1
|
Belfort E, MacMillan C, Weigle P. Peril and Promise: Teens, Tech, and America's Mental Health Crisis. Child Adolesc Psychiatr Clin N Am 2024; 33:485-498. [PMID: 38823819 DOI: 10.1016/j.chc.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
Advances in Internet technologies have implications for the health and development of children and adolescents with potential for both beneficial and harmful outcomes. Similar technological advances also impact how psychiatrists deliver mental health care in clinical settings. Internet tech adds complexities to psychiatric practice in the form of electronic health records, patient portals, and virtual patient contact, which clinicians must understand and successfully incorporate into practice. Digital therapeutics and virtual mental health endeavors offer new treatment delivery options for patients and providers. Some have proven benefits, such as improved accessibility for patients, but all require provider expertise to utilize.
Collapse
Affiliation(s)
- Erin Belfort
- Maine Medical Center, 66 Bramhall Street, Portland, ME 04102, USA.
| | | | - Paul Weigle
- Natchaug Hospital, Hartford Healthcare, Mansfield Center, 89 Storrs Road, Mansfield, CT 06250-0260, USA; Department of Psychiatry, UConn School of Medicine, Farmington, USA
| |
Collapse
|
2
|
Maymon CN, Crawford MT, Blackburne K, Botes A, Carnegie K, Mehr SA, Meier J, Murphy J, Miles NL, Robinson K, Tooley M, Grimshaw GM. The presence of fear: How subjective fear, not physiological changes, shapes the experience of presence. J Exp Psychol Gen 2024; 153:1500-1516. [PMID: 38635168 PMCID: PMC11182719 DOI: 10.1037/xge0001576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
When we become engrossed in novels, films, games, or even our own wandering thoughts, we can feel present in a reality distinct from the real world. Although this subjective sense of presence is, presumably, a ubiquitous aspect of conscious experience, the mechanisms that produce it are unknown. Correlational studies conducted in virtual reality have shown that we feel more present when we are afraid, motivating claims that physiological changes contribute to presence; however, such causal claims remain to be evaluated. Here, we report two experiments that test the causal role of subjective and physiological components of fear (i.e., activation of the sympathetic nervous system) in generating presence. In Study 1, we validated a virtual reality simulation capable of inducing fear. Participants rated their emotions while they crossed a wooden plank that appeared to be suspended above a city street; at the same time, we recorded heart rate and skin conductance levels. Height exposure increased ratings of fear, presence, and both measures of sympathetic activation. Although presence and fear ratings were correlated during height exposure, presence and sympathetic activation were unrelated. In Study 2, we manipulated whether the plank appeared at height or at ground level. We also captured participants' movements, which revealed that alongside increases in subjective fear, presence, and sympathetic activation, participants also moved more slowly at height relative to controls. Using a mediational approach, we found that the relationship between height exposure and presence on the plank was fully mediated by self-reported fear, and not by sympathetic activation. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
Collapse
Affiliation(s)
| | | | | | - André Botes
- University of Auckland, Auckland, New Zealand
| | | | - Samuel A. Mehr
- University of Auckland, Auckland, New Zealand
- Yale Child Study Center, New Haven, USA
| | | | - Justin Murphy
- Victoria University of Wellington, Wellington, New Zealand
| | | | - Kealagh Robinson
- Victoria University of Wellington, Wellington, New Zealand
- Massey University, Palmerston North, New Zealand
| | - Michael Tooley
- Victoria University of Wellington, Wellington, New Zealand
| | | |
Collapse
|
3
|
Lorentz L, Müller K, Suchan B. Virtual reality-based attention training in patients with neurological damage: A pilot study. Neuropsychol Rehabil 2024; 34:701-720. [PMID: 37466958 DOI: 10.1080/09602011.2023.2236349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023]
Abstract
Virtual Reality has been shown to be a valid tool to assess cognitive functions in an ecologically valid way. However, evidence regarding its effectiveness as a treatment option for cognitive rehabilitation has been limited. Furthermore, its potential to facilitate the transfer of training effects to patients' everyday life is still poorly studied. This study aimed to evaluate the efficacy of a VR-based attention training and its transfer to attentional functioning in everyday life. Nineteen inpatients with neurological disorders and attentional deficits underwent daily 30-min VR training sessions over a two-week period. Attentional functions were assessed before and after the training period using several computerized tests, two self-constructed behavioral tasks, and a questionnaire assessing patients' subjective attentional functioning. Pre-Post-analyses show significant decreases in reaction times in the computerized alertness and selective attention tests. Transfer to the behavioral tasks and self-report data could not be observed. Despite the specificity of the changes, confounding effects cannot entirely be ruled out due to the lack of a control group. Results suggest that training was effective in improving attentional functioning along neuropsychological measures, but did not elicit transfer to an ecologically valid or subjective level. Implications for the future development of VR interventions are discussed.
Collapse
Affiliation(s)
- Lukas Lorentz
- St. Mauritius Therapieklinik, Meerbusch, Germany
- Institute of Cognitive Neuroscience, Clinical Neuropsychology, Neuropsychological Therapy Centre, Ruhr University Bochum, Bochum, Germany
| | | | - Boris Suchan
- Institute of Cognitive Neuroscience, Clinical Neuropsychology, Neuropsychological Therapy Centre, Ruhr University Bochum, Bochum, Germany
| |
Collapse
|
4
|
Schmid BC, Marsland D, Jacobs E, Rezniczek GA. A Preparatory Virtual Reality Experience Reduces Anxiety before Surgery in Gynecologic Oncology Patients: A Randomized Controlled Trial. Cancers (Basel) 2024; 16:1913. [PMID: 38791991 PMCID: PMC11119445 DOI: 10.3390/cancers16101913] [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: 04/24/2024] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
Perioperative anxiety is common among patients undergoing surgery, potentially leading to negative outcomes. Immersive virtual reality (VR) has shown promise in reducing anxiety in various clinical settings. This study aimed to evaluate the effectiveness of VR in reducing perioperative anxiety in patients undergoing gynecological oncology surgery and was conducted as a single-center, double-arm, single-blinded randomized controlled trial at the Gold Coast University Hospital, Queensland, Australia. Participants were randomized into the VR intervention + care as usual (CAU) group (n = 39) and the CAU group (n = 41). Anxiety scores were assessed using a six-tier visual facial anxiety scale at baseline, after the intervention/CAU on the same day, and, several days up to weeks later, immediately before surgery. There was no significant difference in baseline anxiety scores, type of operation, or suspected cancer between the two groups. The VR intervention significantly reduced anxiety scores from baseline to preoperative assessment (p < 0.001). The median anxiety score in the VR intervention group decreased from 3 (interquartile range 2 to 5) at baseline to 2 (2 to 3) prior to surgery, while the control group's scores were 4 (2 to 5) and 4 (3 to 5), respectively. Multivariate analysis showed that group assignment was the sole outcome predictor, not age, type of procedure, or the time elapsed until surgery. Thus, VR exposure was effective in reducing perioperative anxiety in patients undergoing gynecological oncology surgery. The use of VR as a preparation tool may improve patient experience and contribute to better surgical outcomes, warranting further research into exploring the potential benefits of VR in other surgical specialties and its long-term impact on patient recovery.
Collapse
Affiliation(s)
- Bernd C. Schmid
- Department of Gynaecological Oncology, Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD 4215, Australia
| | - Dominic Marsland
- Department of Gynaecological Oncology, Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD 4215, Australia
| | - Eilish Jacobs
- Department of Gynaecological Oncology, Gold Coast University Hospital, 1 Hospital Blvd, Southport, QLD 4215, Australia
| | - Günther A. Rezniczek
- Department of Gynecology and Obstetrics, Ruhr-Universität Bochum, Marien Hospital Herne, Hölkeskampring 40, 44625 Herne, Germany
| |
Collapse
|
5
|
Leehr EJ, Seeger FR, Böhnlein J, Gathmann B, Straube T, Roesmann K, Junghöfer M, Schwarzmeier H, Siminski N, Herrmann MJ, Langhammer T, Goltermann J, Grotegerd D, Meinert S, Winter NR, Dannlowski U, Lueken U. Association between resting-state connectivity patterns in the defensive system network and treatment response in spider phobia-a replication approach. Transl Psychiatry 2024; 14:137. [PMID: 38453896 PMCID: PMC10920691 DOI: 10.1038/s41398-024-02799-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 03/09/2024] Open
Abstract
Although highly effective on average, exposure-based treatments do not work equally well for all patients with anxiety disorders. The identification of pre-treatment response-predicting patient characteristics may enable patient stratification. Preliminary research highlights the relevance of inhibitory fronto-limbic networks as such. We aimed to identify pre-treatment neural signatures differing between exposure treatment responders and non-responders in spider phobia and to validate results through rigorous replication. Data of a bi-centric intervention study comprised clinical phenotyping and pre-treatment resting-state functional connectivity (rsFC) data of n = 79 patients with spider phobia (discovery sample) and n = 69 patients (replication sample). RsFC data analyses were accomplished using the Matlab-based CONN-toolbox with harmonized analyses protocols at both sites. Treatment response was defined by a reduction of >30% symptom severity from pre- to post-treatment (Spider Phobia Questionnaire Score, primary outcome). Secondary outcome was defined by a reduction of >50% in a Behavioral Avoidance Test (BAT). Mean within-session fear reduction functioned as a process measure for exposure. Compared to non-responders and pre-treatment, results in the discovery sample seemed to indicate that responders exhibited stronger negative connectivity between frontal and limbic structures and were characterized by heightened connectivity between the amygdala and ventral visual pathway regions. Patients exhibiting high within-session fear reduction showed stronger excitatory connectivity within the prefrontal cortex than patients with low within-session fear reduction. Whereas these results could be replicated by another team using the same data (cross-team replication), cross-site replication of the discovery sample findings in the independent replication sample was unsuccessful. Results seem to support negative fronto-limbic connectivity as promising ingredient to enhance response rates in specific phobia but lack sufficient replication. Further research is needed to obtain a valid basis for clinical decision-making and the development of individually tailored treatment options. Notably, future studies should regularly include replication approaches in their protocols.
Collapse
Affiliation(s)
- Elisabeth J Leehr
- Institute for Translational Psychiatry, University of Münster, Münster, Germany.
| | - Fabian R Seeger
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Würzburg, Germany
- Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Joscha Böhnlein
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Bettina Gathmann
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Münster, Germany
| | - Thomas Straube
- Institute of Medical Psychology and Systems Neuroscience, University of Münster, Münster, Germany
- Otto-Creutzfeld Center for Cognitive and Behavioral Neuroscience, University of Münster, Münster, Germany
| | - Kati Roesmann
- Otto-Creutzfeld Center for Cognitive and Behavioral Neuroscience, University of Münster, Münster, Germany
- Institute for Clinical Psychology and Psychotherapy, University of Siegen, Siegen, Germany
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
- Institute of Psychology, Unit of Clinical Psychology and Psychotherapy in Childhood and Adolescence, University of Osnabrück, Osnabrück, Germany
| | - Markus Junghöfer
- Otto-Creutzfeld Center for Cognitive and Behavioral Neuroscience, University of Münster, Münster, Germany
- Institute for Biomagnetism and Biosignalanalysis, University of Münster, Münster, Germany
| | - Hanna Schwarzmeier
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Niklas Siminski
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Martin J Herrmann
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Würzburg, Germany
| | - Till Langhammer
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Janik Goltermann
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Susanne Meinert
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Nils R Winter
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Ulrike Lueken
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital of Würzburg, Würzburg, Germany
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Mental Health (DZPG), partner site Berlin/Potsdam, Berlin, Germany
| |
Collapse
|
6
|
Mevlevioğlu D, Tabirca S, Murphy D. Real-Time Classification of Anxiety in Virtual Reality Therapy Using Biosensors and a Convolutional Neural Network. BIOSENSORS 2024; 14:131. [PMID: 38534238 DOI: 10.3390/bios14030131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/22/2024] [Accepted: 03/01/2024] [Indexed: 03/28/2024]
Abstract
Virtual Reality Exposure Therapy is a method of cognitive behavioural therapy that aids in the treatment of anxiety disorders by making therapy practical and cost-efficient. It also allows for the seamless tailoring of the therapy by using objective, continuous feedback. This feedback can be obtained using biosensors to collect physiological information such as heart rate, electrodermal activity and frontal brain activity. As part of developing our objective feedback framework, we developed a Virtual Reality adaptation of the well-established emotional Stroop Colour-Word Task. We used this adaptation to differentiate three distinct levels of anxiety: no anxiety, mild anxiety and severe anxiety. We tested our environment on twenty-nine participants between the ages of eighteen and sixty-five. After analysing and validating this environment, we used it to create a dataset for further machine-learning classification of the assigned anxiety levels. To apply this information in real-time, all of our information was processed within Virtual Reality. Our Convolutional Neural Network was able to differentiate the anxiety levels with a 75% accuracy using leave-one-out cross-validation. This shows that our system can accurately differentiate between different anxiety levels.
Collapse
Affiliation(s)
- Deniz Mevlevioğlu
- School of Computer Science and Information Technology, University College Cork, T12 K8AF Cork, Ireland
| | - Sabin Tabirca
- School of Computer Science and Information Technology, University College Cork, T12 K8AF Cork, Ireland
- Faculty of Mathematics and Informatics, Transylvania University of Brasov, 500036 Brasov, Romania
| | - David Murphy
- School of Computer Science and Information Technology, University College Cork, T12 K8AF Cork, Ireland
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
Ribé-Viñes JM, Gutiérrez-Maldonado J, Zabolipour Z, Ferrer-Garcia M. Virtual reality exposure with vibrotactile stimulation for the treatment of fear of flying: A pilot study. J Behav Ther Exp Psychiatry 2024; 82:101915. [PMID: 37862878 DOI: 10.1016/j.jbtep.2023.101915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/30/2023] [Accepted: 09/28/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND AND OBJECTIVES Virtual reality (VR) interventions are becoming more prevalent in treating fear of flying (FoF). Since multisensory stimulation can enhance the sense of presence in a virtual environment, the present study compared virtual reality exposure with and without vibrotactile cues to determine its contribution to the realism of the virtual experience. METHODS A repeated measures design was used. Thirty-one participants were exposed to two experimental conditions with a minimum of a one-week interval between them: one in which participants were exposed to the virtual environment with vibrotactile cues (smart chair, SC), and another in which participants were exposed to the virtual environment without vibrotactile cues (ordinary chair, OC). The administration order of both conditions was counterbalanced to avoid possible order effects. RESULTS Participants felt higher levels of sense of presence when using the SC than the OC. However, the addition of vibrotactile stimulation partially influenced experienced anxiety. Some personality traits were also associated with participants' sense of presence and anxiety responses during the exposure. LIMITATIONS The sample size was smaller than required. Moreover, only self-reported measures were used. Finally, a roller coaster instead of an airplane scenario was used for the exposure, which might not have been suitable enough for provoking anxiety in participants with FoF. CONCLUSIONS Vibrotactile cues enhanced the sense of presence. However, the addition of vibrotactile stimulation did not have a consistent effect on anxiety experienced during exposure. Therefore, the benefits of incorporating vibrotactile cues in virtual reality environments for exposure therapy are not clear.
Collapse
Affiliation(s)
- J M Ribé-Viñes
- Department of Clinical Psychology and Psychobiology. Universitat de Barcelona, Barcelona, Spain.
| | - J Gutiérrez-Maldonado
- Department of Clinical Psychology and Psychobiology. Universitat de Barcelona, Barcelona, Spain; Neuroscience Institute. Universitat de Barcelona, Barcelona, Spain
| | - Zahra Zabolipour
- Department of Clinical Psychology and Psychobiology. Universitat de Barcelona, Barcelona, Spain
| | - M Ferrer-Garcia
- Department of Clinical Psychology and Psychobiology. Universitat de Barcelona, Barcelona, Spain; Neuroscience Institute. Universitat de Barcelona, Barcelona, Spain.
| |
Collapse
|
9
|
Thaysen-Petersen D, Hammerum SK, Vissing AC, Oestrich IH, Nordentoft M, Düring SW, Fink-Jensen A. Virtual reality-assisted cognitive behavioral therapy for patients with alcohol use disorder: a randomized feasibility study. Front Psychiatry 2024; 15:1337898. [PMID: 38419905 PMCID: PMC10899342 DOI: 10.3389/fpsyt.2024.1337898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Cognitive behavioral therapy (CBT) is an evidence-based treatment for alcohol use disorder (AUD). Exposure to high-risk situations in virtual reality (VR) has been suggested to have a potential therapeutical benefit, but no previous study has combined VR and CBT for AUD. We aimed to investigate the feasibility of using VR-simulated high-risk environments in CBT-based treatment of AUD. Methods We randomized ten treatment-seeking AUD-diagnosed individuals to three sessions of conventional CBT or VR-assisted CBT performed at two outpatient clinics in Denmark. In each session, patients randomized to VR-CBT were exposed to VR-simulations from a restaurant to induce authentic thoughts, emotions, physiological reactions, and craving for CBT purposes. The primary outcome measure was feasibility: Drop-out rate, psychological reactions, and simulator sickness. Secondary outcomes were assessment of preliminary short-term changes in alcohol consumption and craving from baseline to one-week and one-month follow-up. In addition, the study was conducted for training in operationalization of VR equipment, treatment manuals, and research questionnaires. Results The majority of patients completed all study visits (90%). VR induced authentic high-risk related thoughts, emotions, and physiological reactions that were considered relevant for CBT by patients and therapists. Four of five patients randomized to VR-CBT experienced cravings during VR simulations, and most of these patients (3/5) experienced mild simulator sickness during VR exposure. The preliminary data showed that patients receiving VR-CBT had more reduction in alcohol consumption than patients receiving conventional CBT at one week- (median 94% vs. 72%) and one-month follow-up (median 98% vs. 55%). Similar results were found regarding changes in cravings. Conclusion We demonstrated VR-CBT to be a feasible intervention for patients with AUD which supports continued investigations in a larger randomized clinical trial evaluating the efficacy of VR-CBT. Clinical trial registration https://www.clinicaltrials.gov/study/NCT04990765?cond=addiction%20CRAVR&rank=2, identifier NCT05042180.
Collapse
Affiliation(s)
- Daniel Thaysen-Petersen
- Mental Health Centre Copenhagen, Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Sigurd Krogh Hammerum
- Mental Health Centre Copenhagen, Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Anne-Cathrine Vissing
- Mental Health Centre Copenhagen, Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
| | - Irene Henriette Oestrich
- Mental Health Centre Sct. Hans, Roskilde, Mental Health Services, Capital Region of Denmark, Roskilde, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Signe Wegmann Düring
- Mental Health Centre Sct. Hans, Roskilde, Mental Health Services, Capital Region of Denmark, Roskilde, Denmark
- Outpatient Clinics, Novavi Foundation, Frederiksberg, Denmark
- Psychiatric Center Amager, Mental Health Services, Capitol Region Hospitals, Amager, Denmark
| | - Anders Fink-Jensen
- Mental Health Centre Copenhagen, Copenhagen, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
10
|
Andersson J, Hallin J, Tingström A, Knutsson J. Virtual reality exposure therapy for fear of spiders: an open trial and feasibility study of a new treatment for arachnophobia. Nord J Psychiatry 2024; 78:128-136. [PMID: 38295831 DOI: 10.1080/08039488.2023.2279643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/11/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE This analogue pilot study examined the feasibility (i.e. preliminary results, safety, acceptability) of a new single-session treatment for adults with a fear of spiders. MATERIALS It used state-of-the-art consumer available VR-hardware for therapist-assisted exposure (VRET-AP). The VRET-AP is largely adapted from Öst's one-session treatment for arachnophobia (Öst, 1987), with the aim of addressing shortcomings of previous VRET treatments, such as marked differences in procedures compared to available and evidence based in-vivo treatments. METHOD Participants (N = 12) were screened for fear of spiders using the Spider Phobia Questionnaire (SPQ), Fear Questionnaire (FQ) and the Behavioral Approach Test (BAT), prior to and directly after treatment in a repeated measures quasi-experimental design. In addition, acceptance and completion rates were measured and participants were interviewed about their experience of the treatment. Mean ratings as well as Reliable Change Index (RCI) for individual trajectories were analyzed. RESULTS The results from the preliminary data indicates potential for improvements with large effect sizes (d = 0.90-1,384) in all measurements of spider fear at post-treatment. Reliable Change Index (RCI) analysis showed that spider fear diminished in all twelve participants although the change was certain in only two. None deteriorated. All that responded accepted the treatment and all 11 participants completed all levels in the treatment. No concerns or adverse effects were reported in the interviews which largely confirm the quantitative results. CONCLUSION VRET-AP is a feasible alternative for delivering effective treatment for fear of spiders and the results motivate larger, randomized trials of VRET-AP involving participants diagnosed with arachnophobia.
Collapse
Affiliation(s)
| | - Joel Hallin
- Department of Psychiatry, Lund University, Lund, Sweden
| | | | - Jens Knutsson
- Department of Psychology, Lund University, Lund, Sweden
| |
Collapse
|
11
|
Jung HW, Jang KW, Nam S, Ahn ME, Lee SK, Kim YJ, Shin JK, Park JH, Roh D. Personalized virtual reality exposure for panic disorder and agoraphobia: A preliminary neurophysiological study. Compr Psychiatry 2024; 129:152447. [PMID: 38134553 DOI: 10.1016/j.comppsych.2023.152447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/17/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Personalization is considered an important principle in virtual reality (VR) exposure therapy. We aimed to identify whether personalized VR exposure could provoke increased anxiety in patients with panic disorder and agoraphobia as it is considered the first step in successful treatment for anxiety. METHODS We performed a double-arm, one-day preliminary study among 28 patients with panic disorder and agoraphobia. Three sessions of VR exposure, including a theater, train, and elevator scenario, were conducted in two groups. In the personalized group (n = 14), the brightness and crowd density were customized based on a pre-assessment. In the control group (n = 14), these conditions were fully randomized. Self-reported anxiety, heart rate, skin conductance, and electroencephalography were measured before, during, and after the VR sessions. RESULTS In the later VR sessions, higher self-reported anxiety levels measured by the Visual Analogue Scale were observed in the personalized exposure group. Increased heart rates during and after the VR sessions were observed in the personalized group. The changes in skin conductance peaks were not significantly different between the groups, but the increase in skin conductance was associated with the participants' perception of presence. The electroencephalogram showed widespread increases in alpha waves in the frontal and temporal areas of the brain in the personalized group than in the control group. CONCLUSION Personalized VR exposure elicits stronger anxiogenic effects in patients with panic disorder and agoraphobia as suggested by self-report and neurophysiological data. Personalization of VR exposure has the potential for effective behavioral therapy.
Collapse
Affiliation(s)
- Han Wool Jung
- Institute for Digital Medicine, Hallym University, Chuncheon, Republic of Korea; Mind-Neuromodulation Laboratory, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Ki Won Jang
- Institute for Digital Medicine, Hallym University, Chuncheon, Republic of Korea; Mind-Neuromodulation Laboratory, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Sangkyu Nam
- Mind-Neuromodulation Laboratory, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Mu Eob Ahn
- Institute for Digital Medicine, Hallym University, Chuncheon, Republic of Korea; Department of Emergency Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Sang-Kyu Lee
- Institute for Digital Medicine, Hallym University, Chuncheon, Republic of Korea; Department of Psychiatry, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Yeo Jin Kim
- Institute for Digital Medicine, Hallym University, Chuncheon, Republic of Korea; Department of Neurology, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jae-Kyoung Shin
- Institute for Digital Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Ju Hyun Park
- Mind-Neuromodulation Laboratory, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Daeyoung Roh
- Institute for Digital Medicine, Hallym University, Chuncheon, Republic of Korea; Mind-Neuromodulation Laboratory, Hallym University College of Medicine, Chuncheon, Republic of Korea; Department of Psychiatry, Hallym University College of Medicine, Chuncheon, Republic of Korea.
| |
Collapse
|
12
|
Terkildsen MD, Bollerup S, Palmhøj C, Jensen LG, Lou S. How institutional logics shape the adoption of virtual reality in mental health care: A qualitative study. Digit Health 2024; 10:20552076241248914. [PMID: 38665887 PMCID: PMC11044789 DOI: 10.1177/20552076241248914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Objective To analyse institutional logics' role in adopting virtual reality in mental health care. Methods Data were collected via qualitative, semi-structured interviews with four frontline staff and seven administrative and service staff, two focus group interviews with three frontline staff and four administrative and service staff, and via participant observation in meetings between stakeholders working on virtual reality. Data were collected from May 2021 to February 2022, analysed using thematic analysis, and theoretically driven by the framework of Institutional logics. Results We identified two different forms of institutional logics being drawn upon by frontline staff and administrative and service staff, respectively, when working with the adoption of virtual reality in mental health care. Frontline staff drew mainly on a Professional logic; administrative and service staff drew on a Diffusion logic. Each logic defined a unique focal point, causal pathway, and perceptions of a meaningful adoption process for virtual reality. Conclusions By taking institutional logics as our theoretical and analytical point of departure, this study demonstrates how the meaning of virtual reality and its adoption in mental health care is grounded in multiple and sometimes conflicting institutional logics. Acknowledging the existence and influence of often multiple institutional logics in the adoption process is crucial to guide the future adoption of virtual reality in mental health care. Organising collaborative venues for stakeholders where their multiple institutional logics are made the subject of joint reflection is essential to counter frictions.
Collapse
Affiliation(s)
- Morten D Terkildsen
- DEFACTUM – Public Health Research, Central Denmark Region, Aarhus, Denmark
- Department of Forensic Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Stina Bollerup
- DEFACTUM – Public Health Research, Central Denmark Region, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Camilla Palmhøj
- DEFACTUM – Public Health Research, Central Denmark Region, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Lotte G Jensen
- DEFACTUM – Public Health Research, Central Denmark Region, Aarhus, Denmark
| | - Stina Lou
- DEFACTUM – Public Health Research, Central Denmark Region, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
13
|
Zhang J, Chen M, Yan J, Wang C, Deng H, Wang J, Gu J, Wang D, Li W, Wang C. Effects of virtual reality-based cue exposure therapy on craving and physiological responses in alcohol-dependent patients-a randomised controlled trial. BMC Psychiatry 2023; 23:951. [PMID: 38110900 PMCID: PMC10726483 DOI: 10.1186/s12888-023-05426-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 11/30/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Cue exposure therapy is used to treat alcohol dependence. However, its effectiveness is controversial due to the limitations of the clinical treatment setting. Virtual reality technology may improve the therapeutic effect. The aim of this study is to explore whether virtual reality-based cue exposure therapy can reduce the psychological craving and physiological responses of patients with alcohol dependence. METHODS Forty-four male alcohol-dependent patients were recruited and divided into the study group (n = 23) and the control group (n = 21) according to a random number table. The control group received only conventional clinical treatment for alcohol dependence. The study group received conventional clinical treatment with the addition of VR cue exposure (treatment). The primary outcome was to assess psychological craving and physiological responses to cues of patients before and after treatment. RESULTS After virtual reality-based cue exposure therapy, the changes in VAS and heart rate before and after cue exposure in the study group were significantly lower than those in the control group (P < 0.05), while the changes in skin conductance and respiration between the study group and the control group were not significantly different (P > 0.05). The changes in VAS and heart rate before and after cue exposure in the study group were significantly lower than those before treatment (P < 0.05), while the changes in skin conductance and respiration were not significantly different from those before treatment (P > 0.05). The changes in VAS, heart rate, skin conductance and respiration before and after cue exposure in the control group were not significantly different from those before treatment (P > 0.05). CONCLUSION Virtual reality-based cue exposure therapy can reduce the psychological craving and part of the physiological responses of alcohol-dependent patients during cue exposure in the short term and may be helpful in the treatment of alcohol dependence. TRIAL REGISTRATION The study protocol was registered at the China Clinical Trial Registry on 26/02/2021 ( www.chictr.org.cn ; ChiCTR ID: ChiCTR2100043680).
Collapse
Affiliation(s)
- Junjun Zhang
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, 207# QianJin Road, Xinxiang, Henan, 453000, China
| | - Ming Chen
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, 207# QianJin Road, Xinxiang, Henan, 453000, China
| | - Junli Yan
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, 207# QianJin Road, Xinxiang, Henan, 453000, China
| | - Chaojun Wang
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, 207# QianJin Road, Xinxiang, Henan, 453000, China
| | - Hongdu Deng
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, 207# QianJin Road, Xinxiang, Henan, 453000, China
- Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia
| | - Jiali Wang
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, 207# QianJin Road, Xinxiang, Henan, 453000, China
| | - Jiapeng Gu
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, 207# QianJin Road, Xinxiang, Henan, 453000, China
| | - Dan Wang
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, 207# QianJin Road, Xinxiang, Henan, 453000, China
| | - Wenhui Li
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, 207# QianJin Road, Xinxiang, Henan, 453000, China.
| | - Chuansheng Wang
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, 207# QianJin Road, Xinxiang, Henan, 453000, China.
| |
Collapse
|
14
|
Lorentz L, Schüppen A, Suchan B, Binkofski F. Neural correlates of virtual reality-based attention training: An fMRI study. Neuroimage 2023; 284:120454. [PMID: 37979896 DOI: 10.1016/j.neuroimage.2023.120454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 11/20/2023] Open
Abstract
THEORETICAL BACKGROUND Virtual Reality technology is increasingly used in attention rehabilitation for functional training purposes. However, the neural mechanisms by which Virtual Reality can affect attentional functioning are still unclear. The current study's objective is to examine the effects of stereoscopic vs. monoscopic presentation on neural processing during a visual attention task. METHOD Thirty-two healthy participants performed a visual attention task in an immersive virtual environment that was displayed via MR-compatible video goggles in an MRI scanner. The paradigm altered between trials that required active engagement with the task and mere observation trials. Furthermore, the form of binocular presentation switched between monoscopic and stereoscopic presentation. RESULTS Analyses yielded evidence for increased activation in stereoscopic compared to monoscopic trials in the tertiary visual cortex area V3A as well as elevated activation in the dorsal attention network when engaging in the attention task. An additional ROI analysis of area V3A revealed significantly lower attentional engagement costs in stereoscopic conditions. DISCUSSION Results support previous findings suggesting that V3A is involved in binocular depth perception. Furthermore, heightened activation in V3A following stereoscopic presentation seemed to facilitate attentional engagement with the task. Considering that V3A is the origin of the dorso-dorsal, ventro-dorsal, and ventral visual processing pathways, we regard it as a gating area that decides which kind of visual perception is processed.
Collapse
Affiliation(s)
- Lukas Lorentz
- Division of Clinical Cognitive Sciences, Department of Neurology, RWTH Aachen University, Aachen, Germany; Institute of Cognitive Neuroscience, Clinical Neuropsychology, Neuropsychological Therapy Centre, Ruhr University Bochum, Bochum, Germany
| | - André Schüppen
- Division of Clinical Cognitive Sciences, Department of Neurology, RWTH Aachen University, Aachen, Germany; Brain Imaging Facility, Interdisciplinary Centre for Clinical Research, RWTH Aachen, Germany
| | - Boris Suchan
- Institute of Cognitive Neuroscience, Clinical Neuropsychology, Neuropsychological Therapy Centre, Ruhr University Bochum, Bochum, Germany
| | - Ferdinand Binkofski
- Division of Clinical Cognitive Sciences, Department of Neurology, RWTH Aachen University, Aachen, Germany; Institute for Neuroscience and Medicine (INM-4), Research Center Jülich GmbH, Jülich, Germany.
| |
Collapse
|
15
|
Yu K, Wang L, Lv S, Ye X, Liu L, Zheng X, Jin R, Zhou D, Zhang Y, Min G, Wu S. Using functional near-infrared spectroscopy to study effects of virtual reality intervention for adolescents with depression in a clinical setting in China: study protocol for a prospective, randomised, controlled trial. BMJ Open 2023; 13:e074129. [PMID: 38101854 PMCID: PMC10729192 DOI: 10.1136/bmjopen-2023-074129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/31/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION Adolescent depression has been shown to be associated with many devastating psychosocial outcomes. However, there are many barriers that may prevent depressed individuals from receiving specialised treatment. Virtual reality (VR) technology has shown promise as one avenue for overcoming these challenges. This study first aims to evaluate the effectiveness of VR intervention on adolescent depression symptoms, and second, to determine the intervention's underlying mechanism of effect using functional near-infrared spectroscopy (fNIRS). METHODS AND ANALYSIS This is a single-centre, prospective, randomised controlled clinical trial. Sixty-six eligible adolescents aged 12-18 years with a diagnosis of depression will be randomised in a 1:1 ratio to either the VR treatment group or the conventional treatment group. All patients for both groups will receive usual treatment during a 4-week intervention period. In addition, patients randomised to VR treatment group (n=33) will complete three 20 min VR sessions including attention, executive function and relaxation training per week. Moreover, 33 healthy adolescents will be recruited as the general population. Primary outcome (ie, depressive symptoms) and secondary outcomes (ie, anxiety symptoms, executive function, treatment emergent symptoms, haemoglobin changes measured by fNIRS) will be collected at preintervention, immediately postintervention and at 4 weeks follow-up. The data assessor and analyst will be blinded to group membership. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Ethics Committee of Lishui Second People's Hospital. Written informed consent will be obtained for all participants. Results will be disseminated through peer-reviewed journals, national or international conference presentations, media outlets, the internet and various community activities. TRIAL REGISTRATION NUMBER ChiCTR2300067747.
Collapse
Affiliation(s)
- Kunqiang Yu
- Department of Mental Rehabilitation, The Second People's Hospital of Lishui, Lishui, Zhejiang, China
- Zhejiang Clinical Medical Research Centre for Psychiatric and Psychological Disorders, Lishui, Zhejiang, China
- Lishui Key Laboratory of Brain Health and Major Brain Diseases, Lishui, Zhejiang, China
| | - Lijun Wang
- Cixi Biomedical Research Institute, Wenzhou Medical University, Ningbo, Zhejiang, China
| | - Shiqiao Lv
- Department of Mental Rehabilitation, The Second People's Hospital of Lishui, Lishui, Zhejiang, China
| | - Xiaofang Ye
- Department of Mental Rehabilitation, The Second People's Hospital of Lishui, Lishui, Zhejiang, China
| | - Linhui Liu
- Psychological Counselling Center, The Second People's Hospital of Lishui, Lishui, Zhejiang, China
| | - Xiuxiu Zheng
- Lishui Key Laboratory of Brain Health and Major Brain Diseases, Lishui, Zhejiang, China
- Psychological Counselling Center, The Second People's Hospital of Lishui, Lishui, Zhejiang, China
| | - Ruomei Jin
- Department of Mental Rehabilitation, The Second People's Hospital of Lishui, Lishui, Zhejiang, China
- Lishui Key Laboratory of Brain Health and Major Brain Diseases, Lishui, Zhejiang, China
| | - Dongsheng Zhou
- Department of Mental Rehabilitation, Ningbo Kangning Hospital, Ningbo, Zhejiang, China
| | - Yan Zhang
- Psychological Counselling Center, The Second People's Hospital of Lishui, Lishui, Zhejiang, China
| | - Guoqing Min
- Department of Mental Rehabilitation, The Second People's Hospital of Lishui, Lishui, Zhejiang, China
- Lishui Key Laboratory of Brain Health and Major Brain Diseases, Lishui, Zhejiang, China
| | - Shaochang Wu
- Department of Mental Rehabilitation, The Second People's Hospital of Lishui, Lishui, Zhejiang, China
- Zhejiang Clinical Medical Research Centre for Psychiatric and Psychological Disorders, Lishui, Zhejiang, China
- Lishui Key Laboratory of Brain Health and Major Brain Diseases, Lishui, Zhejiang, China
| |
Collapse
|
16
|
Ilioudi M, Wallström S, Steingrimsson S, Lindner P, Thunström AO, Ali L. Patient experience of a virtual reality calm room in a psychiatric inpatient care setting in Sweden: a qualitative study with inpatients. BMJ Open 2023; 13:e076285. [PMID: 38101823 PMCID: PMC10729110 DOI: 10.1136/bmjopen-2023-076285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVE Calm rooms have been developed and implemented in psychiatric inpatient care settings to offer patients a dedicated space for relaxation in a convenient and safe environment. Recent technology developments have enabled virtual reality (VR) equivalents of calm rooms that can be feasibly deployed in psychiatric care settings. While research has shown VR environments to be efficacious in inducing relaxation, little is known how these virtual calm rooms are perceived by patients. The aim of this study was to elucidate patient experiences of using a VR calm room in a psychiatric inpatient setting. DESIGN Qualitative interview study. Semi-structured interviews were analysed using qualitive inductive content analysis, which focuses on the interpretation of texts for making replicable and valid inferences. SETTING Swedish hospital psychiatric inpatient care setting with a wireless, three degrees-of-freedom VR head-mounted display running a calm room application simulating nature environment. PARTICIPANTS 20 adult patients (12 women) with bipolar disorder (n=18) or unipolar depression (n=2). RESULTS Participants experienced the use of the VR calm room as having a positive impact on them, inducing awareness, calmness and well-being. They were thankful to be offered a non-pharmacological alternative for anxiety relief. Participants also expressed that they had some concerns about how they would react emotionally before using the VR device. However, after use, they highlighted that their overall experience was positive. They also expressed that they could see potential for further development of VR technology in psychiatric care. CONCLUSIONS VR technology has the potential to solve pressing logistic issues in offering calm rooms in psychiatric inpatient care. VR calm rooms appear to be appreciated by psychiatric inpatients, who value their accessibility, convenience and variety of modalities offered. Participants perceived an increase in their well-being after use.
Collapse
Affiliation(s)
- Maria Ilioudi
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatric Department, Goteborg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gotheborg, Sweden
| | - Sara Wallström
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatric Department, Goteborg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Forensic Psychiatry, Gothenburg, Sweden
- Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden
| | - Steinn Steingrimsson
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatric Department, Goteborg, Sweden
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Goteborg, Sweden
| | - Philip Lindner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute and Stockholm Health Care Services, Stockholm, Sweden
| | - Almira Osmanovic Thunström
- Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Goteborg, Sweden
| | - Lilas Ali
- Region Västra Götaland, Sahlgrenska University Hospital, Psychiatric Department, Goteborg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gotheborg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
Milton AL. Drug memory reconsolidation: from molecular mechanisms to the clinical context. Transl Psychiatry 2023; 13:370. [PMID: 38040677 PMCID: PMC10692359 DOI: 10.1038/s41398-023-02666-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 12/03/2023] Open
Abstract
Since its rediscovery at the beginning of the 21st Century, memory reconsolidation has been proposed to be a therapeutic target for reducing the impact of emotional memories that can go awry in mental health disorders such as drug addiction (substance use disorder, SUD). Addiction can be conceptualised as a disorder of learning and memory, in which both pavlovian and instrumental learning systems become hijacked into supporting drug-seeking and drug-taking behaviours. The past two decades of research have characterised the details of the molecular pathways supporting the reconsolidation of pavlovian cue-drug memories, with more recent work indicating that the reconsolidation of instrumental drug-seeking memories also relies upon similar mechanisms. This narrative review considers what is known about the mechanisms underlying the reconsolidation of pavlovian and instrumental memories associated with drug use, how these approaches have translated to experimental medicine studies, and the challenges and opportunities for the clinical use of reconsolidation-based therapies.
Collapse
Affiliation(s)
- Amy L Milton
- Department of Psychology, University of Cambridge, Cambridge, UK.
| |
Collapse
|
19
|
Humbert A, Kohls E, Baldofski S, Epple C, Rummel-Kluge C. Acceptability, feasibility, and user satisfaction of a virtual reality relaxation intervention in a psychiatric outpatient setting during the COVID-19 pandemic. Front Psychiatry 2023; 14:1271702. [PMID: 37953932 PMCID: PMC10634536 DOI: 10.3389/fpsyt.2023.1271702] [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: 08/02/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
Background The COVID-19 pandemic was particularly difficult for individuals with mental disorders. Due to governmental restrictions, face-to-face offers for psychiatric outpatients like therapies, psychoeducational groups or relaxation courses were limited. Virtual reality (VR) might be a new possibility to support these patients by providing them with a home-based relaxation tool. Objective The aim of this study was to evaluate the acceptability, feasibility, and user satisfaction of a supportive therapy-accompanying, relaxation VR intervention in psychiatric outpatients during the COVID-19 pandemic in Germany. Methods The four-weeks VR intervention consisted of regular watching of relaxing videos in the participants' home environment. Sociodemographics, feasibility (frequency of use, user-friendliness), satisfaction (Client Satisfaction Questionnaire-8), depressive symptoms (Patient Health Questionnaire-9), quality of life (abbreviated World Health Organization Quality of Life assessment), and credibility and expectancy (Credibility Expectancy Questionnaire-8) were measured in an intention-to-treat (ITT) analysis and a per-protocol (PP) analysis of completers. Results In total, N = 40 patients participated in the study. Most of the participants in the ITT analysis (n = 30, 75.0%) used the VR device three or 4 weeks. A majority of the N = 29 completers (PP: n = 18, 62.1%) used it all 4 weeks. Most participants used the device two or more times a week (ITT: n = 30, 83.3%; PP: n = 26, 89.7%) and described the user-friendliness as rather or very easy (ITT: n = 33, 91.7%; PP: n = 26, 89.7%). User satisfaction was high (ITT: 19.42, SD = 4.08; PP: M = 20.00, SD = 4.19) and did not correlate with participants' sex or age (all p < 0.05). Depressive symptoms and psychological quality of life improved significantly from pre-to post-intervention (ITT and PP, all p < 0.05). Higher pre-intervention credibility significantly correlated with a better outcome of satisfaction (ITT and PP), depressive symptoms, physical, psychological, and social quality of life (PP; all p < 0.05). Conclusion A supportive therapy-accompanying VR relaxation intervention is feasible and acceptable in a psychiatric outpatient setting. Due to the high satisfaction and user-friendliness, VR can be an easy to implement relaxation tool to support psychiatric outpatients. Clinical trial registration https://clinicaltrials.gov/, DRKS00027911.
Collapse
Affiliation(s)
- Annika Humbert
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Elisabeth Kohls
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
| | - Sabrina Baldofski
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | | | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
| |
Collapse
|
20
|
Rejbrand C, Fure B, Sonnby K. Stand-alone virtual reality exposure therapy as a treatment for social anxiety symptoms: a systematic review and meta-analysis. Ups J Med Sci 2023; 128:9289. [PMID: 37807998 PMCID: PMC10552696 DOI: 10.48101/ujms.v128.9289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 08/09/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Social anxiety is common and can have far-reaching implications for affected individuals, both on social life and working performance. Usage of virtual reality exposure therapy (VRET) has gained traction. The aim of the present systematic review was to evaluate the effect of stand-alone VRET on social anxiety symptoms. Method We searched systematically in PubMed, Embase, PSYCinfo, and ERIC in May 2022 for studies with participants with social anxiety symptoms receiving stand-alone VRET. Two reviewers independently selected relevant studies in a two-step procedure, and the risk of bias was assessed. Results Of 158 hits, 7 studies were selected for full-text reading, 6 were chosen for evaluation, and 5 were included in meta-analyses. VRET resulted in a significantly lower anxiety score in treated individuals with a standard mean difference of -0.82, 95% confidence interval -1.52 to -0.13, compared to controls. Conclusion Stand-alone VRET may reduce social anxiety symptoms. However, despite promising results, there is still uncertainty as the effect estimate is based on few studies with few participants each and a high risk of bias.
Collapse
Affiliation(s)
- Christian Rejbrand
- Faculty of Medicine and Health, School of Medical Sciences, Campus USÖ, Örebro, Sweden
| | - Brynjar Fure
- Faculty of Medicine and Health, School of Medical Sciences, Campus USÖ, Örebro, Sweden
- Centre for Clinical Research, Region Värmland, Karlstad, Sweden
| | - Karin Sonnby
- Centre for Clinical Research, Region Värmland, Karlstad, Sweden
- Centre for Clinical Research, Region Västmanland, Västerås, Sweden
| |
Collapse
|
21
|
Kroczek LOH, Mühlberger A. Public speaking training in front of a supportive audience in Virtual Reality improves performance in real-life. Sci Rep 2023; 13:13968. [PMID: 37633990 PMCID: PMC10460391 DOI: 10.1038/s41598-023-41155-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 08/22/2023] [Indexed: 08/28/2023] Open
Abstract
Public speaking is a challenging task that requires practice. Virtual Reality allows to present realistic public speaking scenarios in this regard, however, the role of the virtual audience during practice remains unknown. In the present study, 73 participants completed a Virtual Reality practice session while audience was manipulated to be supportive or unsupportive or presentations were practiced without audience. Importantly, following the virtual practice, participants held the presentation during a real university course via Zoom. We measured emotional experience, self-efficacy, and the subjective evaluation of performance at baseline, after VR practice, and after the real presentation. Additionally, participants' performance in the real presentation was evaluated by instructors (blinded to condition). Supportive in contrast to unsupportive audiences led to more positive believes about one's own performance, while there were no changes in beliefs in the group without audience. Importantly, practice in front of a supportive compared to unsupportive audience resulted in a more positive evaluation of speaker confidence in real-life public speaking as rated by the instructors. These results demonstrate an impact of virtual social feedback during public speaking on subsequent subjective performance evaluation. This may increase self-confidence resulting in actual improved public speaking performance in real-life.
Collapse
Affiliation(s)
- Leon O H Kroczek
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Regensburg, Universitätsstraße 31, 93053, Regensburg, Germany.
| | - Andreas Mühlberger
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Regensburg, Universitätsstraße 31, 93053, Regensburg, Germany
| |
Collapse
|
22
|
Bellinger D, Wehrmann K, Rohde A, Schuppert M, Störk S, Flohr-Jost M, Gall D, Pauli P, Deckert J, Herrmann MJ, Erhardt-Lehmann A. The application of virtual reality exposure versus relaxation training in music performance anxiety: a randomized controlled study. BMC Psychiatry 2023; 23:555. [PMID: 37528410 PMCID: PMC10394851 DOI: 10.1186/s12888-023-05040-z] [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: 05/22/2023] [Accepted: 07/20/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Performance anxiety is the most frequently reported anxiety disorder among professional musicians. Typical symptoms are - on a physical level - the consequences of an increase in sympathetic tone with cardiac stress, such as acceleration of heartbeat, increase in blood pressure, increased respiratory rate and tremor up to nausea or flush reactions. These symptoms can cause emotional distress, a reduced musical and artistical performance up to an impaired functioning. While anxiety disorders are preferably treated using cognitive-behavioral therapy with exposure, this approach is rather difficult for treating music performance anxiety since the presence of a public or professional jury is required and not easily available. The use of virtual reality (VR) could therefore display an alternative. So far, no therapy studies on music performance anxiety applying virtual reality exposure therapy have investigated the therapy outcome including cardiovascular changes as outcome parameters. METHODS This mono-center, prospective, randomized and controlled clinical trial has a pre-post design with a follow-up period of 6 months. 46 professional and semi-professional musicians will be recruited and allocated randomly to an VR exposure group or a control group receiving progressive muscle relaxation training. Both groups will be treated over 4 single sessions. Music performance anxiety will be diagnosed based on a clinical interview using ICD-10 and DSM-5 criteria for specific phobia or social anxiety. A behavioral assessment test is conducted three times (pre, post, follow-up) in VR through an audition in a concert hall. Primary outcomes are the changes in music performance anxiety measured by the German Bühnenangstfragebogen and the cardiovascular reactivity reflected by heart rate variability (HRV). Secondary outcomes are changes in blood pressure, stress parameters such as cortisol in the blood and saliva, neuropeptides, and DNA-methylation. DISCUSSION The trial investigates the effect of VR exposure in musicians with performance anxiety compared to a relaxation technique on anxiety symptoms and corresponding cardiovascular parameters. We expect a reduction of anxiety but also a consecutive improvement of HRV with cardiovascular protective effects. TRIAL REGISTRATION This study was registered on clinicaltrials.gov. (ClinicalTrials.gov Number: NCT05735860).
Collapse
Affiliation(s)
- Daniel Bellinger
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital Würzburg, Würzburg, Germany.
| | - Kristin Wehrmann
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Anna Rohde
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital Würzburg, Würzburg, Germany
| | | | - Stefan Störk
- Department Clinical Research & Epidemiology, Comprehensive Heart Failure Center Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - Michael Flohr-Jost
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), Center for Mental Health, University of Würzburg, Würzburg, Germany
| | - Dominik Gall
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), Center for Mental Health, University of Würzburg, Würzburg, Germany
| | - Paul Pauli
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), Center for Mental Health, University of Würzburg, Würzburg, Germany
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Martin J Herrmann
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Angelika Erhardt-Lehmann
- Department of Psychiatry, Psychosomatics, and Psychotherapy, Center for Mental Health, University Hospital Würzburg, Würzburg, Germany
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| |
Collapse
|
23
|
Luck-Sikorski C, Hochrein R, Döllinger N, Wienrich C, Gemesi K, Holzmann S, Holzapfel C, Weinberger NA. Digital communication and virtual reality for extending the behavioural treatment of obesity - the patients' perspective: results of an online survey in Germany. BMC Med Inform Decis Mak 2023; 23:100. [PMID: 37226164 DOI: 10.1186/s12911-023-02197-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 05/15/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND CBT has been found effective for the treatment of EDs and obesity. However not all patients achieve clinically significant weight loss and weight regain is common. In this context, technology-based interventions can be used to enhance traditional CBT but are not yet widespread. This survey therefore explores the status quo of pathways of communication between patients and therapists, the use of digital applications for therapy as well as attitudes towards VR from the perspective of patients with obesity in Germany. METHODS This cross-sectional online survey was conducted in October 2020. Participants were recruited digitally through social media, obesity associations and self-help groups. The standardized questionnaire included items concerning current treatment, paths of communication with their therapists, and attitudes toward VR. The descriptive analyses were performed with Stata. RESULTS The 152 participants were mostly female (90%), had a mean age of 46.5 years (SD = 9.2) and an average BMI of 43.0 kg/m² (SD = 8.4). Face-to-face communication with their therapist was considered of high importance in current treatment (M = 4.30; SD = 0.86) and messenger apps were the most frequently used digital application for communication. Participants were mostly neutral regarding the inclusion of VR methods in obesity treatment (M = 3.27; SD = 1.19). Only one participant had already used VR glasses as part of treatment. Participants considered VR suitable for exercises promoting body image change (M = 3.40; SD = 1.02). DISCUSSION Technological approaches in obesity therapy are not widespread. Face-to-face communication remains the most important setting for treatment. Participants had low familiarity with VR but a neutral to positive attitude toward the technology. Further studies are needed to provide a clearer picture of potential treatment barriers or educational needs and to facilitate the transfer of developed VR systems into clinical practice.
Collapse
Affiliation(s)
- Claudia Luck-Sikorski
- Research Group "Chronic Diseases and Psychological Health" (COPE), SRH University of Applied Health Sciences, Neue Str. 28-30, 07548, Gera, Germany.
| | - Regine Hochrein
- Research Group "Chronic Diseases and Psychological Health" (COPE), SRH University of Applied Health Sciences, Neue Str. 28-30, 07548, Gera, Germany
| | - Nina Döllinger
- Human-Technology-Systems, University of Würzburg, Würzburg, Germany
| | - Carolin Wienrich
- Human-Technology-Systems, University of Würzburg, Würzburg, Germany
| | - Kathrin Gemesi
- School of Medicine, Institute for Nutritional Medicine, Technical University of Munich, Munich, Germany
| | - Sophie Holzmann
- School of Medicine, Institute for Nutritional Medicine, Technical University of Munich, Munich, Germany
| | - Christina Holzapfel
- School of Medicine, Institute for Nutritional Medicine, Technical University of Munich, Munich, Germany
| | - Natascha-Alexandra Weinberger
- Research Group "Chronic Diseases and Psychological Health" (COPE), SRH University of Applied Health Sciences, Neue Str. 28-30, 07548, Gera, Germany
| |
Collapse
|
24
|
Lohse L, Jelinek L, Moritz S, Blömer J, Bücker L, Miegel F. Efficacy of exposure and response prevention therapy in mixed reality for patients with obsessive-compulsive disorder: study protocol for a randomized controlled trial. BMC Psychol 2023; 11:113. [PMID: 37055854 PMCID: PMC10100604 DOI: 10.1186/s40359-023-01116-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/07/2023] [Indexed: 04/15/2023] Open
Abstract
Many patients with obsessive-compulsive disorder (OCD) do not receive cognitive behavioral therapy with exposure and response prevention (first line treatment for OCD), for example, due to patients' fear of the exposure and reservations of the therapists. Technology-supported exposure (e.g., exposure therapy with response prevention in mixed reality [MERP]) for patients with OCD may help to overcome this obstacle. Building upon findings of our pilot study objectives of this study are to evaluate the efficacy, expectations of treatment success, feasibility, and acceptance of MERP as well as to identify possible limitations. In total, 64 outpatients with contamination-related OCD will be recruited and randomized to one of two conditions: MERP (six sessions in six weeks) and self-guided exposure therapy (six exercises in six weeks). Participants will be assessed before (baseline), after the six-week intervention period (post), as well as three months after post assessment (follow-up) regarding symptomatology (Yale-Brown Obsessive Compulsive Scale; Y-BOCS), their subjective evaluation of MERP (acceptance) and sense of presence. The planned study is the first to investigate MERP in patients with OCD.
Collapse
Affiliation(s)
- Luzie Lohse
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jannik Blömer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Lara Bücker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Franziska Miegel
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| |
Collapse
|
25
|
Lepilkina TА, Beniashvili AG, Cheremin RA, Malyukova NG, Morozova MA, Bogdanov MA, Burminsky DS, Potanin SS, Rodkina SV, Rupchev GE, Eip MN. Efficacy of a Relaxation Scenario in Virtual Reality for the Comorbid Symptoms of Anxiety and Asthenia in a General Hospital Setting: A Pilot Comparative Randomized Open-Label Study. CONSORTIUM PSYCHIATRICUM 2023; 4:38-51. [PMID: 38239567 PMCID: PMC10790732 DOI: 10.17816/cp221] [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: 10/28/2022] [Accepted: 02/14/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND Patients in general hospitals often display concomitant signs of mental maladjustment: low mood, anxiety, apathy, asthenia, all of which can have a negative impact on the course of the underlying disease and the recovery process. One of the non-pharmacological approaches that has gained wider acceptance in medical practice in recent years is the use of procedures based on virtual reality. AIM Assess the efficacy of the new domestic, virtual reality application Flow as relates to symptoms of anxiety and asthenia in patients undergoing inpatient treatment. METHODS The study was open-label and had a comparison group; the patients were assigned to the experimental or control group using a randomization table. The patients were assessed using the Spielberger State Anxiety Inventory; the Fatigue Symptom Rating Scale; the Well-being, Activity, Mood questionnaire; the Depression Anxiety Stress Scale; and the Clinical Global Impression Scale. Physical parameters were measured before and after each virtual reality session. The obtained data were statistically processed. RESULTS The study involved 60 patients. In 40 patients, the treatment program included a course of five daily relaxation sessions in virtual reality; the control group consisted of 20 patients, who were treated in accordance with the usual practice of the institution. The addition of virtual reality sessions to the standard treatment course yielded significant advantage in terms of affective symptoms reduction in patients both after a single session and as a result of undergoing the full course, and several days after its completion. The patients in the experimental group also showed a significant decrease in blood pressure after the sessions, and this was most pronounced in individuals who initially had elevated and high blood pressure. CONCLUSION The use of relaxation program courses in the virtual reality application Flow is an effective and promising means of non-pharmacological care for non-psychiatric inpatients showing symptoms of anxiety, apathy, depressive mood, as well as hypertension.
Collapse
|
26
|
Thaysen-Petersen D, Hammerum SK, Vissing AC, Arnfred BT, Nordahl R, Adjorlu A, Nordentoft M, Oestrich IH, Düring SW, Fink-Jensen A. Virtual reality-assisted cognitive behavioural therapy for outpatients with alcohol use disorder (CRAVR): a protocol for a randomised controlled trial. BMJ Open 2023; 13:e068658. [PMID: 36990475 PMCID: PMC10069573 DOI: 10.1136/bmjopen-2022-068658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION Alcohol use disorder (AUD) is a brain disorder linked to over 200 health conditions. Cognitive behavioural therapy (CBT) is considered the best practice in the treatment of AUD, but more than 60% of patients relapse within the first year after treatment. Psychotherapy combined with virtual reality (VR) has received increasing interest in the treatment of AUD. However, existing studies have primarily investigated the use of VR for cue reactivity. We therefore aimed to investigate the effect of VR-assisted CBT (VR-CBT). METHODS AND ANALYSIS This study is an assessor-blinded, randomised clinical trial being conducted at three outpatient clinics in Denmark. We will randomise 102 patients to 14 individual sessions of either manualised VR-CBT or CBT. The VR-CBT group will receive exposure to immersive high-risk VR situations from a pub, bar/party, restaurant, supermarket and at-home (30 videos) to activate high-risk-related beliefs and cravings for subsequent modification using CBT techniques. The treatment period is 6 months, and follow-up visits will be performed 3, 6, 9 and 12 months after inclusion. The primary outcome measure is the change in total alcohol consumption from baseline to 6 months after inclusion, measured with the Timeline Followback Method. Key secondary outcome measures include changes in the number of heavy drinking days, alcohol cravings, cognition, and symptoms of depression and anxiety. ETHICS AND DISSEMINATION Approval has been obtained by the research ethics committee in the Capital Region of Denmark (H-20082136) and the Danish Data Protection Agency (P-2021-217). All patients will receive both oral and written information about the trial and written informed consent will be obtained from each patient before inclusion. The study results will be disseminated in peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ClinicalTrial.gov, NCT05042180.
Collapse
Affiliation(s)
- Daniel Thaysen-Petersen
- Psychiatric Centre Copenhagen, Department of Neuroscience and Pharmacology, Capital Region of Denmark Mental Health Services, Kobenhavn, Hovedstaden, Denmark
| | - Sigurd Krogh Hammerum
- Psychiatric Centre Copenhagen, Department of Neuroscience and Pharmacology, Capital Region of Denmark Mental Health Services, Kobenhavn, Hovedstaden, Denmark
| | - Anne-Cathrine Vissing
- Psychiatric Centre Copenhagen, Department of Neuroscience and Pharmacology, Capital Region of Denmark Mental Health Services, Kobenhavn, Hovedstaden, Denmark
| | - Benjamin Thorup Arnfred
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Capital Region of Denmark Mental Health Services, Kobenhavn, Hovedstaden, Denmark
| | - Rolf Nordahl
- Multisensory Experience Lab, Department of Architecture and Media Technology, Aalborg Universitet, Copenhagen, Denmark
| | - Ali Adjorlu
- Multisensory Experience Lab, Department of Architecture and Media Technology, Aalborg Universitet, Copenhagen, Denmark
| | - Merete Nordentoft
- Copenhagen Research Center for Mental Health-CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Capital Region of Denmark Mental Health Services, Kobenhavn, Hovedstaden, Denmark
| | - Irene Henriette Oestrich
- Psychiatric Center Sct. Hans, Mental Health Services, Capitol Region Hospitals, Capital Region of Denmark Mental Health Services, Kobenhavn, Hovedstaden, Denmark
| | - Signe Wegmann Düring
- Psychiatric Center Sct. Hans, Mental Health Services, Capitol Region Hospitals, Capital Region of Denmark Mental Health Services, Kobenhavn, Hovedstaden, Denmark
| | - Anders Fink-Jensen
- Psychiatric Center Copenhagen, Rigshospitalet, Mental Health Services, Capitol Region Hospitals, Capital Region of Denmark Mental Health Services, Kobenhavn, Hovedstaden, Denmark
| |
Collapse
|
27
|
Can Virtual Reality-Assisted Therapy Offer Additional Benefits to Patients With Vestibular Disorders Compared With Conventional Vestibular Physical Therapy? A Meta-analysis. Arch Phys Med Rehabil 2023; 104:490-501. [PMID: 36265531 DOI: 10.1016/j.apmr.2022.08.972] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine whether virtual reality-assisted therapy (VRAT) significantly improves the treatment of peripheral or central vestibular disorders when compared with conventional vestibular physical therapy (CVPT) alone. Indicators of vestibular symptoms are used to determine this. DATA SOURCES Two reviewers independently searched PubMed, EMBASE, ClinicalTrials.gov, Web of Science, and the Cochrane Collaboration database from January 2010 to January 2022 for studies reporting on VRAT in vestibular disorders. STUDY SELECTION Randomized controlled trials (RCTs) were included that mainly focused on the following measures: the Dizziness Handicap Inventory (DHI), Simulator Sickness Questionnaire, visual analog scale, and balance measures such as the Activities-specific Balance Confidence Scale (ABC), timed Up and Go test, sensory organization test, and center of pressure. The primary outcome was assessment of symptomatic changes before and after VRAT. DATA EXTRACTION Two authors independently conducted the literature search and selection. After screening, meta-analysis was performed on the RCTs using RevMan 5.3 software. DATA SYNTHESIS The results showed that VRAT produced significantly greater improvement than CVPT alone in scores of DHI-Total (standardized mean difference [SMD]: -7.09, 95% confidence interval [CI]: [-12.17, -2.00], P=.006), DHI-Functional (SMD=-3.66, 95% CI: [-6.34, -0.98], P=.007), DHI-Physical (SMD=-3.14, 95% CI: [-5.46, -0.83], P=.008), and DHI-Emotional (SMD=-3.10, 95% CI: [-5.13, -1.08], P=.003). ABC scores did not show improvement (SMD: 0.58, 95% CI: [-3.69, 4.85], P=.79). Subgroup analysis showed that DHI-Total between-group differences were insignificant for central vestibular disorders (SMD=-1.47, 95% CI: [-8.71, -5.78], P=.69), although peripheral disorders showed significant improvements (SMD=-9.58, 95% CI: [-13.92, -5.25], P<.0001). However, the included studies showed high heterogeneity (I2>75%). CONCLUSIONS VRAT may offer additional benefits for rehabilitation from vestibular diseases, especially peripheral disorders, when compared with CVPT alone. However, because of high heterogeneity and limited data, additional studies with a larger sample size and more sensitive and specific measurements are required to conclusively determine the evidence-based utility of virtual reality.
Collapse
|
28
|
An internet-based self-applied rat phobia treatment using a Virtual Therapy Assistant: Study protocol for a randomized controlled trial. PLoS One 2023; 18:e0281338. [PMID: 36791089 PMCID: PMC9931099 DOI: 10.1371/journal.pone.0281338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 01/09/2023] [Indexed: 02/16/2023] Open
Abstract
Specific phobias are a common anxiety disorder that deteriorates the lives of people who suffer from them. To reduce the symptoms produced by this mental disorder exposure therapies have been used. However, low- and middle-income countries, including Mexico, have the lowest rate of treatment due to multiple barriers that prevent addressing mental health problems. Self-applied treatments have been explored in previous studies, nevertheless, high dropout rates are a common problem in this kind of treatment. An alternative is using immersive self-applied treatments that could help increase adherence to the treatment. This article aims to present a study protocol to explore the feasibility of an Internet self-applied exposure treatment for rat phobias, using four types of immersive multimedia elements: images, videos, video games, and 360° videos. Also, the satisfaction and perception of a Virtual Therapy Assistant (VTA) that provides information and support to the user are described. The study protocol will compare two groups of participants, one on the waiting list, and the other will receive the self-applied treatment for rat phobia supported by the VTA. For this study, 45 participants will be recruited and the evaluation measures will be taken at four different times: baseline, post-treatment, and follow-ups at 3 and 6 months. The levels of anxiety and avoidance of the user manifested during the exposure to the multimedia elements, the improvement of the user's clinical symptoms, the level of satisfaction, the perception of effectiveness, and ease of use of the self-applied system will be evaluated. This study is expected to support the viability of self-applied treatment for rat phobias and the use of a VTA, showing the impact on treatment adherence. To the best of our knowledge, this is the first study to explore an exposure treatment for rats using different multimedia elements with the support of a VTA. The work will serve as a basis for the development of new virtual assistants that help in the treatment of other types of specific phobias. This research has been registered in Clinical Trials NCT (NCT05081323).
Collapse
|
29
|
Chowdhury N, Khandoker AH. The gold-standard treatment for social anxiety disorder: A roadmap for the future. Front Psychol 2023; 13:1070975. [PMID: 36755980 PMCID: PMC9901528 DOI: 10.3389/fpsyg.2022.1070975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/30/2022] [Indexed: 01/19/2023] Open
Abstract
Exposure therapy (ET), which follows the Pavlovian extinction model, is regarded as the gold-standard treatment for social anxiety disorder (SAD). The prospect of virtual reality in lieu of a traditional laboratory setting for the treatment of SAD has not been rigorously explored. The aim of the review was to summarize, find gaps in the current literature, and formulate future research direction by identifying two broad research questions: the comparative efficacy between in vivo ET and virtual reality exposure therapy (VRET) and the effectiveness of the Pavlovian extinction model in treating SAD. The criteria for effectiveness were effect size, relapse prevention, attrition rate and ecological validity. A literature search on recent randomized controlled trials yielded a total of 6 original studies (N=358), excluding duplication and overlapping participants. All studies supported that VRET was as effective as in vivo ET. Behavioral therapy that follows classical conditioning principles has a high attrition and relapse rate. Comparisons were drawn between the efficacy of the Pavlovian extinction model and other existing models, including third-wave approaches. The neural markers are suggested to be included as efficacy measures in treating SAD. The gold-standard treatment for SAD requires a paradigm shift through rigorous longitudinal comparative studies.
Collapse
Affiliation(s)
- Nayeefa Chowdhury
- School of Psychological Sciences, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, VIC, Australia,*Correspondence: Nayeefa Chowdhury, ✉
| | - Ahsan H. Khandoker
- Healthcare Engineering Innovation Center, Department of Biomedical Engineering, Khalifa University, Abu Dhabi, United Arab Emirates
| |
Collapse
|
30
|
Tchao D, Lewis-Fung S, Gray H, Pardini S, Harris LR, Appel L. Describing epilepsy-related anxiety to inform the design of a virtual reality exposure therapy: Results from Phase 1 of the AnxEpiVR clinical trial. Epilepsy Behav Rep 2023; 21:100588. [PMID: 36794093 PMCID: PMC9922786 DOI: 10.1016/j.ebr.2023.100588] [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: 10/16/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/18/2023] Open
Abstract
People with epilepsy (PwE) are at a greater risk of comorbid anxiety, which is often related to the fear of having another seizure for safety or social reasons. While virtual reality (VR) exposure therapy (ET) has been successfully used to treat several anxiety disorders, no studies to date have investigated its use in this population. This paper discusses Phase 1 of the three-phase AnxEpiVR pilot study. In Phase 1, we aimed to explore and validate scenarios that provoke epilepsy/seizure-specific (ES) interictal anxiety and provide recommendations that lay the foundation for designing VR-ET scenarios to treat this condition in PwE. An anonymous online questionnaire (including open- and closed-ended questions) that targeted PwE and those affected by it (e.g., through a family member, friend, or as a healthcare professional) was promoted by a major epilepsy foundation in Toronto, Canada. Responses from n = 18 participants were analyzed using grounded theory and the constant comparison method. Participants described anxiety-provoking scenes, which were categorized under the following themes: location, social setting, situational, activity, physiological, and previous seizure. While scenes tied to previous seizures were typically highly personalized and idiosyncratic, public settings and social situations were commonly reported fears. Factors consistently found to increase ES-interictal anxiety included the potential for danger (physical injury or inability to get help), social factors (increased number of unfamiliar people, social pressures), and specific triggers (stress, sensory, physiological, and medication-related). We make recommendations for incorporating different combinations of anxiety-related factors to achieve a customizable selection of graded exposure scenarios suitable for VR-ET. Subsequent phases of this study will include creating a set of VR-ET hierarchies (Phase 2) and rigorously evaluating their feasibility and effectiveness (Phase 3).
Collapse
Affiliation(s)
| | | | - Hannah Gray
- Faculty of Health, Department of Psychology, York University, Toronto, ON, Canada,Faculty of Science, Department of Biology, York University, Toronto, ON, Canada
| | - Susanna Pardini
- OpenLab, University Health Network, Toronto, ON, Canada,Department of General Psychology, University of Padova, Padova, Italy,Digital Health Lab, Centre for Health and Wellbeing, Bruno Kessler Foundation, Trento, Italy
| | - Laurence R. Harris
- Faculty of Health, Department of Psychology, York University, Toronto, ON, Canada
| | - Lora Appel
- OpenLab, University Health Network, Toronto, ON, Canada,Faculty of Health, School of Health Policy and Management, York University, Toronto, ON, Canada,Michael Garron Hospital, Toronto, ON, Canada,Corresponding author at: 242 Roselawn Ave, Toronto, Ontario, M4R 1E9, Canada.
| |
Collapse
|
31
|
Andreatta M, Winkler MH, Collins P, Gromer D, Gall D, Pauli P, Gamer M. VR for Studying the Neuroscience of Emotional Responses. Curr Top Behav Neurosci 2023; 65:161-187. [PMID: 36592276 DOI: 10.1007/7854_2022_405] [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: 06/17/2023]
Abstract
Emotions are frequently considered as the driving force of behavior, and psychopathology is often characterized by aberrant emotional responding. Emotional states are reflected on a cognitive-verbal, physiological-humoral, and motor-behavioral level but to date, human research lacks an experimental protocol for a comprehensive and ecologically valid characterization of such emotional states. Virtual reality (VR) might help to overcome this situation by allowing researchers to study mental processes and behavior in highly controlled but reality-like laboratory settings. In this chapter, we first elucidate the role of presence and immersion as requirements for eliciting emotional states in a virtual environment and discuss different VR methods for emotion induction. We then consider the organization of emotional states on a valence continuum (i.e., from negative to positive) and on this basis discuss the use of VR to study threat processing and avoidance as well as reward processing and approach behavior. Although the potential of VR has not been fully realized in laboratory and clinical settings yet, this technological tool can open up new avenues to better understand the neurobiological mechanisms of emotional responding in healthy and pathological conditions.
Collapse
Affiliation(s)
- Marta Andreatta
- Department of Psychology, Educational Sciences, and Child Studies, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Markus H Winkler
- Department of Psychology, University of Wuerzburg, Wuerzburg, Germany
| | - Peter Collins
- Department of Psychology, University of Wuerzburg, Wuerzburg, Germany
| | - Daniel Gromer
- Department of Psychology, University of Wuerzburg, Wuerzburg, Germany
| | - Dominik Gall
- Department of Psychology, University of Wuerzburg, Wuerzburg, Germany
| | - Paul Pauli
- Department of Psychology, University of Wuerzburg, Wuerzburg, Germany
| | - Matthias Gamer
- Department of Psychology, University of Wuerzburg, Wuerzburg, Germany.
| |
Collapse
|
32
|
Bagnall R, Cadman A, Russell A, Brosnan M, Otte M, Maras KL. Police suspect interviews with autistic adults: The impact of truth telling versus deception on testimony. Front Psychol 2023; 14:1117415. [PMID: 37034927 PMCID: PMC10074602 DOI: 10.3389/fpsyg.2023.1117415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/28/2023] [Indexed: 04/11/2023] Open
Abstract
Investigative interviews by police are socially and cognitively demanding encounters, likely presenting significant challenges to those on the autism spectrum. Behavioral and communication differences mean that autistic people may also be more likely to be perceived as deceptive in the context of an investigative interview. In the present study, 32 autistic and 33 (age and IQ-matched) non-autistic adults took part in a novel virtual burglary scenario in either an 'innocent' or 'guilty' condition. In a subsequent mock-police interview, innocent suspects were instructed to tell the truth about what they did, while guilty suspects were instructed to lie in order to convince the interviewer of their innocence. In the mock-interviews, innocent autistic mock-suspects reported fewer details that would support their innocence than non-autistic mock-suspects, although both innocent and guilty autistic and non-autistic mock-suspects reported similar levels of investigation-relevant information and had similar levels of statement-evidence consistency. In post-interview questionnaires, innocent and guilty autistic mock-suspects self-reported greater difficulty in understanding interview questions, higher anxiety and perceived the interview as less supportive than non-autistic participants. Implications for investigative interviewing with autistic suspects and cues to deception are discussed.
Collapse
Affiliation(s)
- Ralph Bagnall
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, United Kingdom
- *Correspondence: Ralph Bagnall,
| | - Aimee Cadman
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, United Kingdom
| | - Ailsa Russell
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, United Kingdom
| | - Mark Brosnan
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, United Kingdom
| | - Marco Otte
- Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Katie L. Maras
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, United Kingdom
| |
Collapse
|
33
|
Tsamitros N, Beck A, Sebold M, Schouler-Ocak M, Bermpohl F, Gutwinski S. [The application of virtual reality in the treatment of mental disorders]. DER NERVENARZT 2023; 94:27-33. [PMID: 36053303 PMCID: PMC9859917 DOI: 10.1007/s00115-022-01378-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Virtual reality (VR) enables immersion in an interactive digital world with realistic experiences, that can be applied for controlled and personalized interventions. This review summarizes the current research on VR in the treatment of mental disorders. METHODS Selective literature search in PubMed and Google Scholar. RESULTS An increasing number of publications report the therapeutic application of VR for the treatment of mental disorders. Most VR applications are based on established therapy approaches, such as exposure therapy. According to meta-analytic data, virtual exposure therapy (VRET) for specific phobia and agoraphobia with panic disorder is as effective as traditional in vivo exposure therapy. VRET for the treatment of social phobia is significantly more effective than waitlist and placebo control groups with, however, currently inconsistent metanalytic results when compared to in vivo exposure therapy. VRET for the treatment of posttraumatic stress disorder (PTSD) is similar in effectiveness compared to active psychotherapy. For psychosis, positive results have been reported for the VR-based treatment of auditory verbal hallucinations. For patients with a substance use disorder, VR can induce craving, with still unverified diagnostic and therapeutic relevance. CONCLUSIONS VRET can broaden the psychotherapy options for anxiety disorders. Encouraging results of VR-based treatments for psychosis and PTSD indicate the need for further research concerning its effectiveness and safety. In the field of substance use disorders, evaluation of clinical-orientated VR applications is needed.
Collapse
Affiliation(s)
- N. Tsamitros
- Psychiatrische Universitätsklinik der Charité – Universitätsmedizin Berlin im St. Hedwig-Krankenhaus/Institutsambulanz, Müllerstr. 56–58, 13349 Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - A. Beck
- Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland ,Fakultät Gesundheit, Health and Medical University, Campus Potsdam, Potsdam, Deutschland
| | - M. Sebold
- Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - M. Schouler-Ocak
- Psychiatrische Universitätsklinik der Charité – Universitätsmedizin Berlin im St. Hedwig-Krankenhaus/Institutsambulanz, Müllerstr. 56–58, 13349 Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - F. Bermpohl
- Psychiatrische Universitätsklinik der Charité – Universitätsmedizin Berlin im St. Hedwig-Krankenhaus/Institutsambulanz, Müllerstr. 56–58, 13349 Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| | - S. Gutwinski
- Psychiatrische Universitätsklinik der Charité – Universitätsmedizin Berlin im St. Hedwig-Krankenhaus/Institutsambulanz, Müllerstr. 56–58, 13349 Berlin, Deutschland ,Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Deutschland
| |
Collapse
|
34
|
Wiebe A, Kannen K, Selaskowski B, Mehren A, Thöne AK, Pramme L, Blumenthal N, Li M, Asché L, Jonas S, Bey K, Schulze M, Steffens M, Pensel MC, Guth M, Rohlfsen F, Ekhlas M, Lügering H, Fileccia H, Pakos J, Lux S, Philipsen A, Braun N. Virtual reality in the diagnostic and therapy for mental disorders: A systematic review. Clin Psychol Rev 2022; 98:102213. [PMID: 36356351 DOI: 10.1016/j.cpr.2022.102213] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 08/21/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Virtual reality (VR) technologies are playing an increasingly important role in the diagnostics and treatment of mental disorders. OBJECTIVE To systematically review the current evidence regarding the use of VR in the diagnostics and treatment of mental disorders. DATA SOURCE Systematic literature searches via PubMed (last literature update: 9th of May 2022) were conducted for the following areas of psychopathology: Specific phobias, panic disorder and agoraphobia, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, dementia disorders, attention-deficit/hyperactivity disorder, depression, autism spectrum disorder, schizophrenia spectrum disorders, and addiction disorders. ELIGIBILITY CRITERIA To be eligible, studies had to be published in English, to be peer-reviewed, to report original research data, to be VR-related, and to deal with one of the above-mentioned areas of psychopathology. STUDY EVALUATION For each study included, various study characteristics (including interventions and conditions, comparators, major outcomes and study designs) were retrieved and a risk of bias score was calculated based on predefined study quality criteria. RESULTS Across all areas of psychopathology, k = 9315 studies were inspected, of which k = 721 studies met the eligibility criteria. From these studies, 43.97% were considered assessment-related, 55.48% therapy-related, and 0.55% were mixed. The highest research activity was found for VR exposure therapy in anxiety disorders, PTSD and addiction disorders, where the most convincing evidence was found, as well as for cognitive trainings in dementia and social skill trainings in autism spectrum disorder. CONCLUSION While VR exposure therapy will likely find its way successively into regular patient care, there are also many other promising approaches, but most are not yet mature enough for clinical application. REVIEW REGISTRATION PROSPERO register CRD42020188436. FUNDING The review was funded by budgets from the University of Bonn. No third party funding was involved.
Collapse
Affiliation(s)
- Annika Wiebe
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Kyra Kannen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Benjamin Selaskowski
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Aylin Mehren
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Ann-Kathrin Thöne
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lisa Pramme
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Nike Blumenthal
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Mengtong Li
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Laura Asché
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Stephan Jonas
- Institute for Digital Medicine, University Hospital Bonn, Bonn, Germany
| | - Katharina Bey
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Marcel Schulze
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Maria Steffens
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Max Christian Pensel
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Matthias Guth
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Felicia Rohlfsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Mogda Ekhlas
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Helena Lügering
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Helena Fileccia
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Julian Pakos
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Niclas Braun
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.
| |
Collapse
|
35
|
Therapeutic Alliance and Treatment Expectations: Predicting Outcomes in Exposure Treatments for Specific Phobia. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10343-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
36
|
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.
Collapse
|
37
|
Preliminary Study of Efficacy and Safety of Self-Administered Virtual Exposure Therapy for Social Anxiety Disorder vs. Cognitive-Behavioral Therapy. Brain Sci 2022; 12:brainsci12091236. [PMID: 36138972 PMCID: PMC9496986 DOI: 10.3390/brainsci12091236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/05/2022] [Accepted: 09/05/2022] [Indexed: 12/02/2022] Open
Abstract
Social anxiety disorder (SAD) is one of the most frequent mental disorders. Exposure to virtual reality can be a solution complementing standard CBT (cognitive-behavioral therapy) or can be used as an independent therapeutic tool. The study’s objective was to assess the safety and efficacy of using self-administered virtual reality exposure vs. CBT and CBT with virtual exposure. We assessed the efficacy of the applied intervention with the Leibowitz Social Anxiety Scale (LSAS). We compared three groups: CBT (n = 25), CBT + VR (n = 29), and self-administered therapy without aid of a therapist (n = 19). The results indicated that all three groups showed changes on the LSAS. The simple effect analysis showed that there were no differences between experimental conditions at T0 (session 1) and T1 (session 9) and that the only significant difference occurred at T2 (session 14). The pairwise comparisons showed that the participants in the VR condition scored higher on the LSAS score during the measurement at T2 than participants in CBT condition. Our study has several limitations. The presented initial study shows that the methods of CBT for social anxiety used so far are also effective, while the VR tool for self-therapy requires further research.
Collapse
|
38
|
Sarpourian F, Samad‐Soltani T, Moulaei K, Bahaadinbeigy K. The effect of virtual reality therapy and counseling on students' public speaking anxiety. Health Sci Rep 2022; 5:e816. [PMID: 36189405 PMCID: PMC9489082 DOI: 10.1002/hsr2.816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 08/04/2022] [Accepted: 08/17/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Fatemeh Sarpourian
- Medical Informatics Research Center, Institute for Futures Studies in Health Kerman University of Medical Sciences Kerman Iran
| | - Taha Samad‐Soltani
- Department of Health Information Management, School of Management and Medical Informatics Tabriz University of Medical Sciences Tabriz Iran
| | - Khadijeh Moulaei
- Medical Informatics Research Center, Institute for Futures Studies in Health Kerman University of Medical Sciences Kerman Iran
| | - Kambiz Bahaadinbeigy
- Medical Informatics Research Center, Institute for Futures Studies in Health Kerman University of Medical Sciences Kerman Iran
| |
Collapse
|
39
|
Polak M, Tanzer N, Carlbring P. PROTOCOL: Effects of virtual reality exposure therapy versus in vivo exposure in treating social anxiety disorder in adults: A systematic review and meta-analysis. CAMPBELL SYSTEMATIC REVIEWS 2022; 18:e1259. [PMID: 36909890 PMCID: PMC9246294 DOI: 10.1002/cl2.1259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This is the protocol for a Campbell systematic review. The objectives are as follows: (a) to quantify the effect sizes for virtual reality exposure therapy (VRET) in the treatment of social anxiety disorder (SAD), targeting primary social anxiety symptoms, comorbid anxiety and depression symptoms and improvements in quality of life, when compared to WL, information control, care-as-usual and placebo; (b) to compare VRET to in vivo cognitive and cognitive-behavioral interventions in treating SAD, at posttest and follow-up, using between-group design; (c) to identify the key features which are linked to beneficial outcomes in the two formats in treating SAD and (d) to collect and interpret information on differences in treatment uptake, adherence and attrition, as well as clinical significance and therapist-time in both treatment formats.
Collapse
Affiliation(s)
- Martin Polak
- Department of PsychologyUniversity of GrazGrazAustria
| | | | - Per Carlbring
- Department of PsychologyStockholm UniversityStockholmSweden
| |
Collapse
|
40
|
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]
|
41
|
Sunkara C, Thakkar R, Ong T, Bunnell BE. Characterizing Consumer Smartphone Apps for Virtual Reality-Based Exposure Therapy: Content Analysis (Preprint). J Med Internet Res 2022; 25:e41807. [PMID: 37058343 PMCID: PMC10148210 DOI: 10.2196/41807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/18/2022] [Accepted: 03/15/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND In vivo exposure therapy is the most effective treatment for phobias but is often impractical. Virtual reality exposure therapy (VRET) can help overcome critical barriers to in vivo exposure therapy. However, accessible mobile software related to VRET is not well understood. OBJECTIVE The purpose of our study is to describe the landscape of accessible smartphone apps with potential utility for clinical VRET. METHODS We conducted a content analysis of publicly available smartphone apps related to virtual reality on the Google Play Store and the Apple App Store as of March 2020. RESULTS The initial search yielded 525 apps, with 84 apps (52 on the Google Play Store and 32 on the Apple App Store) included for analysis. The most common phobic stimulus depicted was bodies of water or weather events (25/84, 29.8%), followed by heights (24/84, 28.6%), and animals (23/84, 27.4%). More than half of the apps were visually abstract (39/84, 53.5%). Most apps were free to use (48/84, 57.1%), while the rest were free to try (22/84, 26.2%) or required payment for use (14/84, 16.7%), with the highest cost for use being US $6. The average overall app rating was 2.9 stars out of 5, but the number of ratings ranged from 0 to 49,233. None of the 84 apps advertised compliance with the Health Insurance Portability and Accountability Act, offered the ability to monitor data, provided clinician control over variables in the app experiences, or explicitly stated use by or development with clinicians. CONCLUSIONS None of the smartphone apps reviewed were explicitly developed for phobia therapy. However, 16 of the 84 included apps were considered ideal candidates to investigate further as part of treatment due to their accessibility, depiction of phobia-relevant stimuli, low or no cost, and high user scores. Most of these apps were visually abstract and free to use, making them accessible and potentially flexible as part of clinical exposure hierarchies. However, none of the apps were designed for clinical use, nor did they provide tools for clinician workflows. Formal evaluation of these accessible smartphone apps is needed to understand the clinical potential of accessible VRET solutions.
Collapse
Affiliation(s)
- Charvi Sunkara
- Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Rajvi Thakkar
- Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Triton Ong
- Doxy.me Research, Doxy.me Inc, Rochester, NY, United States
| | - Brian E Bunnell
- Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
- Doxy.me Research, Doxy.me Inc, Rochester, NY, United States
| |
Collapse
|
42
|
Lacey C, Frampton C, Beaglehole B. oVRcome - Self-guided virtual reality for specific phobias: A randomised controlled trial. Aust N Z J Psychiatry 2022; 57:736-744. [PMID: 35818296 DOI: 10.1177/00048674221110779] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Mobile health applications for mental health are widely accessible but most have had limited research evaluation. Virtual reality exposure therapy is an emerging treatment for specific phobias. Most virtual reality studies have investigated high-end virtual reality devices, typically only available in research and limited clinical settings for a single phobia. This study evaluated the effectiveness of oVRcome, a mobile health application combining self-guided virtual reality exposure and cognitive behaviour therapy, for five specific phobias. METHODS This is a 2-arm 6-week randomised controlled trial, with a waitlist control group and follow-up at week 12. Participants were required to live in New Zealand; be aged 18-64 years; have a fear of flying, heights, spiders, dogs and needles; score above 4 on the Brief Standard Self-rating scale for phobic patients; and have access to a smartphone and Internet. oVRcome consists of six modules of psychoeducation, relaxation, mindfulness, cognitive techniques, exposure through virtual reality and relapse prevention over 6 weeks. The primary outcome was the change from baseline to week 6 on the Severity Measures for Specific Phobia - Adults. All analyses were performed on intention-to-treat set. RESULTS A total of 126 participants were randomised, and 109 completed the follow-up at week 6, for a retention rate of 86.5%. The mean change in Severity Measures for Specific Phobia - Adults score from baseline to week 6 was greater in the active group compared with the waitlist group (active group -20.53 [standard deviation = 8.24]; waitlist group: - 12.31 [standard deviation = 10.66]; p < 0.001). The effect size for this difference was 0.86. CONCLUSION Self-guided use of the oVRcome app was effective at reducing severity of specific phobia symptoms in a sample of people with a self-reported fear of flying, heights, spiders, dogs or needles.Trial registry clinicaltrials.gov NCT04909177.
Collapse
Affiliation(s)
- Cameron Lacey
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Chris Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Ben Beaglehole
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| |
Collapse
|
43
|
Pallavicini F, Orena E, di Santo S, Greci L, Caragnano C, Ranieri P, Vuolato C, Pepe A, Veronese G, Stefanini S, Achille F, Dakanalis A, Bernardelli L, Sforza F, Rossini A, Caltagirone C, Fascendini S, Clerici M, Riva G, Mantovani F. A virtual reality home-based training for the management of stress and anxiety among healthcare workers during the COVID-19 pandemic: study protocol for a randomized controlled trial. Trials 2022; 23:451. [PMID: 35655231 PMCID: PMC9161181 DOI: 10.1186/s13063-022-06337-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/23/2022] [Indexed: 01/08/2023] Open
Abstract
Background Healthcare workers represent one of the most affected categories by the adverse effects of the COVID-19 pandemic on mental health. Excessive stress and anxiety are critical factors that could compromise work performance. Besides, high levels of stress and anxiety may have long-term physical and psychological consequences. Recent studies investigated virtual reality to reduce stress and anxiety among healthcare workers during the COVID-19 pandemic. However, the proposed virtual reality interventions have important limitations related to their location (i.e., research lab and hospitals) and content (i.e., virtual experiences only for relaxation). Within this context, this randomized controlled trial aims to investigate the efficacy and acceptability of a brief home-based virtual reality training for managing stress and anxiety during the COVID-19 crisis in a sample of Italian healthcare workers. Methods The study is a randomized controlled trial. It includes two groups of 30 individuals recruited from healthcare workers: (1) the experimental group and (2) the control group. Participants in the experimental group will receive a training consisting of three home sessions performed in a week. In each session, participants will try through an immersive virtual reality standalone system (i.e., Oculus Quest 2) a virtual psychoeducation experience on stress and anxiety (i.e., MIND-VR). Subsequently, they will try the virtual relaxation content (i.e., The Secret Garden). The control group will receive no training and will be reassessed one week and one month after the initial evaluation. Discussion If the proposed brief home-based virtual reality training will result helpful and easy to use, it could become an empirically assessed viable option for protecting healthcare workers’ mental health both during the COVID-19 pandemic and once it will be over. Furthermore, the intervention might be easily adapted for other categories of people who need support in managing stress and anxiety. Trial registration ClinicalTrials.gov NCT04611399.
Collapse
Affiliation(s)
- Federica Pallavicini
- Department of Human Sciences for Education, University of Milano Bicocca, Riccardo Massa", Milan, Italy.
| | - Eleonora Orena
- Foundation IRCCS, Neurological Institute Carlo Besta, Milan, Italy
| | - Simona di Santo
- IRCCS Fondazione Santa Lucia, Rome, Italy.,Università Degli Studi Di Roma Tor Vergata, Rome, Italy
| | - Luca Greci
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing (STIIMA), National Research Council of Italy (CNR), Lecco, Italy
| | - Chiara Caragnano
- University of Milano Bicocca, Department of Psychology, Milan, Italy
| | - Paolo Ranieri
- University of Milano-Bicocca, Specialization School in Psychology, Lecco, Italy
| | - Costanza Vuolato
- Foundation IRCCS, Neurological Institute Carlo Besta, Milan, Italy
| | - Alessandro Pepe
- Department of Human Sciences for Education, University of Milano Bicocca, Riccardo Massa", Milan, Italy
| | - Guido Veronese
- Department of Human Sciences for Education, University of Milano Bicocca, Riccardo Massa", Milan, Italy
| | | | | | - Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | | | | | | | | | - Sara Fascendini
- Fondazione Europea Ricerca Biomedica (FERB), Gazzaniga, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Giuseppe Riva
- Humane Technology Lab, Università Cattolica del Sacro Cuore, Milan, Italy.,Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milan, Italy
| | - Fabrizia Mantovani
- Department of Human Sciences for Education, University of Milano Bicocca, Riccardo Massa", Milan, Italy
| |
Collapse
|
44
|
Planert J, Machulska A, Hildebrand AS, Roesmann K, Otto E, Klucken T. Self-guided digital treatment with virtual reality for panic disorder and agoraphobia: a study protocol for a randomized controlled trial. Trials 2022; 23:426. [PMID: 35597959 PMCID: PMC9123669 DOI: 10.1186/s13063-022-06366-x] [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: 02/05/2022] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background Cognitive behavioral therapy is the first-line treatment for patients with panic disorder (PD) and agoraphobia (AG). Yet, many patients remain untreated due to limited treatment resources. Digital self-guided short-term treatment applications may help to overcome this issue. While some therapeutic applications are already supported by health insurance companies, data on their efficacy is limited. The current study investigates the effect of self-guided digital treatment comprising psychoeducation and virtual reality exposure therapy (VRET). Methods Thirty patients diagnosed with PD, AG, or panic disorder with agoraphobia (PDA) will be randomly assigned to either the experimental group (EG) or the control group (CG). Participants of both groups will undergo baseline diagnostics in the first two sessions. The subsequent treatment for the EG consists of a self-guided 6-week phase of application-based psychoeducation, one therapy session preparing for the VRET, and 4 weeks of application-based self-guided VRET. To control for the potential effects of the therapy session with the therapist, the CG will receive relaxation and stress-reduction training instead. All patients will then undergo a closing session which terminates with the post-assessment (~ 10 weeks after baseline assessment) and a follow-up assessment 6 weeks following the closing session. Symptom severity (primary outcome) will be assessed at baseline, interim, post-treatment, and follow-up. Additionally, remission status (secondary outcome) will be obtained at follow-up. Both measures will be compared between the groups. Discussion The current study aims at providing insights into the efficacy of short-term treatment applications including psychoeducation and self-guided VRET. If successful, this approach might be a feasible and promising way to ease the burden of PD, AG, and PDA on the public health system and contribute to a faster access to treatment. Trial registration ISRCTN ISRCTN10661970. Prospectively registered on 17 January 2022. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06366-x.
Collapse
Affiliation(s)
- Jari Planert
- Department of Clinical Psychology and Psychotherapy, University of Siegen, Obergraben 23, 57072, Siegen, Germany.
| | - Alla Machulska
- Department of Clinical Psychology and Psychotherapy, University of Siegen, Obergraben 23, 57072, Siegen, Germany
| | - Anne-Sophie Hildebrand
- Department of Clinical Psychology and Psychotherapy, University of Siegen, Obergraben 23, 57072, Siegen, Germany
| | - Kati Roesmann
- Department of Clinical Psychology and Psychotherapy, University of Siegen, Obergraben 23, 57072, Siegen, Germany
| | - Esra Otto
- Department of Clinical Psychology and Psychotherapy, University of Siegen, Obergraben 23, 57072, Siegen, Germany
| | - Tim Klucken
- Department of Clinical Psychology and Psychotherapy, University of Siegen, Obergraben 23, 57072, Siegen, Germany
| |
Collapse
|
45
|
Hildebrand AS, Roesmann K, Planert J, Machulska A, Otto E, Klucken T. Self-guided virtual reality therapy for social anxiety disorder: a study protocol for a randomized controlled trial. Trials 2022; 23:395. [PMID: 35549980 PMCID: PMC9097393 DOI: 10.1186/s13063-022-06320-x] [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] [Received: 02/17/2022] [Accepted: 04/19/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Social anxiety disorder (SAD) is a highly prevalent mental disorder associated with enormous stress and suffering. Cognitive behavior therapy (CBT) is the first-line treatment for SAD, yet its accessibility is often constrained with long waiting times. Digital therapeutic applications, including psychoeducation and self-guided behavioral experiments in virtual reality (VR), could facilitate access and reduce waiting times. The study aims to investigate if ultra-short-time therapy involving self-guided digital therapeutic applications with VR components can reduce the severity of SAD. METHODS Forty SAD patients will participate in this randomized controlled trial. Half will get access to a self-guided, digital therapeutic application with exposure-based behavioral experiments in VR, while the other half will receive a control treatment. Both treatments include four therapeutic appointments. Changes in the severity of SAD will be measured after each appointment and on a 6-week follow-up assessment and will be compared between groups, with the change in SAD measured at baseline- and post-assessment as primary outcome. DISCUSSION Self-guided digital therapeutic applications including ultra-short-time therapy combined with VR could help reduce the waiting time for patients and relieve the health system. The results of this study may inform psychotherapists regarding the potential of self-guided digital therapeutic applications including exposure-based behavioral experiments in VR for SAD and will provide important insight for future research on VR therapy. TRIAL REGISTRATION Current Controlled Trials ISRCTN18013983 . Registered on 1 February 2022.
Collapse
Affiliation(s)
- Anne Sophie Hildebrand
- Department of Clinical Psychology and Psychotherapy, University of Siegen, Obergraben 23, 57072 Siegen, Germany
| | - Kati Roesmann
- Department of Clinical Psychology and Psychotherapy, University of Siegen, Obergraben 23, 57072 Siegen, Germany
| | - Jari Planert
- Department of Clinical Psychology and Psychotherapy, University of Siegen, Obergraben 23, 57072 Siegen, Germany
| | - Alla Machulska
- Department of Clinical Psychology and Psychotherapy, University of Siegen, Obergraben 23, 57072 Siegen, Germany
| | - Esra Otto
- Department of Clinical Psychology and Psychotherapy, University of Siegen, Obergraben 23, 57072 Siegen, Germany
| | - Tim Klucken
- Department of Clinical Psychology and Psychotherapy, University of Siegen, Obergraben 23, 57072 Siegen, Germany
| |
Collapse
|
46
|
Elphinston RA, Vaezipour A, Fowler JA, Russell TG, Sterling M. Psychological therapy using virtual reality for treatment of driving phobia: a systematic review. Disabil Rehabil 2022; 45:1582-1594. [PMID: 35532316 DOI: 10.1080/09638288.2022.2069293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Driving phobia is prevalent in injured individuals following motor vehicle crashes (MVCs). The evidence for virtual reality (VR) based psychological treatments for driving phobia is unknown. This systematic review synthesized the available evidence on the effectiveness, feasibility, and user experience of psychological treatments for driving phobia using VR. METHODS Three databases (PsycINFO, SCOPUS, and PubMed) were searched. Eligibility criteria included adults with clinical or sub-clinical levels of driving phobia manifesting as part of an anxiety disorder or post-traumatic stress disorder (PTSD). Primary outcomes were driving-related anxiety/fear or avoidance, PTSD symptoms and driving frequency/intensity, as well as treatment feasibility including recruitment, treatment completion and retention rates, user experience and immersion/presence in the VR program. Secondary outcomes were other health outcomes (e.g., depression) and VR technological features. RESULTS The 14 included studies were of low methodological quality. Clinical and methodological heterogeneity prevented quantitative pooling of data. The evidence provided in this review is limited by trials with small sample sizes, and lack of diagnostic clarity, controlled designs, and long-term assessment. The evidence did suggest that VR-based psychological interventions could be feasible and acceptable in this population. CONCLUSIONS For VR-based psychological interventions to be recommended for driving phobia, more high-quality trials are needed. Implications for rehabilitationVirtual reality (VR) based psychological treatments may be feasible and acceptable to patients with driving phobia.There is potential to increase accessibility to psychological therapies in patients with driving phobia following motor vehicle crashes through the use of digital psychiatry such as VR.
Collapse
Affiliation(s)
- Rachel A Elphinston
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia.,National Health and Medical Research Council Centre for Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Brisbane, Australia.,School of Psychology, The University of Queensland, Brisbane, Australia
| | - Atiyeh Vaezipour
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
| | - James A Fowler
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
| | - Trevor G Russell
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
| | - Michele Sterling
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia.,National Health and Medical Research Council Centre for Research Excellence in Road Traffic Injury Recovery, The University of Queensland, Brisbane, Australia
| |
Collapse
|
47
|
Developing the Rationale for Including Virtual Reality in Cognitive Rehabilitation and Exercise Training Approaches for Managing Cognitive Dysfunction in MS. NEUROSCI 2022. [DOI: 10.3390/neurosci3020015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cognitive impairment is a common and detrimental consequence of multiple sclerosis (MS) and current rehabilitation methods are insufficient. Cognitive rehabilitation (CR) and exercise training (ET) are the most promising behavioral approaches to mitigate cognitive deficits, but effects are small and do not effectively translate to improvements in everyday function. This article presents a conceptual framework supporting the use of virtual reality (VR) as an ideal, common adjuvant traditional CR and ET in MS. VR could strengthen the effects of CR and ET by increasing sensory input and promoting multisensory integration and processing during rehabilitation. For ET specifically, VR can also help incorporate components of CR into exercise sessions. In addition, VR can enhance the transfer of cognitive improvements to everyday functioning by providing a more ecologically valid training environment. There is a clear interest in adding VR to traditional rehabilitation techniques for neurological populations, a stronger body of evidence of this unique approach is needed in MS. Finally, to better understand how to best utilize VR in rehabilitation for cognitive deficits in MS, more systematic research is needed to better understand the mechanism(s) of action of VR with CR and ET.
Collapse
|
48
|
Carrier JD, Gallagher F, Vanasse A, Roberge P. Strategies to improve access to cognitive behavioral therapies for anxiety disorders: A scoping review. PLoS One 2022; 17:e0264368. [PMID: 35231039 PMCID: PMC8887746 DOI: 10.1371/journal.pone.0264368] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/09/2022] [Indexed: 11/24/2022] Open
Abstract
Background Strategies to improve access to evidence-based psychological treatments (EBPTs) include but are not limited to implementation strategies. No currently available framework accounts for the full scope of strategies available to allow stakeholders to improve access to EBPTs. Anxiety disorders are common and impactful mental conditions for which EBPTs, especially cognitive-behavioral therapies (CBT), are well-established yet often hard to access. Objective Describe and classify the various strategies reported to improve access to CBT for anxiety disorders. Methods Scoping review with a keyword search of several databases + additional grey literature documents reporting on strategies to improve access to CBT for anxiety disorders. A thematic and inductive analysis of data based on grounded theory principles was conducted using NVivo. Results We propose to classify strategies to improve access to CBT for anxiety disorders as either "Contributing to the evidence base," "Identifying CBT delivery modalities to adopt in practice," "Building capacity for CBT delivery," "Attuning the process of access to local needs," "Engaging potential service users," or "Improving programs and policies." Each of these strategies is defined, and critical information for their operationalization is provided, including the actors that could be involved in their implementation. Implications This scoping review highlights gaps in implementation research regarding improving access to EBPTs that should be accounted for in future studies.
Collapse
Affiliation(s)
- Jean-Daniel Carrier
- Department of family medicine and emergency medicine, PRIMUS research group, Université de Sherbrooke, Sherbrooke, Canada
- Department of psychiatry, Université de Sherbrooke, Sherbrooke, Canada
- * E-mail:
| | - Frances Gallagher
- School of nursing, Université de Sherbrooke, Sherbrooke, Canada
- Centre de recherche du CHUS, Sherbrooke, Canada
| | - Alain Vanasse
- Department of family medicine and emergency medicine, PRIMUS research group, Université de Sherbrooke, Sherbrooke, Canada
- Centre de recherche du CHUS, Sherbrooke, Canada
| | - Pasquale Roberge
- Department of family medicine and emergency medicine, PRIMUS research group, Université de Sherbrooke, Sherbrooke, Canada
- Department of psychiatry, Université de Sherbrooke, Sherbrooke, Canada
- Centre de recherche du CHUS, Sherbrooke, Canada
| |
Collapse
|
49
|
Ong T, Wilczewski H, Soni H, Nisbet Q, Paige SR, Barrera JF, Welch BM, Bunnell BE. The Symbiosis of Virtual Reality Exposure Therapy and Telemental Health: A Review. FRONTIERS IN VIRTUAL REALITY 2022; 3:848066. [PMID: 37483657 PMCID: PMC10361704 DOI: 10.3389/frvir.2022.848066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Phobias and related anxiety are common and costly mental health disorders. Experts anticipate the prevalence of phobias will increase due to the COVID-19 pandemic. Exposure therapies have been established as effective and reliable treatments for anxiety, including recent innovations in virtual reality-based exposure therapy (VRET). With the recent advent of telemental health (TMH), VRET is poised to become mainstream. The combination of VRET and TMH has the potential to extend provider treatment options and improve patient care experiences. In this narrative review, we describe how recent events have accelerated VRET + TMH, identify barriers to VRET + TMH implementation, and discuss strategies to navigate those barriers.
Collapse
Affiliation(s)
- Triton Ong
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
| | | | - Hiral Soni
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
| | - Quinn Nisbet
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
| | | | - Janelle F. Barrera
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
- Biomedical Informatics Center, Public Health and Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Brandon M. Welch
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
- Innovation in Mental Health Lab, Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, United States
| | - Brian E. Bunnell
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
- Biomedical Informatics Center, Public Health and Sciences, Medical University of South Carolina, Charleston, SC, United States
| |
Collapse
|
50
|
Chard I, van Zalk N. Virtual Reality Exposure Therapy for Treating Social Anxiety: A Scoping Review of Treatment Designs and Adaptation to Stuttering. Front Digit Health 2022; 4:842460. [PMID: 35281220 PMCID: PMC8913509 DOI: 10.3389/fdgth.2022.842460] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 01/28/2022] [Indexed: 12/16/2022] Open
Abstract
Virtual Reality Exposure Therapy (VRET) has been shown to be an effective technique for reducing social anxiety. People who stutter are at greater risk of developing heightened social anxiety. Cognitive behavior therapy protocols have shown promise in reducing social anxiety in people who stutter, but no studies have investigated VRET targeting social anxiety associated with stuttering. The aim of the current review is to provide an overview of VRET techniques used to treat social anxiety and insights into how these techniques might be adopted in the case of comorbid stuttering and social anxiety. Twelve studies were reviewed to understand key distinctions in VRET protocols used to treat social anxiety. Distinctions include exercises targeting public speaking vs. general social anxiety, computer-generated virtual environments vs. 360° video, and therapist guided vs. automated VRET. Based on the review findings, we propose how certain features could be applied in the case of stuttering. Virtual therapists, inhibitory learning techniques and integration into speech therapy may be suitable ways to tailor VRET. Regardless of these different techniques, VRET should consider the situations and cognitive-behavioral processes that underlie the experience of social anxiety amongst people who stutter.
Collapse
Affiliation(s)
- Ian Chard
- Design Psychology Lab, Dyson School of Design Engineering, Imperial College London, London, United Kingdom
| | | |
Collapse
|