Virtual Reality in the Assessment, Understanding and Treatment of Mental Health Disorders

SafeVRwards: Designing a complementary virtual reality module to the Safewards framework intended to relax and manage conflict in mental health wards

BACKGROUND

Aggression and negative activation in mental health inpatient units pose significant challenges for both patients and staff with severe physical and psychological ramifications. The Safewards model is an evidence-based conflict-containment framework including 10 strategies, such as 'Calm Down Methods'. As virtual reality (VR) scenarios have successfully enhanced anxiolytic and deactivating effects of therapeutic interventions, they are increasingly considered a means to enhance current models, like Safewards.

OBJECTIVES

The present participatory design investigates the feasibility and user experience of integrating VR therapy as an add-on strategy to the Safewards model, gathering preliminary data and qualitative feedback from bedside staff in an adult inpatient mental health unit.

METHODS

An exploratory within-subjects design combining qualitative observations, self-report questionnaires and semistructured interviews is employed with four nurse champions from the mental health unit at Michael Garron Hospital (Toronto, Canada).

RESULTS

A chronological overview of the design process, adaptations and description of the user experience is reported.

CONCLUSION

'SafeVRwards' introduces VR as a promising conflic-containment strategy complementary to the Safewards model, which can be optimised for deployment through user-oriented refinements and enhanced customisation capacity driven by clinical staff input.

Enfacement illusions: Filling a knowledge gap in eating disorder risk assessment, prevention, and intervention?

Body image disturbance (BID) is central to eating disorders (EDs), yet the role of self-face perception has received limited empirical attention despite rising sociocultural pressures emphasizing facial appearance through technologies such as social media. Emerging evidence suggests impairments in self-face recognition accuracy and distorted perceptions of facial appearance among individuals with EDs. Enfacement illusions, involving the experimental induction of perceived ownership over another's face, offer a novel paradigm to comprehensively investigate the perceptual multisensory integration processes underlying self-face perception disturbances in ED populations. Such an approach may hold promise for elucidating core pathological mechanisms contributing to BID and ED psychopathology. We discuss how rigorous investigation of self-face perception through the enfacement illusion paradigm represents an innovative direction of research and/or clinical application that may advance etiological models of EDs and possibly inform interventions targeting the potentially multidimensional nature of body and facial image disturbances characterizing EDs. PUBLIC SIGNIFICANCE STATEMENT: Body image disturbance is central to eating disorders (EDs), yet, the role of face-related disturbances remains critically under-investigated. After summarizing findings on face-related disturbances in EDs we propose how enfacement illusions (i.e., the experimental induction of ownership over another's face) may elucidate self-face perception disturbances in EDs, and their underlying mechanisms. Enfacement illusions may also offer an intervention to potentially address multifaceted face and body image disturbances characterizing EDs.

Impact of virtual reality education on disease-specific knowledge and anxiety for hepatocellular carcinoma patient scheduled for liver resection: a randomized controlled study

PURPOSE

Hepatocellular carcinoma (HCC) is a significant health concern, and the complexity of liver anatomy poses challenges in conveying radiologic findings and surgical plans to patients. This study aimed to evaluate the impact of a virtual reality (VR) education program on anxiety and knowledge in HCC patients undergoing hepatic resection.

METHOD

From 1 January 2022 to 28 February 2023, 88 patients were enrolled in a randomized controlled trial, divided into the VR group ( n =44) and the control group ( n =44). The VR group received patient-specific 3D liver model education through a VR platform, while the control group underwent conventional explanation processes. Both groups completed preintervention and postintervention questionnaires assessing anxiety (using STAI-X-1, STAI-X-2, and VAS) and knowledge about liver resection. Comparison of the questionnaires were performed between the two groups. Multivariable logistic regression was performed to analyze factor related to decrease in anxiety.

RESULT

While there was no significant difference in preintervention anxiety and knowledge scores between the two groups, the VR group exhibited significant reduction in STAI-X-1 scores (-4.14±7.5) compared to the control group (-0.84±5.7, P =0.023), as well as knowledge scores (17.20±2.6) compared to the control group (13.42±3.3, P <0.001). In the multivariable logistic regression model, VR education showed significant impact on decrease in STAI-X-1 score, postintervention. (OR=2.902, CI=1.097-7.674, P =0.032).

CONCLUSION

The VR education program significantly improved knowledge and reduced anxiety among HCC patients compared to conventional methods. This study suggests that VR can be a valuable tool in patient education, enhancing comprehension and alleviating presurgical anxiety.

Virtual reality interventions designed to support parents during and throughout the first year after birth: A scoping review

Objective

Virtual reality (VR) has become increasingly popular in clinical and health settings where it has been used for a wide range of purposes. A recent scoping review explored VR applications to assist pregnant women and found that VR was a useful method to be used for a range of different purposes in both pregnancy and labour. However, no such review exists for the period after birth.

Method

We aimed to search for studies that used VR to support parents during birth and in the first year postpartum (Population) in different settings (Context), and finally provided data on the characteristics, reported effectiveness and experience of VR interventions (Concept). Two hundred and fifty-one studies were identified, of which ten were eligible. Two authors independently extracted data including study design, participants and results.

Results

Findings indicate that VR has been used effectively in this context to alleviate depression anxiety, and multiple domains of pain and to improve childbirth satisfaction. The majority of the studies explored the use of VR technology on outcomes such as pain and anxiety during labour and birth. The studies included used a broad range of VR hardware and software. All of the studies reported positive experiences of using VR.

Conclusions

Across these studies, VR was found to be effective in terms of both physiological and psychological outcomes. There are many unexplored maternal and infant focused applications of VR which warrant further investigation as emerging evidence indicates this is becoming an increasingly accessible method to improve maternal and infant health outcomes from pregnancy through to parenthood.

Application of Virtual Reality in Spatial Memory

In recent years, virtual reality (VR) has become a widely used tool with a plethora of applications in neuroscience [...].

A systematic review on the efficacy of virtual reality and gamification interventions for managing anxiety and depression

This systematic review aims to assess the effectiveness of virtual reality (VR) and gamification interventions in addressing anxiety and depression. The review also seeks to identify gaps in the current VR treatment landscape and provide guidelines for future research and development. A systematic literature search was conducted using Scopus, Web of Science, and PubMed databases, focusing on studies that utilized VR and gamification technology to address anxiety and depression disorders. A total of 2,664 studies were initially identified, 15 of those studies fulfilled the inclusion criteria for this systematic review. The efficacy of VR in addressing anxiety and depression was evident across all included studies. However, the diversity among VR interventions highlights the need for further investigation. It is advised to incorporate more diverse participant samples and larger cohorts and explore a broader spectrum of therapeutic approaches within VR interventions for addressing anxiety and depression to enhance the credibility of future research. Additionally, conducting studies in varying socioeconomic contexts would contribute to a more comprehensive understanding of their real-world applicability.

Effects of a Nonwearable Digital Therapeutic Intervention on Preschoolers With Autism Spectrum Disorder in China: Open-Label Randomized Controlled Trial

BACKGROUND

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that can cause difficulty with communication and social interactions as well as complicated family dynamics. Digital health interventions can reduce treatment costs and promote healthy lifestyle changes. These therapies can be adjunctive or replace traditional treatments. However, issues with cooperation and compliance prevent preschool patients with ASD from applying these tools. In this open-label, randomized controlled trial, we developed a nonwearable digital therapy called virtual reality-incorporated cognitive behavioral therapy (VR-CBT).

OBJECTIVE

The aim of this study was to assess the adjunctive function of VR-CBT by comparing the effects of VR-CBT plus learning style profile (LSP) intervention with those of LSP-only intervention in preschool children with ASD.

METHODS

This trial was performed in China on 78 preschool children (age 3-6 years, IQ>70) diagnosed with ASD who were randomized to receive a 20-week VR-CBT plus LSP intervention (intervention group, 39/78, 50%) or LSP intervention only (control group, 39/78, 50%). The primary outcome was the change of scores from baseline to week 20, assessed by using the parent-rated Autism Behavior Checklist (ABC). Secondary outcomes included the Childhood Autism Rating Scale (CARS), Attention-Deficit/Hyperactivity Disorder Rating Scale-IV (ADHD-RS-IV), and behavioral performance data (accuracy and reaction time) in go/no-go tasks. All primary and secondary outcomes were analyzed in the intention-to-treat population.

RESULTS

After the intervention, there was an intervention effect on total ABC (β=-5.528; P<.001) and CARS scores (β=-1.365; P=.02). A similar trend was observed in the ABC subscales: sensory (β=-1.133; P=.047), relating (β=-1.512; P=.03), body and object use (β=-1.211; P=.03), and social and self-help (β=-1.593; P=.03). The intervention also showed statistically significant effects in improving behavioral performance (go/no-go task, accuracy, β=2.923; P=.04). Moreover, a significant improvement of ADHD hyperactivity-impulsivity symptoms was observed in 53 children with comorbid ADHD based on ADHD-RS-IV (β=-1.269; P=.02). No statistically significant intervention effect was detected in the language subscale of ABC (β=-.080; P=.83). Intervention group girls had larger improvements in ABC subscales, that is, sensory and body and object use and in the CARS score and accuracy of go/no-go task (all P<.05) than the control group girls. Statistically significant intervention effects could be observed in hyperactivity-impulsivity symptoms in the intervention group boys with comorbid ADHD compared with those in the control group boys (β=-1.333; P=.03).

CONCLUSIONS

We found potentially positive effects of nonwearable digital therapy plus LSP on core symptoms associated with ASD, leading to a modest improvement in the function of sensory, motor, and response inhibition, while reducing impulsivity and hyperactivity in preschoolers with both ASD and ADHD. VR-CBT was found to be an effective and feasible adjunctive digital tool.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR2100053165; http://www.chictr.org.cn/showproj.aspx?proj=137016.

Virtual Reality Technology in Nursing Professional Skills Training: Bibliometric Analysis

BACKGROUND

Nursing professional skills training has undergone significant transformation due to the exponential growth of computer and medical technology. The innovative use of virtual reality (VR) in nursing education has emerged as a cutting-edge technical support technique that has gained attention as a highly effective method for improving nurse training quality.

OBJECTIVE

This study aims to review the current status of VR technology in nursing professional skills training, research hotspots, and emerging trends in the last 15 years.

METHODS

The Web of Science Core Collection database was used to search for literature on VR technology in nursing professional skills training covering the period from 2006 to 2022. Biblioshiny (K-Synth Srl) was used to import and convert the records to Bibliometrix (K-Synth Srl) for analysis, and R (R Core Team) was used for descriptive bibliometric analysis. VOSviewer (Leiden University) was used to cluster co-occurring keywords, and Scimago Graphica (version 1.0.16; Scimago Lab) was used to generate a geographical visualization of published countries and regions.

RESULTS

A total of 1073 papers were analyzed, indicating a surge in research on the application of VR in nursing professional skills training in recent years, as evidenced by a positive trend in annual publication of relevant literature. The majority of studies were from the United States (n=340) and Canada (n=107), and Margaret Verkuyl was the most prolific author, leading the way with 9 publications. Furthermore, "Computerized Virtual Patients in Health Professions Education: a Systematic Review and Meta-Analysis" was the most frequently cited reference. Keywords such as education, simulation, skills, students, and care were most commonly used by researchers.

CONCLUSIONS

The bibliometric analysis provides a comprehensive overview of the use of VR in nursing professional skills training, indicating that VR-based training is an effective means of improving the skills and competencies of nursing students and professionals alike. The COVID-19 pandemic has reinforced the importance of developing VR-based distance education, despite challenges such as integrating virtual and real-world training and mitigating safety risks.

Effect of environmental enrichment on relapse rates in patients with severe alcohol use disorder: protocol for a randomised controlled trial

INTRODUCTION

Alcohol use disorder (AUD) ranks among the most prevalent psychiatric disorders worldwide. Despite current treatments, more than half of patients relapse within weeks after treatment. In animal models, exposure to environmental enrichment (EE) has been shown to be a promising approach to reduce relapse. However, controlled, multimodal EE is difficult to transpose to humans. To address this gap, this study aims at assessing the effectiveness of exposure to a newly designed EE protocol during AUD treatment in reducing relapse to alcohol use. Our EE will allow an enhancement of the standard intervention, and will combine several promising enrichment factors identified in the literature-physical activity, cognitive stimulation, mindfulness and virtual reality (VR).

METHODS AND ANALYSIS

A randomised controlled trial involving 135 participants receiving treatment for severe AUD will be conducted. Patients will be randomised to an intervention enhancement group or a control group. The enhanced intervention will consist of six 40-min sessions of EE spread over 9 days. During the first 20 min of these sessions, patients will practise mindfulness in multisensory VR, in virtual environments designed to practise mindfulness and use it to regulate craving induced by virtual cues or stress. Then, participants will practise indoor cycling combined with cognitive training exercises. The control group will undergo standard management for AUD. The primary outcome is relapse assessed at 2 weeks after treatment, using a questionnaire and biological indicators. Relapse will be defined as drinking at least five drinks per occasion or drinking at least five times a week. It is predicted that the group receiving the EE intervention will have a lower relapse rate than the control group. The secondary outcomes are relapse at 1 month and 3 months after treatment, craving and drug-seeking behaviour, mindfulness skills acquisition and the effect of the intervention enhancement on the perceived richness of the daily environment, assessed by questionnaires and neuropsychological tasks.

ETHICS AND DISSEMINATION

All participants have to give written informed consent to the investigator. This study is approved by the Ethics Committee Nord Ouest IV of Lille (reference number 2022-A01156-37). Results will be disseminated through presentations, peer-reviewed journals and seminar conferences. All information on ethical considerations and open science practices can be accessed at https://osf.io/b57uj/ TRIAL REGISTRATION NUMBER: NCT05577741.

Telemedicine-Rehabilitation and Virtual Reality in Orthopaedics and Sports Medicine

Introduction

Tele-rehabilitation is a method of delivering rehabilitation services using information, technology and communication to everyone, irrespective of their geographic location. National zeal for competitive sports and COVID pandemic has led to an increase in its demand and popularity worldwide. The athletes need immediate treatment and correct rehabilitation to keep them in their game. This review aims to bring into perspective the importance of telemedicine and telerehabilitation in orthopaedics and sports medicine with a focus on virtual reality.

Methods

Articles were searched based on suitable keywords 'telemedicine', 'telerehabilitation' 'orthopedics', 'orthopaedics', 'sports' and 'India*' which were combined using suitable boolean operators in PubMed, Scopus and Web of Science. Government guidelines and laws were also reviewed in view of telehealth and telemedicine.

Conclusion

Tele-rehabilitation and virtual physical therapy are innovative and cost-effective ways to provide the best rehabilitative services to the patients at their doorstep. Virtual reality should be incorporated into the Indian telehealth delivering system with a special focus on the remote athlete population.

The Treatment of Substance Use Disorders: Recent Developments and New Perspectives

Substance-related disorders are complex psychiatric disorders that are characterized by continued consumption in spite of harmful consequences. Addiction affects various brain networks critically involved in learning, reward, and motivation, as well as inhibitory control. Currently applied therapeutic approaches aim at modification of behavior that ultimately leads to decrease of consumption or abstinence in individuals with substance use disorders. However, traditional treatment methods might benefit from recent neurobiological and cognitive neuroscientific research findings. Novel cognitive-behavioral approaches in the treatment of addictive behavior aim at enhancement of strategies to cope with stressful conditions as well as craving-inducing cues and target erroneous learning mechanisms, including cognitive bias modification, reconsolidation-based interventions, mindfulness-based interventions, virtual-reality-based cue exposure therapy as well as pharmacological augmentation strategies. This review discusses therapeutic strategies that target dysregulated neurocognitive processes associated with the development and maintenance of disordered substance use and may hold promise as effective treatments for substance-related disorders.

Virtual Reality Technology in Cognitive Rehabilitation Application: A Bibliometric Analysis (Preprint)

Background

In recent years, with the development of computer science and medical science, virtual reality (VR) technology has become a promising tool for improving cognitive function. Research on VR-based cognitive training has garnered increasing attention.

Objective

This study aimed to investigate the application status, research hot spots, and emerging trends of VR in cognitive rehabilitation over the past 20 years.

Methods

Articles on VR-based cognitive rehabilitation from 2001 to 2021 were retrieved from the Web of Science Core Collection. CiteSpace software was used for the visual analysis of authors and countries or regions, and Scimago Graphica software was used for the geographic visualization of published countries or regions. Keywords were clustered using the gCLUTO software.

Results

A total of 1259 papers were included. In recent years, research on the application of VR in cognitive rehabilitation has been widely conducted, and the annual publication of relevant literature has shown a positive trend. The main research areas include neuroscience and neurology, psychology, computer science, and rehabilitation. The United States ranked first with 328 papers, and Italy ranked second with 140 papers. Giuseppe Riva, an Italian academic, was the most prolific author with 29 publications. The most frequently cited reference was “Using Reality to Characterize Episodic Memory Profiles in Amnestic Mild Cognitive Impairment and Alzheimer’s Disease: Influence of Active and Passive Encoding.” The most common keywords used by researchers include “virtual reality,” “cognition,” “rehabilitation,” “performance,” and “older adult.” The largest source of research funding is from the public sector in the United States.

Conclusions

The bibliometric analysis provided an overview of the application of VR in cognitive rehabilitation. VR-based cognitive rehabilitation can be integrated into multiple disciplines. We conclude that, in the context of the COVID-19 pandemic, the development of VR-based telerehabilitation is crucial, and there are still many problems that need to be addressed, such as the lack of consensus on treatment methods and the existence of safety hazards.

Review on visualization technology in simulation training system for major natural disasters

Major natural disasters have occurred frequently in the last few years, resulting in increased loss of life and economic damage. Most emergency responders do not have first-hand experience with major natural disasters, and thus, there is an urgent need for pre-disaster training. Due to the scenes unreality of traditional emergency drills, the failure to appeal to the target audience and the novel coronavirus pandemic, people are forced to maintain safe social distancing. Therefore, it is difficult to carry out transregional or transnational emergency drills in many countries under the lockdown. There is an increasing demand for simulation training systems that use virtual reality, augmented reality, and mixed reality visualization technologies to simulate major natural disasters. The simulation training system related to natural disasters provides a new way for popular emergency avoidance science education and emergency rescue personnel to master work responsibilities and improve emergency response capabilities. However, to our knowledge, there is no overview of the simulation training system for major natural disasters. Hence, this paper uncovers the visualization techniques commonly used in simulation training systems, and compares, analyses and summarizes the architecture and functions of the existing simulation training systems for different emergency phases of common natural disasters. In addition, the limitations of the existing simulation training system in practical applications and future development directions are discussed to provide reference for relevant researchers to better understand the modern simulation training system.

Human-Computer Interaction in Digital Mental Health

Human-computer interaction (HCI) has contributed to the design and development of some efficient, user-friendly, cost-effective, and adaptable digital mental health solutions. But HCI has not been well-combined into technological developments resulting in quality and safety concerns. Digital platforms and artificial intelligence (AI) have a good potential to improve prediction, identification, coordination, and treatment by mental health care and suicide prevention services. AI is driving web-based and smartphone apps; mostly it is used for self-help and guided cognitive behavioral therapy (CBT) for anxiety and depression. Interactive AI may help real-time screening and treatment in outdated, strained or lacking mental healthcare systems. The barriers for using AI in mental healthcare include accessibility, efficacy, reliability, usability, safety, security, ethics, suitable education and training, and socio-cultural adaptability. Apps, real-time machine learning algorithms, immersive technologies, and digital phenotyping are notable prospects. Generally, there is a need for faster and better human factors in combination with machine interaction and automation, higher levels of effectiveness evaluation and the application of blended, hybrid or stepped care in an adjunct approach. HCI modeling may assist in the design and development of usable applications, and to effectively recognize, acknowledge, and address the inequities of mental health care and suicide prevention and assist in the digital therapeutic alliance.

A virtual reality-based mind-body approach to downregulate psychophysiological arousal in adolescent insomnia

Objective

In this study, we describe the rationale, supported by preliminary data, for a novel, digital, immersive virtual reality (VR)-based mind-body approach, designed to reduce bedtime arousal in adolescents with insomnia.

Methods

Fifty-two high-school students (16-20 years; 32 female) with (N = 18) and without (N = 34) DSM-5 insomnia symptoms engaged with 20 min of immersive VR-guided meditation and paced breathing (0.1 Hz) (intervention condition) and 20 min of quiet activity (control condition), right before bedtime, on two separate evenings.

Results

The intervention resulted in acute autonomic and cortical modulation (p < 0.05), leading to reduced physiological arousal (↓heart rate, ↓cortisol) compared with the control condition, with similar effects in adolescents with and without insomnia. No significant changes were detected for cognitive arousal levels. During the intervention, all participants were able to achieve the targeted 0.1 Hz breathing rate, and the majority experienced no discomfort associated with the VR exposure. However, 30-40% of the participants experienced some trouble slowing down their breathing.

Conclusions

The study provides supporting preliminary evidence for the mechanism behind a novel VR-based digital approach, designed to regulate psychophysiological arousal levels by acting on neurocognitive and autonomic pathways. Further studies (e.g. randomized clinical trials) are needed to evaluate the isolated and synergistic effects of its components (e.g. VR vs. VR + paced breathing), and its efficacy, acceptance, and feasibility in alleviating insomnia symptoms in adolescents.

Design of a Virtual Reality Interactive Training System for Public Health Emergency Preparedness for Major Emerging Infectious Diseases: Theory and Framework

Background

Sufficient public health emergency preparedness (PHEP) is the key factor in effectively responding to and recovering from major emerging infectious diseases (MEIDs). However, in the face of MEIDs, PHEP is insufficient, so it is necessary to improve PHEP. The rapid development of virtual reality and human-computer interaction provides unprecedented opportunities for innovative educational methods.

Objective

This study designed a virtual reality interactive training system (VRITS) to provide an effective path for improving PHEP in the context of MEIDs so that the public can effectively respond to and recover from MEIDs.

Methods

This study used interactive narrative, situated learning and human-computer interaction theories as a theoretical framework to guide the design of the system. We used the literature research method and the Delphi method; consulted multidisciplinary experts, such as infectious diseases, disease control, psychology, and public health personnel, to determine the educational content framework; and set up an interdisciplinary team to construct an operating system framework for the VRITS.

Results

We named the VRITS “People’s War Against Pandemic.” The educational content framework includes 20 knowledge, emotion, and behavior skills in 5 aspects (cooperating with prevention and control work, improving emergency response ability, guaranteeing supplies and equipment, preparing economic resources, and maintaining physical and mental health). The operating system framework includes virtual interactive training, knowledge corner, intelligent evaluation, and community forum modules, and the core module is the virtual interactive training module. In this module, users control virtual characters to move in various scenes, and then identify and analyze the controllability and harmfulness of the evolving pandemic and select the correct prevention and control strategy to avoid infecting themselves and others.

Conclusions

The development and sharing of the multidisciplinary theoretical framework adopted by People’s War Against Pandemic can help us clarify the design ideas and assumptions of the VRITS; predict training results; understand the ability of training to change emergency knowledge, emergency emotion, and behavioral responses to MEIDs; and promote the development of more effective training systems based on virtual reality.

Virtual Reality Applications in Medicine During the COVID-19 Pandemic: Systematic Review (Preprint)

Background

Virtual reality can play an important role during the COVID-19 pandemic in the health care sector. This technology has the potential to supplement the traditional in-hospital medical training and treatment, and may increase access to training and therapies in various health care settings.

Objective

This systematic review aimed to describe the literature on health care–targeted virtual reality applications during the COVID-19 crisis.

Methods

We conducted a systematic search of the literature on the PsycINFO, Web of Science, and MEDLINE databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search string was as follows: “[(virtual reality)] AND [(COVID-19) OR (coronavirus) OR (SARS-CoV-2) OR (healthcare)].” Papers published in English after December 2019 in peer-reviewed journals were selected and subjected to the inclusion and exclusion criteria. We used the Mixed Methods Appraisal Tool to assess the quality of studies and the risk of bias.

Results

Thirty-nine studies met the inclusion criteria. Seventeen studies showed the usefulness of virtual reality during the COVID-19 crisis for reducing stress, anxiety, depression, and pain, and promoting physical activity. Twenty-two studies revealed that virtual reality was a helpful learning and training tool during the COVID-19 crisis in several areas, including emergency medicine, nursing, and pediatrics. This technology was also used as an educational tool for increasing public understanding of the COVID-19 pandemic. Different levels of immersion (ie, immersive and desktop virtual reality), types of head-mounted displays (ie, PC-based, mobile, and standalone), and content (ie, 360° videos and photos, virtual environments, virtual reality video games, and embodied virtual agents) have been successfully used. Virtual reality was helpful in both face-to-face and remote trials.

Conclusions

Virtual reality has been applied frequently in medicine during the COVID-19 pandemic, with positive effects for treating several health conditions and for medical education and training. Some barriers need to be overcome for the broader adoption of virtual reality in the health care panorama.

Trial Registration

International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) INPLASY202190108; https://inplasy.com/inplasy-2021-9-0108/

Changes in Brain Activation through Cognitive-Behavioral Therapy with Exposure to Virtual Reality: A Neuroimaging Study of Specific Phobia

Background: Cognitive-behavioral therapy (CBT) with exposure is the treatment of choice for specific phobia. Virtual reality exposure therapy (VRET) has shown benefits for the treatment and prevention of the return of fear in specific phobias by addressing the therapeutic limitations of exposure to real images. Method: Thirty-one participants with specific phobias to small animals were included: 14 were treated with CBT + VRET (intervention group), and 17 were treated with CBT + exposure to real images (active control group). Participants’ scores in anxiety and phobia levels were measured at baseline, post-treatment, and 3-month follow-up, and brain activation was measured through functional magnetic resonance imaging (fMRI) baseline and post-treatment. Results: Both groups showed a significant decrease in anxiety and phobia scores after the therapy and were maintained until follow-up. There were no significant differences between both groups. Overall, fMRI tests showed a significant decrease in brain activity after treatment in some structures (e.g., prefrontal and frontal cortex) and other structures (e.g., precuneus) showed an increasing activity after therapy. However, structures such as the amygdala remained active in both groups. Conclusions: The efficacy of CBT + VRET was observed in the significant decrease in anxiety responses. However, the results of brain activity observed suggest that there was still a fear response in the brain, despite the significant decrease in subjective anxiety levels.

Virtual Reality-Based Treatment Approaches in the Field of Substance Use Disorders

Purpose

Substance use disorders (SUD) are burdening chronic conditions characterized by high relapse rates despite severe negative consequences. Substance-related cues that elicit craving by means of automatic physiological and behavioural responses have long been suggested to predict relapse. One major mechanism contributing to relapse behaviour are cue-induced behavioural approach tendencies towards the addictive agent. Recently, there has been an emerging interest in virtual reality (VR)-based approaches to assess and modify craving and its related responses. This review aims at elucidating (1) VR techniques applied in the field of SUD, (2) VR as an induction/assessment tool for biopsychological correlates of craving and (3) VR-based therapeutic approaches.

Findings

There is an emerging number of studies focusing on different substances of abuse incorporating VR in craving induction/assessment as well as therapy. Despite some limitations as missing of randomized controlled clinical trials with large samples and missing data on the long-term effects of VR treatment, the VR approach showed consistent results in eliciting and reducing craving across different substances.

Summary

This review suggests virtual reality as a promising tool for the assessment and treatment of craving among individuals with substance use disorders. Because of its ecological validity, VR unifies the benefits of a laboratory setting with the advantages of a realistic environment. Further studies with large samples and randomized controlled clinical trials using more homogenous VR techniques as well as assessment of objective biophysiological craving markers are required.

The use of virtual reality in assessment and treatment of anxiety and related disorders

In recent years the development of new virtual environments has been qualitatively high and fast at the same time, but the dissemination of virtual reality (VR) in clinical practice is still scarce. The aim of this review is to give an insight into the state of the art of the use of VR as an assessment tool and treatment intervention in anxiety and related disorders as posttraumatic stress disorder and obsessive-compulsive disorders. Besides an overview into the efficacy of VR, a summary will be given on assumed working mechanisms in virtual reality exposure therapy and how this aligns with current theoretical models. Further, it will be discussed how VR is accepted by patients and research into the reluctance of therapist to use this technology during treatment with focus on the therapeutic alliance and how it may be influenced by the use of VR. Finally, we discuss clinical and future issues as, for example, dissemination into clinical practice and what VR has to offer therapists in future. This not only in adult population but as well in younger patients, as young adolescents VR has a great potential as it connects easily with its playful elements to this population and might be a low threshold step to offer treatment or preventive interventions.

Facial Affect Recognition by Patients with Schizophrenia Using Human Avatars

People with schizophrenia have difficulty recognizing the emotions in the facial expressions of others, which affects their social interaction and functioning in the community. Static stimuli such as photographs have been used traditionally to examine deficiencies in the recognition of emotions in patients with schizophrenia, which has been criticized by some authors for lacking the dynamism that real facial stimuli have. With the aim of overcoming these drawbacks, in recent years, the creation and validation of virtual humans has been developed. This work presents the results of a study that evaluated facial recognition of emotions through a new set of dynamic virtual humans previously designed by the research team, in patients diagnosed of schizophrenia. The study included 56 stable patients, compared with 56 healthy controls. Our results showed that patients with schizophrenia present a deficit in facial affect recognition, compared to healthy controls (average hit rate 71.6% for patients vs 90.0% for controls). Facial expressions with greater dynamism (compared to less dynamic ones), as well as those presented from frontal view (compared to profile view) were better recognized in both groups. Regarding clinical and sociodemographic variables, the number of hospitalizations throughout life did not correlate with recognition rates. There was also no correlation between functioning or quality of life and recognition. A trend showed a reduction in the emotional recognition rate as a result of increases in Positive and Negative Syndrome Scale (PANSS), being statistically significant for negative PANSS. Patients presented a learning effect during the progression of the task, slightly greater in comparison to the control group. This finding is relevant when designing training interventions for people with schizophrenia. Maintaining the attention of patients and getting them to improve in the proposed tasks is a challenge for today’s psychiatry.

Translating Virtual Reality Cue Exposure Therapy for Binge Eating into a Real-World Setting: An Uncontrolled Pilot Study

Binge-eating disorder (BED) and bulimia nervosa (BN) have adverse psychological and medical consequences. Innovative interventions, like the integration of virtual reality (VR) with cue-exposure therapy (VR-CET), enhance outcomes for refractory patients compared to cognitive behavior therapy (CBT). Little is known about the feasibility and acceptability of translating VR-CET into real-world settings. To investigate this question, adults previously treated for BED or BN with at least one objective or subjective binge episode/week were recruited from an outpatient university eating disorder clinic to receive up to eight weekly one-hour VR-CET sessions. Eleven of 16 (68.8%) eligible patients were enrolled; nine (82%) completed treatment; and 82% (9/11) provided follow-up data 7.1 (SD = 2.12) months post-treatment. Overall, participant and therapist acceptability of VR-CET was high. Intent-to-treat objective binge episodes (OBEs) decreased significantly from 3.3 to 0.9/week (p < 0.001). Post-treatment OBE 7-day abstinence rate for completers was 56%, with 22% abstinent for 28 days at follow-up. Among participants purging at baseline, episodes decreased from a mean of one to zero/week, with 100% abstinence maintained at follow-up. The adoption of VR-CET into real-world clinic settings appears feasible and acceptable, with a preliminary signal of effectiveness. Findings, including some loss of treatment gains during follow-up may inform future treatment development.