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Examining the impact of experiencing auditory verbal hallucinations from a first-person perspective on the degree of empathy and stigmatization in a group of psychology students: A study using 360° immersive videos. Compr Psychiatry 2023; 123:152379. [PMID: 36870090 DOI: 10.1016/j.comppsych.2023.152379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023] Open
Abstract
BACKGROUND Stigmatization toward psychosis is persistent among mental health professionals (MHPs) and negatively impacts the patients' outcomes. One suggested way of reducing stigmatization is to expose MHPs to simulations of psychotic symptoms. This approach has been associated with an increase in empathy, but also with an increase in the desire of social distance. The addition of an empathic task (ET) has been suggested to neutralize this effect on social distance. The present study aims to (1) examine the effect of a remotely administered 360° immersive video (360IV) simulation on empathy and stigma among psychology students and (2) replicate the neutralizing effect of an ET on social distance. Finally, the potential role of immersive properties on changes will also be explored. METHODS A 360IV simulating auditory hallucinations was constructed in collaboration with patient partners. 121 psychology students were allocated to one of three conditions: (i) exposure to the 360IV, (ii) exposure to the 360IV and to an ET (360IV + ET), and (iii) no exposure (control). Measures of empathy and stigma (stereotypes and social distance) were collected before and after the interventions. RESULTS An increase of empathy was observed in the 360IV and 360IV + ET conditions compared to the control condition. There was an increase of stereotypes in all conditions and no effect on social distance. CONCLUSIONS This study confirms the effectiveness of a 360IV simulation intervention in increasing empathy in psychology students but questions its efficacy in reducing stigma.
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García-Batista ZE, Guerra-Peña K, Alsina-Jurnet I, Cano-Vindel A, Álvarez-Hernández A, Cantisano-Guzmán LM, Bordas-Puras M, Moretti L, Medrano LA. Design and validation of virtual environments for the treatment of cleaning obsessive-compulsive disorder. Heliyon 2022; 8:e12487. [PMID: 36575692 PMCID: PMC9780645 DOI: 10.1016/j.heliyon.2022.e12487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 04/22/2022] [Accepted: 12/10/2022] [Indexed: 12/24/2022] Open
Abstract
During the coronavirus outbreak, it was noted that pre-existing psychological illnesses worsened, and numerous research indicate that those with contamination-related obsessions and cleaning compulsions (C-OCD) may be more affected. Virtual Reality (VR) and other immersive technologies have shown to be effective for the treatment of disorders related to anxiety, thus showing their potential to transform OCD treatment by means of integrating virtual elements. VR exposure has shown benefits compared to live or imagined exposure, however, to be effective it must be able to elicit high emotional arousal in users. Based on this, the present work aimed to develop different virtual environments scenarios and evaluate their efficacy in generating an emotional response in people with C-OCD symptoms. Based on the literature review, two virtual scenarios were created (dirty public bathroom and unhygienic kitchen). Subsequently, two groups were then constituted: C-OCD group (n = 20, aged between 18 and 48 years) characterized by an obtained score of more than 13 points (cut-point) in the Yale-Brown Scale for Obsessive-Compulsive Disorder (Y-BOCS) and by showing C-OCD symptoms when doing the structured interview (SCID-I), and a control group (n = 20, aged between 18 and 56 years), all participants were residents of the Dominican Republic. Exposure to the virtual environments generated high levels of state and subjective anxiety in both groups, although significantly higher in the C-OCD group. The results obtained indicate that the VR scenarios developed are suitable for eliciting emotional responses and, consequently, that they can be used to complement the treatment of C-OCD.
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Affiliation(s)
- Zoilo Emilio García-Batista
- Pontificia Universidad Católica Madre y Maestra (PUCMM), 1 ½ Autopista Duarte Av., Santiago de los Caballeros, Santiago 51000, Dominican Republic
- Corresponding author.
| | - Kiero Guerra-Peña
- Pontificia Universidad Católica Madre y Maestra (PUCMM), 1 ½ Autopista Duarte Av., Santiago de los Caballeros, Santiago 51000, Dominican Republic
| | - Ivan Alsina-Jurnet
- Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Sagrada Família, 7. Vic, 08500 Catalunya, Spain
| | | | - Adriana Álvarez-Hernández
- Pontificia Universidad Católica Madre y Maestra (PUCMM), 1 ½ Autopista Duarte Av., Santiago de los Caballeros, Santiago 51000, Dominican Republic
| | - Luisa Marilia Cantisano-Guzmán
- Pontificia Universidad Católica Madre y Maestra (PUCMM), 1 ½ Autopista Duarte Av., Santiago de los Caballeros, Santiago 51000, Dominican Republic
| | - Marlia Bordas-Puras
- Pontificia Universidad Católica Madre y Maestra (PUCMM), 1 ½ Autopista Duarte Av., Santiago de los Caballeros, Santiago 51000, Dominican Republic
| | - Luciana Moretti
- Pontificia Universidad Católica Madre y Maestra (PUCMM), 1 ½ Autopista Duarte Av., Santiago de los Caballeros, Santiago 51000, Dominican Republic
- Universidad Siglo 21, Calle de los Latinos, 8555 Córdoba, Argentina
| | - Leonardo Adrián Medrano
- Pontificia Universidad Católica Madre y Maestra (PUCMM), 1 ½ Autopista Duarte Av., Santiago de los Caballeros, Santiago 51000, Dominican Republic
- Universidad Siglo 21, Calle de los Latinos, 8555 Córdoba, Argentina
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3
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Javaherirenani R, Mortazavi SS, Shalbafan M, Ashouri A, Farani AR. Virtual reality exposure and response prevention in the treatment of obsessive-compulsive disorder in patients with contamination subtype in comparison with in vivo exposure therapy: a randomized clinical controlled trial. BMC Psychiatry 2022; 22:740. [PMID: 36443695 PMCID: PMC9706986 DOI: 10.1186/s12888-022-04402-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/17/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Obsessive-Compulsive Disorder (OCD) is characterized by disturbing and unwanted thoughts as well as repetitive and time-consuming behaviors that interfere with performance. Cognitive Behavior Therapy (CBT) has shown to have beneficial effects on reducing OCD symptoms as the first line of treatment. Moreover, Virtual Reality (VR) has been a more feasible and accessible intervention for OCD in recent years. Regarding the point, the objective of this study was to evaluate the effectiveness of virtual reality exposure and response prevention (VRERP) in the treatment of the OCD contamination subtype. METHODS A total number of 36 adults with OCD-contamination subtype were registered and randomly assigned to the intervention and control groups. The intervention group received a 60-min CBT including a "contaminated" virtual environment while the control group received CBT as a standardized treatment. Out of these, 29 patients completed the treatment in 12 weekly sessions. The patients completed the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Obsessive Beliefs Questionnaire-44(OBQ-44), and World Health Organization Disability Assessment Scale-2 (WHODAS-2) at week 0, week 12 and after 3 months follow-up. RESULTS Based on the results of the repeated measure analysis of variances, the total score of obsession and compulsion subscales of Y-BOCS significantly decreased as a primary outcome in the intervention group (F = 60.97, P < 0.001, partial eta squared = 0.82; F = 20.46, P < 0.001, partial eta squared = 0.61; F = 29.57, P < 0.001, partial eta squared = 0.69; respectively). The total score of BDI-II and BAI was reduced in both groups but there was no significant difference between them (BDI-II: F = 0.54, P = 0.47, partial eta squared = 0.02; BAI: F = 3.12, P = 0.06, partial eta squared = 0.19). However, there was a significant difference in the OBQ-44 (F = 16.78, P < 0.001, partial eta squared = 0.56) and the total WHODAS-2 score between the groups (F = 14.64, P < 0.001, partial eta squared = 0.53). CONCLUSIONS This study demonstrated the effectiveness of VRERP in the treatment of the OCD-contamination subtype. Therefore, VRERP can be used in CBT as an alternative exposure tool. TRIAL REGISTRATION Iranian Registry of Clinical Trials, IRCT ID: IRCT20210214050353N1 , Registered on 16/10/2021.
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Affiliation(s)
- Razieh Javaherirenani
- Present Address: Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Seyede Salehe Mortazavi
- Present Address: Geriatric Mental Health Research Center, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Shalbafan
- Present Address: Mental Health Research Center, Psychosocial Health Research Institute. Department of Psychiatry, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Brain and Cognition Clinic, Institute for Cognitive Sciences Studies, Tehran, Iran
| | - Ahmad Ashouri
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Ramezani Farani
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran.
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Pons P, Navas-Medrano S, Soler-Dominguez JL. Extended reality for mental health: Current trends and future challenges. FRONTIERS IN COMPUTER SCIENCE 2022. [DOI: 10.3389/fcomp.2022.1034307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Virtual and augmented reality have been used to diagnose and treat several mental health disorders for decades. Technological advances in these fields have facilitated the availability of commercial solutions for end customers and practitioners. However, there are still some barriers and limitations that prevent these technologies from being widely used by professionals on a daily basis. In addition, the COVID-19 pandemic has exposed a variety of new scenarios in which these technologies could play an essential role, like providing remote treatment. Disorders that traditionally had received less attention are also getting in the spotlight, such as depression or obsessive-compulsive disorder. Improvements in equipment and hardware, like Mixed Reality Head Mounted Displays, could help open new opportunities in the mental health field. Extended reality (XR) is an umbrella term meant to comprise Virtual reality (VR), mixed reality (MR), and augmented reality (AR). While XR applications are eminently visual, other senses are being explored in literature around multisensory interactions, such as auditory, olfactory, or haptic feedback. Applying such stimuli within XR experiences around mental disorders is still under-explored and could greatly enrich the therapeutic experience. This manuscript reviews recent research regarding the use of XR for mental health scenarios, highlighting trends, and potential applications as well as areas for improvement. It also discusses future challenges and research areas in upcoming topics such as the use of wearables, multisensory, and multimodal interaction. The main goal of this paper is to unpack how these technologies could be applied to XR scenarios for mental health to exploit their full potential and follow the path of other health technologies by promoting personalized medicine.
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5
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Garrido LE, Frías-Hiciano M, Moreno-Jiménez M, Cruz GN, García-Batista ZE, Guerra-Peña K, Medrano LA. Focusing on cybersickness: pervasiveness, latent trajectories, susceptibility, and effects on the virtual reality experience. VIRTUAL REALITY 2022; 26:1347-1371. [PMID: 35250349 PMCID: PMC8886867 DOI: 10.1007/s10055-022-00636-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 02/03/2022] [Indexed: 06/14/2023]
Abstract
UNLABELLED Although virtual reality (VR) usage has become widespread in the last decade, its adoption has been hampered by experiences of user discomfort known as cybersickness. The present study, in line with the "2020 cybersickness R&D agenda", sought to provide a broad examination of the cybersickness phenomenon, assessing its pervasiveness, latent trajectories, impacts on the VR experience, and predictor variables. The study was composed of 92 participants living in the Dominican Republic with ages ranging from 18 to 52 years (M = 26.22), who experienced a 10-min VR immersion in two environments designed for psychotherapy. The results indicated that cybersickness was pervasive, with 65.2% of the participants experiencing it, and 23.9% severely. Additionally, the latent trajectories of cybersickness were positive and curvilinear, with large heterogeneity across individuals. Cybersickness also had a substantive negative impact on the user experience and the intentions to adopt the VR technology. Finally, motion sickness susceptibility, cognitive stress, and recent headaches uniquely predicted greater severity of cybersickness, while age was negatively related. These combined results highlight the critical role that cybersickness plays on the VR experience and underscore the importance of finding solutions to the problems, such as technological advancements or special usage protocols for the more susceptible individuals. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10055-022-00636-4.
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Affiliation(s)
- Luis Eduardo Garrido
- Department of Psychology, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Maite Frías-Hiciano
- Department of Psychology, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Mariano Moreno-Jiménez
- Department of Psychology, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Gabriella Nicole Cruz
- Department of Psychology, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Zoilo Emilio García-Batista
- Department of Psychology, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Kiero Guerra-Peña
- Department of Psychology, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Leonardo Adrián Medrano
- Department of Psychology, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
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Kelson JN, Ridout B, Steinbeck K, Campbell AJ. The Use of Virtual Reality for Managing Psychological Distress in Adolescents: Systematic Review. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2021; 24:633-641. [PMID: 34558970 DOI: 10.1089/cyber.2021.0090] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Acute and chronic psychological distress are prevalent during adolescence and can have negative impacts on adolescents in all life domains. The aim of this systematic review was to appraise the use of virtual reality (VR) interventions to manage symptoms of psychological distress symptoms among adolescents. MEDLINE, PubMed, PsycINFO, and Scopus databases were searched up to June 2020. Available citations were de-duplicated and screened by two authors using title and abstract information. A total of 301 articles were retained for full-text evaluation next to eligibility criteria. Empirical studies of all designs and comparator groups were included if these appraised the impact of an immersive VR intervention on any standardized measure indicative of psychological distress in an adolescent sample. Data were extracted into a standardized coding sheet. Results were tabulated and discussed with a narrative synthesis due to the heterogeneity between studies. A total of seven studies met inclusion criteria. There were four randomized controlled trials and three uncontrolled pilot studies on new VR interventions. Distress-related issues included: state-anxiety, venepuncture, risk taking, public speaking anxiety, social anxiety disorder, sexual victimization, and chemotherapy administration. All studies reported significant changes on outcome measures after VR treatment. Six studies reported small-to-large reductions in symptoms. The average attrition rate was 3.6 percent during the active VR treatment phase. Treatment acceptability was high in the studies that assessed user engagement factors. The VR technology can provide a safe, rapidly efficacious, and acceptable treatment modality for managing psychological distress in several key adolescent populations.
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Affiliation(s)
- Joshua N Kelson
- Faculty of Business, Justice and Behavioural Sciences, Charles Sturt University, Bathurst, Australia
| | - Brad Ridout
- Cyberpsychology Research Group, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Katharine Steinbeck
- Discipline of Child and Adolescent Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Andrew J Campbell
- Cyberpsychology Research Group, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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7
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Colombo D, Díaz-García A, Fernandez-Álvarez J, Botella C. Virtual reality for the enhancement of emotion regulation. Clin Psychol Psychother 2021; 28:519-537. [PMID: 34048621 DOI: 10.1002/cpp.2618] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/22/2021] [Accepted: 05/21/2021] [Indexed: 01/21/2023]
Abstract
In recent decades, a growing body of literature has focused on emotion regulation (ER), which refers to the ability to implement strategies in order to modulate emotional responses and reach desirable goals. To date, impaired ER (i.e., emotion dysregulation) has been identified as a transdiagnostic factor across a wide range of psychopathological conditions, which shows the importance of improving patients' ability to regulate negative and positive emotions in clinical practice. In addition to the increasing evidence showing its efficacy in the treatment of several clinical conditions, virtual reality (VR) has recently emerged as a potentially powerful tool for enhancing ER, thus breaking new ground in the development of cutting-edge transdiagnostic interventions. In the present narrative review, we will provide an overview of the existing evidence about VR-based interventions in the field of ER, emphasizing the promising findings and the barriers that still have to be addressed. To this aim, the available VR-based literature will be analysed in relation to four categories of ER strategies: situational strategies, attentional strategies, cognitive strategies, and response modulation strategies. Furthermore, new emerging fields of research targeting innovative aspects of ER will be highlighted, including the use of VR to promote positive emotions and interpersonal ER skills. Besides, its cost-effectiveness will be discussed, taking into account the costs for both developers (e.g., clinicians and researchers) and end-users. Finally, future directions in this promising field of research will be outlined.
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Affiliation(s)
- Desirée Colombo
- Department of Basic Psychology, Clinic and Psychobiology, Jaume I University, Castellón de la Plana, Spain
| | - Amanda Díaz-García
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
| | | | - Cristina Botella
- Department of Basic Psychology, Clinic and Psychobiology, Jaume I University, Castellón de la Plana, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
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8
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García-Batista ZE, Guerra-Peña K, Alsina-Jurnet I, Cano-Vindel A, Cantisano-Guzmán LM, Nazir-Ferreiras A, Moretti LS, Medrano LA, Garrido LE. Design and Validation of Augmented Reality Stimuli for the Treatment of Cleaning Obsessive-Compulsive Disorder. Front Psychol 2021; 12:618874. [PMID: 34135802 PMCID: PMC8201081 DOI: 10.3389/fpsyg.2021.618874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 04/01/2021] [Indexed: 11/13/2022] Open
Abstract
Fear to contamination is an easy-to-provoke, intense, hard-to-control, and extraordinarily persistent fear. A worsening of preexisting psychiatric disorders was observed during the COVID-19 (coronavirus disease 2019) outbreak, and several studies suggest that those with obsessive-compulsive disorder (OCD) may be more affected than any other group of people. In the face of worsening OCD symptoms, there is a need for mental health professionals to provide the support needed not only to treat patients who still report symptoms, but also to improve relapse prevention. In this line, it is recommended to improve alternative strategies such as online consultations and digital psychiatry. The aim of this study is to develop augmented reality (AR) stimuli that are clinically relevant for patients with cleaning OCD and assess their efficiency to obtain emotionally significant responses. Four AR stimuli were developed: a plastic bag full of garbage, a piece of bread with mold, a dirty sports shoe, and a piece of rotten meat. All stimuli were shown to a clinical group (17 patients with cleaning OCD) and a control group (11 patients without OCD). Relevant results were the design of the AR stimuli. These stimuli were validated with the statistical difference in perceived anxiety in the meat stimuli between the clinical and control groups. Nevertheless, when looking at effect sizes, all stimuli present effect sizes from small (plastic bag) to large (meat), with both shoe and bread between small and medium effect sizes. These results are a valuable support for the clinical use of these AR stimuli in the treatment of cleaning OCD.
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Affiliation(s)
- Zoilo Emilio García-Batista
- Escuela de Psicología, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Kiero Guerra-Peña
- Escuela de Psicología, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Ivan Alsina-Jurnet
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, Universidad de Vic-Universitat Central de Catalunya (UVIC-UCC), Barcelona, Spain
| | - Antonio Cano-Vindel
- Departamento de Psicología Básica, Facultad de Psicología, Universidad Complutense de Madrid, Spain
| | | | - Asha Nazir-Ferreiras
- Escuela de Psicología, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Luciana Sofía Moretti
- Escuela de Psicología, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic.,Facultad de Psicología, Universidad Siglo 21, Argentina
| | - Leonardo Adrián Medrano
- Escuela de Psicología, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic.,Facultad de Psicología, Universidad Siglo 21, Argentina
| | - Luis Eduardo Garrido
- Escuela de Psicología, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
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Meyerbröker K, Morina N. The use of virtual reality in assessment and treatment of anxiety and related disorders. Clin Psychol Psychother 2021; 28:466-476. [PMID: 34097318 PMCID: PMC8362145 DOI: 10.1002/cpp.2623] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/28/2021] [Accepted: 05/30/2021] [Indexed: 12/20/2022]
Abstract
In recent years the development of new virtual environments has been qualitatively high and fast at the same time, but the dissemination of virtual reality (VR) in clinical practice is still scarce. The aim of this review is to give an insight into the state of the art of the use of VR as an assessment tool and treatment intervention in anxiety and related disorders as posttraumatic stress disorder and obsessive-compulsive disorders. Besides an overview into the efficacy of VR, a summary will be given on assumed working mechanisms in virtual reality exposure therapy and how this aligns with current theoretical models. Further, it will be discussed how VR is accepted by patients and research into the reluctance of therapist to use this technology during treatment with focus on the therapeutic alliance and how it may be influenced by the use of VR. Finally, we discuss clinical and future issues as, for example, dissemination into clinical practice and what VR has to offer therapists in future. This not only in adult population but as well in younger patients, as young adolescents VR has a great potential as it connects easily with its playful elements to this population and might be a low threshold step to offer treatment or preventive interventions.
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Affiliation(s)
- Katharina Meyerbröker
- Department of Clinical PsychologyUtrecht UniversityUtrechtThe Netherlands
- Altrecht Academic Anxiety CentreUtrechtThe Netherlands
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10
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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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11
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van Bennekom MJ, de Koning PP, Gevonden MJ, Kasanmoentalib MS, Denys D. A Virtual Reality Game to Assess OCD Symptoms. Front Psychiatry 2021; 11:550165. [PMID: 33551856 PMCID: PMC7862340 DOI: 10.3389/fpsyt.2020.550165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 12/23/2020] [Indexed: 01/21/2023] Open
Abstract
Background: Symptoms of obsessive-compulsive disorder (OCD) are often underreported by patients and mainly triggered in the patients private domain, making it harder for clinicians to recognize OCD. Virtual reality (VR) can be used to assess OCD symptoms in the clinician's office. We developed a VR game in order to provoke subjective and physiological OCD symptoms. We hypothesize that (1) the VR game provokes more OCD symptoms in patients compared to healthy controls, (2) performing virtual compulsions leads to a reduction in emotional responses in OCD patients and that (3) the severity of VR game provoked symptoms correlates with severity of OCD symptoms. Methods: Participants played the VR game on a laptop while physiological measures were recorded simultaneously. We measured emotional responses, virtual compulsions and physiological arousal in response to our VR game in 26 OCD patients and 26 healthy controls. We determined correlations between emotional responses, virtual compulsions and OCD severity. Results: We found higher levels of VR-provoked anxiety (U = 179.5, p = 0.004) and virtual compulsions in OCD patients compared to healthy controls (p = 0.001). There was a significant reduction in emotional responses after performing virtual compulsions in the OCD patients. The emotional responses and virtual compulsions did not correlate significantly with Y-BOCS scores. A baseline difference between patients and healthy controls was found in heart rate variability (HRV), but no significant change in HRV, heartrate and skin conductance was found during the VR game Conclusions: Our study clearly shows our OCD VR game is capable of provoking more anxiety and virtual compulsions in patients with OCD compared to healthy controls. Providing a direct patient-rated measurement in the clinicians room, the VR game could help in assessing core OCD symptoms and recognizing OCD. Clinical Trial Registry Number: Netherlands Trial Register NTR5935.
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Affiliation(s)
- Martine J. van Bennekom
- Department of Psychiatry, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Pelle P. de Koning
- Department of Psychiatry, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Martin J. Gevonden
- Department of Biological Psychology, Vrije Universiteit Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - M. Soemiati Kasanmoentalib
- Department of Psychiatry, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Damiaan Denys
- Department of Psychiatry, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
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12
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Dehghan B, Saeidimehr S, Sayyah M, Rahim F. The Effect of Virtual Reality on Emotional Response and Symptoms Provocation in Patients With OCD: A Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:733584. [PMID: 35177996 PMCID: PMC8846333 DOI: 10.3389/fpsyt.2021.733584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 11/22/2021] [Indexed: 12/15/2022] Open
Abstract
This systematic review and meta-analysis aimed to evaluate the effectiveness of virtual reality (VR)-based technology on emotional response and symptoms in patients with obsessive-compulsive disorder (OCD). We systematically searched major electronic databases, including PubMed/Medline, Scopus, Embase, ISI Web of Science, PsycINFO, and Cochrane central, up to April 14, 2021, with no data or language limits. We performed reference, related articles, and citation searches to find additional articles. We included original articles comparing and studying VR-based technology in patients with OCD against the control group. We observed that VR significantly increases in anxiety (SMD = 2.92; 95% CI 1.89-3.94, p < 0.0001; I 2 = 95%), disgust (SMD = 2.52; 95% CI 1.36-3.68, p < 0.0001; I 2 = 95%), urge to wash (SMD = 3.12; 95% CI 1.92-4.32, p < 0.0001; I 2 = 94%), checking time (SMD = 1.06; 95% CI 0.71-1.4, p < 0.0001; I 2 = 44%), number of checking behavior (SMD = 1.45; 95% CI 0.06-2.83, p = 0.04; I 2 = 93%), and uncertainty (SMD = 2.59; 95% CI 0.90-4.27, p = 0.003; I 2 = 70%) in OCD patients compared with healthy controls using a random-effect model. This meta-analysis found that this environment has a moderate enhancement in emotional response and symptoms test scores of patients with OCD. However, our findings should be generalized with caution due to the lack of standardized methods and high heterogeneity among included evidence. The appropriate mode of integrating VR-based technology for patients with OCD requires more exploration.
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Affiliation(s)
- Bahram Dehghan
- Department of Medicine, Naft Grand Hospital, The Health Affair Organization of Oils and Refineries Industry, Ahvaz, Iran
| | - Saied Saeidimehr
- Department of Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Sayyah
- Education Development Center (EDC), Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Fakher Rahim
- Research Center of Thalassemia and Hemoglobinopathies, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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13
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Parsons TD, Gaggioli A, Riva G. Extended Reality for the Clinical, Affective, and Social Neurosciences. Brain Sci 2020; 10:E922. [PMID: 33265932 PMCID: PMC7761460 DOI: 10.3390/brainsci10120922] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/21/2020] [Accepted: 11/26/2020] [Indexed: 12/15/2022] Open
Abstract
Brain science research often involves the use of low-dimensional tools and stimuli that lack several of the potentially valuable features of everyday activities and interactions. Although this research has provided important information about cognitive, affective, and social processes for both clinical and nonclinical populations, there is growing interest in high-dimensional simulations that extend reality. These high-dimensional simulations involve dynamic stimuli presented serially or concurrently to permit the assessment and training of perceivers' integrative processes over time. Moreover, high-dimensional simulation platforms can contextually restrain interpretations of cues about a target's internal states. Extended reality environments extend assessment and training platforms that balance experimental control with emotionally engaging background narratives aimed at extending the affective experience and social interactions. Herein, we highlight the promise of extended reality platforms for greater ecological validity in the clinical, affective, and social neurosciences.
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Affiliation(s)
- Thomas D. Parsons
- iCenter for Affective Neurotechnologies (iCAN), Denton, TX 76203, USA
- Computational Neuropsychology and Simulation (CNS) Laboratory, University of North Texas, Denton, TX 76203, USA
- College of Information, University of North Texas, Denton, TX 76203, USA
| | - Andrea Gaggioli
- Humane Technology Lab, Università Cattolica del Sacro Cuore, 20123 Milan, Italy; (A.G.); (G.R.)
- Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, 20145 Milan, Italy
| | - Giuseppe Riva
- Humane Technology Lab, Università Cattolica del Sacro Cuore, 20123 Milan, Italy; (A.G.); (G.R.)
- Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, 20145 Milan, Italy
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14
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Welches Potenzial haben virtuelle Realitäten in der klinischen und forensischen Psychiatrie? Ein Überblick über aktuelle Verfahren und Einsatzmöglichkeiten. FORENSISCHE PSYCHIATRIE, PSYCHOLOGIE, KRIMINOLOGIE 2020. [DOI: 10.1007/s11757-020-00611-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungVirtuelle Realitäten (VR) werden in der Diagnose und Behandlung von Patienten im klinischen Feld bereits seit 20 Jahren erfolgreich eingesetzt und weiterentwickelt. Seit etwas mehr als 5 Jahren gibt es nun auch erste Beispiele über die Anwendung von VR in psychiatrisch-forensischen Kontexten. Für die forensische Psychiatrie ist die Möglichkeit, realistische, sichere und kontrollierbare Diagnostik- und Lernumgebungen zu schaffen, der ausschlaggebende Vorteil der VR-Technologie. So können z. B. Straftäter in Szenarien behandelt oder begutachtet werden, welche im echten Leben risikoreich, unethisch oder ökologisch invalide wären. In diesem Artikel werden unterschiedliche aktuelle Studienbeispiele zu klinischer Behandlung und Diagnose von Patienten sowie der forensischen Prognose und Therapie von Straftätern vorgestellt. Damit zeigt der Überblick, dass VR mittlerweile auch in der forensischen Psychiatrie ein vielversprechendes Werkzeug sein kann, welches bereits etablierte Instrumente ergänzen oder erweitern kann. Auch in der Ausbildung von forensisch-psychiatrischem Fachpersonal können VR-Anwendungen eine Hilfe sein. Hier gibt es bereits erste vielversprechende Einsätze durch das Training mithilfe von virtuellen Patienten, jedoch benötigt es noch umfangreiche Forschungsarbeit auf diesem Feld, um sie im professionellen Alltag einsetzen zu können. Vor dem Einsatz von VR-Anwendungen sollten sich Forscher und Praktiker neben den Vorteilen auch mit den Nachteilen von VR auseinandersetzen und ein besonderes Augenmerk auf die ethischen Richtlinien werfen, welche in den letzten Jahren dazu erarbeitet wurden. Die stetige Weiterentwicklung und der immer breitere Einsatz von VR im klinischen und forensisch-psychiatrischen Feld zeigen, dass VR auch hier das Potenzial hat, ein etabliertes Forschungs- sowie Therapieinstrument zu werden.
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15
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Lognoul M, Nasello J, Triffaux JM. La thérapie par exposition en réalité virtuelle pour les états de stress post-traumatiques, les troubles obsessionnels compulsifs et les troubles anxieux : indications, plus-value et limites. Encephale 2020; 46:293-300. [DOI: 10.1016/j.encep.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 01/08/2020] [Accepted: 01/10/2020] [Indexed: 12/27/2022]
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16
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Miloff A, Carlbring P, Hamilton W, Andersson G, Reuterskiöld L, Lindner P. Measuring Alliance Toward Embodied Virtual Therapists in the Era of Automated Treatments With the Virtual Therapist Alliance Scale (VTAS): Development and Psychometric Evaluation. J Med Internet Res 2020; 22:e16660. [PMID: 32207690 PMCID: PMC7139418 DOI: 10.2196/16660] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/09/2019] [Accepted: 12/15/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Automated virtual reality exposure therapies (VRETs) are self-help treatments conducted by oneself and supported by a virtual therapist embodied visually and/or with audio feedback. This simulates many of the nonspecific relational elements and common factors present in face-to-face therapy and may be a means of improving adherence to and efficacy of self-guided treatments. However, little is known about alliance toward the virtual therapist, despite alliance being an important predictor of treatment outcome. OBJECTIVE In this study, we aimed to evaluate the first alliance instrument developed for use with embodied virtual therapists in an automated treatment format-the Virtual Therapist Alliance Scale (VTAS)-by (1) assessing its psychometric properties, (2) verifying the dimensionality of the scale, and (3) determining the predictive ability of the scale with treatment outcome. METHODS A psychometric evaluation and exploratory factor analysis of the VTAS was conducted using data from two samples of spider-fearful patients treated with VRET and the help of an embodied, voice-based virtual therapist (n=70). Multiple regression models and bivariate correlations were used to assess the VTAS relationship with treatment outcome, according to self-reported fear and convergence with presence and user-friendliness process measures. RESULTS The VTAS showed a sound two-factor solution composed of a primary factor covering task, goal, and copresence; adequate internal consistency; and good convergent validity, including moderate correlation (r=.310, P=.01) with outcomes over follow-up. CONCLUSIONS These preliminary results suggest that alliance toward a virtual therapist is a significant predictor of treatment outcome, favors the importance of a task-goal over bond-factor, and should be explored in studies with larger sample sizes and in additional forms of embodiment.
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Affiliation(s)
- Alexander Miloff
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Lena Reuterskiöld
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Philip Lindner
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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17
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Lindner P, Miloff A, Bergman C, Andersson G, Hamilton W, Carlbring P. Gamified, Automated Virtual Reality Exposure Therapy for Fear of Spiders: A Single-Subject Trial Under Simulated Real-World Conditions. Front Psychiatry 2020; 11:116. [PMID: 32210850 PMCID: PMC7069224 DOI: 10.3389/fpsyt.2020.00116] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 02/10/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Virtual Reality exposure therapy (VRET) is an evidence-based treatment of phobias and recent research suggests that this applies also to self-contained, automated interventions requiring no therapist guidance. With the advent and growing adoption of consumer VR technology, automated VR intervention have the potential to close the considerable treatment gap for specific phobias through dissemination as consumer applications, self-help at clinics, or as blended treatment. There is however a lack of translational effectiveness studies on VRET treatment effects under real-world conditions. METHODS We conducted a single-arm (n = 25), single-subject study of automated, gamified VRET for fear of spiders, under simulated real-world conditions. After setup and reading instructions, participants completed the automated, single-session treatment by themselves. Self-rated fear of spiders and quality of life served as outcome measures, measured twice before, and one and two weeks after treatment, and at a six-month follow-up. Session characteristics and user experience measures were collected at the end of the session. RESULTS Mixed-effects modeling revealed a significant and large (d = 1.26) effect of treatment-onset on phobia symptoms (p < .001), and a small (d = 0.49) effect on quality of life (p = .025). Results were maintained at a six-month follow-up (p > .053). The intervention was tolerable and practical. There were no significant correlations between any user experience measure and decrease in phobia symptoms (p > .209). CONCLUSIONS An automated VRET intervention for fear of spiders showed equivalent effects on phobia symptoms under effectiveness conditions as previously reported under efficacy conditions. These results suggest that automated VRET applications are promising self-help treatments also when provided under real-world conditions. PRE-REGISTRATION Open Science Foundation, https://doi.org/10.17605/OSF.IO/78GUB.
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Affiliation(s)
- Philip Lindner
- Department of Psychology, Stockholm University, Stockholm, Sweden.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Alexander Miloff
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Camilla Bergman
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Gerhard Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.,Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden
| | | | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
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18
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Kahlon S, Lindner P, Nordgreen T. Virtual reality exposure therapy for adolescents with fear of public speaking: a non-randomized feasibility and pilot study. Child Adolesc Psychiatry Ment Health 2019; 13:47. [PMID: 31890004 PMCID: PMC6933883 DOI: 10.1186/s13034-019-0307-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 12/17/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Public Speaking Anxiety (PSA) is a common anxiety with onset in adolescence and early adulthood. With the advent of consumer virtual reality (VR) technology, VR-delivered exposure therapy is now a scalable and practical treatment option and has previously been shown to be efficacious with adults. In this non-randomized feasibility and pilot trial, we explore the effect of one-session (90 min) VR-delivered exposure therapy for adolescents (aged 13-16) with PSA. METHODS A total of 27 adolescents were recruited from Norwegian high schools and completed self-report measures of PSA twice prior to treatment, 1 week after treatment, and at 1 and 3 month follow-up. Heart rate was recorded during the treatment session. A low-cost head-mounted VR display with a custom-built VR stimuli material depicting a cultural and age appropriate classroom and audience were used when a series of speech (exposure exercises) were performed. RESULTS Linear mixed effects model revealed a significant decrease in PSA symptoms (Cohen's d = 1.53) pre-post treatment, and improvements were maintained at follow-ups. Physiological data revealed a small increase in heart rate during exposure tasks. Based on feedback from the adolescents, the feasibility of the intervention was increased during the trial. CONCLUSIONS The results show that low-cost, consumer VR hardware can be used to deliver efficacious treatment for PSA in adolescents, in a feasible one-session format.
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Affiliation(s)
- Smiti Kahlon
- 0000 0000 9753 1393grid.412008.fDivision of Psychiatry, Haukeland University Hospital, Haukelandsbakken 15, 5009 Bergen, Norway
| | - Philip Lindner
- 0000 0000 9753 1393grid.412008.fDivision of Psychiatry, Haukeland University Hospital, Haukelandsbakken 15, 5009 Bergen, Norway ,0000 0004 1936 9377grid.10548.38Department of Psychology, Stockholm University, Stockholm, Sweden ,0000 0001 2326 2191grid.425979.4Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Tine Nordgreen
- 0000 0000 9753 1393grid.412008.fDivision of Psychiatry, Haukeland University Hospital, Haukelandsbakken 15, 5009 Bergen, Norway ,0000 0004 1936 7443grid.7914.bDepartment of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
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19
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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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20
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Bouchard S, Dumoulin S, Robillard G, Guitard T, Klinger É, Forget H, Loranger C, Roucaut FX. Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: a three-arm randomised controlled trial. Br J Psychiatry 2017; 210:276-283. [PMID: 27979818 DOI: 10.1192/bjp.bp.116.184234] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 08/11/2016] [Accepted: 08/25/2016] [Indexed: 11/23/2022]
Abstract
BackgroundPeople with social anxiety disorder (SAD) fear social interactions and may be reluctant to seek treatments involving exposure to social situations. Social exposure conducted in virtual reality (VR), embedded in individual cognitive-behavioural therapy (CBT), could be an answer.AimsTo show that conducting VR exposure in CBT for SAD is effective and is more practical for therapists than conducting exposure in vivoMethodParticipants were randomly assigned to either VR exposure (n = 17), in vivo exposure (n = 22) or waiting list (n = 20). Participants in the active arms received individual CBT for 14 weekly sessions and outcome was assessed with questionnaires and a behaviour avoidance test. (Trial registration number ISRCTN99747069)ResultsImprovements were found on the primary (Liebowitz Social Anxiety Scale) and all five secondary outcome measures in both CBT groups compared with the waiting list. Conducting exposure in VR was more effective at post-treatment than in vivo on the primary outcome measure and on one secondary measure. Improvements were maintained at the 6-month follow-up. VR was significantly more practical for therapists than in vivo exposure.ConclusionsUsing VR can be advantageous over standard CBT as a potential solution for treatment avoidance and as an efficient, cost-effective and practical medium of exposure.
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Affiliation(s)
- Stéphane Bouchard
- Stéphane Bouchard, PhD, Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Gatineau and Centre intégré de santé et de services sociaux de l'Outaouais, Gatineau, Québec, Canada; Stéphanie Dumoulin, MPs, private practice, Gatineau, Québec, Canada; Geneviève Robillard, MSc, Université du Québec en Outaouais, Gatineau, Québec, Canada; Tanya Guitard, MPs, Université du Québec en Outaouais, Gatineau, Québec, Canada;Évelyne Klinger, PhD, Digital Interactions Health and Disability Lab, ESIEA, Laval, France; Hélène Forget, PhD, Université du Québec en Outaouais, Gatineau, Québec, Canada; Claudie Loranger, DPs, Centre intégré de santé et de services sociaux de l'Outaouais, Gatineau, Québec, Canada; François Xavier Roucaut, MD, Université de Montréal, Montréal, Canada, and Centre Hospitalier Affilié Universitaire Régional de Trois-Rivières, Québec, Canada
| | - Stéphanie Dumoulin
- Stéphane Bouchard, PhD, Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Gatineau and Centre intégré de santé et de services sociaux de l'Outaouais, Gatineau, Québec, Canada; Stéphanie Dumoulin, MPs, private practice, Gatineau, Québec, Canada; Geneviève Robillard, MSc, Université du Québec en Outaouais, Gatineau, Québec, Canada; Tanya Guitard, MPs, Université du Québec en Outaouais, Gatineau, Québec, Canada;Évelyne Klinger, PhD, Digital Interactions Health and Disability Lab, ESIEA, Laval, France; Hélène Forget, PhD, Université du Québec en Outaouais, Gatineau, Québec, Canada; Claudie Loranger, DPs, Centre intégré de santé et de services sociaux de l'Outaouais, Gatineau, Québec, Canada; François Xavier Roucaut, MD, Université de Montréal, Montréal, Canada, and Centre Hospitalier Affilié Universitaire Régional de Trois-Rivières, Québec, Canada
| | - Geneviève Robillard
- Stéphane Bouchard, PhD, Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Gatineau and Centre intégré de santé et de services sociaux de l'Outaouais, Gatineau, Québec, Canada; Stéphanie Dumoulin, MPs, private practice, Gatineau, Québec, Canada; Geneviève Robillard, MSc, Université du Québec en Outaouais, Gatineau, Québec, Canada; Tanya Guitard, MPs, Université du Québec en Outaouais, Gatineau, Québec, Canada;Évelyne Klinger, PhD, Digital Interactions Health and Disability Lab, ESIEA, Laval, France; Hélène Forget, PhD, Université du Québec en Outaouais, Gatineau, Québec, Canada; Claudie Loranger, DPs, Centre intégré de santé et de services sociaux de l'Outaouais, Gatineau, Québec, Canada; François Xavier Roucaut, MD, Université de Montréal, Montréal, Canada, and Centre Hospitalier Affilié Universitaire Régional de Trois-Rivières, Québec, Canada
| | - Tanya Guitard
- Stéphane Bouchard, PhD, Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Gatineau and Centre intégré de santé et de services sociaux de l'Outaouais, Gatineau, Québec, Canada; Stéphanie Dumoulin, MPs, private practice, Gatineau, Québec, Canada; Geneviève Robillard, MSc, Université du Québec en Outaouais, Gatineau, Québec, Canada; Tanya Guitard, MPs, Université du Québec en Outaouais, Gatineau, Québec, Canada;Évelyne Klinger, PhD, Digital Interactions Health and Disability Lab, ESIEA, Laval, France; Hélène Forget, PhD, Université du Québec en Outaouais, Gatineau, Québec, Canada; Claudie Loranger, DPs, Centre intégré de santé et de services sociaux de l'Outaouais, Gatineau, Québec, Canada; François Xavier Roucaut, MD, Université de Montréal, Montréal, Canada, and Centre Hospitalier Affilié Universitaire Régional de Trois-Rivières, Québec, Canada
| | - Évelyne Klinger
- Stéphane Bouchard, PhD, Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Gatineau and Centre intégré de santé et de services sociaux de l'Outaouais, Gatineau, Québec, Canada; Stéphanie Dumoulin, MPs, private practice, Gatineau, Québec, Canada; Geneviève Robillard, MSc, Université du Québec en Outaouais, Gatineau, Québec, Canada; Tanya Guitard, MPs, Université du Québec en Outaouais, Gatineau, Québec, Canada;Évelyne Klinger, PhD, Digital Interactions Health and Disability Lab, ESIEA, Laval, France; Hélène Forget, PhD, Université du Québec en Outaouais, Gatineau, Québec, Canada; Claudie Loranger, DPs, Centre intégré de santé et de services sociaux de l'Outaouais, Gatineau, Québec, Canada; François Xavier Roucaut, MD, Université de Montréal, Montréal, Canada, and Centre Hospitalier Affilié Universitaire Régional de Trois-Rivières, Québec, Canada
| | - Hélène Forget
- Stéphane Bouchard, PhD, Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Gatineau and Centre intégré de santé et de services sociaux de l'Outaouais, Gatineau, Québec, Canada; Stéphanie Dumoulin, MPs, private practice, Gatineau, Québec, Canada; Geneviève Robillard, MSc, Université du Québec en Outaouais, Gatineau, Québec, Canada; Tanya Guitard, MPs, Université du Québec en Outaouais, Gatineau, Québec, Canada;Évelyne Klinger, PhD, Digital Interactions Health and Disability Lab, ESIEA, Laval, France; Hélène Forget, PhD, Université du Québec en Outaouais, Gatineau, Québec, Canada; Claudie Loranger, DPs, Centre intégré de santé et de services sociaux de l'Outaouais, Gatineau, Québec, Canada; François Xavier Roucaut, MD, Université de Montréal, Montréal, Canada, and Centre Hospitalier Affilié Universitaire Régional de Trois-Rivières, Québec, Canada
| | - Claudie Loranger
- Stéphane Bouchard, PhD, Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Gatineau and Centre intégré de santé et de services sociaux de l'Outaouais, Gatineau, Québec, Canada; Stéphanie Dumoulin, MPs, private practice, Gatineau, Québec, Canada; Geneviève Robillard, MSc, Université du Québec en Outaouais, Gatineau, Québec, Canada; Tanya Guitard, MPs, Université du Québec en Outaouais, Gatineau, Québec, Canada;Évelyne Klinger, PhD, Digital Interactions Health and Disability Lab, ESIEA, Laval, France; Hélène Forget, PhD, Université du Québec en Outaouais, Gatineau, Québec, Canada; Claudie Loranger, DPs, Centre intégré de santé et de services sociaux de l'Outaouais, Gatineau, Québec, Canada; François Xavier Roucaut, MD, Université de Montréal, Montréal, Canada, and Centre Hospitalier Affilié Universitaire Régional de Trois-Rivières, Québec, Canada
| | - François Xavier Roucaut
- Stéphane Bouchard, PhD, Département de psychoéducation et de psychologie, Université du Québec en Outaouais, Gatineau and Centre intégré de santé et de services sociaux de l'Outaouais, Gatineau, Québec, Canada; Stéphanie Dumoulin, MPs, private practice, Gatineau, Québec, Canada; Geneviève Robillard, MSc, Université du Québec en Outaouais, Gatineau, Québec, Canada; Tanya Guitard, MPs, Université du Québec en Outaouais, Gatineau, Québec, Canada;Évelyne Klinger, PhD, Digital Interactions Health and Disability Lab, ESIEA, Laval, France; Hélène Forget, PhD, Université du Québec en Outaouais, Gatineau, Québec, Canada; Claudie Loranger, DPs, Centre intégré de santé et de services sociaux de l'Outaouais, Gatineau, Québec, Canada; François Xavier Roucaut, MD, Université de Montréal, Montréal, Canada, and Centre Hospitalier Affilié Universitaire Régional de Trois-Rivières, Québec, Canada
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Fleming TM, Bavin L, Stasiak K, Hermansson-Webb E, Merry SN, Cheek C, Lucassen M, Lau HM, Pollmuller B, Hetrick S. Serious Games and Gamification for Mental Health: Current Status and Promising Directions. Front Psychiatry 2016; 7:215. [PMID: 28119636 PMCID: PMC5222787 DOI: 10.3389/fpsyt.2016.00215] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/28/2016] [Indexed: 11/14/2022] Open
Abstract
Computer games are ubiquitous and can be utilized for serious purposes such as health and education. "Applied games" including serious games (in brief, computerized games for serious purposes) and gamification (gaming elements used outside of games) have the potential to increase the impact of mental health internet interventions via three processes. First, by extending the reach of online programs to those who might not otherwise use them. Second, by improving engagement through both game-based and "serious" motivational dynamics. Third, by utilizing varied mechanisms for change, including therapeutic processes and gaming features. In this scoping review, we aim to advance the field by exploring the potential and opportunities available in this area. We review engagement factors which may be exploited and demonstrate that there is promising evidence of effectiveness for serious games for depression from contemporary systematic reviews. We illustrate six major categories of tested applied games for mental health (exergames, virtual reality, cognitive behavior therapy-based games, entertainment games, biofeedback, and cognitive training games) and demonstrate that it is feasible to translate traditional evidence-based interventions into computer gaming formats and to exploit features of computer games for therapeutic change. Applied games have considerable potential for increasing the impact of online interventions for mental health. However, there are few independent trials, and direct comparisons of game-based and non-game-based interventions are lacking. Further research, faster iterations, rapid testing, non-traditional collaborations, and user-centered approaches are needed to respond to diverse user needs and preferences in rapidly changing environments.
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Affiliation(s)
- Theresa M Fleming
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Lynda Bavin
- Department of Psychological Medicine, University of Auckland , Auckland , New Zealand
| | - Karolina Stasiak
- Department of Psychological Medicine, University of Auckland , Auckland , New Zealand
| | - Eve Hermansson-Webb
- Department of Psychological Medicine, University of Auckland , Auckland , New Zealand
| | - Sally N Merry
- Department of Psychological Medicine, University of Auckland , Auckland , New Zealand
| | - Colleen Cheek
- University of Tasmania Rural Clinical School , Burnie, TAS , Australia
| | - Mathijs Lucassen
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand; Department of Health, Wellbeing and Social Care, The Open University, Milton Keynes, UK
| | - Ho Ming Lau
- Department of Psychiatry, VU University Medical Center , Amsterdam , Netherlands
| | - Britta Pollmuller
- School of Art and Design, Auckland University of Technology , Auckland , New Zealand
| | - Sarah Hetrick
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne , Parkville, VIC , Australia
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