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Diemer J, Kothgassner OD, Herrmann MJ, Zwanzger P. [VR-supported therapy for anxiety and posttraumatic stress disorder: current possibilities and limitations]. DER NERVENARZT 2024; 95:223-229. [PMID: 38051348 DOI: 10.1007/s00115-023-01570-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Virtual reality (VR) is increasingly used in psychotherapy, and the speed of development of therapeutic VR tools is continuously increasing. OBJECTIVE This narrative review provides an overview of the state of the art regarding VR applications for psychotherapy. MATERIAL AND METHODS The current state of VR therapy research for anxiety disorders and posttraumatic stress disorder (PTSD) is summarized. The focus lies on VR exposure therapy. Current developments in the field are outlined. RESULTS For anxiety disorders, especially phobic disorders, there are already positive recommendations in the current German S3 guidelines. For PTSD, the development of VR therapy tools is still in a relatively early stage. CONCLUSION The development of mobile cost-effective VR solutions in recent years has enabled entirely new applications for VR. The empirical challenges of these new developments are considerable. Nevertheless, the chances for an improvement of psychotherapeutic routine care are good.
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Affiliation(s)
- Julia Diemer
- Fachbereich Psychosomatische Medizin, Kompetenzschwerpunkt Angst, Versorgungsforschung, kbo-Inn-Salzach-Klinikum, Gabersee 7, 83512, Wasserburg am Inn, Deutschland
- Department Psychologie, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Oswald D Kothgassner
- Stress in Childhood & Adolescence Research Unit (SCAR-Unit), Universitätsklinik für Kinder- und Jugendpsychiatrie, Medizinische Universität Wien, Wien, Österreich
| | - Martin J Herrmann
- Zentrum für Psychische Gesundheit (ZEP), Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Peter Zwanzger
- Fachbereich Psychosomatische Medizin, Kompetenzschwerpunkt Angst, Versorgungsforschung, kbo-Inn-Salzach-Klinikum, Gabersee 7, 83512, Wasserburg am Inn, Deutschland.
- Klinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München, München, Deutschland.
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2
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Sigurvinsdottir R, Skúladóttir H, Antonsdóttir HF, Cardenas P, Georgsdóttir MT, Írisardóttir Þórisdóttir M, Jónsdóttir EK, Konop M, Valdimarsdóttir HB, Vilhjálmsson HH, Ásgeirsdóttir BB. A Virtual Reality Courtroom for Survivors of Sexual Violence: A Mixed-Method Pilot Study on Application Possibilities. Violence Against Women 2024; 30:249-274. [PMID: 37801610 DOI: 10.1177/10778012231205589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
This mixed-method pilot study examined the application possibilities of a virtual courtroom to support survivors of sexual violence who may experience courtroom-associated distress. Female sexual violence survivors (n = 13) who had testified in court following victimization entered an interactive virtual courtroom replica. Their reactions were measured quantitatively and qualitatively. The virtual courtroom evoked both subjective and physiological stress. Participants perceived the virtual reality environment as similar to the real-life courtroom. Most reported negative experiences from interacting with the criminal justice system. The virtual courtroom is a possible future strategy to support survivors when reporting violence to the justice system.
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Affiliation(s)
| | | | | | - Paola Cardenas
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | | | | | | | - Magdalena Konop
- Department of Psychotherapy, Jagiellonian University Medical College, Krakow, Poland
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3
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Diemer J, Mühlberger A, Yassouridis A, Zwanzger P. Distraction versus focusing during VR exposure therapy for acrophobia: A randomized controlled trial. J Behav Ther Exp Psychiatry 2023; 81:101860. [PMID: 37141687 DOI: 10.1016/j.jbtep.2023.101860] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 01/03/2023] [Accepted: 04/15/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND AND OBJECTIVES The therapeutic mechanisms of exposure therapy are not well understood. Research suggests that focusing on the most feared aspect might not be necessary, and that distraction with a low cognitive load (e.g., conversation) might enhance exposure. We aimed at systematically testing the efficacy of exposure therapy with focusing vs. conversational distraction, hypothesizing that distracted exposure would yield superior effects. METHODS Thirty-eight patients with acrophobia (specific phobia of heights; clinician-determined) (free from relevant somatic or other mental disorders) were randomly assigned (1:1) to one virtual reality (VR) session of either focused (n = 20) or distracted exposure (n = 18). This monocentric trial took place at a psychiatric university hospital. RESULTS Both conditions resulted in a significant reduction of acrophobic fear and avoidance, and a significant increase of self-efficacy (primary outcome variables). However, condition did not have a significant effect on any of these variables. Effects were stable at four-week follow-up. Heart rate and skin conductance level indicated significant arousal, but did not differ between conditions. LIMITATIONS Eye-tracking was unavailable, nor did we assess emotions other than fear. Power was limited due to sample size. CONCLUSIONS A balanced exposure protocol combining attention to fear cues with conversational distraction, while not being superior, might be as effective as focused exposure for acrophobia, at least during the initial stages of exposure therapy. These results support previous findings. This study demonstrates how VR can be exploited for therapy process research, as VR supports dismantling designs and the incorporation of online process measures.
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Affiliation(s)
- Julia Diemer
- Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149, Muenster, Germany; kbo-Inn-Salzach-Klinikum, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine, Geriatrics and Neurology, Gabersee 7, 83512, Wasserburg/Inn, Germany; Department of Psychology, LMU Munich, Leopoldstr. 13, 80802, Munich, Germany.
| | - Andreas Mühlberger
- Department of Clinical Psychology and Psychotherapy, University of Regensburg, Universitaetsstr. 31, 93053, Regensburg, Germany
| | - Alexander Yassouridis
- Max-Planck-Institute of Psychiatry, Kraepelinstr. 2-10, 80804, Munich, Germany; Ethics Committee, LMU Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
| | - Peter Zwanzger
- Department of Psychiatry and Psychotherapy, University of Muenster, Albert-Schweitzer-Campus 1, Building A9, 48149, Muenster, Germany; kbo-Inn-Salzach-Klinikum, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine, Geriatrics and Neurology, Gabersee 7, 83512, Wasserburg/Inn, Germany; Department of Psychiatry and Psychotherapy, LMU Munich, Nußbaumstr. 7, 80336, Munich, Germany
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4
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Stasiak JE, Mitchell WJ, Reisman SS, Gregory DF, Murty VP, Helion C. Physiological arousal guides situational appraisals and metacognitive recall for naturalistic experiences. Neuropsychologia 2023; 180:108467. [PMID: 36610494 DOI: 10.1016/j.neuropsychologia.2023.108467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/25/2022] [Accepted: 01/01/2023] [Indexed: 01/06/2023]
Abstract
As individuals navigate the world, they are bound to have emotionally intense experiences. These events not only influence momentary physiological and affective responses, but may also have a powerful impact on one's memory for their emotional experience. In this research, we used the naturalistic context of a haunted house to examine how physiological arousal is associated with metacognitive emotional memory (i.e., the extent to which an individual remembers having experienced a certain emotion). Participants first navigated the haunted house while heart rate and explicit situational appraisals were recorded, and then recalled specific events from the haunted house and the intensity of these affective events approximately one week later. We found that heart rate predicted both the intensity of reported scariness in the haunted house and meta-cognitive memory of affect during recall. Critically, we found evidence for malleability in metacognitive emotional memory based on how the event was initially labeled. Individuals tended to recall events that they explicitly labeled as fear-evoking as being more intense than they reported at the time of the event. We found the opposite relationship for events that they labeled as not fear-evoking. Taken together, this indicates that there are strong relationships between physiological arousal and emotional experiences in naturalistic contexts, but that affective labeling can modulate the relationship between these features when reflecting on the emotionality of that experience in memory.
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Affiliation(s)
- Joanne E Stasiak
- Department of Psychological and Brain Sciences, University of California, Santa Barbara, USA
| | | | - Samantha S Reisman
- Department of Cognitive, Linguistics, and Psychological Sciences, Brown University, USA
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5
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Mavridou I, Balaguer-Ballester E, Nduka C, Seiss E. A reliable and robust online validation method for creating a novel 3D Affective Virtual Environment and Event Library (AVEL). PLoS One 2023; 18:e0278065. [PMID: 37053205 PMCID: PMC10101521 DOI: 10.1371/journal.pone.0278065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 11/09/2022] [Indexed: 04/14/2023] Open
Abstract
This paper describes the development and validation of 3D Affective Virtual environments and Event Library (AVEL) for affect induction in Virtual Reality (VR) settings with an online survey; a cost-effective method for remote stimuli validation which has not been sufficiently explored. Three virtual office-replica environments were designed to induce negative, neutral and positive valence. Each virtual environment also had several affect inducing events/objects. The environments were validated using an online survey containing videos of the virtual environments and pictures of the events/objects. They survey was conducted with 67 participants. Participants were instructed to rate their perceived levels of valence and arousal for each virtual environment (VE), and separately for each event/object. They also rated their perceived levels of presence for each VE, and they were asked how well they remembered the events/objects presented in each VE. Finally, an alexithymia questionnaire was administered at the end of the survey. User ratings were analysed and successfully validated the expected affect and presence levels of each VE and affect ratings for each event/object. Our results demonstrate the effectiveness of the online validation of VE material in affective and cognitive neuroscience and wider research settings as a good scientific practice for future affect induction VR studies.
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Affiliation(s)
- Ifigeneia Mavridou
- Centre of Digital Entertainment, Bournemouth University, Bournemouth, United Kingdom
- Emteq Labs, Sussex Innovation Centre, Brighton, United Kingdom
| | - Emili Balaguer-Ballester
- Department of Computing and Informatics, Faculty of Science and Technology and Interdisciplinary Neuroscience Research Centre, Bournemouth University, Poole, United Kingdom
- Bernstein Center for Computational Neuroscience Heidelberg-Mannheim, Medical Faculty of Mannheim and Heidelberg University, Mannheim, Germany
| | - Charles Nduka
- Emteq Labs, Sussex Innovation Centre, Brighton, United Kingdom
| | - Ellen Seiss
- Department of Psychology, Faculty of Science and Technology and Interdisciplinary Neuroscience Research Centre, Bournemouth University, Bournemouth, United Kingdom
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6
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Fear, psychophysiological arousal, and cognitions during a Virtual Social Skills Training in Social Anxiety Disorder while manipulating gaze duration. Biol Psychol 2022; 175:108432. [DOI: 10.1016/j.biopsycho.2022.108432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 08/29/2022] [Accepted: 09/28/2022] [Indexed: 11/20/2022]
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7
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Linares-Chamorro M, Domènech-Oller N, Jerez-Roig J, Piqué-Buisan J. Immersive Therapy for Improving Anxiety in Health Professionals of a Regional Hospital during the COVID-19 Pandemic: A Quasi-Experimental Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9793. [PMID: 36011433 PMCID: PMC9407751 DOI: 10.3390/ijerph19169793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/01/2022] [Accepted: 08/06/2022] [Indexed: 06/15/2023]
Abstract
Background: Immersive therapy through virtual reality represents a novel strategy used in psychological interventions, but there is still a need to strengthen the evidence on its effects on health professionals’ mental health. Objective: To analyze the results of immersive therapy through virtual reality on the levels of anxiety and well-being of the health professionals working in a regional hospital in Olot (Spain). Methods: Pilot quasi-experimental study including a group of 35 female (mean age = 45.7, SD = 8.43) health professionals who undertook immersive therapy for 8 weeks. The intervention was implemented through virtual reality, and its effect on anxiety levels and well-being was evaluated through the Hamilton and Eudemon scales, respectively. Data on age, gender, active pharmacological or psychological treatment, mental health disorders and number of sessions were also collected. Results: A statistically significant (p < 0.001) improvement in anxiety and well-being was found, with large and moderate effect sizes (0.90 and 0.63 respectively). In addition, these changes were clinically significant. No significant associations were found between the improvements and the different variables, but a greater trend was identified among the group of professionals with untreated or unidentified levels of anxiety. Conclusion: This group of health professionals showed a statistically and clinically significant improvement in anxiety and well-being after the application of immersive therapy using virtual reality. Further studies with a control group are necessary to further analyze this novel intervention.
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Affiliation(s)
- Marta Linares-Chamorro
- Department of Psychology, Fundació Hospital d’Olot i Comarcal de la Garrotxa, 17800 Olot, Spain
| | - Neus Domènech-Oller
- Department of Knowledge and Innovation, Fundació Hospital d’Olot i Comarcal de la Garrotxa, 17800 Olot, Spain
| | - Javier Jerez-Roig
- Centre for Health and Social Care Research (CESS), Research Group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, University of Vic-Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
| | - Joel Piqué-Buisan
- Department of Knowledge and Innovation, Fundació Hospital d’Olot i Comarcal de la Garrotxa, 17800 Olot, Spain
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8
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Asbrand J, Vögele C, Heinrichs N, Nitschke K, Tuschen-Caffier B. Autonomic Dysregulation in Child Social Anxiety Disorder: An Experimental Design Using CBT Treatment. Appl Psychophysiol Biofeedback 2022; 47:199-212. [PMID: 35641719 PMCID: PMC9296402 DOI: 10.1007/s10484-022-09548-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/26/2022]
Abstract
Models of social anxiety disorder (SAD) stress the relevance of physiological arousal. So far, limited research has been conducted in children with SAD in experimental stress designs. Thus, examining autonomic arousal, children with and without SAD completed a standardized social stressor (Trier Social Stress Test for Children-C; TSST-C). Pre-existing differences to healthy controls (HC) were expected to decrease after receiving cognitive behavior therapy (CBT). Children with SAD (n = 64) and HC children (n = 55) completed a TSST-C. Children with SAD participated in a second TSST-C after either cognitive-behavioral treatment or a waitlist-control period (WLC). As expected, children with SAD showed blunted heart rate reactivity compared to HC children. Further, children with SAD had elevated levels of tonic sympathetic arousal as indexed by skin conductance level compared to HC. Children with SAD showed lower parasympathetic arousal during the baseline compared to HC. Children receiving treatment did not differ from children in the WLC condition in a repeated social stress test. Psychophysiological differences between children with SAD and HC children could be confirmed as indicated by previous research. The lack of physiological effects of the intervention as an experimental manipulation might be related to slower changes in physiology compared to e.g. cognition.
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Affiliation(s)
- Julia Asbrand
- Department of Psychology, Albert-Ludwigs-University of Freiburg, Freiburg im Breisgau, Germany.
- Department of Psychology, Humboldt-Universität Zu Berlin, Berlin, Germany.
| | - Claus Vögele
- Clinical Psychophysiology Laboratory (CLIPSLAB), Institute for Health and Behaviour, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Nina Heinrichs
- Department of Psychology, University of Bremen, Bremen, Germany
| | - Kai Nitschke
- Department of Psychology, Albert-Ludwigs-University of Freiburg, Freiburg im Breisgau, Germany
| | - Brunna Tuschen-Caffier
- Department of Psychology, Albert-Ludwigs-University of Freiburg, Freiburg im Breisgau, Germany
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9
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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: 58] [Impact Index Per Article: 29.0] [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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10
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Binder FP, Pöhlchen D, Zwanzger P, Spoormaker VI. Facing Your Fear in Immersive Virtual Reality: Avoidance Behavior in Specific Phobia. Front Behav Neurosci 2022; 16:827673. [PMID: 35571283 PMCID: PMC9094686 DOI: 10.3389/fnbeh.2022.827673] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 02/25/2022] [Indexed: 11/30/2022] Open
Abstract
Specific phobias are the most common anxiety disorder and are characterized by avoidance behavior. Avoidance behavior impacts daily function and is proposed to impair extinction learning. However, despite its prevalence, its objective assessment remains a challenge. To this end, we developed a fully automated experimental procedure using immersive virtual reality. The procedure contained a behavioral search, forced-choice, and an approach task with varying degrees of freedom and task relevance of the stimuli. In this study, we examined the sensitivity and feasibility of these tasks to assess avoidance behavior in patients with specific phobia. We adapted the tasks by replacing the originally conditioned stimuli with a spider and a neutral animal and investigated 31 female participants composed of 15 spider-phobic and 16 non-phobic participants. As the non-phobics were quite heterogeneous in terms of their Fear of Spiders Questionnaire (FSQ) scores, we subdivided them into six “fearfuls” that had elevated FSQ scores, and 10 “non-fearfuls” that had no fear of spiders. The phobics successfully managed to complete the procedure and showed consistent avoidance behavior across all behavioral tasks. Compared to the non-fearfuls, which did not show any avoidance behavior at all, the phobics looked at the spider much more often and clearly directed their body toward it in the search task. In the approach task, they hesitated most when they were close to the spider, and their difficulty to touch the spider was reflected in a strong increase in right hand acceleration changes. The fearfuls showed avoidance behavior depending on the tasks: strongest in the search task and weakest in the approach task. Additionally, we identified subjective valence ratings of the spider as the main influence on both objective avoidance behavior and subjective well-being after exposure, mediating the effect of the FSQ. In summary, the behavioral tasks are well suited to assess avoidance behavior in phobic participants and provide detailed insights into the process of avoidance.
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Affiliation(s)
- Florian P. Binder
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Max Planck Institute of Psychiatry, Munich, Germany
- *Correspondence: Florian P. Binder,
| | - Dorothee Pöhlchen
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
- International Max Planck Research School for Translational Psychiatry (IMPRS-TP), Max Planck Institute of Psychiatry, Munich, Germany
| | - Peter Zwanzger
- kbo-Inn-Salzach-Hospital, Clinical Center for Psychiatry, Psychotherapy, Psychosomatic Medicine and Geriatrics, Wasserburg am Inn, Germany
- Department of Psychiatry and Psychotherapy, Ludwig Maximilian University of Munich, Munich, Germany
| | - Victor I. Spoormaker
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
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11
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Kredlow MA, de Voogd LD, Phelps EA. A Case for Translation From the Clinic to the Laboratory. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2022; 17:1120-1149. [PMID: 35245166 DOI: 10.1177/17456916211039852] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Laboratory procedures have been used for decades as analogues for clinical processes with the goal of improving our understanding of psychological treatments for emotional disorders and identifying strategies to make treatments more effective. This research has often focused on translation from the laboratory to the clinic. Although this approach has notable successes, it has not been seamless. There are many examples of strategies that work in the laboratory that fail to lead to improved outcomes when applied clinically. One possible reason for this gap between experimental and clinical research is a failure to focus on translation from the clinic to the laboratory. Here, we discuss potential benefits of translation from the clinic to the laboratory and provide examples of how this might be implemented. We first consider two well-established laboratory analogues (extinction and cognitive reappraisal), identify critical aspects of the related clinical procedures (exposure and cognitive restructuring) that are missing from these analogues, and propose variations to better capture the clinical process. Second, we discuss two clinical procedures that have more recently been brought into the laboratory (eye-movement desensitization and reprocessing and imagery rescripting). We conclude by highlighting potential implications of this proposed shift in focus for translational research.
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Affiliation(s)
- M Alexandra Kredlow
- Department of Psychology, Tufts University.,Department of Psychology, Harvard University
| | - Lycia D de Voogd
- Donders Institute for Brain, Cognition, and Behavior, Radboud University and Radboud University Medical Center
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12
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Pfeifer LS, Heyers K, Ocklenburg S, Wolf OT. Stress research during the COVID-19 pandemic and beyond. Neurosci Biobehav Rev 2021; 131:581-596. [PMID: 34599918 PMCID: PMC8480136 DOI: 10.1016/j.neubiorev.2021.09.045] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 12/27/2022]
Abstract
The COVID-19 pandemic confronts stress researchers in psychology and neuroscience with unique challenges. Widely used experimental paradigms such as the Trier Social Stress Test feature physical social encounters to induce stress by means of social-evaluative threat. As lockdowns and contact restrictions currently prevent in-person meetings, established stress induction paradigms are often difficult to use. Despite these challenges, stress research is of pivotal importance as the pandemic will likely increase the prevalence of stress-related mental disorders. Therefore, we review recent research trends like virtual reality, pre-recordings and online adaptations regarding their usefulness for established stress induction paradigms. Such approaches are not only crucial for stress research during COVID-19 but will likely stimulate the field far beyond the pandemic. They may facilitate research in new contexts and in homebound or movement-restricted participant groups. Moreover, they allow for new experimental variations that may advance procedures as well as the conceptualization of stress itself. While posing challenges for stress researchers undeniably, the COVID-19 pandemic may evolve into a driving force for progress eventually.
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Affiliation(s)
- Lena Sophie Pfeifer
- Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany,Corresponding author at: Lena Sophie Pfeifer (Cognitive Psychology, Ruhr University Bochum, Universitätsstraße 150, Room: IB 6/77, 44780, Bochum, Germany)
| | - Katrin Heyers
- Biopsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany,General Psychology II and Biological Psychology, Institute of Psychology, School of Human Sciences, Osnabrück University, Osnabrück, Germany
| | - Sebastian Ocklenburg
- Biopsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
| | - Oliver T. Wolf
- Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
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13
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Methodological and institutional considerations for the use of 360-degree video and pet animals in human subject research: An experimental case study from the United States. Behav Res Methods 2021; 53:977-992. [PMID: 32918168 DOI: 10.3758/s13428-020-01458-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Head-mounted virtual-reality headsets and virtual-reality content have experienced large technological advances and rapid proliferation over the last years. These immersive technologies bear great potential for the facilitation of the study of human decision-making and behavior in safe, perceptually realistic virtual environments. Best practices and guidelines for the effective and efficient use of 360-degree video in experimental research is also evolving. In this paper, we summarize our research group's experiences with a sizable experimental case study on virtual-reality technology, 360-degree video, pet animals, and human participants. Specifically, we discuss the institutional, methodological, and technological challenges encountered during the implementation of our 18-month-long research project on human emotional response to short-duration 360-degree videos of human-pet interactions. Our objective in this paper is to contribute to the growing body of research on 360-degree video and to lower barriers related to the conceptualization and practice of research at the intersection of virtual-reality experiences, 360-degree video, live animals, and human behavior. Practical suggestions for human-subject researchers interested in utilizing virtual-reality technology, 360-degree videos, and pet animals as a part of their research are discussed.
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Technology-Based Assessments and Treatments of Anxiety in Autistic Individuals: Systematic Review and Narrative Synthesis. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00275-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractThis systematic review (Prospero Registration Number: CRD42019142910) aimed to narratively synthesise technology-aided assessments and treatments of anxiety in individuals with autism spectrum disorder (ASD) for the first time. Sixteen studies were identified: 5 assessment studies and 11 treatment studies. Assessment studies targeted state anxiety using ecological momentary assessment, wearables, or computerised tasks. Treatment studies targeted specific fears/phobias using electronic screen media or transdiagnostic anxiety using telemedicine. Broadly, results indicated technology-aided assessments and treatments may be feasible and effective at targeting anxiety in ASD, except treatments involving social scripts or peer modelling. Assessment results further indicated that state anxiety in ASD has a distinct psychophysiological signature and is evoked by idiosyncratic triggers. However, larger scale studies with representative samples are needed.
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Bolinski F, Etzelmüller A, De Witte NAJ, van Beurden C, Debard G, Bonroy B, Cuijpers P, Riper H, Kleiboer A. Physiological and self-reported arousal in virtual reality versus face-to-face emotional activation and cognitive restructuring in university students: A crossover experimental study using wearable monitoring. Behav Res Ther 2021; 142:103877. [PMID: 34029860 DOI: 10.1016/j.brat.2021.103877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/16/2021] [Accepted: 04/26/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Arousal may be important for learning to restructure ones' negative cognitions, a core technique in depression treatment. In virtual reality (VR), situations may be experienced more vividly than, e.g., in an imaginative approach, potentially aiding the emotional activation of negative cognitions. However, it is unclear whether such activation and subsequent cognitive restructuring in VR elicits more physiological, e.g. changes in skin conductance (SC), heart rate (HR), and self-reported arousal. METHOD In a cross-over experiment, 41 healthy students experienced two sets, one in VR, one face-to-face (F2F), of three situations aimed at activating negative cognitions. Order of the sets and mode of delivery were randomised. A wristband wearable monitored SC and HR; self-reported arousal was registered verbally. RESULTS Repeated measures analyses of variance revealed significantly more SC peaks per minute, F (1, 40) = 13.89, p = .001, higher mean SC, F (1,40) = 7.47, p = .001, and higher mean HR, F (1, 40) = 75.84, p < .001 in VR compared to F2F. No differences emerged on the paired-samples t-test for self-reported arousal, t (40) = -1.35, p = .18. DISCUSSION To the best of our knowledge, this is the first study indicating that emotional activation and subsequent cognitive restructuring in VR can lead to significantly more physiological arousal compared to an imaginative approach. These findings need to be replicated before they can be extended to patient populations.
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Affiliation(s)
- Felix Bolinski
- Vrije Universiteit Amsterdam, Department of Clinical, Neuro- & Developmental Psychology, Section of Clinical Psychology, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands.
| | - Anne Etzelmüller
- Vrije Universiteit Amsterdam, Department of Clinical, Neuro- & Developmental Psychology, Section of Clinical Psychology, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands; GET.ON Institute/HelloBetter, Hamburg, Germany
| | - Nele A J De Witte
- Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Cecile van Beurden
- Vrije Universiteit Amsterdam, Department of Clinical, Neuro- & Developmental Psychology, Section of Clinical Psychology, Amsterdam, the Netherlands
| | - Glen Debard
- Mobilab & Care, Thomas More University of Applied Sciences, Geel, Belgium
| | - Bert Bonroy
- Mobilab & Care, Thomas More University of Applied Sciences, Geel, Belgium
| | - Pim Cuijpers
- Vrije Universiteit Amsterdam, Department of Clinical, Neuro- & Developmental Psychology, Section of Clinical Psychology, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Heleen Riper
- Vrije Universiteit Amsterdam, Department of Clinical, Neuro- & Developmental Psychology, Section of Clinical Psychology, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
| | - Annet Kleiboer
- Vrije Universiteit Amsterdam, Department of Clinical, Neuro- & Developmental Psychology, Section of Clinical Psychology, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, the Netherlands
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Cullen AJ, Dowling NL, Segrave R, Carter A, Yücel M. Exposure therapy in a virtual environment: Validation in obsessive compulsive disorder. J Anxiety Disord 2021; 80:102404. [PMID: 33894550 DOI: 10.1016/j.janxdis.2021.102404] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 03/29/2021] [Accepted: 04/13/2021] [Indexed: 11/28/2022]
Abstract
Exposure and response prevention (ERP) is the current first-line psychological treatment for Obsessive-compulsive disorder (OCD). However, substantial inter-individual variability exists in treatment outcomes, including inadequate symptom improvements, and notable refusal and attrition rates. These are driven, in part, by impracticalities in simulating intrusive thoughts within clinical settings. Virtual reality (VR) offers the potential of overcoming these limitations in a manner that allows for finely controlled anxiety-provoking scenarios to be created within supportive clinical settings. To validate the potential of VR for treating contamination-based OCD, 22 patients undertook a VR ERP session and a matched session of the current gold-standard of in vivo ERP. In VR, patients were immersed within a contamination environment that permitted flexible delivery of customisable, graded exposure tasks. The VR environment utilised HTC Vive hardware, to allow for patients to both interact with, and physically move through the environment. Subjective and objective measures of distress were recorded, including heart and respiration rates. These measures indicate virtual and in vivo ERP sessions provoke consistent anxiety profiles across an exposure hierarchy. Virtual exposure was advantageous for engagement and adherence to tasks, and the therapeutic alliance was upheld. VR is a promising mechanism for ERP in contamination OCD.
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Affiliation(s)
- Alison J Cullen
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, 770 Blackburn Rd, Clayton, Victoria, Australia; The Melbourne Clinic Professorial Unit, Salisbury Street, Richmond, Victoria, Australia.
| | - Nathan L Dowling
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, 770 Blackburn Rd, Clayton, Victoria, Australia; The Melbourne Clinic Professorial Unit, Salisbury Street, Richmond, Victoria, Australia
| | - Rebecca Segrave
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, 770 Blackburn Rd, Clayton, Victoria, Australia
| | - Adrian Carter
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, 770 Blackburn Rd, Clayton, Victoria, Australia
| | - Murat Yücel
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, 770 Blackburn Rd, Clayton, Victoria, Australia.
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17
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Modrego-Alarcón M, López-Del-Hoyo Y, García-Campayo J, Pérez-Aranda A, Navarro-Gil M, Beltrán-Ruiz M, Morillo H, Delgado-Suarez I, Oliván-Arévalo R, Montero-Marin J. Efficacy of a mindfulness-based programme with and without virtual reality support to reduce stress in university students: A randomized controlled trial. Behav Res Ther 2021; 142:103866. [PMID: 33957506 DOI: 10.1016/j.brat.2021.103866] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To evaluate the efficacy of a mindfulness-based programme (MBP) for reducing stress in university students and its action mechanisms and to explore the capacity of virtual reality (VR) exposure to enhance adherence to the intervention. METHODS This randomized controlled trial (RCT) involved assessment time points of baseline, posttreatment, and 6-month follow-up. A total of 280 students from two Spanish universities were randomly assigned to 'MBP', 'MBP + VR', or 'Relaxation' (active controls). Perceived stress posttreatment was the primary outcome; wellbeing and academic functional outcomes were assessed as well. Multilevel mixed-effects models were performed to estimate the efficacy of the programme. RESULTS Both 'MBP' (B = -2.77, d = -0.72, p = .006) and 'MBP + VR' (B = -2.44, d = -0.59, p = .014) were superior to 'Relaxation' in improving stress, as well as most of the secondary outcomes, with medium-to-large effects posttreatment and at follow-up. The long-term effects of MBPs on stress were mediated by mindfulness and self-compassion in parallel. Treatment adherence was improved in the 'MBP + VR' group, with higher retention rates and session attendance (p < .001). CONCLUSIONS This RCT supports the efficacy of an MBP compared to relaxation for reducing stress in university students through mindfulness and self-compassion as mechanisms of change. VR exposure may enhance treatment adherence. TRIAL REGISTRATION ClinicalTrials.gov NCT03771300.
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Affiliation(s)
- Marta Modrego-Alarcón
- Health Research Institute of Aragon (IIS Aragón), Zaragoza, Spain; Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain; Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Yolanda López-Del-Hoyo
- Health Research Institute of Aragon (IIS Aragón), Zaragoza, Spain; Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain; Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Javier García-Campayo
- Health Research Institute of Aragon (IIS Aragón), Zaragoza, Spain; Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain; Miguel Servet University Hospital, Zaragoza, Spain
| | - Adrián Pérez-Aranda
- Health Research Institute of Aragon (IIS Aragón), Zaragoza, Spain; AGORA Research Group; Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain; Department of Basic Psychology, Autonomous University of Barcelona, Cerdanyola Del Vallès, Spain.
| | - Mayte Navarro-Gil
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain; Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - María Beltrán-Ruiz
- Health Research Institute of Aragon (IIS Aragón), Zaragoza, Spain; Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
| | - Héctor Morillo
- Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain; Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Irene Delgado-Suarez
- Health Research Institute of Aragon (IIS Aragón), Zaragoza, Spain; Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
| | - Rebeca Oliván-Arévalo
- AGORA Research Group; Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, St. Boi de Llobregat, Spain
| | - Jesus Montero-Marin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
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18
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Machulska A, Eiler TJ, Kleinke K, Grünewald A, Brück R, Jahn K, Niehaves B, Klucken T. Approach bias retraining through virtual reality in smokers willing to quit smoking: A randomized-controlled study. Behav Res Ther 2021; 141:103858. [PMID: 33862407 DOI: 10.1016/j.brat.2021.103858] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/25/2021] [Accepted: 03/25/2021] [Indexed: 11/26/2022]
Abstract
Automatic approach biases toward smoking-related cues have been implicated in the development and maintenance of addictive behaviors. Studies aiming at modifying such biases have shown promise in changing maladaptive approach tendencies for smoking cues and reducing smoking behavior. However, training effects tend to be small and partly inconsistent. The present randomized-controlled trial incorporated virtual reality (VR) technology into Approach Bias Modification (ABM) to improve efficacy. One-hundred-eight smokers attended behavioral counseling for smoking cessation and were thereafter randomized to receive VR-ABM or VR-control training. During VR-ABM, participants trained to implicitly avoid smoking-related objects and to approach alternative objects, while no such contingency existed in the VR-control condition. Trainings were administered in six sessions within a two-week period. Assessments were conducted at baseline, post-intervention (three weeks after baseline), and at follow-up (seven weeks after baseline). VR-ABM did not change approach biases, nor other cognitive biases, but it was superior in reducing daily smoking. However, this effect was limited to the two-week training period. Both groups improved in other smoking- and health-related variables across time. Future work should continue to investigate working mechanisms of ABM, in particular crucial training ingredients. VR could prove valuable for public health as the potential of VR-based treatments is large and not fully explored.
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Affiliation(s)
- Alla Machulska
- Department of Clinical Psychology, University of Siegen, Siegen, Germany.
| | - Tanja Joan Eiler
- Medical Informatics and Micro Systems Engineering, University of Siegen, Siegen, Germany; Life Science Faculty, University of Siegen, Siegen, Germany.
| | - Kristian Kleinke
- Department of Clinical Psychology, University of Siegen, Siegen, Germany.
| | - Armin Grünewald
- Medical Informatics and Micro Systems Engineering, University of Siegen, Siegen, Germany; Life Science Faculty, University of Siegen, Siegen, Germany.
| | - Rainer Brück
- Life Science Faculty, University of Siegen, Siegen, Germany.
| | - Katharina Jahn
- Department of Business Informatics, University of Siegen, Siegen, Germany.
| | - Björn Niehaves
- Department of Business Informatics, University of Siegen, Siegen, Germany.
| | - Tim Klucken
- Department of Clinical Psychology, University of Siegen, Siegen, Germany.
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19
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Wang Q, Wang H, Hu F, Hua C, Wang D. Using convolutional neural networks to decode EEG-based functional brain network with different severity of acrophobia. J Neural Eng 2021; 18. [DOI: 10.1088/1741-2552/abcdbd] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/25/2020] [Indexed: 12/11/2022]
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20
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Tao G, Garrett B, Taverner T, Cordingley E, Sun C. Immersive virtual reality health games: a narrative review of game design. J Neuroeng Rehabil 2021; 18:31. [PMID: 33573684 PMCID: PMC7879508 DOI: 10.1186/s12984-020-00801-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND High quality head-mounted display based virtual reality (HMD-VR) has become widely available, spurring greater development of HMD-VR health games. As a behavior change approach, these applications use HMD-VR and game-based formats to support long-term engagement with therapeutic interventions. While the bulk of research to date has primarily focused on the therapeutic efficacy of particular HMD-VR health games, how developers and researchers incorporate best-practices in game design to achieve engaging experiences remains underexplored. This paper presents the findings of a narrative review exploring the trends and future directions of game design for HMD-VR health games. METHODS We searched the literature on the intersection between HMD-VR, games, and health in databases including MEDLINE, Embase, CINAHL, PsycINFO, and Compendex. We identified articles describing HMD-VR games designed specifically as health applications from 2015 onwards in English. HMD-VR health games were charted and tabulated according to technology, health context, outcomes, and user engagement in game design. FINDINGS We identified 29 HMD-VR health games from 2015 to 2020, with the majority addressing health contexts related to physical exercise, motor rehabilitation, and pain. These games typically involved obstacle-based challenges and extrinsic reward systems to engage clients in interventions related to physical functioning and pain. Less common were games emphasizing narrative experiences and non-physical exercise interventions. However, discourse regarding game design was diverse and often lacked sufficient detail. Game experience was evaluated using primarily ad-hoc questionnaires. User engagement in the development of HMD-VR health games primarily manifested as user studies. CONCLUSION HMD-VR health games are promising tools for engaging clients in highly immersive experiences designed to address diverse health contexts. However, more in-depth and structured attention to how HMD-VR health games are designed as game experiences is needed. Future development of HMD-VR health games may also benefit from greater involvement of end-users in participatory approaches.
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Affiliation(s)
- Gordon Tao
- Graduate Programs in Rehabilitation Science, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - Bernie Garrett
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Tarnia Taverner
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Elliott Cordingley
- Faculty of Science, University of British Columbia, Vancouver, BC, Canada
| | - Crystal Sun
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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21
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Pittig A, Hoyer J, Noack R. Smart-Glass Guided Exposure for Anxiety Disorders: A Proof-of-Concept Study. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Szczepańska-Gieracha J, Cieślik B, Rutkowski S, Kiper P, Turolla A. What can virtual reality offer to stroke patients? A narrative review of the literature. NeuroRehabilitation 2021; 47:109-120. [PMID: 32741792 DOI: 10.3233/nre-203209] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Studies demonstrated the efficacy of virtual reality (VR) as a method supporting the post-stroke neuro-rehabilitation process by activating motor learning processes. Nevertheless, stroke is frequently accompanied by serious psychological problems including depression, which is associated with an increased risk of mortality, lower post-stroke physical activity, and higher disability in stroke patients. OBJECTIVES To explore the current use of VR as a method supporting the neuro-rehabilitation process, both in physical and psychological dimensions. METHODS An exploratory review was conducted with a narrative synthesis. PubMed was used for literature search. Search includes the use of VR in physical rehabilitation, and as support therapy in psychiatric disorders. Both primary research and systematic reviews were included. RESULTS In neurological disorders rehabilitation, out of 22 studies, 16 concerned stroke survivors. In psychiatric disorders, 44 literature reviews were included. CONCLUSION The studies confirmed the effectiveness of various forms of VR treatment in the alleviation of psychological and behavioral problems and psychiatric disorders. There is a shortage of VR-based technological solutions that would, besides physical rehabilitation, offer stroke patients therapeutic tools to alleviate psychological disturbance and improve the patient's mood and motivation. Such solutions will most likely become a field of intensive research in the coming years.
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Affiliation(s)
| | - Błażej Cieślik
- Jan Dlugosz University in Czestochowa, Czestochowa, Poland
| | | | - Paweł Kiper
- Laboratory of Neurorehabilitation Technologies, San Camillo IRCCS S.r.l., Venice, Italy
| | - Andrea Turolla
- Laboratory of Neurorehabilitation Technologies, San Camillo IRCCS S.r.l., Venice, Italy
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23
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Whiteside SPH, Brennan E, Biggs BK, Vickers K, Hathaway J, Seifert SJ, Kramer KM, Hofschulte DR. The feasibility of verbal and virtual reality exposure for youth with academic performance worry. J Anxiety Disord 2020; 76:102298. [PMID: 32937260 DOI: 10.1016/j.janxdis.2020.102298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/28/2020] [Accepted: 08/30/2020] [Indexed: 12/17/2022]
Abstract
With exposure emerging as a key ingredient in anxiety treatment for childhood anxiety disorders (CADs), expansion of exposure techniques is a promising avenue for improving treatment efficacy. The present study examined use of imaginal exposure (IE), a technique understudied in the treatment of CADs. Specifically, the study tested whether two forms of exposure to worries (verbal IE and virtual reality exposure therapy, VRET) would be effective and acceptable forms of exposure with youth. Twenty youth with fears of academic failure completed both types of worry exposure, presented in randomized order. Regardless of order of presentation, both verbal IE and VRET elicited moderate anxiety that decreased to mild over the span of the exposures. Both were found to be acceptable by youth and neither was associated with negative side effects. Youth found VRET to be slightly more interesting and novel, but noted that verbal IE was more realistic and individualized. The present study supports the use of standalone worry exposure as an effective and acceptable treatment for general worries in youth and suggests VRET could be more effective with improved realism.
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Affiliation(s)
| | - Elle Brennan
- Department of Psychiatry and Psychology, Mayo Clinic, United States
| | - Bridget K Biggs
- Department of Psychiatry and Psychology, Mayo Clinic, United States
| | - Kristin Vickers
- Department of Psychiatry and Psychology, Mayo Clinic, United States; Office of Patient Education, Mayo Clinic, United States
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24
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Reynolds T, Boutwell B, Shackelford TK, Weekes-Shackelford V, Nedelec J, Beaver K, Abed MG. Child mortality and parental grief: An evolutionary analysis. NEW IDEAS IN PSYCHOLOGY 2020. [DOI: 10.1016/j.newideapsych.2020.100798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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25
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Cieślik B, Mazurek J, Rutkowski S, Kiper P, Turolla A, Szczepańska-Gieracha J. Virtual reality in psychiatric disorders: A systematic review of reviews. Complement Ther Med 2020; 52:102480. [PMID: 32951730 DOI: 10.1016/j.ctim.2020.102480] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/01/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Virtual reality (VR) is being used more and more often as a therapeutic tool in psychology or psychiatry. In recent years, VR interventions appear more extensively also in disorders such as depression, anxiety and phobia. However, there has yet to be a comprehensive synthesis and critical review of the literature to identify future directions to advance the field in this area. OBJECTIVES To broadly characterize the literature to date on the application of VR in psychiatric disorders by conducting a systematic review of reviews, describe the limitations of existing research, suggest avenues for future research to address gaps in the current literature and provide practical recommendations for incorporating VR into various treatments for psychiatric disorders. METHODS PubMed and Web of Science databases were searched for reviews on VR use in psychiatric disorders (e.g. various pain perceptions, post-traumatic stress disorder, phobias, attention deficit hyperactivity disorder, psychosis, depression). The methodological quality of each literature review was assessed using AMSTAR. RESULTS The original search identified 848 reviews, of which 70 were included in the systematic review of reviews. Broadly, the literature indicates that various VR interventions could be useful in different psychiatric disorders. CONCLUSION This study provides evidence supporting the positive impact of VR therapy in psychiatric disorders. However, the impact is defined differently according to the studied area. Nevertheless, due to the continuous development of VR hardware and software, it is essential to conduct further research in the area of psychiatric disorders, especially as no review has concluded that VR does not work.
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Affiliation(s)
- Błażej Cieślik
- Faculty of Health Sciences, Jan Dlugosz University in Czestochowa, Czestochowa, Poland.
| | - Justyna Mazurek
- Department and Division of Medical Rehabilitation, Wroclaw Medical University, Wroclaw, Poland.
| | - Sebastian Rutkowski
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland.
| | - Paweł Kiper
- Laboratory of Neurorehabilitation Technologies, San Camillo IRCCS S.r.l., Venice, Italy.
| | - Andrea Turolla
- Laboratory of Neurorehabilitation Technologies, San Camillo IRCCS S.r.l., Venice, Italy.
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26
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Tinga AM, Nyklíček I, Jansen MP, de Back TT, Louwerse MM. Respiratory Biofeedback Does Not Facilitate Lowering Arousal in Meditation Through Virtual Reality. Appl Psychophysiol Biofeedback 2020; 44:51-59. [PMID: 30377895 PMCID: PMC6373281 DOI: 10.1007/s10484-018-9421-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The current study examined the effectiveness of respiratory biofeedback in lowering subjective and objective arousal after stress. Participants were presented with a meditation session in virtual reality while subjective and objective arousal were measured, the latter measured through ECG and EEG. Three conditions were used: (a) a respiratory biofeedback condition, in which visual feedback was paired to breathing; (b) a control feedback placebo condition, in which visual feedback was not paired to breathing; and (c) a control no-feedback condition, in which no visual feedback was used. Subjective and objective arousal decreased during meditation after stress in all conditions, demonstrating recovery after stress during meditation in virtual reality. However, the reduction in arousal (on all outcome measures combined and heart rate specifically) was largest in the control feedback placebo condition, in which no biofeedback was used, indicating that respiratory biofeedback had no additional value in reducing arousal. The findings of the current study highlight the importance of including a control feedback placebo condition in order to establish the exact additional value of biofeedback and offer insights in applying cost-effective virtual reality meditation training.
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Affiliation(s)
- Angelica M Tinga
- Department of Cognitive Science & Artificial Intelligence, Tilburg University, Dante Building, Room D 330, Warandelaan 2, 5037 AB, Tilburg, The Netherlands.
| | - Ivan Nyklíček
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Michel P Jansen
- Department of Electrical Engineering, Mathematics, and Computer Science, University of Twente, Enschede, The Netherlands
| | - Tycho T de Back
- Department of Cognitive Science & Artificial Intelligence, Tilburg University, Dante Building, Room D 330, Warandelaan 2, 5037 AB, Tilburg, The Netherlands
| | - Max M Louwerse
- Department of Cognitive Science & Artificial Intelligence, Tilburg University, Dante Building, Room D 330, Warandelaan 2, 5037 AB, Tilburg, The Netherlands
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27
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Persky S. A Virtual Home for the Virtual Clinical Trial. J Med Internet Res 2020; 22:e15582. [PMID: 31899455 PMCID: PMC6969384 DOI: 10.2196/15582] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/11/2019] [Accepted: 10/20/2019] [Indexed: 12/29/2022] Open
Abstract
Virtual clinical trials (VCTs) can satisfy the need for rigorous clinical trials by using distributed technological solutions that eliminate the need for a physical trial site. This report explores potential benefits of using virtual reality (VR) to provide a "virtual site" for VCTs, a shared immersive hub in which VCT participants could experience elements of the trial and interact with the trial team. VR is a communication technology that has been emerging alongside the development of VCTs, although they have never been merged in a substantial way. Many of the gaps within the VCT paradigm are areas in which VR excels. VR environments are standardized and precisely uniform, the technology allows introduction of an almost endless set of stimuli to participants' visual and auditory systems, and VR systems are adept at capturing precise movement and behavioral data. Although VR has not yet found its way into VCTs, much of the groundwork for such integration has been laid through research and technological development achieved in the past few years. Future implementation of VR within VCTs could move us from site-less trials to those with a virtual site serving as a hub for trial information provision, interaction with trial representatives, administration of evaluations and assessments, and more.
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Affiliation(s)
- Susan Persky
- Social and Behavioral Research Branch, National Human Genome Research Institute, Bethesda, MD, United States
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Helminen EC, Morton ML, Wang Q, Felver JC. A meta-analysis of cortisol reactivity to the Trier Social Stress Test in virtual environments. Psychoneuroendocrinology 2019; 110:104437. [PMID: 31536942 DOI: 10.1016/j.psyneuen.2019.104437] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 08/12/2019] [Accepted: 09/05/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Maladaptive responses to stressors can lead to poor physical and psychological health outcomes. Laboratory studies of stress induction commonly use the Trier Social Stress Test (TSST). The TSST has been shown to reliably induce a stress response, most commonly measured via cortisol reactivity. Recently, researchers have used virtual environment versions of the TSST (V-TSST) in place of the traditional TSST. The V-TSST has many advantages over the traditional TSST, including increased standardization and use of fewer resources, but V-TSST has yet to be quantitatively reviewed and compared to the traditional TSST. This review aims to quantifying the effectiveness of V-TSST with a meta-analysis of cortisol response effects and identify potential moderating variables that are more likely to induce a cortisol response with V-TSST. METHODS Literature searches were conducted including the key words Trier Social Stress Test, TSST, and virtual reality. Thirteen studies were included in this meta-analysis after meeting the inclusion criteria of utilizing a V-TSST and having cortisol measurements at baseline and peak stress to assess cortisol reactivity. The standardized mean gain effect size was used. RESULTS AND DISCUSSION There was a medium average effect size (ESsg = 0.65) across all studies for increase in cortisol from baseline to peak measurement. Significant moderating effects were seen for participant age, sex, and level of immersivity of the virtual environment. Studies in which participants were under 25 years old, or all male, showed greater effect sizes for cortisol reactivity. Virtual environments that were more immersive also evidenced greater effect sizes. Although the V-TSST is effective at inducing psychosocial stress, the magnitude of this response is less than the traditional TSST. Based on these results, recommendations for future research are provided.
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Affiliation(s)
- Emily C Helminen
- Department of Psychology, 430 Huntington Hall, Syracuse University, Syracuse, NY, 13244, United States
| | - Melissa L Morton
- Department of Psychology, 430 Huntington Hall, Syracuse University, Syracuse, NY, 13244, United States
| | - Qiu Wang
- Department of Higher Education, 350 Huntington Hall, Syracuse University, Syracuse, NY, 13244, United States
| | - Joshua C Felver
- Department of Psychology, 430 Huntington Hall, Syracuse University, Syracuse, NY, 13244, United States.
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Rosiak O, Krajewski K, Woszczak M, Jozefowicz-Korczynska M. Evaluation of the effectiveness of a Virtual Reality-based exercise program for Unilateral Peripheral Vestibular Deficit. J Vestib Res 2019; 28:409-415. [PMID: 30714985 PMCID: PMC9249289 DOI: 10.3233/ves-180647] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Recently, two types of movement sensors have been introduced into Virtual Reality (VR) therapy: motion trackers and force-plate platforms. Combining these two methods could produce better rehabilitation outcomes. Such devices, encompassing motion trackers and force platforms, are referred to as "hybrid" VR units. OBJECTIVE To assess the effectiveness of a low-cost hybrid VR based vestibular rehabilitation programMETHODS: A prospective, non-randomized, controlled group study comparing training using a hybrid VR unit (Group 1 n = 25) vs. static posturography with visual feedback (Group 2 n = 25) in patients with peripheral vestibular dysfunction was conducted. The subjects underwent 10 training sessions over 10 days (30 minute sessions). All were examined on a posturography platform at the start and 1 month after rehabilitation and completed the Vertigo Symptom Scale - Short Form (VSS-SF) questionnaire. RESULTS Both groups demonstrated improvement in posturographic parameters, which were statistically significant, but when comparing results between both groups there were no differences. The patients reported improvement in their subjective perception of symptoms on the VSS-SF scale, which were statistically significant in both groups, but greater in the VR group. CONCLUSIONS Both methods reduce postural sway, however subjective reduction of symptoms was greater in the VR group.
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Affiliation(s)
- Oskar Rosiak
- Department of Otolaryngology, Balance Disorders Unit, Medical University of Lodz, The Norbert Barlicki Memorial Teaching Hospital, Lodz, Poland
| | - Krzysztof Krajewski
- Department of Otolaryngology, Balance Disorders Unit, Medical University of Lodz, The Norbert Barlicki Memorial Teaching Hospital, Lodz, Poland
| | - Marek Woszczak
- Department of Rehabilitation, The Norbert Barlicki Memorial Teaching Hospital, Lodz, Poland
| | - Magdalena Jozefowicz-Korczynska
- Department of Otolaryngology, Balance Disorders Unit, Medical University of Lodz, The Norbert Barlicki Memorial Teaching Hospital, Lodz, Poland
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Martens MAG, Antley A, Freeman D, Slater M, Harrison PJ, Tunbridge EM. It feels real: physiological responses to a stressful virtual reality environment and its impact on working memory. J Psychopharmacol 2019; 33:1264-1273. [PMID: 31294651 PMCID: PMC6764008 DOI: 10.1177/0269881119860156] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Virtual reality (VR) is increasingly used to study and treat psychiatric disorders. Its fidelity depends in part on the extent to which the VR environment provides a convincing simulation, for example whether a putatively stressful VR situation actually produces a stress response. METHODS We studied the stress response in 28 healthy men exposed either to a stressor VR elevator (which simulated travelling up the outside of a tall building and culminated in the participant being asked to step off the elevator platform), or to a control elevator. We measured psychological and physiological (salivary cortisol and alpha-amylase, blood pressure, pulse, skin conductance) stress indices. We also measured subsequent performance on the N-back task because acute stress has been reported to impact on working memory. RESULTS Compared to participants in the control elevator, those in the external elevator had increases in skin conductance, pulse and subjective stress and anxiety ratings, altered heart rate variability, and a delayed rise in cortisol. N-back performance was unaffected. CONCLUSIONS A putatively stressful VR elevator produces a physiological as well as a psychological stress response, supporting its use in the investigation and treatment of stress-related disorders, and its potential value as an experimental laboratory stressor.
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Affiliation(s)
- Marieke AG Martens
- Department of Psychiatry, University of
Oxford, Warneford Hospital, Oxford, UK,Oxford Health NHS Foundation Trust,
Warneford Hospital, Oxford, UK
| | - Angus Antley
- Department of Psychiatry, University of
Oxford, Warneford Hospital, Oxford, UK,Oxford Health NHS Foundation Trust,
Warneford Hospital, Oxford, UK
| | - Daniel Freeman
- Department of Psychiatry, University of
Oxford, Warneford Hospital, Oxford, UK,Oxford Health NHS Foundation Trust,
Warneford Hospital, Oxford, UK
| | - Mel Slater
- Department of Clinical Psychology and
Psychobiology, University of Barcelona, Barcelona, Spain
| | - Paul J Harrison
- Department of Psychiatry, University of
Oxford, Warneford Hospital, Oxford, UK,Oxford Health NHS Foundation Trust,
Warneford Hospital, Oxford, UK
| | - Elizabeth M Tunbridge
- Department of Psychiatry, University of
Oxford, Warneford Hospital, Oxford, UK,Oxford Health NHS Foundation Trust,
Warneford Hospital, Oxford, UK,Elizabeth M Tunbridge, University Department
of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
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Ströhle A, Gensichen J, Domschke K. The Diagnosis and Treatment of Anxiety Disorders. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 155:611-620. [PMID: 30282583 DOI: 10.3238/arztebl.2018.0611] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 04/30/2018] [Accepted: 07/31/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Anxiety disorders are the most common type of mental illness in Europe, with a 12-month prevalence of 14% among persons aged 14 to 65. Their onset is usually in adolescence or early adulthood. The affected patients often develop further mental or somatic illnesses (sequential comorbidity). METHODS This review is based on pertinent publications retrieved by a selective search in PubMed. RESULTS The group of anxiety disorders includes generalized anxiety disorder (GAD), phobic disorders, panic disorders, and two disorders that are often restricted to childhood-separation anxiety and selective mutism. A comprehensive differential diag- nostic evaluation is essential, because anxiety can be a principal manifestation of other types of mental or somatic illness as well. Psychotherapy and treatment with psychoactive drugs are the therapeutic strategies of first choice. Of all types of psycho- therapy, cognitive behavioral therapy has the best documented efficacy. Modern antidepressants are the drugs of first choice for the treatment of panic disorders, agoraphobia, social phobia, and GAS; pregabalin is a further drug of first choice for GAS. CONCLUSION In general, anxiety disorders can now be effectively treated. Patients should be informed of the therapeutic options and should be involved in treatment planning. Current research efforts are centered on individualized and therefore, it is hoped, even more effective treatment approaches than are available at present.
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Affiliation(s)
- Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte (CCM), Charité-Universitätsmedizin Berlin; Institute of General Practice, Faculty of Medicine, Ludwig-Maximilians-Universität München; Department of Psychiatry and Psychotherapy, University Hospital of Freiburg
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Poyade M, Morris G, Taylor IC, Portela V. iSenseVR: bringing VR exposure therapy outside the laboratory. JOURNAL OF ENABLING TECHNOLOGIES 2019. [DOI: 10.1108/jet-12-2018-0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to present the preliminary outcomes of a research which takes gradual exposure in virtual reality (VR) outside the laboratory to empower people with “hidden disabilities” breaking down their barriers towards independent living. It explores the use of VR through smartphones to practically apply gradual exposure to environment stressors that are typically found in busy spaces from one’s own safe environment.Design/methodology/approachAberdeen International Airport has kindly accepted to take part to this research as a case study. Following a participatory design and usability testing, a semi-controlled seven-day study was conducted among seven individuals with hidden disabilities to assess user acceptance.FindingsResults showed undeniable participants’ engagement and enthusiasm for the proposed approach, although further research is needed to increase the presence and improve the overall user experience.Research limitations/implicationsThe proposed research has been conducted on small cohort of participants outside of a clinical setting. Further engagement with individuals with hidden disabilities is required in order to determine the effectiveness of the proposed approach.Originality/valueThis research presents a methodological and technological framework which contributes effectively to the practicality of VR exposure therapy outside of the laboratory setting, from one’s own safe place.
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Raber J, Arzy S, Bertolus JB, Depue B, Haas HE, Hofmann SG, Kangas M, Kensinger E, Lowry CA, Marusak HA, Minnier J, Mouly AM, Mühlberger A, Norrholm SD, Peltonen K, Pinna G, Rabinak C, Shiban Y, Soreq H, van der Kooij MA, Lowe L, Weingast LT, Yamashita P, Boutros SW. Current understanding of fear learning and memory in humans and animal models and the value of a linguistic approach for analyzing fear learning and memory in humans. Neurosci Biobehav Rev 2019; 105:136-177. [PMID: 30970272 DOI: 10.1016/j.neubiorev.2019.03.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/30/2019] [Accepted: 03/18/2019] [Indexed: 01/04/2023]
Abstract
Fear is an emotion that serves as a driving factor in how organisms move through the world. In this review, we discuss the current understandings of the subjective experience of fear and the related biological processes involved in fear learning and memory. We first provide an overview of fear learning and memory in humans and animal models, encompassing the neurocircuitry and molecular mechanisms, the influence of genetic and environmental factors, and how fear learning paradigms have contributed to treatments for fear-related disorders, such as posttraumatic stress disorder. Current treatments as well as novel strategies, such as targeting the perisynaptic environment and use of virtual reality, are addressed. We review research on the subjective experience of fear and the role of autobiographical memory in fear-related disorders. We also discuss the gaps in our understanding of fear learning and memory, and the degree of consensus in the field. Lastly, the development of linguistic tools for assessments and treatment of fear learning and memory disorders is discussed.
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Affiliation(s)
- Jacob Raber
- Department of Behavioral Neuroscience, ONPRC, Oregon Health & Science University, Portland, OR, USA; Departments of Neurology and Radiation Medicine, and Division of Neuroscience, ONPRC, Oregon Health & Science University, Portland, OR, USA.
| | - Shahar Arzy
- Department of Medical Neurobiology, Hebrew University, Jerusalem 91904, Israel
| | | | - Brendan Depue
- Departments of Psychological and Brain Sciences and Anatomical Sciences and Neurobiology, University of Louisville, Louisville, KY, USA
| | - Haley E Haas
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, GA, USA
| | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Maria Kangas
- Department of Psychology, Macquarie University, Sydney, Australia
| | | | - Christopher A Lowry
- Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Hilary A Marusak
- Department of Pharmacy Practice, Wayne State University, Detroit, MI, USA
| | - Jessica Minnier
- School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Anne-Marie Mouly
- Lyon Neuroscience Research Center, CNRS-UMR 5292, INSERM U1028, Université Lyon, Lyon, France
| | - Andreas Mühlberger
- Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Regensburg, Germany; PFH - Private University of Applied Sciences, Department of Psychology (Clinical Psychology and Psychotherapy Research), Göttingen, Germany
| | - Seth Davin Norrholm
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, GA, USA
| | - Kirsi Peltonen
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland
| | - Graziano Pinna
- The Psychiatric Institute, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Christine Rabinak
- Department of Pharmacy Practice, Wayne State University, Detroit, MI, USA
| | - Youssef Shiban
- Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Regensburg, Germany; PFH - Private University of Applied Sciences, Department of Psychology (Clinical Psychology and Psychotherapy Research), Göttingen, Germany
| | - Hermona Soreq
- Department of Biological Chemistry, Edmond and Lily Safra Center of Brain Science and The Institute of Life Sciences, Hebrew University, Jerusalem 91904, Israel
| | - Michael A van der Kooij
- Translational Psychiatry, Department of Psychiatry and Psychotherapy, Universitatsmedizin der Johannes Guttenberg University Medical Center, Mainz, Germany
| | | | - Leah T Weingast
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, GA, USA
| | - Paula Yamashita
- School of Public Health, Oregon Health & Science University, Portland, OR, USA
| | - Sydney Weber Boutros
- Department of Behavioral Neuroscience, ONPRC, Oregon Health & Science University, Portland, OR, USA
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Abstract
The processing and regulation of fear is one of the key components of posttraumatic stress disorder (PTSD). Fear can involve both acute and potential threats that can manifest in different behaviors and result from activity within different neural nodes and networks. Fear circuits have been studied extensively in animal models for several decades and in human neuroimaging research for almost 20 years. Therefore, the centrality of fear processing to PTSD lends the disorder to be more tractable to investigation at the level of brain and behavior, and provides several observable phenotypes that can be linked to PTSD symptoms. Moreover, psychophysiological metrics of fear conditioning offer tools that can be used to shift diagnostic paradigms in psychiatry toward neurobiology-consistent with a Research Domain Criteria approach to PTSD. In general, mammalian fear processing can be divided into fear learning (or acquisition), during which an association develops between previously neutral stimuli and aversive outcomes, and fear extinction, in which the latter associations are suppressed by a new form of learning. This review describes translational research in both fear acquisition and extinction, along with their relevance to PTSD and PTSD treatment, focusing specifically on the empirical value and potential clinical utility of psychophysiological methods.
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Campos D, Bretón-López J, Botella C, Mira A, Castilla D, Mor S, Baños R, Quero S. Efficacy of an internet-based exposure treatment for flying phobia (NO-FEAR Airlines) with and without therapist guidance: a randomized controlled trial. BMC Psychiatry 2019; 19:86. [PMID: 30841930 PMCID: PMC6404352 DOI: 10.1186/s12888-019-2060-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Internet-based treatments appear to be a promising way to enhance the in vivo exposure approach, specifically in terms of acceptability and access to treatment. However, the literature on specific phobias is scarce, and, as far as we know, there are no studies on Flying Phobia (FP). This study aims to investigate the effectiveness of an Internet-based exposure treatment for FP (NO-FEAR Airlines) that includes exposure scenarios composed of images and sounds, versus a waiting-list control group. A secondary aim is to explore two ways of delivering NO-FEAR Airlines, with and without therapist guidance. METHODS A randomized controlled trial (RCT) was conducted in which 69 participants were allocated to: 1) NO-FEAR Airlines totally self-applied, 2) NO-FEAR Airlines with therapist guidance, 3) a waiting-list control group. Primary outcome measures were the Fear of Flying Questionnaire-II and the Fear of Flying Scale. Secondary outcomes included the Fear and Avoidance Scales, Clinician Severity Scale, and Patient's Improvement scale. Behavioral outcomes (post-treatment flights and safety behaviors) were also included. Mixed-model analyses with no ad hoc imputations were conducted for primary and secondary outcome measures. RESULTS NO-FEAR Airlines (with and without therapist guidance) was significantly effective, compared to the waiting list control group, on all primary and secondary outcomes (all ps < .05), and no significant differences were found between the two ways of delivering the intervention. Significant improvements on diagnostic status and reliable change indexes were also found in both treatment groups at post-treatment. Regarding behavioral outcomes, significant differences in safety behaviors were found at post-treatment, compared to the waiting list. Treatment gains were maintained at 3- and 12-month follow-ups. CONCLUSION FP can be treated effectively via the Internet. NO-FEAR Airlines helps to enhance the exposure technique and provide access to evidence-based psychological treatment to more people in need. These data are congruent with previous studies highlighting the usefulness of computer-assisted exposure programs for FP, and they contribute to the literature on Internet-based interventions. To the best of our knowledge, this is the first RCT to investigate the effectiveness of an Internet-based treatment for FP and explore two ways of delivering the intervention (with and without therapist guidance). TRIAL REGISTRATION Clinicaltrials.gov: NCT02298478 ( https://clinicaltrials.gov/ct2/show/NCT02298478 ). Trial registration date 3 November 2014.
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Affiliation(s)
- Daniel Campos
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain
| | - Juana Bretón-López
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain ,0000 0000 9314 1427grid.413448.eCIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Cristina Botella
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain ,0000 0000 9314 1427grid.413448.eCIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Adriana Mira
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain ,0000 0001 2152 8769grid.11205.37Department of Psychology and Sociology, Area of Psychobiology, University of Zaragoza, IIS Aragón, Teruel, Spain
| | - Diana Castilla
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain ,0000 0000 9314 1427grid.413448.eCIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain ,0000 0001 2152 8769grid.11205.37Department of Psychology and Sociology, Area of Psychobiology, University of Zaragoza, IIS Aragón, Teruel, Spain
| | - Sonia Mor
- 0000 0001 1957 9153grid.9612.cUniversitat Jaume I, Av. Vicente Sos Baynat s/n, 12006 Castellón, Spain
| | - Rosa Baños
- 0000 0000 9314 1427grid.413448.eCIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain ,0000 0001 2173 938Xgrid.5338.dUniversitat de València, Valencia, Spain
| | - Soledad Quero
- Universitat Jaume I, Av. Vicente Sos Baynat s/n, 12006, Castellón, Spain. .,CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain.
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Guitard T, Bouchard S, Bélanger C, Berthiaume M. Exposure to a Standardized Catastrophic Scenario in Virtual Reality or a Personalized Scenario in Imagination for Generalized Anxiety Disorder. J Clin Med 2019; 8:jcm8030309. [PMID: 30841509 PMCID: PMC6463165 DOI: 10.3390/jcm8030309] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 02/21/2019] [Accepted: 02/26/2019] [Indexed: 11/16/2022] Open
Abstract
The cognitive behavioral treatment of generalized anxiety disorder (GAD) often involves exposing patients to a catastrophic scenario depicting their most feared worry. The aim of this study was to examine whether a standardized scenario recreated in virtual reality (VR) would elicit anxiety and negative affect and how it compared to the traditional method of imagining a personalized catastrophic scenario. A sample of 28 participants were first exposed to a neutral non-catastrophic scenario and then to a personalized scenario in imagination or a standardized virtual scenario presented in a counterbalanced order. The participants completed questionnaires before and after each immersion. The results suggest that the standardized virtual scenario induced significant anxiety. No difference was found when comparing exposure to the standardized scenario in VR and exposure to the personalized scenario in imagination. These findings were specific to anxiety and not to the broader measure of negative affect. Individual differences in susceptibility to feel present in VR was a significant predictor of increase in anxiety and negative affect. Future research could use these scenarios to conduct a randomized control trial to test the efficacy and cost/benefits of using VR in the treatment of GAD.
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Affiliation(s)
- Tanya Guitard
- Département de Psychologie, Université du Québec à Montréal, Montréal, QC H3C 3P8, Canada.
| | - Stéphane Bouchard
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, Gatineau, QC J8X 3X7, Canada.
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
| | - Claude Bélanger
- Département de Psychologie, Université du Québec à Montréal, Montréal, QC H3C 3P8, Canada.
| | - Maxine Berthiaume
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada.
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Gujjar KR, van Wijk A, Kumar R, de Jongh A. Efficacy of virtual reality exposure therapy for the treatment of dental phobia in adults: A randomized controlled trial. J Anxiety Disord 2019; 62:100-108. [PMID: 30717830 DOI: 10.1016/j.janxdis.2018.12.001] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 12/07/2018] [Accepted: 12/07/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although Virtual Reality Exposure Therapy (VRET) has proven to be effective in the treatment of various subtypes of specific phobia, there is limited evidence of its role in the treatment of dental phobia. METHOD A single-blind RCT was conducted among 30 randomized patients with dental phobia to either VRET or informational pamphlet (IP) condition. Primary outcome anxiety measures (VAS-A, MDAS and DFS) were evaluated at baseline, pre- and post-intervention, 1-week, 3-months and 6-months follow-up. Secondary outcome measures assessed were pre-post behavioral avoidance, temporal variations of heart rate and VR-experience during and post-VRET, and dental treatment acceptance in both conditions at 6-month follow-up. RESULTS Intention to treat analysis, using a repeated measures MANOVA, revealed a multivariate interaction effect between time and condition (p = 0.015) for all primary outcome measures (all ps < 0.001). Only patients of the VRET condition showed a significant reduction in anxiety scores (mean reduction [s.d.]: VAS-A 44.4 [36.1]; MDAS 7.1 [5.4]; DFS 21.2 [13.1]) whereas the patients in the IP group did not (mean reduction [s.d.]: VAS-A -0.33 [7.7]; MDAS -0.33 [1.3]; DFS -1.9 [3.8]), F (15, 14) = 3.3, p = 0.015. CONCLUSIONS VRET was found to be efficacious in the treatment of dental phobia.
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Affiliation(s)
- Kumar Raghav Gujjar
- Faculty of Dentistry, SEGi University, Petaling Jaya, Selangor, Malaysia; Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, the Netherlands.
| | - Arjen van Wijk
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, the Netherlands
| | - Ratika Kumar
- School of Public Health, The University of Queensland, Public Health Building, Brisbane, Australia
| | - Ad de Jongh
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, the Netherlands; School of Psychology, Queen's University, Belfast, Northern Ireland; Institute of Health and Society, University of Worcester, United Kingdom
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Gromer D, Reinke M, Christner I, Pauli P. Causal Interactive Links Between Presence and Fear in Virtual Reality Height Exposure. Front Psychol 2019; 10:141. [PMID: 30761054 PMCID: PMC6363698 DOI: 10.3389/fpsyg.2019.00141] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/15/2019] [Indexed: 12/13/2022] Open
Abstract
Virtual reality plays an increasingly important role in research and therapy of pathological fear. However, the mechanisms how virtual environments elicit and modify fear responses are not yet fully understood. Presence, a psychological construct referring to the ‘sense of being there’ in a virtual environment, is widely assumed to crucially influence the strength of the elicited fear responses, however, causality is still under debate. The present study is the first that experimentally manipulated both variables to unravel the causal link between presence and fear responses. Height-fearful participants (N = 49) were immersed into a virtual height situation and a neutral control situation (fear manipulation) with either high versus low sensory realism (presence manipulation). Ratings of presence and verbal and physiological (skin conductance, heart rate) fear responses were recorded. Results revealed an effect of the fear manipulation on presence, i.e., higher presence ratings in the height situation compared to the neutral control situation, but no effect of the presence manipulation on fear responses. However, the presence ratings during the first exposure to the high quality neutral environment were predictive of later fear responses in the height situation. Our findings support the hypothesis that experiencing emotional responses in a virtual environment leads to a stronger feeling of being there, i.e., increase presence. In contrast, the effects of presence on fear seem to be more complex: on the one hand, increased presence due to the quality of the virtual environment did not influence fear; on the other hand, presence variability that likely stemmed from differences in user characteristics did predict later fear responses. These findings underscore the importance of user characteristics in the emergence of presence.
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Affiliation(s)
- Daniel Gromer
- Department of Psychology, Biological Psychology, Clinical Psychology and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Max Reinke
- Department of Psychology, Biological Psychology, Clinical Psychology and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Isabel Christner
- Department of Psychology, Biological Psychology, Clinical Psychology and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Paul Pauli
- Department of Psychology, Biological Psychology, Clinical Psychology and Psychotherapy, University of Würzburg, Würzburg, Germany.,Center of Mental Health, Medical Faculty, University of Würzburg, Würzburg, Germany
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Stolz C, Endres D, Mueller EM. Threat-conditioned contexts modulate the late positive potential to faces-A mobile EEG/virtual reality study. Psychophysiology 2018; 56:e13308. [PMID: 30548599 DOI: 10.1111/psyp.13308] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 09/28/2018] [Accepted: 10/18/2018] [Indexed: 12/17/2022]
Abstract
In everyday life, the motivational value of faces is bound to the contexts in which faces are perceived. Electrophysiological studies have demonstrated that inherent negatively valent contexts modulate cortical face processing as assessed with ERP components. However, it is not well understood whether learned (rather than inherent) and three-dimensional aversive contexts similarly modulate the neural processing of faces. Using full immersive virtual reality (VR) and mobile EEG techniques, 25 participants underwent a differential fear conditioning paradigm, in which one virtual room was paired with an aversive noise burst (threat context) and another with a nonaversive noise burst (safe context). Subsequently, avatars with neutral or angry facial expressions were presented in the threat and safe contexts while EEG was recorded. Analysis of the late positive potential (LPP), which presumably indicates motivational salience, revealed a significant interaction of context (threat vs. safe) and face type (neutral vs. angry). Neutral faces evoked increased LPP amplitudes in threat versus safe contexts, while angry faces evoked increased early LPP amplitudes regardless of context. In addition to indicating that threat-conditioned contexts alter the processing of ambiguous faces, the present study demonstrates the successful integration of EEG and VR with particular relevance for affective neuroscience research.
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Affiliation(s)
| | - Dominik Endres
- Department of Psychology, University of Marburg, Marburg, Germany
| | - Erik M Mueller
- Department of Psychology, University of Marburg, Marburg, Germany
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Kazzi C, Blackmore C, Shirbani F, Tan I, Butlin M, Avolio AP, Barin E. Effects of instructed meditation augmented by computer-rendered artificial virtual environment on heart rate variability. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2018:2768-2771. [PMID: 30440975 DOI: 10.1109/embc.2018.8512816] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Previous research has supported the use of virtual reality (VR) to decrease stress, anxiety, perceptions of pain, and increase positive affect. However, the effect of VR on blood pressure (BP) and autonomic function in healthy populations have not been explored. This study quantifies the effect of instructed meditation augmented by a virtual environment (VE) on BP and heart rate variability (HRV) during rest and following physical (isometric handgrip) or mental (serial sevens subtraction) stress. Sixteen healthy participants underwent all conditions, and those that responded to the stress tests were included in the analysis of stress recovery. Results showed that under resting conditions, VE had no significant effect on BP or HRV when compared to seated rest and the VE video on a 2D screen. Following serial sevens, VE maintained the increased low frequency (LF) power of HRV $( 66 \pm 4$ normalized units (n.u.)) compared to seated rest $( 55 \pm 5\mathrm {n}$.u., $\mathrm {p}=0.0060)$; VE maintained the decreased high frequency (HF) power of HRV $( 34 \pm 4\mathrm {n}$.u.) compared to seated rest $( 44 \pm 5\mathrm {n}$.u., $\mathrm {p}=0.014)$; and VE maintained the increased LF/HF ratio $( 2.4 \pm 0.5)$ compared to seated rest $( 1.6 \pm 0.3$, $\mathrm {p}=0.012)$. Hence, after mental stress, VE sustains the increased sympathetic drive and reduced parasympathetic drive. VE may act as a stimulatory driver for autonomic activity and BP. Further studies are required to investigate the effect of different types of VE on BP and autonomic function.
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Garrett B, Taverner T, Gromala D, Tao G, Cordingley E, Sun C. Virtual Reality Clinical Research: Promises and Challenges. JMIR Serious Games 2018; 6:e10839. [PMID: 30333096 PMCID: PMC6231864 DOI: 10.2196/10839] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 07/31/2018] [Accepted: 08/07/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Virtual reality (VR) therapy has been explored as a novel therapeutic approach for numerous health applications, in which three-dimensional virtual environments can be explored in real time. Studies have found positive outcomes for patients using VR for clinical conditions such as anxiety disorders, addictions, phobias, posttraumatic stress disorder, eating disorders, stroke rehabilitation, and for pain management. OBJECTIVE This work aims to highlight key issues in the implementation of clinical research for VR technologies. METHODS A discussion paper was developed from a narrative review of recent clinical research in the field, and the researchers' own experiences in conducting VR clinical research with chronic pain patients. RESULTS Some of the key issues in implementing clinical VR research include theoretical immaturity, a lack of technical standards, the problems of separating effects of media versus medium, practical in vivo issues, and costs. CONCLUSIONS Over the last decade, some significant successes have been claimed for the use of VR. Nevertheless, the implementation of clinical VR research outside of the laboratory presents substantial clinical challenges. It is argued that careful attention to addressing these issues in research design and pilot studies are needed in order to make clinical VR research more rigorous and improve the clinical significance of findings.
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Affiliation(s)
- Bernie Garrett
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Tarnia Taverner
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Diane Gromala
- School of Interactive Arts and Technology, Simon Fraser University, Surrey, BC, Canada
| | - Gordon Tao
- Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Elliott Cordingley
- Faculty of Science, University of British Columbia, Vancouver, BC, Canada
| | - Crystal Sun
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
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Kropp P, Meyer B, Meyer W, Dresler T. An update on behavioral treatments in migraine - current knowledge and future options. Expert Rev Neurother 2017; 17:1059-1068. [PMID: 28877611 DOI: 10.1080/14737175.2017.1377611] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Besides pharmacological and interventional treatments a variety of non-medical therapeutic options exist for migraine, which has largely been derived from behavioral therapy. Areas covered: For our update we collected available studies via PubMed searches. This review highlights that already consulting of the patient is able to reduce the frequency of migraine attacks. Relaxation techniques, especially progressive muscle relaxation, and various types of biofeedback are effective, as is the implementation of cognitive behavioral therapy. However, recent reviews also point to some existing inconsistencies and methodological limitations. The advent of modern information technology based approaches (e.g. online therapy, smartphone applications) further advanced the arsenal of behavioral treatment regimes. The combination of behavioral treatment options and the combination with pharmacotherapy lead to additive effects. In modern multidisciplinary treatment approaches, behavioral therapy is an indispensable component. Expert commentary: Behavioral treatment in prophylaxis of migraine is as effective as pharmacological treatment with additional effects when pharmacological and behavioral treatment is applied in combination. Novel treatment approaches using online technology and electronic devices offer interesting options that will spread more in the future.
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Affiliation(s)
- Peter Kropp
- a Institute of Medical Psychology and Medical Sociology , University Medicine Rostock , Rostock , Germany
| | - Bianca Meyer
- a Institute of Medical Psychology and Medical Sociology , University Medicine Rostock , Rostock , Germany
| | - Wolfgang Meyer
- b Barts and the London School of Medicine and Dentistry , Queen Mary University of London , London , United Kingdom
| | - Thomas Dresler
- c Department of Psychiatry & Psychotherapy , University Hospital Tuebingen , Tuebingen , Germany.,d LEAD Graduate School & Research Network , University of Tuebingen , Tuebingen , Germany
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Jayasinghe N, Finkelstein-Fox L, Sar-Graycar L, Ojie MJ, Bruce ML, Difede J. Systematic Review of the Clinical Application of Exposure Techniques to Community-Dwelling Older Adults with Anxiety. Clin Gerontol 2017; 40:141-158. [PMID: 28452667 PMCID: PMC6072459 DOI: 10.1080/07317115.2017.1291546] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Although exposure techniques are a first-line intervention for anxiety, clear evidence is lacking for their efficacy in treating the prevalent and debilitating condition of late life anxiety. This study sought to review the current literature on use of exposure with community-dwelling older patients. METHODS Searches of electronic databases were conducted to identify articles published through December 7, 2016. Inclusion criteria were: 1) sample age > 55, 2) therapy that included exposure, 3) anxiety as a target of the treatment. Exclusion criteria were: 1) not available in English, 2) no quantitative data, 3) inpatient setting. Methodological data and findings were extracted from the articles chosen for review. RESULTS The 54 eligible articles presented a total of 16 case studies, 9 uncontrolled trials, 24 controlled trials, and 6 secondary studies. A majority of the studies were conducted in the U.S.A with participants who received individual treatment. In vivo and imaginal exposure were the most frequently delivered techniques, and most treatments were multicomponent. Most studies found a reduction in anxiety symptoms. CONCLUSIONS Important research gaps need to be addressed. CLINICAL IMPLICATIONS The surveyed research provides a modest foundation of evidence for mental health practitioners who wish to incorporate exposure into treatment plans.
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Affiliation(s)
| | - Lucy Finkelstein-Fox
- Weill Cornell Medical College, New York, NY, U.S.A
- University of Connecticut, Storrs, CT, U.S.A
| | | | - Mary-Jane Ojie
- Weill Cornell Medical College, New York, NY, U.S.A
- Kennedy Krieger Institute/Johns Hopkins School of Medicine, Baltimore, MD, U.S.A
| | | | - JoAnn Difede
- Weill Cornell Medical College, New York, NY, U.S.A
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Trier Social Stress Test in vivo and in virtual reality: Dissociation of response domains. Int J Psychophysiol 2016; 110:47-55. [PMID: 27742258 DOI: 10.1016/j.ijpsycho.2016.10.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/04/2016] [Accepted: 10/10/2016] [Indexed: 11/19/2022]
Abstract
The Trier Social Stress Test (TSST) is considered a reliable paradigm for inducing psychosocial stress. Virtual reality (VR) has successfully been applied to ensure a greater degree of efficiency and standardization in the TSST. Studies using the TSST in VR (VR-TSST) have reported significant stress reactions, with subjective and peripheral physiological reactions comparable to those in response to the in vivo TSST and with lower cortisol reactions. The current study examined whether an additional virtual competitive factor triggers larger stress responses than a standard VR-TSST. Forty-five male participants were randomly assigned to either in vivo TSST, VR-TSST (VR) or VR-TSST with a virtual competitor (VR+). A significant increase of self-reported stress, electrodermal activity, and heart rate indicated a pronounced stress reaction with no differences between groups. For salivary cortisol, however, responder rates differed significantly between groups, with in vivo participants showing overall higher response rates (86%) than participants of both VR groups (VR: 33%, VR+: 47%). In contrast, participants of both VR groups judged the task significantly more challenging than did in vivo TSST participants. In sum, our results indicate successful stress induction in all experimental conditions, and a marked dissociation of salivary cortisol levels on the one hand, and the physiological and psychological stress reactions on the other hand. The competitive scenario did not significantly enhance stress reactions. VR technology may serve as a standardized tool for inducing social stress in experimental settings, but further research is needed to clarify why the stress reaction as assessed by cortisol differs from peripheral and subjective stress reactions in VR.
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Laforest M, Bouchard S, Crétu AM, Mesly O. Inducing an Anxiety Response Using a Contaminated Virtual Environment: Validation of a Therapeutic Tool for Obsessive–Compulsive Disorder. ACTA ACUST UNITED AC 2016. [DOI: 10.3389/fict.2016.00018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Campos D, Bretón-López J, Botella C, Mira A, Castilla D, Baños R, Tortella-Feliu M, Quero S. An Internet-based treatment for flying phobia (NO-FEAR Airlines): study protocol for a randomized controlled trial. BMC Psychiatry 2016; 16:296. [PMID: 27544428 PMCID: PMC4992303 DOI: 10.1186/s12888-016-0996-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 08/04/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Flying phobia (FP) is a common and disabling mental disorder. Although in vivo exposure is the treatment of choice, it is linked to a number of limitations in its implementation. Particularly important, is the limited access to the feared stimulus (i.e., plane). Moreover, the economic cost of in vivo exposure should be specially considered as well as the difficulty of applying the exposure technique in an appropriate way; controlling important variables such as the duration of the exposure or the number of sessions. ICTs could help to reduce these limitations. Computer-assisted treatments have remarkable advantages in treating FP. Furthermore, they can be delivered through the Internet, increasing their advantages and reaching more people in need. The Internet has been established as an effective way to treat a wide range of mental disorders. However, as far as we know, no controlled studies exist on FP treatment via the Internet. This study aims to evaluate the efficacy of an Internet-based treatment for FP (NO-FEAR Airlines) versus a waiting list control group. Secondary objectives will be to explore two ways of delivering NO-FEAR Airlines, with or without therapist guidance, and study the patients' acceptance of the program. This paper presents the study protocol. METHODS/DESIGN The study is a randomized controlled trial. A minimum of 57 participants will be randomly assigned to three conditions: a) NO-FEAR Airlines totally self-applied, b) NO-FEAR Airlines with therapist guidance, or c) a waiting list control group (6 weeks). Primary outcomes measures will be the Fear of Flying Questionnaire-II and the Fear of Flying Scale. Secondary outcomes will be included to assess other relevant clinical measures, such as the Fear and Avoidance Scales, Clinician Severity Scale, and Patient's Improvement scale. Analyses of post-treatment flights will be conducted. Treatment acceptance and preference measures will also be included. Intention-to-treat and per protocol analyses will be conducted. DISCUSSION An Internet-based treatment for FP could have considerable advantages in managing in vivo exposure limitations, specifically in terms of access to treatment, acceptance, adherence, and the cost-effectiveness of the intervention. This is the first randomized controlled trial to study this issue. TRIAL REGISTRATION Clinicaltrials.gov: NCT02298478 . Trial registration date 3 November 2014.
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Affiliation(s)
| | - Juana Bretón-López
- Universitat Jaume I, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | - Cristina Botella
- Universitat Jaume I, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
| | | | | | - Rosa Baños
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
- Universitat de València, Valencia, Spain
| | | | - Soledad Quero
- Universitat Jaume I, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain
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Deppermann S, Notzon S, Kroczek A, Rosenbaum D, Haeussinger F, Diemer J, Domschke K, Fallgatter A, Ehlis AC, Zwanzger P. Functional co-activation within the prefrontal cortex supports the maintenance of behavioural performance in fear-relevant situations before an iTBS modulated virtual reality challenge in participants with spider phobia. Behav Brain Res 2016; 307:208-17. [DOI: 10.1016/j.bbr.2016.03.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/24/2016] [Accepted: 03/14/2016] [Indexed: 12/17/2022]
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Crescentini C, Chittaro L, Capurso V, Sioni R, Fabbro F. Psychological and physiological responses to stressful situations in immersive virtual reality: Differences between users who practice mindfulness meditation and controls. COMPUTERS IN HUMAN BEHAVIOR 2016. [DOI: 10.1016/j.chb.2016.02.031] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Baseline psychophysiological and cortisol reactivity as a predictor of PTSD treatment outcome in virtual reality exposure therapy. Behav Res Ther 2016; 82:28-37. [PMID: 27183343 DOI: 10.1016/j.brat.2016.05.002] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 12/14/2022]
Abstract
Baseline cue-dependent physiological reactivity may serve as an objective measure of posttraumatic stress disorder (PTSD) symptoms. Additionally, prior animal model and psychological studies would suggest that subjects with greatest symptoms at baseline may have the greatest violation of expectancy to danger when undergoing exposure based psychotherapy; thus treatment approaches which enhanced the learning under these conditions would be optimal for those with maximal baseline cue-dependent reactivity. However methods to study this hypothesis objectively are lacking. Virtual reality (VR) methodologies have been successfully employed as an enhanced form of imaginal prolonged exposure therapy for the treatment of PTSD. Our goal was to examine the predictive nature of initial psychophysiological (e.g., startle, skin conductance, heart rate) and stress hormone responses (e.g., cortisol) during presentation of VR-based combat-related stimuli on PTSD treatment outcome. Combat veterans with PTSD underwent 6 weeks of VR exposure therapy combined with either d-cycloserine (DCS), alprazolam (ALP), or placebo (PBO). In the DCS group, startle response to VR scenes prior to initiation of treatment accounted for 76% of the variance in CAPS change scores, p < 0.001, in that higher responses predicted greater changes in symptom severity over time. Additionally, baseline cortisol reactivity was inversely associated with treatment response in the ALP group, p = 0.04. We propose that baseline cue-activated physiological measures will be sensitive to predicting patients' level of response to exposure therapy, in particular in the presence of enhancement (e.g., DCS).
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