlines) using two types of images with different levels of immersion (still and navigable images). A secondary aim is to explore the potential effectiveness of the two experimental conditions using two types of images compared to a waiting list control group. Finally, the role of navigable images compared to the still images in the level of anxiety, sense of presence, and reality judgement will also be explored. This paper presents the study protocol. METHODS This study is a three-armed feasibility pilot study with the following conditions: NO-FEAR Airlines with navigable images, NO-FEAR Airlines with still images, and a waiting list group. A minimum of 60 participants will be recruited. The intervention will have a maximum duration of 6 weeks. Measurements will be taken at four different moments: baseline, post-intervention, and two follow-ups (3- and 12-month). Participants' opinions, preference, satisfaction and acceptance regarding the images used in the exposure scenarios will be assessed. FP symptomatology outcomes will also be considered for secondary analyses. The anxiety, sense of presence, and reality judgement in the exposure scenarios will also be analysed. DISCUSSION This study will conduct a pilot study on the feasibility of an ICBT for FP and it is the first one to explore the evaluation of patients of the two type of images (still and navigable) and the role of presence and reality judgement in exposure scenarios delivered through the Internet. Research in this field can have an impact on the way these scenarios are designed and developed, as well as helping to explore whether they have any effect on adherence. TRIAL REGISTRATION NCT03900559. Trial Registration date 3 April 2019, retrospectively registered.
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Affiliation(s)
- Sonia Mor
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Cristina Botella
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain
| | - Daniel Campos
- Department of Psychology and Sociology, University of Zaragoza, Huesca, Spain
- Instituto de Investigación Sanitaria Aragón (IISAragon), Zaragoza, Spain
| | - Cintia Tur
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
| | | | | | - Soledad Quero
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Carlos III Institute of Health, Madrid, Spain
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Lichters M, Möslein R, Sarstedt M, Scharf A. Segmenting consumers based on sensory acceptance tests in sensory labs, immersive environments, and natural consumption settings. Food Qual Prefer 2021. [DOI: 10.1016/j.foodqual.2020.104138] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Knaust T, Felnhofer A, Kothgassner OD, Höllmer H, Gorzka RJ, Schulz H. Virtual Trauma Interventions for the Treatment of Post-traumatic Stress Disorders: A Scoping Review. Front Psychol 2020; 11:562506. [PMID: 33281664 PMCID: PMC7691274 DOI: 10.3389/fpsyg.2020.562506] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 09/30/2020] [Indexed: 12/16/2022] Open
Abstract
Some post-traumatic stress disorder (PTSD) patients do not benefit from imaginal exposure therapy. One possible approach to reach such patients are virtual trauma interventions. Herein, a qualitative scoping review was conducted. Different types of virtual trauma exposure interventions were identified. For each type of virtual trauma exposure interventions it was examined in detail: (1) which in sensu trauma exposure approach serves as therapeutic framework, how it was transferred into virtual reality, and if it was manualized; (2) which hardware and software were used; (3) whether the influence of spatial and social presence on the efficacy of virtual trauma interventions have been measured, and (4) whether the efficacy of virtual trauma interventions for PTSD patients having imagination difficulties was evaluated. These research questions were analyzed qualitatively. Accordingly, an extensive literature search was conducted using the databases Web of Science, PsycINFO, LIVIVO, PTSDpubs, and PubMed for scientific articles published between January 2013 and July 2020. Only studies aimed to reduce PTSD symptoms using virtual trauma interventions were included. The literature search was not limited to a specific study design, treatment/intervention method, or a minimum sample size. Eighteen studies were identified, which reported three different virtual trauma intervention approaches, namely, virtual reality exposure therapy (VRET), multi-modular motion-assisted memory desensitization and reconsolidation (3MDR), and action-centered exposure therapy (ACET). Seven randomized controlled trials (RCTs), two pilot studies, and one case study were focused on VRET; while two RCTs, one pilot study, and three case studies focused on 3MDR, and two case studies on ACET. Regarding the first research question (1), the results show that VRET is based on prolonged exposure, aiming for a virtual re-creation of the patient's traumatic recounting. Several treatment protocols exist for VRET. 3MDR is based on eye movement desensitization and reprocessing, aiming to reduce the patient's avoidance behavior. In 3MDR patients walk toward individualized trauma-related symbolic images in a cave automatic virtual environment (CAVE). One treatment protocol exists for 3MDR. ACET is based on the inhibitory learning theory, aiming for active interactions with a virtual trauma-associated environment to alter the anxiety structure through new secondary inhibitory learning. One treatment protocol exists for ACET. For the second research question (2), the results indicate that all VRET studies used head-mounted displays (HMDs) with a virtual version of the Iraq/Afghanistan or the World Trade Center attacks, while 3MDR studies utilized two different versions of a CAVE with personalized trauma-related images, and the ACET studies used HMDs with virtual street scenarios. For the third research question (3), the results demonstrate that the influence of spatial or social presence on the efficacy of virtual trauma interventions was not examined in any of the included studies. Similarly, for the fourth research question (4), the results show that empirical evidence for the efficacy of virtual trauma interventions on PTSD patients having imagination difficulties was lacking. Therefore, such empirical studies are needed to fill these research gaps.
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Affiliation(s)
- Thiemo Knaust
- Center for Mental Health, Bundeswehr Hospital Hamburg, Hamburg, Germany
| | - Anna Felnhofer
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Oswald D. Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Helge Höllmer
- Center for Mental Health, Bundeswehr Hospital Hamburg, Hamburg, Germany
| | - Robert-Jacek Gorzka
- Department of Applied Military and Operational Psychology, Military Police Command, Hanover, Germany
| | - Holger Schulz
- Department of Medical Psychology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Horigome T, Kurokawa S, Sawada K, Kudo S, Shiga K, Mimura M, Kishimoto T. Virtual reality exposure therapy for social anxiety disorder: a systematic review and meta-analysis. Psychol Med 2020; 50:2487-2497. [PMID: 33070784 DOI: 10.1017/s0033291720003785] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Virtual reality exposure therapy (VRET) is currently being used to treat social anxiety disorder (SAD); however, VRET's magnitude of efficacy, duration of efficacy, and impact on treatment discontinuation are still unclear. METHODS We conducted a meta-analysis of studies that investigated the efficacy of VRET for SAD. The search strategy and analysis method are registered at PROSPERO (#CRD42019121097). Inclusion criteria were: (1) studies that targeted patients with SAD or related phobias; (2) studies where VRET was conducted for at least three sessions; (3) studies that included at least 10 participants. The primary outcome was social anxiety evaluation score change. Hedges' g and its 95% confidence intervals were calculated using random-effect models. The secondary outcome was the risk ratio for treatment discontinuation. RESULTS Twenty-two studies (n = 703) met the inclusion criteria and were analyzed. The efficacy of VRET for SAD was significant and continued over a long-term follow-up period: Hedges' g for effect size at post-intervention, -0.86 (-1.04 to -0.68); three months post-intervention, -1.03 (-1.35 to -0.72); 6 months post-intervention, -1.14 (-1.39 to -0.89); and 12 months post-intervention, -0.74 (-1.05 to -0.43). When compared to in vivo exposure, the efficacy of VRET was similar at post-intervention but became inferior at later follow-up points. Participant dropout rates showed no significant difference compared to in vivo exposure. CONCLUSION VRET is an acceptable treatment for SAD patients that has significant, long-lasting efficacy, although it is possible that during long-term follow-up, VRET efficacy lessens as compared to in vivo exposure.
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Affiliation(s)
- Toshiro Horigome
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Shunya Kurokawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | | | - Shun Kudo
- Department of Neuropsychiatry, Japanese Red Cross Ashikaga Hospital, Tochigi, Japan
| | - Kiko Shiga
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Taishiro Kishimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Psychiatry at Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA
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Abstract
AbstractVirtual reality (VR) is an immersive technology capable of creating a powerful, perceptual illusion of being present in a virtual environment. VR technology has been used in cognitive behavior therapy since the 1990s and accumulated an impressive evidence base, yet with the recent release of consumer VR platforms came a true paradigm shift in the capabilities and scalability of VR for mental health. This narrative review summarizes the past, present, and future of the field, including milestone studies and discussions on the clinical potential of alternative embodiment, gamification, avatar therapists, virtual gatherings, immersive storytelling, and more. Although the future is hard to predict, clinical VR has and will continue to be inherently intertwined with what are now rapid developments in technology, presenting both challenges and exciting opportunities to do what is not possible in the real world.
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Rus-Calafell M, Ward T, Zhang XC, Edwards CJ, Garety P, Craig T. The Role of Sense of Voice Presence and Anxiety Reduction in AVATAR Therapy. J Clin Med 2020; 9:jcm9092748. [PMID: 32854387 PMCID: PMC7564300 DOI: 10.3390/jcm9092748] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 01/15/2023] Open
Abstract
AVATAR therapy offers a unique therapeutic context that uses virtual reality technology to create a virtual embodiment of the voice-hearing experience, enabling the person to visualize their persecutory voice and engage in real-time "face-to-face" dialogue. The present study explores, for the first time, the contribution of sense of voice presence, together with session-by-session reduction of anxiety and paranoid attributions about the avatar, to changes in primary outcomes following AVATAR therapy. Data from 39 participants, who completed AVATAR therapy and attended a 12-week follow-up assessment, were analysed. Mid- to high-levels of sense of voice presence were reported across the therapy sessions, along with significant reductions of anxiety levels and paranoid attributions about the avatar. The interaction of sense of voice presence and reduction of anxiety was associated with two of the significant therapy outcomes: PSYRATS total and frequency of voices. The findings suggest that improvements in voice severity and frequency at post AVATAR therapy may be influenced by the combination of feeling less anxious in the context of a realistic simulation of the voice, while voice-related distress may involve additional cognitive and relational processes.
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Affiliation(s)
- Mar Rus-Calafell
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, 44787 Bochum, Germany;
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AB, UK;
- Correspondence:
| | - Thomas Ward
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AB, UK; (T.W.); (C.J.E.); (P.G.)
- South London & Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Xiao Chi Zhang
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, 44787 Bochum, Germany;
| | - Clementine J. Edwards
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AB, UK; (T.W.); (C.J.E.); (P.G.)
- South London & Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AB, UK; (T.W.); (C.J.E.); (P.G.)
- South London & Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Tom Craig
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AB, UK;
- South London & Maudsley NHS Foundation Trust, London SE5 8AZ, UK
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42
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Lognoul M, Nasello J, Triffaux JM. La thérapie par exposition en réalité virtuelle pour les états de stress post-traumatiques, les troubles obsessionnels compulsifs et les troubles anxieux : indications, plus-value et limites. Encephale 2020; 46:293-300. [DOI: 10.1016/j.encep.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 12/27/2022]
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de Bruijn GJ, de Vries J, Bolman C, Wiers R. (No) escape from reality? Cigarette craving in virtual smoking environments. J Behav Med 2020; 44:138-143. [PMID: 32710157 DOI: 10.1007/s10865-020-00170-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
Cue-Exposure Therapy (CET) is considered an effective strategy to combat cigarette cravings and smoking relapses, but evidence is mixed. In this lab-based experimental study, we manipulated levels of realism for smoking scenarios in Virtual Environments (VE) and randomly exposed smokers and recent-quitters to one of two versions (low versus high realism) of these scenarios. Prior and after scenario exposure, valid measures of cigarette craving were obtained. Prior to exposure, we assessed nicotine dependence and smoking status (current smokers versus recent-quitter). Within-subject repeated measures analysis of covariance showed that there was an interaction of experimental condition with smoking status on cigarette craving. Amongst recent-quitters, high realistic scenarios produced stronger increases in craving than low realistic scenarios, but this effect was reversed in current smokers. It is concluded that VE technologies are a potentially relevant tool for smoking CET that warrant further exploration.
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Affiliation(s)
- Gert-Jan de Bruijn
- Amsterdam School of Communication Research ASCoR, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV, Amsterdam, The Netherlands.
| | - Joost de Vries
- Amsterdam School of Communication Research ASCoR, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV, Amsterdam, The Netherlands
| | - Catherine Bolman
- Department of Psychology and Educational Sciences, Open University of the Netherlands, Heerlen, The Netherlands
| | - Reinout Wiers
- Addiction Development and Psychopathology (ADAPT)-Lab, Department of Psychology and Center for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
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Holmberg TT, Eriksen TL, Petersen R, Frederiksen NN, Damgaard-Sørensen U, Lichtenstein MB. Social Anxiety Can Be Triggered by 360-Degree Videos in Virtual Reality: A Pilot Study Exploring Fear of Shopping. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2020; 23:495-499. [PMID: 32551867 DOI: 10.1089/cyber.2019.0295] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Social anxiety disorder (SAD) involves intense fear of being scrutinized, judged, or embarrassed in public. Virtual reality exposure therapy (VRET) is an exposure tool for SAD. Previous studies have developed computer-generated avatars and virtual environments, but this method is time-consuming and expensive. Preliminary evidence shows that 360-degree virtual reality (VR) videos with real-life situations may be an easy, relatively cheap, and effective alternative. This study aimed to develop VR videos with real-life content from a shopping situation and to evaluate participants' anxiety responses and feelings of presence. Three 360-degree VR videos were filmed in a shopping center. Nine patients with SAD and nine controls matched on gender and age participated in the study. The participants' levels of anxiety during the VR videos were assessed using the Subjective Unit of Discomfort Scale and through semistructured interviews. The SAD patients reported higher levels of presence and significantly increased anxiety levels before, during, and after the videos, whereas controls reported no symptom of anxiety. The patients found the videos authentic and recommended VRET to be integrated into the early stages of treatment before in vivo exposure. Anxiety responses can be triggered in patients with SAD by 360-degree shopping videos. Further studied are needed to investigate the potential of using 360-degree videos for VRET in anxiety disorders.
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Affiliation(s)
- Trine Theresa Holmberg
- Research Unit for Telepsychiatry and e-Mental Health, Centre for Telepsychiatry, Odense, Denmark
| | - Tanja Lilly Eriksen
- Research Unit for Telepsychiatry and e-Mental Health, Centre for Telepsychiatry, Odense, Denmark
| | - Rasmus Petersen
- The Mærsk Mc-Kinney Møller Institute, University of Southern Denmark, Odense, Denmark
| | | | | | - Mia Beck Lichtenstein
- Research Unit for Telepsychiatry and e-Mental Health, Centre for Telepsychiatry, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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45
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Strojny PM, Dużmańska-Misiarczyk N, Lipp N, Strojny A. Moderators of Social Facilitation Effect in Virtual Reality: Co-presence and Realism of Virtual Agents. Front Psychol 2020; 11:1252. [PMID: 32612559 PMCID: PMC7307460 DOI: 10.3389/fpsyg.2020.01252] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 05/13/2020] [Indexed: 11/13/2022] Open
Abstract
Social facilitation has been researched for decades, but in the face of the development of virtual reality technology, new questions arise regarding the possibility of its occurrence in this environment -in the presence of computer-generated agents. Past research provided inconclusive answers: several experiments confirmed this possibility, but several others disagreed. On the other hand, previous studies have shown the important role of VR characteristics, such as realism or co-presence, in evoking other psychological phenomena. However, no study has investigated the interplay between the presence of computer-generated agents and perceived social realism in evoking social facilitation in virtual reality. To this end, the present randomized control study was conducted. The sample consisted of professional firefighters (N = 48), divided into an experimental group with virtual bystanders and a control group without them. Subjects were instructed to perform a rescue procedure in a virtual reality headset. The performance of participants was logged and they completed questionnaires regarding sense of presence in the virtual environment, perceived realism of the environment and perceived co-presence of virtual agents. The obtained results confirmed the role of social realism as a moderator of the occurrence of social facilitation in the presence of computer-generated agents. At the same time, the main effect of facilitation was not confirmed. These results support predictions that the subjective feeling of being in a realistic company of others may be more important in evoking social facilitation than objective facts. Furthermore, the results contribute to the debate regarding the mechanism of social facilitation, suggesting that simple augmentation of the environment with social distractors is not always enough, thus questioning the attentional explanation of the effect. Taken together, our results extend previous findings on social facilitation and open up new possibilities for designing effective virtual environments.
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Affiliation(s)
- Paweł M Strojny
- Faculty of Management and Social Communication, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland.,R&D Unit, Nano Games sp. z o.o., Kraków, Poland
| | - Natalia Dużmańska-Misiarczyk
- Faculty of Management and Social Communication, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland.,R&D Unit, Nano Games sp. z o.o., Kraków, Poland
| | - Natalia Lipp
- Faculty of Management and Social Communication, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland.,R&D Unit, Nano Games sp. z o.o., Kraków, Poland
| | - Agnieszka Strojny
- Faculty of Management and Social Communication, Institute of Applied Psychology, Jagiellonian University, Kraków, Poland.,R&D Unit, Nano Games sp. z o.o., Kraków, Poland
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46
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Kim J, Jung YH, Shin YB, Kim MK, Eom H, Kim E, Kim J, Kim JJ. Feasibility of a virtual reality-based interactive feedback program for modifying dysfunctional communication: a preliminary study. BMC Psychol 2020; 8:50. [PMID: 32410661 PMCID: PMC7227289 DOI: 10.1186/s40359-020-00418-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 05/06/2020] [Indexed: 11/18/2022] Open
Abstract
Background Functional communication is vital in many areas of daily life, and modifying dysfunctional communication has been emphasized in various social areas, including family and school. The present preliminary study addressed the feasibility of a virtual reality (VR)-based interactive feedback program for the modification of dysfunctional communication. Methods Thirty-seven healthy young males completed psychological assessments associated with functional communication and participated in the VR-based program, consisting of the three tasks of ‘exploring the communication style,’ ‘practicing functional communication,’ and ‘expressing empathy.’ Behavioral parameters were recorded based on the participants’ choices among available options and the visual analog scale scores that resulted in responses to questions in the tasks. Results Participants completed the program without dropping-out and reported 10.76 (SD, 9.66) in the Simulator Sickness Questionnaire and 106.97 (SD, 16.66) in the Presence Questionnaire. In exploring the communication style, there was no difference between the dysfunction level-with family and dysfunction level-with a friend, but only the dysfunction level-with family showed significant correlations with the level of communication with parents. In practicing functional communication, the communication scores with the placating, blaming, and computing styles significantly increased according to the repetition of trials. In expressing empathy, the empathetic feeling score was negatively correlated with the perspective-taking score, whereas the emotional intensity score was positively correlated with the level of differentiation of the self. Conclusion These results suggest that the program may have a tolerable level of cybersickness, an adequate level of presence, an improvement in the behavioral parameters that may reflect the important aspects of communication, and a proper reflection of psychological states or interpersonal characteristics. The use of this program can be an important starting point for the development of a more convenient method for delivering VR programs designed to modify dysfunctional communication, which can further increase computerized dissemination.
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Affiliation(s)
- Junhyung Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Hoon Jung
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yu-Bin Shin
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Min-Kyeong Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyojung Eom
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eunjoo Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea.,Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joohan Kim
- Department of Communication, Yonsei University College of Social Sciences, Seoul, Republic of Korea
| | - Jae-Jin Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea. .,Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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47
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Lindner P, Rozental A, Jurell A, Reuterskiöld L, Andersson G, Hamilton W, Miloff A, Carlbring P. Experiences of Gamified and Automated Virtual Reality Exposure Therapy for Spider Phobia: Qualitative Study. JMIR Serious Games 2020; 8:e17807. [PMID: 32347803 PMCID: PMC7221644 DOI: 10.2196/17807] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/25/2020] [Accepted: 03/11/2020] [Indexed: 12/13/2022] Open
Abstract
Background Virtual reality exposure therapy is an efficacious treatment of anxiety disorders, and recent research suggests that such treatments can be automated, relying on gamification elements instead of a real-life therapist directing treatment. Such automated, gamified treatments could be disseminated without restrictions, helping to close the treatment gap for anxiety disorders. Despite initial findings suggesting high efficacy, very is little is known about how users experience this type of intervention. Objective The aim of this study was to examine user experiences of automated, gamified virtual reality exposure therapy using in-depth qualitative methods. Methods Seven participants were recruited from a parallel clinical trial comparing automated, gamified virtual reality exposure therapy for spider phobia against an in vivo exposure equivalent. Participants received the same virtual reality treatment as in the trial and completed a semistructured interview afterward. The transcribed material was analyzed using thematic analysis. Results Many of the uncovered themes pertained directly or indirectly to a sense of presence in the virtual environment, both positive and negative. The automated format was perceived as natural and the gamification elements appear to have been successful in framing the experience not as psychotherapy devoid of a therapist but rather as a serious game with a psychotherapeutic goal. Conclusions Automated, gamified virtual reality exposure therapy appears to be an appealing treatment modality and to work by the intended mechanisms. Findings from the current study may guide the next generation of interventions and inform dissemination efforts and future qualitative research into user experiences.
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Affiliation(s)
- Philip Lindner
- Department of Psychology, Stockholm University, Stockholm, Sweden.,Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Alexander Rozental
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Alice Jurell
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Lena Reuterskiöld
- Department of Psychology, Stockholm University, Stockholm, Sweden.,Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Gerhard Andersson
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.,Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | | | - Alexander Miloff
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
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48
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Simon J, Etienne AM, Bouchard S, Quertemont E. Alcohol Craving in Heavy and Occasional Alcohol Drinkers After Cue Exposure in a Virtual Environment: The Role of the Sense of Presence. Front Hum Neurosci 2020; 14:124. [PMID: 32296322 PMCID: PMC7136534 DOI: 10.3389/fnhum.2020.00124] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 03/17/2020] [Indexed: 12/31/2022] Open
Abstract
The development of new technologies, and more specifically the opportunity to immerse participants in virtual controlled environments, provides a new ecological framework for researchers to study complex behaviors. This experiment aimed to compare post-immersion craving in occasional and heavy alcohol drinkers. Twenty-two occasional drinkers and eighteen heavy drinkers were recruited and immersed in a virtual bar, including alcoholic beverages. After the exposure, heavy drinkers reported a significantly higher craving than occasional drinkers. Post-immersion alcohol craving was significantly related to the levels of perceived ecological validity of the virtual environment. Finally, a moderation analysis suggested that the levels of craving more strongly increased with perceived ecological validity in heavy drinkers than in occasional drinkers. Therefore, the perceived ecological validity was an important experimental parameter to study craving in a virtual environment. These results further suggested that virtual reality might be a useful tool for both the scientific study of alcohol addiction and the treatment of alcohol dependence and relapse.
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Affiliation(s)
- Jessica Simon
- Psychology and Neuroscience of Cognition-PsyNCogn, University of Liège, Liège, Belgium
| | - Anne-Marie Etienne
- Interfaculties Research Unit on Health and Society-URiSS, University of Liège, Liège, Belgium
| | - Stéphane Bouchard
- Cyberpsychology Lab-Université du Québec en Outaouais, Gatineau, QC, Canada
| | - Etienne Quertemont
- Psychology and Neuroscience of Cognition-PsyNCogn, University of Liège, Liège, Belgium
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49
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Miloff A, Carlbring P, Hamilton W, Andersson G, Reuterskiöld L, Lindner P. Measuring Alliance Toward Embodied Virtual Therapists in the Era of Automated Treatments With the Virtual Therapist Alliance Scale (VTAS): Development and Psychometric Evaluation. J Med Internet Res 2020; 22:e16660. [PMID: 32207690 PMCID: PMC7139418 DOI: 10.2196/16660] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/09/2019] [Accepted: 12/15/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Automated virtual reality exposure therapies (VRETs) are self-help treatments conducted by oneself and supported by a virtual therapist embodied visually and/or with audio feedback. This simulates many of the nonspecific relational elements and common factors present in face-to-face therapy and may be a means of improving adherence to and efficacy of self-guided treatments. However, little is known about alliance toward the virtual therapist, despite alliance being an important predictor of treatment outcome. OBJECTIVE In this study, we aimed to evaluate the first alliance instrument developed for use with embodied virtual therapists in an automated treatment format-the Virtual Therapist Alliance Scale (VTAS)-by (1) assessing its psychometric properties, (2) verifying the dimensionality of the scale, and (3) determining the predictive ability of the scale with treatment outcome. METHODS A psychometric evaluation and exploratory factor analysis of the VTAS was conducted using data from two samples of spider-fearful patients treated with VRET and the help of an embodied, voice-based virtual therapist (n=70). Multiple regression models and bivariate correlations were used to assess the VTAS relationship with treatment outcome, according to self-reported fear and convergence with presence and user-friendliness process measures. RESULTS The VTAS showed a sound two-factor solution composed of a primary factor covering task, goal, and copresence; adequate internal consistency; and good convergent validity, including moderate correlation (r=.310, P=.01) with outcomes over follow-up. CONCLUSIONS These preliminary results suggest that alliance toward a virtual therapist is a significant predictor of treatment outcome, favors the importance of a task-goal over bond-factor, and should be explored in studies with larger sample sizes and in additional forms of embodiment.
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Affiliation(s)
- Alexander Miloff
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Lena Reuterskiöld
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Philip Lindner
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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Kritikos J, Zoitaki C, Tzannetos G, Mehmeti A, Douloudi M, Nikolaou G, Alevizopoulos G, Koutsouris D. Comparison between Full Body Motion Recognition Camera Interaction and Hand Controllers Interaction used in Virtual Reality Exposure Therapy for Acrophobia. SENSORS 2020; 20:s20051244. [PMID: 32106452 PMCID: PMC7085665 DOI: 10.3390/s20051244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 11/16/2022]
Abstract
Virtual Reality has already been proven as a useful supplementary treatment tool for anxiety disorders. However, no specific technological importance has been given so far on how to apply Virtual Reality with a way that properly stimulates the phobic stimulus and provide the necessary means for lifelike experience. Thanks to technological advancements, there is now a variety of hardware that can help enhance stronger emotions generated by Virtual Reality systems. This study aims to evaluate the feeling of presence during different hardware setups of Virtual Reality Exposure Therapy, and, particularly how the user's interaction with those setups can affects their sense of presence during the virtual simulation. An acrophobic virtual scenario is used as a case study by 20 phobic individuals and the Witmer-Singer presence questionnaire was used for presence evaluation by the users of the system. Statistical analysis on their answers revealed that the proposed full body Motion Recognition Cameras system generates a better feeling of presence compared to the Hand Controllers system. This is thanks to the Motion Recognition Cameras, which track and allow display of the user's entire body within the virtual environment. Thus, the users are enabled to interact and confront the anxiety-provoking stimulus as in real world. Further studies are recommended, in which the proposed system could be used in Virtual Reality Exposure Therapy trials with acrophobic patients and other anxiety disorders as well, since the proposed system can provide natural interaction in various simulated environments.
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Affiliation(s)
- Jacob Kritikos
- School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece; (C.Z.); (G.T.)
- Correspondence: (J.K.); (D.K.)
| | - Chara Zoitaki
- School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece; (C.Z.); (G.T.)
| | - Giannis Tzannetos
- School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece; (C.Z.); (G.T.)
| | - Anxhelino Mehmeti
- Department of Informatics and Telecommunications, National Kapodistrian University of Athens, 15784 Athens, Greece; (A.M.); (G.N.)
| | - Marilina Douloudi
- Department of Biology, National Kapodistrian University of Athens, 15784 Athens, Greece;
| | - George Nikolaou
- Department of Informatics and Telecommunications, National Kapodistrian University of Athens, 15784 Athens, Greece; (A.M.); (G.N.)
| | | | - Dimitris Koutsouris
- School of Electrical and Computer Engineering, National Technical University of Athens, 15780 Athens, Greece; (C.Z.); (G.T.)
- Correspondence: (J.K.); (D.K.)
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