1
|
Olff M, Hein I, Amstadter AB, Armour C, Skogbrott Birkeland M, Bui E, Cloitre M, Ehlers A, Ford JD, Greene T, Hansen M, Harnett NG, Kaminer D, Lewis C, Minelli A, Niles B, Nugent NR, Roberts N, Price M, Reffi AN, Seedat S, Seligowski AV, Vujanovic AA. The impact of trauma and how to intervene: a narrative review of psychotraumatology over the past 15 years. Eur J Psychotraumatol 2025; 16:2458406. [PMID: 39912534 PMCID: PMC11803766 DOI: 10.1080/20008066.2025.2458406] [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: 02/07/2025] Open
Abstract
To mark 15 years of the European Journal of Psychotraumatology, editors reviewed the past 15-year years of research on trauma exposure and its consequences, as well as developments in (early) psychological, pharmacological and complementary interventions. In all sections of this paper, we provide perspectives on sex/gender aspects, life course trends, and cross-cultural/global and systemic societal contexts. Globally, the majority of people experience stressful events that may be characterized as traumatic. However, definitions of what is traumatic are not necessarily straightforward or universal. Traumatic events may have a wide range of transdiagnostic mental and physical health consequences, not limited to posttraumatic stress disorder (PTSD). Research on genetic, molecular, and neurobiological influences show promise for further understanding underlying risk and resilience for trauma-related consequences. Symptom presentation, prevalence, and course, in response to traumatic experiences, differ depending on individuals' age and developmental phase, sex/gender, sociocultural and environmental contexts, and systemic socio-political forces. Early interventions have the potential to prevent acute posttraumatic stress reactions from escalating to a PTSD diagnosis whether delivered in the golden hours or weeks after trauma. However, research on prevention is still scarce compared to treatment research where several evidence-based psychological, pharmacological and complementary/ integrative interventions exist, and novel forms of delivery have become available. Here, we focus on how best to address the range of negative health outcomes following trauma, how to serve individuals across the age spectrum, including the very young and old, and include considerations of sex/gender, ethnicity, and culture in diverse contexts, beyond Western, Educated, Industrialized, Rich, and Democratic (WEIRD) countries. We conclude with providing directions for future research aimed at improving the well-being of all people impacted by trauma around the world. The 15 years EJPT webinar provides a 90-minute summary of this paper and can be downloaded here [http://bit.ly/4jdtx6k].
Collapse
Affiliation(s)
- Miranda Olff
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam Public Health and Amsterdam Neuroscience, Amsterdam, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | - Irma Hein
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam Public Health and Amsterdam Neuroscience, Amsterdam, The Netherlands
- Levvel, Amsterdam, The Netherlands
| | - Ananda B. Amstadter
- Departments of Psychiatry, Psychology, & Human and Molecular Genetics, Virginia Commonwealth University, Richmond, USA
| | - Cherie Armour
- Trauma and Mental Health Research Centre, School of Psychology, Queens University Belfast, Belfast, UK
| | | | - Eric Bui
- Caen University Hospital, University of Caen Normandy, Caen, France
- Massachusetts General Hospital, Boston, MA, USA
| | - Marylene Cloitre
- National Center for PTSD, Palo Alto, CA, USA
- New York University, Silver School of Social Work, New York, NY, USA
| | - Anke Ehlers
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Julian D. Ford
- Department of Psychiatry, University of Connecticut Health Center, Farmington, USA
| | - Talya Greene
- Clinical, Educational and Health Psychology, University College London, London, UK
| | - Maj Hansen
- THRIVE, Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Nathaniel G. Harnett
- Neurobiology of Affective and Traumatic Experiences Laboratory, McLean Hospital, Belmont, USA
- Harvard Medical School, Boston, MA, USA
| | - Debra Kaminer
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Catrin Lewis
- National Centre for Mental Health (NCMH), Cardiff University, Cardiff, UK
| | - Alessandra Minelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
- Genetics Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Barbara Niles
- Boston University Chobonian and Avedisian School of Medicine, USA
- National Center for PTSD Behavioral Science Division at VA Boston Healthcare System, Boston, MA, USA
| | - Nicole R. Nugent
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence RI, USA
| | - Neil Roberts
- Psychology & Psychological Therapies Directorate, Cardiff & Vale University Health Board, Cardiff, UK
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | | | - Anthony N. Reffi
- Sleep Disorders & Research Center, Henry Ford Health, Detroit, MI, USA
- Department of Surgery, Division of Acute Care Surgery, Henry Ford Health, Detroit, MI, USA
| | - Soraya Seedat
- SAMRC/SU Genomics of Brain Disorders Research Unit, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Antonia V. Seligowski
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, USA
| | - Anka A. Vujanovic
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA
| |
Collapse
|
2
|
Kukharuk O, Tkalich K, Kamash N, Georgiou O. Effectiveness of immersive VR therapy in reducing stress-associated symptoms in Ukraine. Eur J Psychotraumatol 2025; 16:2488097. [PMID: 40260973 PMCID: PMC12016277 DOI: 10.1080/20008066.2025.2488097] [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: 12/02/2024] [Revised: 02/24/2025] [Accepted: 03/21/2025] [Indexed: 04/24/2025] Open
Abstract
Background: The ongoing conflict in Ukraine has led to a rise in stress-related symptoms, including anxiety and depression, among veterans, necessitating accessible and effective mental health interventions. Traditional rehabilitation resources are often limited, prompting exploration into alternative therapies.Objective: This paper aims to assess the effectiveness of immersive 360° video-based Virtual Reality (VR) therapy as an enhancement to standard rehabilitation programmes for Ukrainian veterans experiencing anxiety and depression.Method: A randomised controlled trial (RCT) was conducted with 69 participants, who were randomly assigned to either the experimental group (n = 34), receiving daily VR sessions alongside standard rehabilitation, or the control group (n = 35), following standard rehabilitation alone. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS) both at baseline and post-intervention. Additionally, momentary changes in anxiety and mood were measured immediately before and after each VR session to evaluate the immediate effects. The VR intervention was designed with veteran and expert feedback to enhance emotional regulation and stress resilience, integrating evidence-based psychotherapeutic techniques.Results: Results demonstrate significant rapid improvement in mood and reduction in anxiety following each session, along with significant reductions in anxiety (up to 14.5%) and depression (up to 12.3%) upon programme completion. Consistent results across all study iterations confirmed the reliability and scalability of 360-VR therapy as a short-term rehabilitation tool.Conclusions: Immersive VR therapy presents an effective, accessible solution for managing the psychological impact of war, particularly within the limitations of Ukraine's healthcare system.
Collapse
Affiliation(s)
- Olga Kukharuk
- Institute for Social and Political Psychology, Kyiv, Ukraine
- Aspichi Charity Foundation, Kyiv, Ukraine
| | | | | | | |
Collapse
|
3
|
Shankar R, Siva Kumar FD, Bundele A, Mukhopadhyay A. Virtual reality for stress management and burnout reduction in nursing: A systematic review protocol. PLoS One 2025; 20:e0319247. [PMID: 40193343 PMCID: PMC11975074 DOI: 10.1371/journal.pone.0319247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Accepted: 01/30/2025] [Indexed: 04/09/2025] Open
Abstract
BACKGROUND Burnout is a pervasive issue in the nursing profession, with detrimental consequences for nurses' well-being, patient care, and healthcare systems. Virtual reality (VR) is a promising tool for delivering immersive and engaging interventions to manage stress and reduce burnout. This systematic review aims to synthesize the evidence on the effectiveness of VR interventions for stress and burnout in nursing, characterize the specific intervention approaches, and guide future research and practice. METHODS We will search for published and unpublished studies in PubMed, Web of Science, Embase, CINAHL, MEDLINE, The Cochrane Library, PsycINFO, and Scopus from database inception to the present. Randomized controlled trials, quasi-experimental studies, and pre-post studies examining VR interventions for stress and/or burnout in licensed nurses will be included. Two reviewers will independently screen studies, extract data, and assess risk of bias using the Cochrane Risk of Bias 2 tool for randomized trials and the ROBINS-I tool for non-randomized studies. If appropriate, meta-analysis will be performed to estimate pooled effects on stress and burnout outcomes. Subgroup and sensitivity analyses will explore the influence of intervention characteristics and study quality. Narrative synthesis will be conducted if quantitative synthesis is not possible. The review protocol follows the PRISMA-P guidelines and is registered in PROSPERO. DISCUSSION This systematic review will provide a comprehensive synthesis of the evidence on VR interventions for stress and burnout management in nurses. By critically appraising the research and identifying the most promising approaches, the review will guide the development and implementation of evidence-based VR programs to support nurses' well-being and address the urgent problem of burnout. The findings will also identify gaps in the literature and directions for future research to optimize the design and delivery of VR interventions for this high-need population. Systematic review registration: PROSPERO CRD42024604179.
Collapse
Affiliation(s)
- Ravi Shankar
- Research and Innovation, Medical Affairs, Alexandra Hospital, National University Health System, Singapore
| | - Fiona Devi Siva Kumar
- Research and Innovation, Medical Affairs, Alexandra Hospital, National University Health System, Singapore
| | - Anjali Bundele
- Research and Innovation, Medical Affairs, Alexandra Hospital, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Amartya Mukhopadhyay
- Research and Innovation, Medical Affairs, Alexandra Hospital, National University Health System, Singapore
- Division of Respiratory & Critical Care Medicine, Department of Medicine, National University Health System, Singapore
| |
Collapse
|
4
|
Goldental N, Gross R, Amital D, Harel EV, Hendler T, Tendler A, Levi L, Lavro D, Harmelech T, Grinapol S, Nacasch N, Fruchter E. Amygdala EFP Neurofeedback Effects on PTSD Symptom Clusters and Emotional Regulation Processes. J Clin Med 2025; 14:2421. [PMID: 40217870 PMCID: PMC11989595 DOI: 10.3390/jcm14072421] [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: 02/20/2025] [Revised: 03/20/2025] [Accepted: 03/27/2025] [Indexed: 04/14/2025] Open
Abstract
Background: Post-traumatic stress disorder (PTSD) manifests through distinct symptom clusters that can respond differently to treatments. Neurofeedback guided by the Amygdala-derived-EEG-fMRI-Pattern (Amyg-EFP-NF) has been utilized to train PTSD patients to regulate amygdala-related activity and decrease symptoms. Methods: We conducted a combined analysis of 128 PTSD patients from three clinical trials of Amyg-EFP-NF to evaluate effects across symptom clusters (as assessed by CAPS-5 subscales) and on emotion regulation processing (evaluated by the ERQ). Results: Amyg-EFP-NF significantly reduced severity across all PTSD symptom clusters immediately post-treatment, with improvements maintained at three-month follow-up. The arousal and reactivity cluster showed continued significant improvement during follow-up. Combined effect sizes were large (η2p = 0.23-0.35) across all symptom clusters. Regression analysis revealed that emotion regulation processes significantly explained 17% of the variance in symptom improvement during the follow-up period. Conclusions: Reduction of PTSD symptoms following Amyg-EFP-NF occurs across all symptom clusters, with emotional regulation processes potentially serving as an underlying mechanism of action. These results support Amyg-EFP-NF as a comprehensive treatment approach for PTSD that continues to show benefits after treatment completion.
Collapse
Affiliation(s)
- Nadav Goldental
- Division of Psychiatry, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel;
| | - Raz Gross
- Department of Epidemiology, School of Public Health and Department of Psychiatry, School of Medicine, Tel Aviv University, Sheba Medical Center, Tel Aviv 6997801, Israel;
| | - Daniela Amital
- Division of Psychiatry, Barzilai Medical Center, Ashkelon 7830604, Israel;
| | - Eiran V. Harel
- Be’er Ya’akov Mental Health Center, Be’er Ya’akov 70350, Israel;
| | - Talma Hendler
- Sagol Brain Institute, Tel Aviv Sourasky Medical Center, School of Psychological Sciences, Faculty of Medical and Health Sciences and Sagol School of Neuroscience, Tel-Aviv 6997801, Israel;
- GrayMatters Health Ltd., Haifa 3303403, Israel; (L.L.); (D.L.)
| | - Aron Tendler
- GrayMatters Health Ltd., Haifa 3303403, Israel; (L.L.); (D.L.)
| | - Liora Levi
- GrayMatters Health Ltd., Haifa 3303403, Israel; (L.L.); (D.L.)
| | - Dmitri Lavro
- GrayMatters Health Ltd., Haifa 3303403, Israel; (L.L.); (D.L.)
| | - Tal Harmelech
- GrayMatters Health Ltd., Haifa 3303403, Israel; (L.L.); (D.L.)
| | - Shulamit Grinapol
- Department of Community Mental Health, University of Haifa, Haifa 3498838, Israel;
| | - Nitsa Nacasch
- Clalit Health Services Community Division, Ramat-Chen Brull Mental Health Center, Tel Aviv-Yafo 6719709, Israel;
| | - Eyal Fruchter
- ICAR Collective and the Brus Rappaport Medical Faculty of the Technion, Haifa 3200003, Israel;
| |
Collapse
|
5
|
Spark J, Rowe E, Alvarez-Jimenez M, Bell I, Byrne L, Dzafic I, Ellinghaus C, Lavoie S, Lum J, McLean B, Thomas N, Thompson A, Wadley G, Whitford T, Wood S, Yuen HP, Nelson B. Integrating Virtual Reality, Neurofeedback, and Cognitive Behavioral Therapy for Auditory Verbal Hallucinations (Hybrid): Protocol of a Pilot, Unblinded, Single-Arm Interventional Study. JMIR Res Protoc 2025; 14:e63405. [PMID: 40168662 PMCID: PMC12000783 DOI: 10.2196/63405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Revised: 10/14/2024] [Accepted: 02/25/2025] [Indexed: 04/03/2025] Open
Abstract
BACKGROUND Current treatments for schizophrenia and other psychotic disorders have limited efficacy, with high rates of nonresponse to "gold standard" treatments. New approaches are therefore urgently required. OBJECTIVE The aims of this pilot study are to investigate the feasibility, acceptability, safety, and usability of Hybrid treatment (primary aim); and to explore Hybrid's treatment efficacy and engagement of treatment targets (secondary aim). The primary aim will be assessed via face-to-face user experience surveys on a (self-assessed) 5-point Likert scale (and qualitative open-ended questions) examining: (1) acceptability, (2) helpfulness, (3) engagement, and (4) perceived safety. We will also examine consent and completion rates, and the number of sessions attended. Our threshold for moving on to efficacy trials will be at least 70% of our participants to rate 3 and above (which corresponds to agree or strongly agree) that the intervention package was acceptable, feasible, and safe. The secondary aims will be assessed by observing whether individuals achieve self-directed modulation of high-β neurophysiological activity (neural target) and progression upwards through the VR-based exposure hierarchy (psychological target), and by assessing symptom change scores. This study developed a new treatment approach for auditory verbal hallucinations, a major symptom of psychotic disorders, that integrates advances in psychological therapy (cognitive behavioral therapy for psychosis), technology (virtual reality, VR), and neuroscience (electroencephalography-based neurofeedback). METHODS Hybrid takes a "symptom capture" approach using individually tailored VR-based exposure exercises. Participants (N=10) will receive the intervention package weekly over 12 face-to-face sessions. Here, participants will be progressively exposed to symptom triggers and develop methods of downregulating neural activity associated with these symptoms (neurofeedback component) while concurrently receiving clinician-delivered cognitive behavioral therapy for psychosis. RESULTS As of February 2025, Hybrid has commenced (unblinded) recruitment activities from Orygen clinical services in Northwestern Melbourne, Australia. A total of 75 individuals have been approached and 64 individuals have been prescreened (41 individuals were deemed eligible, 15 individuals were ineligible, and 8 individuals declined or did not respond to contact attempts) and 5 individuals have been included in the study. Of the 5 individuals who have commenced the Hybrid treatment, 4 are actively engaged in the program and 1 individual has withdrawn. We expect recruitment to conclude in July 2025 and for the results to be published in 2026. CONCLUSIONS The Hybrid study is piloting a novel approach that has the potential to address the shortcomings of current treatments for psychotic symptoms. If there is favorable evidence for the acceptability, feasibility, safety and usability of Hybrid, the study team will move on to efficacy trials. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12624000357550; https://tinyurl.com/24ey8hpy. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/63405.
Collapse
Affiliation(s)
- Jessica Spark
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Elise Rowe
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Imogen Bell
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Linda Byrne
- School of Psychology, Deakin University, Burwood, Australia
- The Cairnmillar Institute, Hawthorn East, Australia
| | - Ilvana Dzafic
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Carli Ellinghaus
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Suzie Lavoie
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Jarrad Lum
- School of Psychology, Deakin University, Burwood, Australia
| | - Brooke McLean
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Neil Thomas
- Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, Australia
| | - Andrew Thompson
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Greg Wadley
- School of Computing and Information Systems, University of Melbourne, Parkville, Australia
| | - Thomas Whitford
- Orygen, Parkville, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Stephen Wood
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
- School of Psychology, University of Birmingham, Edgbaston, United Kingdom
| | - Hok Pan Yuen
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| | - Barnaby Nelson
- Orygen, Parkville, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Australia
| |
Collapse
|
6
|
Mardon AK, Wilson D, Leake HB, Harvie D, Andrade A, Chalmers KJ, Bowes A, Moseley GL. The acceptability, feasibility, and usability of a virtual reality pain education and rehabilitation program for Veterans: a mixed-methods study. FRONTIERS IN PAIN RESEARCH 2025; 6:1535915. [PMID: 40182802 PMCID: PMC11965608 DOI: 10.3389/fpain.2025.1535915] [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: 11/28/2024] [Accepted: 03/06/2025] [Indexed: 04/05/2025] Open
Abstract
Introduction Persistent pain is a leading cause of medical discharges for Veterans. Pain science education (PSE) aims to better people's understanding about pain and is effective at reducing pain and depressive symptoms in Veterans. Preliminary evidence suggests virtual reality (VR)-delivered PSE has clinical benefits for people with persistent pain. This study investigated the acceptability, feasibility, and usability for VR-PSE for Veterans with persistent pain. Methods Veterans (n = 7) and healthcare professionals (HCPs) experienced in treating Veterans (n = 5) participated in workshops that involved working through the VR-PSE program, online questionnaires, and a focus group. Quantitative data were analysed by descriptive statistics. Qualitative data were analysed using a framework analysis according to the Theoretical Framework of Acceptability (TFA). A mixed-methods analysis combined the quantitative and qualitative data via triangulation, with the findings presented according to the TFA domains. Results The VR-PSE program was considered easy to use, engaging, and adaptable for different functional capabilities. Appropriate screening for contraindications prior to using the VR-PSE program was considered important by HCPs. Both Veterans and HCPs emphasized the need for a trusting client-clinician relationship to improve the acceptability of the VR-PSE program. Discussion Overall, the VR-PSE program was found to be acceptable, feasible, and usable and may be a useful tool to incorporate into the clinical management of Veterans with persistent pain. Further research is needed to investigate the efficacy of VR-PSE programs on clinical outcomes for Veterans with persistent pain.
Collapse
Affiliation(s)
- Amelia K. Mardon
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
- The Pain Education Team to Advance Learning (PETAL) Collaboration
- NICM Health Research Institute, Western Sydney University, Westmead, NSW, Australia
| | - Dianne Wilson
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Hayley B. Leake
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
- The Pain Education Team to Advance Learning (PETAL) Collaboration
| | - Daniel Harvie
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
| | - Andre Andrade
- Quality Use of Medicine Research Centre, The University of South Australia, Adelaide, SA, Australia
| | - K. Jane Chalmers
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
- The Pain Education Team to Advance Learning (PETAL) Collaboration
| | - Aaron Bowes
- IPAR Rehabilitation, Melbourne, VIC, Australia
| | - G. Lorimer Moseley
- IIMPACT in Health, University of South Australia, Adelaide, SA, Australia
- The Pain Education Team to Advance Learning (PETAL) Collaboration
| |
Collapse
|
7
|
Felnhofer A, Pfannerstill F, Gänsler L, Kothgassner OD, Humer E, Büttner J, Probst T. Barriers to adopting therapeutic virtual reality: the perspective of clinical psychologists and psychotherapists. Front Psychiatry 2025; 16:1549090. [PMID: 40171310 PMCID: PMC11958971 DOI: 10.3389/fpsyt.2025.1549090] [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: 12/20/2024] [Accepted: 02/19/2025] [Indexed: 04/03/2025] Open
Abstract
Background and objective Despite evidence supporting the effectiveness of Virtual Reality (VR) for mental disorders, VR adoption in therapy remains low. As VR-technology continues to advance, it is crucial to examine individual and contextual barriers preventing implementation of therapeutic VR. Methods An online survey with closed and open-ended questions regarding knowledge of VR, VR-usage and barriers to VR adoption was conducted among clinical psychologists and psychotherapists in Austria (Mage=51.71 years, 76% women). Results Of 694 participants, only 10 reported using therapeutic VR. Chi-square tests revealed significant differences regarding interest in therapeutic VR based on prior experience, employment status, professional training, and therapeutic cluster. Besides a small age effect, no effects of gender or professional experience were found. Participants interested in VR (interest group, IG) frequently cited barriers and other reasons (see thematic analysis) for not having used VR yet. Those not interested in VR (no interest group, NIG) indicated a lack of relevance, no perceived advantage, or disinterest as reasons for not using VR. Thematic analysis identified four themes shared by both IG and NIG, each encompassing group-specific sub-themes: professional barriers (lack of knowledge, training, time, personal reasons), financial barriers (costs, cost-benefit-ratio), therapeutic barriers (clinical applicability, concerns about "real" therapeutic relationship), and technological barriers (immature technology, cybersickness, no equipment). Conclusions Significant barriers to the adoption of therapeutic VR among clinical psychologists and psychotherapists are gaps in knowledge and training, financial constraints, and lack of motivation, all of which highlight the need for training and financial support to enhance VR implementation.
Collapse
Affiliation(s)
- Anna Felnhofer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Franziska Pfannerstill
- Division of Psychotherapy, Department of Psychology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Lisa Gänsler
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Pulmonology, Allergology and Endocrinology, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
- Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Oswald D. Kothgassner
- Department of Child and Adolescent Psychiatry, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Elke Humer
- Faculty for Psychotherapy Science, Sigmund Freud University Vienna, Vienna, Austria
- Department for Psychosomatic Medicine and Psychotherapy, University for Continuing Education Krems, Krems, Austria
| | - Johanna Büttner
- Division of Psychotherapy, Department of Psychology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Thomas Probst
- Division of Psychotherapy, Department of Psychology, Paris Lodron University Salzburg, Salzburg, Austria
| |
Collapse
|
8
|
Namazinia M, Mohajer S, Abbaspour S, Lopez V, Sarboozi-Hoseinabadi T. Effects of virtual reality on pain induced by arteriovenous fistula needle insertion in patients undergoing hemodialysis: A randomized clinical trial. J Vasc Access 2025; 26:531-539. [PMID: 38326286 DOI: 10.1177/11297298231225755] [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: 02/09/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is characterized by irreversible damage to renal function. For patients undergoing replacement therapies like hemodialysis (HD), the pain caused by arteriovenous fistula (AVF) cannulation becomes a significant aspect of their daily lives. This study aimed to examine the impact of virtual reality (VR) distraction techniques on the pain experienced during AVF needle insertion in patients undergoing HD. MATERIALS AND METHODS This randomized clinical trial (RCT) recruited a total of 60 patients undergoing HD from the 9 Dey Hospital in Torbat Heydariyeh, Iran, between March and August 2022. These patients were then divided into two groups: the intervention group and the control group. The intervention group received distraction techniques using the Shinecon 4th Gen Virtual Reality Headset, while the control group received routine care services. To assess the level of pain experienced during AVF cannulation, the Visual Analog Scale (VAS) was utilized. The collected data were analyzed using SPSS20. Various statistical tests, including the Chi-square test, Mann-Whitney U test, Multiple linear regression, and independent-samples t-test, were employed for data analysis. Additionally, Cohen's d was used to determine the effect size of the intervention. RESULTS The analysis of the data revealed a statistically significant difference in the mean (SD) pain scores between the control group (7.6 ± 0.8) and the intervention group (5.1 ± 0.9) (p < 0.002 after Bonferroni correction). Furthermore, it was observed that a majority of patients in the intervention group reported experiencing moderate pain, whereas the control group experienced more severe pain. CONCLUSIONS The study findings demonstrated that the use of virtual reality (VR) was effective in reducing the intensity of pain experienced during AVF needle insertion in patients undergoing HD. Based on these results, it is recommended to incorporate VR as a routine practice in the HD department of the hospital. TRIAL REGISTRATION This study, with the code no. IRCT20180429039463N3, was registered on the Iranian Registry of Clinical Trials on 28/03/2022.
Collapse
Affiliation(s)
- Mohammad Namazinia
- Department of Nursing, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Razavi Khorasan, Iran
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Razavi Khorasan, Iran
| | - Samira Mohajer
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Razavi Khorasan, Iran
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Seddigheh Abbaspour
- Department of Nursing, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Razavi Khorasan, Iran
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Razavi Khorasan, Iran
| | - Violeta Lopez
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Tahere Sarboozi-Hoseinabadi
- Department of Nursing, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Razavi Khorasan, Iran
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Razavi Khorasan, Iran
| |
Collapse
|
9
|
Wu JY, Tsai YY, Chen YJ, Hsiao FC, Hsu CH, Lin YF, Liao LD. Digital transformation of mental health therapy by integrating digitalized cognitive behavioral therapy and eye movement desensitization and reprocessing. Med Biol Eng Comput 2025; 63:339-354. [PMID: 39400854 DOI: 10.1007/s11517-024-03209-6] [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: 03/03/2024] [Accepted: 09/17/2024] [Indexed: 10/15/2024]
Abstract
Digital therapy has gained popularity in the mental health field because of its convenience and accessibility. One major benefit of digital therapy is its ability to address therapist shortages. Posttraumatic stress disorder (PTSD) is a debilitating mental health condition that can develop after an individual experiences or witnesses a traumatic event. Digital therapy is an important resource for individuals with PTSD who may not have access to traditional in-person therapy. Cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR) are two evidence-based psychotherapies that have shown efficacy in treating PTSD. This paper examines the mechanisms and clinical symptoms of PTSD as well as the principles and applications of CBT and EMDR. Additionally, the potential of digital therapy, including internet-based CBT, video conferencing-based therapy, and exposure therapy using augmented and virtual reality, is explored. This paper also discusses the engineering techniques employed in digital psychotherapy, such as emotion detection models and text analysis, for assessing patients' emotional states. Furthermore, it addresses the challenges faced in digital therapy, including regulatory issues, hardware limitations, privacy and security concerns, and effectiveness considerations. Overall, this paper provides a comprehensive overview of the current state of digital psychotherapy for PTSD treatment and highlights the opportunities and challenges in this rapidly evolving field.
Collapse
Affiliation(s)
- Ju-Yu Wu
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 35053, Taiwan
- Doctoral Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Ying-Ying Tsai
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 35053, Taiwan
- Department of Biomedical Engineering & Environmental Sciences, National Tsing-Hua University, Hsinchu, Taiwan
| | - Yu-Jie Chen
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 35053, Taiwan
| | - Fan-Chi Hsiao
- Department of Counseling, Clinical and Industrial/Organizational Psychology, Ming Chuan University, Taoyuan City, Taiwan
| | - Ching-Han Hsu
- Department of Biomedical Engineering & Environmental Sciences, National Tsing-Hua University, Hsinchu, Taiwan
| | - Yen-Feng Lin
- Center for Neuropsychiatric Research, National Health Research Institutes, 35, Keyan Road, Zhunan Town, Miaoli County, 350, Taiwan
| | - Lun-De Liao
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 35053, Taiwan.
- Doctoral Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung, Taiwan.
| |
Collapse
|
10
|
Casey BJ, Lin YC, Meyer HC. Examining threat responses through a developmental lens. Cereb Cortex 2025; 35:19-33. [PMID: 39562146 DOI: 10.1093/cercor/bhae449] [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: 06/24/2024] [Revised: 10/21/2024] [Indexed: 11/21/2024] Open
Abstract
Adolescence has been characterized by risk taking and fearlessness. Yet, the emergence of anxiety disorders that are associated with fear peaks during this developmental period. Moreover, adolescents show heightened sensitivity to stress relative to children and adults. To address inconsistencies between the common characterization of adolescents as fearless and the evidence of heightened anxiety and stress during this time, we build upon foundational discoveries of threat-related circuitry and behavior in adult rodents by Joseph LeDoux and colleagues. Specifically, the conservation of this circuitry across species has provided opportunities for identifying mechanisms underlying threat responses that we have extended to developing humans and rodents. We elucidate situations in which adolescents show heightened threat responses and others where they appear fearless and link them to developmental changes of threat circuitry during this period. We discuss the potential adaptiveness of these threat responses for survival of the individual and species but also the potential risks for anxiety and stress. We end by offering potential new ways in which behavioral treatments for youth with anxiety and stress-related disorders may be optimized to target the developing vs developed brain.
Collapse
Affiliation(s)
- B J Casey
- Department of Neuroscience and Behavior, Barnard College-Columbia University, 3009 Broadway, New York, NY 10027, United States
| | - Yen-Chu Lin
- Department of Neuroscience and Behavior, Barnard College-Columbia University, 3009 Broadway, New York, NY 10027, United States
| | - Heidi C Meyer
- Department of Psychological and Brain Sciences, Boston University, 610 Commonwealth Ave, 7th Floor, Boston, MA 02215, United States
| |
Collapse
|
11
|
Olff M. Celebrating 15 years of Psychotraumatology - a future with generative AI? Eur J Psychotraumatol 2024; 15:2429921. [PMID: 39633615 PMCID: PMC11622376 DOI: 10.1080/20008066.2024.2429921] [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: 12/07/2024] Open
Abstract
The European Journal of Psychotraumatology (EJPT) was launched in 2010. In this editorial, we review the journal's developments over the past 15 years, and discuss some of the current ethical challenges in scientific publishing, including the impact of generative AI. How can we responsibly use these new technologies? Additionally, we present 15 years of journal metrics, highlight past and upcoming special issues on 'hot topics,' and are pleased to announce awards for the best paper and best reviewer of 2023, recognizing two outstanding recipients.
Collapse
Affiliation(s)
- Miranda Olff
- Department of Psychiatry, University of Amsterdam Academic Medical Center, Amsterdam, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
| |
Collapse
|
12
|
Chenais N, Görgen A. Immersive interfaces for clinical applications: current status and future perspective. Front Neurorobot 2024; 18:1362444. [PMID: 39664264 PMCID: PMC11631914 DOI: 10.3389/fnbot.2024.1362444] [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: 12/28/2023] [Accepted: 11/04/2024] [Indexed: 12/13/2024] Open
Abstract
Digital immersive technologies have become increasingly prominent in clinical research and practice, including medical communication and technical education, serious games for health, psychotherapy, and interfaces for neurorehabilitation. The worldwide enthusiasm for digital health and digital therapeutics has prompted the development and testing of numerous applications and interaction methods. Nevertheless, the lack of consistency in the approaches and the peculiarity of the constructed environments contribute to an increasing disparity between the eagerness for new immersive designs and the long-term clinical adoption of these technologies. Several challenges emerge in aligning the different priorities of virtual environment designers and clinicians. This article seeks to examine the utilization and mechanics of medical immersive interfaces based on extended reality and highlight specific design challenges. The transfer of skills from virtual to clinical environments is often confounded by perceptual and attractiveness factors. We argue that a multidisciplinary approach to development and testing, along with a comprehensive acknowledgement of the shared mechanisms that underlie immersive training, are essential for the sustainable integration of extended reality into clinical settings. The present review discusses the application of a multilevel sensory framework to extended reality design, with the aim of developing brain-centered immersive interfaces tailored for therapeutic and educational purposes. Such a framework must include broader design questions, such as the integration of digital technologies into psychosocial care models, clinical validation, and related ethical concerns. We propose that efforts to bridge the virtual gap should include mixed methodologies and neurodesign approaches, integrating user behavioral and physiological feedback into iterative design phases.
Collapse
Affiliation(s)
- Naïg Chenais
- Swiss Center for Design and Health, Nidau, Switzerland
- Department of Ophthalmology, Jules-Gonin Eye Hospital, University of Lausanne, Lausanne, Switzerland
| | - Arno Görgen
- Swiss Center for Game Design Studies, Institute of Design Research, Academy of the Arts, Bern University of Applied Science, Bern, Switzerland
| |
Collapse
|
13
|
Javanbakht A, Hinchey L, Gorski K, Ballard A, Ritchie L, Amirsadri A. Unreal that feels real: artificial intelligence-enhanced augmented reality for treating social and occupational dysfunction in post-traumatic stress disorder and anxiety disorders. Eur J Psychotraumatol 2024; 15:2418248. [PMID: 39508526 PMCID: PMC11544745 DOI: 10.1080/20008066.2024.2418248] [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: 08/08/2024] [Revised: 10/06/2024] [Accepted: 10/08/2024] [Indexed: 11/15/2024] Open
Abstract
Background: Fear- and trauma-related conditions, such as post-traumatic stress disorder (PTSD) and social phobia, often manifest as socially avoidant behaviours, which commonly contribute to social and occupational disability transdiagnostically. While gold-standard treatments (i.e. exposure therapy, psychotropic medications) are effective, they are hindered by high dropout rates and limited impact on real-world functioning. Furthermore, most existing interventions only target symptom reduction, with few addressing avoidance-related deficits in social and occupational functioning.Objectives: This methods paper introduces an innovative augmented reality exposure therapy (ARET) technology designed to address the limitations of traditional interventions for anxiety disorders and PTSD, by directly targeting social and occupational dysfunction through exposure to real-life social contexts.Method: We introduce an ARET system, using artificial intelligence (AI)-driven, augmented reality (AR) technology, that enables exposure to realistic scenarios within the patient's real-world environment, fostering contextual generalization and functional improvement. Featuring holographic three-dimensional humans, precise surface mapping, wireless mobility, and telemedicine capabilities, the software provides customizable exposure scenarios to transform an environment into various spaces (e.g. grocery store, house party) with diverse human characters, as well as flexible AI-driven human interactions tailored to individual needs.Results: We share observations and feedback from the treatment of first responders with PTSD. Patients found the technology easy to use, with immersive realism, active engagement, and strong emotional responses needed for effective exposure therapy. Advances in AI-driven character development and AR hardware accessibility support the wider adoption of ARET by clinicians.Conclusion: By bridging the gap between clinical interventions and real-world functioning, ARET offers a transformative approach to addressing the pervasive impact of psychiatric disorders on social and occupational outcomes.
Collapse
Affiliation(s)
- Arash Javanbakht
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Liza Hinchey
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Kathleen Gorski
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Alex Ballard
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Alireza Amirsadri
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| |
Collapse
|
14
|
Kanstrup M, Singh L, Leehr EJ, Göransson KE, Pihlgren SA, Iyadurai L, Dahl O, Falk AC, Lindström V, Hadziosmanovic N, Gabrysch K, Moulds ML, Holmes EA. A guided single session intervention to reduce intrusive memories of work-related trauma: a randomised controlled trial with healthcare workers in the COVID-19 pandemic. BMC Med 2024; 22:403. [PMID: 39300443 PMCID: PMC11414261 DOI: 10.1186/s12916-024-03569-8] [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: 04/26/2024] [Accepted: 08/19/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Intrusive memories of psychologically traumatic events bring distress both sub-clinically and clinically. This parallel-group, two-arm randomised controlled trial evaluated the effect of a brief behavioural intervention on reducing intrusive memories in frontline healthcare workers exposed to traumatic events during the COVID-19 pandemic. METHODS Participants with at least two intrusive memories of work-related trauma in the week before recruitment were randomised 1:1 to an imagery-competing task intervention (n = 73) or attention-based control task (n = 71). The number of intrusive memories was assessed at baseline and 5 weeks after the guided session (primary endpoint). RESULTS The intervention significantly reduced intrusive memory frequency compared with control [intervention Mdn = 1.0 (IQR = 0-3), control Mdn = 5.0 (IQR = 1-17); p < 0.0001, IRR = 0.30; 95% CI = 0.17-0.53] and led to fewer post-traumatic stress-related symptoms at 1, 3 and 6 month follow-ups (secondary endpoints). Participants and statisticians were blinded to allocation. Adverse events data were acquired throughout the trial, demonstrating safety. There was high adherence and low attrition. CONCLUSIONS This brief, single-symptom, repeatable digital intervention for subclinical-to-clinical samples after trauma allows scalability, taking a preventing-to-treating approach after trauma. TRIAL REGISTRATION 2020-07-06, ClinicalTrials.gov identifier: NCT04460014.
Collapse
Affiliation(s)
- Marie Kanstrup
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Behavioral Medicine, Theme Women's Health and Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
| | - Laura Singh
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Swedish Collegium for Advanced Study, Uppsala, Sweden
| | - Elisabeth Johanna Leehr
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Institute for Translational Psychiatry, University of Münster, Münster, Germany
| | - Katarina E Göransson
- Emergency and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- School of Health and Welfare, Department of Caring Sciences, Dalarna University, Falun, Sweden
| | - Sara Ahmed Pihlgren
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | | | - Oili Dahl
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Perioperativ Medicin and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Ann-Charlotte Falk
- Department for Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
| | - Veronica Lindström
- Department for Health Promoting Science, Sophiahemmet University, Stockholm, Sweden
- Department of Nursing, Section of Ambulance Service Region of Västerbotten, Umeå University, Umeå, Sweden
| | | | - Katja Gabrysch
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Michelle L Moulds
- School of Psychology, The University of New South Wales, UNSW Sydney, Sydney, Australia
| | - Emily A Holmes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Department of Women's and Children's Health, Uppsala University, Akademiska Sjukhuset, 751 85, Uppsala, Sweden.
| |
Collapse
|
15
|
Salazar de Pablo G, Ríos Hernández O, Gómez Vallejo S, Young AH, Cella M, Valmaggia L. Use of virtual reality in bipolar disorder: a systematic review. Psychol Med 2024; 54:2807-2822. [PMID: 39228287 DOI: 10.1017/s0033291724001247] [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: 09/05/2024]
Abstract
Virtual reality (VR) is a technology that allows to interact with recreated digital environments and situations with enhanced realism. VR has shown good acceptability and promise in different mental health conditions. No systematic review has evaluated the use of VR in Bipolar Disorder (BD). This PRISMA-compliant systematic review searched PubMed and Web of Science databases (PROSPERO: CRD42023467737) to identify studies conducted in individuals with BD in which VR was used. Results were systematically synthesized around four categories (cognitive and functional evaluation, clinical assessment, response to VR and safety/acceptability). Eleven studies were included (267 individuals, mean age = 36.6 years, 60.7% females). Six studies using VR to carry out a cognitive evaluation detected impairments in neuropsychological performance and delayed reaction times. VR was used to assess emotional regulation. No differences in well-being between VR-based and physical calm rooms were found. A VR-based stress management program reduced subjective stress, depression, and anxiety levels. VR-based cognitive remediation improved cognition, depressive symptoms, and emotional awareness. 48.7% of the individuals with BD considered VR-based cognitive remediation 'excellent', whereas 28.2% considered it 'great'. 87.2% of individuals did not report any side effects. 81.8% of studies received a global quality rating of moderate. Emerging data point towards a promising use of VR in BD as an acceptable assessment/intervention tool. However, multiple unstudied domains as comorbidity, relapse and prodromal symptoms should be investigated. Research on children and adolescents is also recommended. Further research and replication of findings are required to disentangle which VR-interventions for which populations and outcomes are effective.
Collapse
Affiliation(s)
- Gonzalo Salazar de Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Omar Ríos Hernández
- Department of Psychology, Consorcio Hospitalario Provicial de Castellon, Spain
- Department of Personality, Evaluation and Psychological Treatments, University of Valencia, Spain
| | - Sandra Gómez Vallejo
- Child and Adolescent Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clínic, Barcelona, Spain
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Kent, UK
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, Katholieke Leuven Universitet, Leuven, Belgium
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
16
|
Ong T, Barrera JF, Sunkara C, Soni H, Ivanova J, Cummins MR, Schuler KR, Wilczewski H, Welch BM, Bunnell BE. Mental health providers are inexperienced but interested in telehealth-based virtual reality therapy: survey study. FRONTIERS IN VIRTUAL REALITY 2024; 5:1332874. [PMID: 39228388 PMCID: PMC11370306 DOI: 10.3389/frvir.2024.1332874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Virtual reality (VR) is an emerging technology that can enhance experiences and outcomes in mental healthcare. However, mental health therapists have been slow to adopt VR into practice. Implementation of telehealth-based VR therapy (tele-VR) could catalyze adoption and innovation in mental healthcare. To explore therapists' perspectives on tele-VR, we conducted a cross-sectional survey of practicing mental health providers in the United States in June-July 2023. We analyzed 176 completed surveys from therapists, of whom 51.14% had no prior experience with VR, only 6.25% had used VR clinically, and 56.82% had neutral impressions of VR for therapy. Despite therapists' general inexperience with VR, therapists indicated a wide variety of tele-VR simulations (e.g., social situations, flying, heights) and features (e.g., personalized spaces, homework, interactivity) would be moderately to extremely useful for their practices. Therapists also requested additional VR simulations and features for their telehealth clients such as behavioral skills training, exposure therapy, gender identity therapy, and psychological assessments in VR. Therapists rated Health Insurance Portability and Accountability Act compliance, the ability to try VR before buying, affordability for therapists, accessibility for clients, and insurance coverage as the five most influential implementation factors for tele-VR. Overall, therapists were generally inexperienced and neutral about VR for telehealth therapy, but were interested in tele-VR for specific applications. These findings provide actionable directions for future research and collaborative development of therapeutic VR content and features.
Collapse
Affiliation(s)
- Triton Ong
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
| | - Janelle F. Barrera
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Charvi Sunkara
- Lake Erie College of Osteopathic Medicine, Bradenton, FL, United States
| | - Hiral Soni
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
| | - Julia Ivanova
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
| | - Mollie R. Cummins
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
- College of Nursing and Department of Biomedical Informatics, University of Utah, Salt Lake City, UT, United States
| | - Kaitlyn R. Schuler
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | | | - Brandon M. Welch
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
- Biomedical Informatics Center, Medical University of South Carolina, Public Health and Sciences, Charleston, SC, United States
| | - Brian E. Bunnell
- Doxy.me Research, Doxy.me Inc., Rochester, NY, United States
- Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| |
Collapse
|
17
|
Adrien V, Bosc N, Peccia Galletto C, Diot T, Claverie D, Reggente N, Trousselard M, Bui E, Baubet T, Schoeller F. Enhancing Agency in Posttraumatic Stress Disorder Therapies Through Sensorimotor Technologies. J Med Internet Res 2024; 26:e58390. [PMID: 38742989 PMCID: PMC11250045 DOI: 10.2196/58390] [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: 03/14/2024] [Revised: 04/17/2024] [Accepted: 05/02/2024] [Indexed: 05/16/2024] Open
Abstract
Posttraumatic stress disorder (PTSD) is a significant public health concern, with only a third of patients recovering within a year of treatment. While PTSD often disrupts the sense of body ownership and sense of agency (SA), attention to the SA in trauma has been lacking. This perspective paper explores the loss of the SA in PTSD and its relevance in the development of symptoms. Trauma is viewed as a breakdown of the SA, related to a freeze response, with peritraumatic dissociation increasing the risk of PTSD. Drawing from embodied cognition, we propose an enactive perspective of PTSD, suggesting therapies that restore the SA through direct engagement with the body and environment. We discuss the potential of agency-based therapies and innovative technologies such as gesture sonification, which translates body movements into sounds to enhance the SA. Gesture sonification offers a screen-free, noninvasive approach that could complement existing trauma-focused therapies. We emphasize the need for interdisciplinary collaboration and clinical research to further explore these approaches in preventing and treating PTSD.
Collapse
Affiliation(s)
- Vladimir Adrien
- Department of Infectious and Tropical Diseases, Avicenne Hospital, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
- Institute of Psychiatry and Neuroscience of Paris, Inserm UMR-S 1266, Université Paris Cité, Paris, France
- Department of Psychopathology, Avicenne Hospital, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
| | - Nicolas Bosc
- Department of Psychopathology, Avicenne Hospital, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
| | | | - Thomas Diot
- Department of Adult Psychiatry, Impact, Mondor Hospital, AP-HP, Université Paris-Est Créteil, Créteil, France
| | - Damien Claverie
- Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge, France
| | - Nicco Reggente
- Institute for Advanced Consciousness Studies, Santa Monica, CA, United States
| | - Marion Trousselard
- Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge, France
- INSPIIRE, Inserm UMR 1319, Université de Lorraine, Nancy, France
- ADES, CNRS UMR 7268, Aix-Marseille Université, Marseille, France
| | - Eric Bui
- Department of Psychiatry, Caen Normandy University Hospital, Normandie Université, Caen, France
- Physiopathology and Imaging of Neurological Disorders, UNICAEN, Inserm UMR-S 1237, Normandie Université, Caen, France
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Thierry Baubet
- Department of Psychopathology, Avicenne Hospital, AP-HP, Université Sorbonne Paris Nord, Bobigny, France
- Unité Transversale de Psychogénèse et Psychopathologie, Université Sorbonne Paris Nord, Villetaneuse, France
- Centre National de Ressources et de Résilience, Lille, France
| | - Félix Schoeller
- Institute for Advanced Consciousness Studies, Santa Monica, CA, United States
- Media Lab, Massachusetts Institute of Technology, Cambridge, MA, United States
| |
Collapse
|
18
|
Blanco D, Roberts RM, Gannoni A, Cook S. Assessment and treatment of mental health conditions in children and adolescents: A systematic scoping review of how virtual reality environments have been used. Clin Child Psychol Psychiatry 2024; 29:1070-1086. [PMID: 37738029 PMCID: PMC11188554 DOI: 10.1177/13591045231204082] [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: 09/23/2023]
Abstract
BACKGROUND There is growing interest in the use of virtual reality environments (VREs) in psychological treatment and assessment. Most research has focused on the application of VREs in adult psychological disorders with fewer studies focusing on its applicability with children and adolescents. A systematic scoping review was undertaken of research assessing how VREs have been used in the treatment and assessment of childhood mental health disorders to provide an overview of the current state of the literature and identify future research directions. METHOD Systematic searches of online databases were conducted in PsycInfo, PubMed, Embase, Scopus, and Web of Science. RESULTS Eleven studies met eligibility criteria and were included in this review, with the majority focusing on VRE interventions for anxiety-related disorders. There is also emerging support for VRE deep breathing training for anxiety, VRE assisted treatment of internet gaming disorder and anorexia nervosa, and VRE assessment of body image evaluation in anorexia nervosa. Most studies were pilot and feasibility studies with only three randomised-controlled trials (RCT). CONCLUSIONS The current literature shows some promise for the use of VRE assessments and interventions of childhood mental health problems, particularly for anxiety-related disorders such as social anxiety and specific phobias. However, high-quality RCTs are now needed to establish effectiveness of VREs in this population, and how it compares to existing evidence-based approaches, given its promise to improve both engagement and outcomes.
Collapse
Affiliation(s)
- Dana Blanco
- School of Psychology, University of Adelaide, Australia
| | | | - Anne Gannoni
- Child & Adolescent Mental Health Services, Women’s & Children’s Health Network, Australia
| | - Steve Cook
- School of Humanities, University of Adelaide, Australia
| |
Collapse
|
19
|
Marks M, Brendel RW, Shachar C, Cohen IG. Essentials of Informed Consent to Psychedelic Medicine. JAMA Psychiatry 2024; 81:611-617. [PMID: 38598209 DOI: 10.1001/jamapsychiatry.2024.0184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
Importance Interest in administering psychedelic agents as mental health treatment is growing rapidly. As drugmakers invest in developing psychedelic medicines for several psychiatric indications, lawmakers are enacting legal reforms to speed access globally, and health agencies are preparing to approve these treatments. Meanwhile, US states, such as Oregon and Colorado, are making psychedelics available for supervised use outside the conventional health care system. Observations Despite legal change and potentially imminent regulatory approval in some countries, standards for integrating psychedelics into health care have lagged, including norms for designing and implementing informed consent processes. Informed consent is complicated by the unique features of psychedelics and their means of administration. Because no governments have approved any classic psychedelics for general medical or psychiatric use, only clinical researchers have obtained informed consent from trial participants. Accordingly, there is an unmet need for informed consent processes tailored to the challenges of administering psychedelics in nonresearch settings. Conclusions and Relevance Analysis of the challenges of designing and implementing psychedelic informed consent practices revealed 7 essential components, including the possibility of short- and long-term perceptual disturbances, potential personality changes and altered metaphysical beliefs, the limited role of reassuring physical touch, the potential for patient abuse or coercion, the role and risks of data collection, relevant practitioner disclosures, and interactive patient education and comprehension assessment. Because publicly available informed consent documents for psychedelic clinical trials often overlook or underemphasize these essential elements, sample language and procedures to fill the gap are proposed.
Collapse
Affiliation(s)
- Mason Marks
- Project on Psychedelics Law and Regulation (POPLAR), Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School, Cambridge, Massachusetts
- Florida State University College of Law, Tallahassee, Florida
| | | | - Carmel Shachar
- Center for Health Law and Policy Innovation, Harvard Law School, Cambridge, Massachusetts
| | - I Glenn Cohen
- Project on Psychedelics Law and Regulation (POPLAR), Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School, Cambridge, Massachusetts
| |
Collapse
|
20
|
Gausemel Å, Filkuková P. Virtual realities, real recoveries: exploring the efficacy of 3MDR therapy for treatment-resistant PTSD. Front Psychol 2024; 15:1291961. [PMID: 38813557 PMCID: PMC11135474 DOI: 10.3389/fpsyg.2024.1291961] [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: 09/10/2023] [Accepted: 04/16/2024] [Indexed: 05/31/2024] Open
Abstract
Exposure-based therapies have shown promise in treating post-traumatic stress disorder (PTSD), but challenges exist in maintaining patient engagement and finding appropriate stimuli for graded exposure. Virtual reality (VR) technology has been used to enhance exposure therapy, but current software lacks customization and some patients remain treatment-resistant. A novel approach called multimodular motion-assisted memory desensitization and reconsolidation (3MDR) has the potential to solve some of the current limitations of VR-assisted exposure therapy. This study examines the efficacy of 3MDR treatment for individuals with treatment-resistant PTSD through a systematic review of relevant literature and clinical studies. Preliminary findings indicate promise for 3MDR in reducing PTSD symptoms, including emotional regulation and moral injury. However, further research with larger samples and controlled studies is needed to understand underlying mechanisms and validate these results. Moreover, this study highlights the importance of health-economic evaluations to assess costs and resource utilization associated with implementing 3MDR treatment in clinical services.
Collapse
Affiliation(s)
- Åsmund Gausemel
- Department of Psychology, Inland Norway University of Applied Sciences, Lillehammer, Norway
| | - Petra Filkuková
- Department of Psychology, Inland Norway University of Applied Sciences, Lillehammer, Norway
- Department of High Performance Computing, Simula Research Laboratory, Oslo, Norway
| |
Collapse
|
21
|
Barbieri M, Albanese GA, Merello A, Crepaldi M, Setti W, Gori M, Canessa A, Sabatini SP, Facchini V, Sandini G. Assessing REALTER simulator: analysis of ocular movements in simulated low-vision conditions with extended reality technology. Front Bioeng Biotechnol 2024; 12:1285107. [PMID: 38638317 PMCID: PMC11024368 DOI: 10.3389/fbioe.2024.1285107] [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: 08/31/2023] [Accepted: 03/14/2024] [Indexed: 04/20/2024] Open
Abstract
Immersive technology, such as extended reality, holds promise as a tool for educating ophthalmologists about the effects of low vision and for enhancing visual rehabilitation protocols. However, immersive simulators have not been evaluated for their ability to induce changes in the oculomotor system, which is crucial for understanding the visual experiences of visually impaired individuals. This study aimed to assess the REALTER (Wearable Egocentric Altered Reality Simulator) system's capacity to induce specific alterations in healthy individuals' oculomotor systems under simulated low-vision conditions. We examined task performance, eye movements, and head movements in healthy participants across various simulated scenarios. Our findings suggest that REALTER can effectively elicit behaviors in healthy individuals resembling those observed in individuals with low vision. Participants with simulated binocular maculopathy demonstrated unstable fixations and a high frequency of wide saccades. Individuals with simulated homonymous hemianopsia showed a tendency to maintain a fixed head position while executing wide saccades to survey their surroundings. Simulation of tubular vision resulted in a significant reduction in saccade amplitudes. REALTER holds promise as both a training tool for ophthalmologists and a research instrument for studying low vision conditions. The simulator has the potential to enhance ophthalmologists' comprehension of the limitations imposed by visual disabilities, thereby facilitating the development of new rehabilitation protocols.
Collapse
Affiliation(s)
- Mattia Barbieri
- Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Genova, Italy
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | - Giulia A. Albanese
- Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Genova, Italy
| | - Andrea Merello
- Electronic Design Laboratory, Istituto Italiano di Tecnologia, Genova, Italy
| | - Marco Crepaldi
- Electronic Design Laboratory, Istituto Italiano di Tecnologia, Genova, Italy
| | - Walter Setti
- Unit for Visually Impaired People, Istituto Italiano di Tecnologia, Genova, Italy
| | - Monica Gori
- Unit for Visually Impaired People, Istituto Italiano di Tecnologia, Genova, Italy
| | - Andrea Canessa
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | - Silvio P. Sabatini
- Department of Informatics, Bioengineering, Robotics and Systems Engineering, University of Genoa, Genoa, Italy
| | | | - Giulio Sandini
- Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Genova, Italy
| |
Collapse
|
22
|
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
|
23
|
Kim JW, Jhon M, Kang HJ, Kim SW, Kim JM. Two Cases of Posttraumatic Stress Disorder Caused by a Motor Vehicle Accident Treated with Virtual Reality Exposure Therapy. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE : THE OFFICIAL SCIENTIFIC JOURNAL OF THE KOREAN COLLEGE OF NEUROPSYCHOPHARMACOLOGY 2024; 22:194-199. [PMID: 38247426 PMCID: PMC10811391 DOI: 10.9758/cpn.22.1036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 01/23/2024]
Abstract
Exposure-response prevention is an effective approach to treat anxiety disorders. Virtual reality exposure therapy (VRET) is a promising treatment for patients with posttraumatic stress disorder (PTSD). New research has helped refine and update VRET. In this study, we introduce a form of VRET developed for patients suffering from PTSD after a traffic accident, and present two cases treated using this protocol. After 6 weeks of VRET treatment, the two participants not only improved their PTSD symptoms, but also improved their depressed mood, anxiety, and insomnia symptoms. Future studies of VRET for car accident-related PTSD should utilize a controlled design with randomization in order to account for numerous possible confounds.
Collapse
Affiliation(s)
- Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Min Jhon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Korea
| |
Collapse
|
24
|
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
|
25
|
Brassel S, Brunner M, Campbell A, Power E, Togher L. Exploring Discussions About Virtual Reality on Twitter to Inform Brain Injury Rehabilitation: Content and Network Analysis. J Med Internet Res 2024; 26:e45168. [PMID: 38241072 PMCID: PMC10837760 DOI: 10.2196/45168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 07/06/2023] [Accepted: 10/29/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Virtual reality (VR) use in brain injury rehabilitation is emerging. Recommendations for VR development in this field encourage end user engagement to determine the benefits and challenges of VR use; however, existing literature on this topic is limited. Data from social networking sites such as Twitter may further inform development and clinical practice related to the use of VR in brain injury rehabilitation. OBJECTIVE This study collected and analyzed VR-related tweets to (1) explore the VR tweeting community to determine topics of conversation and network connections, (2) understand user opinions and experiences of VR, and (3) identify tweets related to VR use in health care and brain injury rehabilitation. METHODS Publicly available tweets containing the hashtags #virtualreality and #VR were collected up to twice weekly during a 6-week period from July 2020 to August 2020 using NCapture (QSR International). The included tweets were analyzed using mixed methods. All tweets were coded using inductive content analysis. Relevant tweets (ie, coded as "VR in health care" or "talking about VR") were further analyzed using Dann's content coding. The biographies of users who sent relevant tweets were examined descriptively. Tweet data networks were visualized using Gephi computational analysis. RESULTS A total of 260,715 tweets were collected, and 70,051 (26.87%) were analyzed following eligibility screening. The sample comprised 33.68% (23,596/70,051) original tweets and 66.32% (46,455/70,051) retweets. Content analysis generated 10 main categories of original tweets related to VR (ie, advertising and promotion, VR content, talking about VR, VR news, general technology, VR industry, VR live streams, VR in health care, VR events, and VR community). Approximately 4.48% (1056/23,596) of original tweets were related to VR use in health care, whereas 0.19% (45/23,596) referred to VR in brain injury rehabilitation. In total, 14.86% (3506/23,596) of original tweets featured commentary on user opinions and experiences of VR applications, equipment, and software. The VR tweeting community comprised a large network of 26,001 unique Twitter users. Users that posted tweets related to "VR in health care" (2124/26,001, 8.17%) did not form an interconnected VR network, whereas many users "talking about VR" (3752/26,001, 14.43%) were connected within a central network. CONCLUSIONS This study provides valuable data on community-based experiences and opinions related to VR. Tweets showcased various VR applications, including in health care, and identified important user-based considerations that can be used to inform VR use in brain injury rehabilitation (eg, technical design, accessibility, and VR sickness). Limited discussions and small user networks related to VR in brain injury rehabilitation reflect the paucity of literature on this topic and the potential underuse of this technology. These findings emphasize that further research is required to understand the specific needs and perspectives of people with brain injuries and clinicians regarding VR use in rehabilitation.
Collapse
Affiliation(s)
- Sophie Brassel
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Melissa Brunner
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Andrew Campbell
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Emma Power
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Leanne Togher
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Western Sydney Local Health District, Sydney, Australia
| |
Collapse
|
26
|
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
|
27
|
Schröder D, Wrona KJ, Müller F, Heinemann S, Fischer F, Dockweiler C. Impact of virtual reality applications in the treatment of anxiety disorders: A systematic review and meta-analysis of randomized-controlled trials. J Behav Ther Exp Psychiatry 2023; 81:101893. [PMID: 37453405 DOI: 10.1016/j.jbtep.2023.101893] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/15/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Anxiety disorders are the most prevalent mental disorders worldwide. Virtual reality (VR) treatment approaches have increasingly been studied. Before clinical implementation, it is necessary to evaluate the treatment effect of VR applications. The objective is to evaluate the treatment effect of virtual reality applications in the treatment of anxiety disorders compared to conventional therapy. METHODS A systematic literature review with meta-analysis was conducted. Four databases were used to identify randomized controlled trials published between April 2011 and April 2021 which compare VR applications with non-VR interventions or waiting lists. Study characteristics, pre- and post-treatment data were extracted. Hedges g was calculated as effect size. Primary outcome was anxiety symptoms. RESULTS Data from 17 studies from 827 participants was extracted. The studies examined specific phobia (n = 9), social anxiety disorder (n = 4), agoraphobia (n = 2) and panic disorder (n = 2). 16 out of 17 studies used head-mounted displays as VR application. A non-significant effect size with significant heterogeneity was observed in favor of the use of VR applications in anxiety symptoms (g, 0.33; 95%-CI, -0.20-0.87). Compared to passive control groups, VR applications are associated significant with lower anxiety symptoms (g, 1.29; 95%-CI, 0.68-1.90). LIMITATIONS The study and patient characteristics varied between the individual studies which is reflected in a high statistical heterogeneity of the effect sizes. CONCLUSIONS The added value of VR applications over waiting-list or psychoeducation only control groups is obvious. VR applications can be used as part of the treatment of anxiety disorders, especially when conventional therapy is unavailable.
Collapse
Affiliation(s)
- Dominik Schröder
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany.
| | - Kamil J Wrona
- Hochschule Bielefeld University of Applied Sciences and Arts, Bielefeld, Germany
| | - Frank Müller
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany; Department of Family Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Stephanie Heinemann
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany; Department of Geriatrics, University Medical Center Göttingen, Göttingen, Germany
| | - Florian Fischer
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany; Bavarian Research Center for Digital Health and Social Care, Kempten University, Kempten, Germany
| | - Christoph Dockweiler
- Department Digital Biomedicine and Health Sciences, School of Life Sciences, University Siegen, Siegen, Germany; School of Public Health, Bielefeld University, Bielefeld, Germany
| |
Collapse
|
28
|
Flanagan K, Saikia MJ. Consumer-Grade Electroencephalogram and Functional Near-Infrared Spectroscopy Neurofeedback Technologies for Mental Health and Wellbeing. SENSORS (BASEL, SWITZERLAND) 2023; 23:8482. [PMID: 37896575 PMCID: PMC10610697 DOI: 10.3390/s23208482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/04/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
Neurofeedback, utilizing an electroencephalogram (EEG) and/or a functional near-infrared spectroscopy (fNIRS) device, is a real-time measurement of brain activity directed toward controlling and optimizing brain function. This treatment has often been attributed to improvements in disorders such as ADHD, anxiety, depression, and epilepsy, among others. While there is evidence suggesting the efficacy of neurofeedback devices, the research is still inconclusive. The applicability of the measurements and parameters of consumer neurofeedback wearable devices has improved, but the literature on measurement techniques lacks rigorously controlled trials. This paper presents a survey and literary review of consumer neurofeedback devices and the direction toward clinical applications and diagnoses. Relevant devices are highlighted and compared for treatment parameters, structural composition, available software, and clinical appeal. Finally, a conclusion on future applications of these systems is discussed through the comparison of their advantages and drawbacks.
Collapse
Affiliation(s)
- Kira Flanagan
- Electrical Engineering, University of North Florida, Jacksonville, FL 32224, USA
- Biomedical Sensors and Systems Laboratory, University of North Florida, Jacksonville, FL 32224, USA
| | - Manob Jyoti Saikia
- Electrical Engineering, University of North Florida, Jacksonville, FL 32224, USA
- Biomedical Sensors and Systems Laboratory, University of North Florida, Jacksonville, FL 32224, USA
| |
Collapse
|
29
|
Ghasempeyvandi M, Torkan H. The effect of virtual reality exposure therapy on focus of attention, self-criticism, and interpretation bias in university students with social anxiety. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:310. [PMID: 38023104 PMCID: PMC10670870 DOI: 10.4103/jehp.jehp_1742_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/02/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND The present research aims to investigate the effectiveness of virtual reality exposure therapy on the focus of attention, self-criticism, and interpretation bias among university students with social anxiety. MATERIALS AND METHODS The present research was conducted using quasi-experimental research with pre-test and post-test control group design. The participants were university students aged between 10 and 30 years old who had visited Isfahan counseling centers in 1399 HS. Among 53 patients referred to the counseling centers, 30 were randomly selected by convenience sampling and then assigned to an experimental group (15 individuals) and a control group (15 individuals). The experimental group received eight sessions of 30-minute and face-to-face virtual reality-based interventions. In contrast, the control group remained on the waiting list. A structured clinical interview and Social Phobia Inventory (SPIN) were used to select and screen students, and the Focus of Attention Questionnaire (FAQ), Levels of Self-Criticism Scale (LOSC), and revised interpretation bias inventory were applied for the pre-test and the post-test. Then, all the data were analyzed by a statistical analysis of covariance. RESULTS The results showed that virtual reality exposure therapy significantly reduces the symptoms of the focus of attention, self-criticism, and interpretation bias in the experimental group compared to the control group. (P < 0/01). CONCLUSION The research showed that virtual reality exposure therapy reduced the symptoms of social anxiety. Therefore, this method can be applied to reduce some symptoms of social anxiety in university students.
Collapse
Affiliation(s)
- Monir Ghasempeyvandi
- Master of Clinical Psychology, Department of Psychology, Faculty of Psychology and Education, Islamic Azad University, Isfahan (Khorasgan) Branch, Isfahan, Iran
| | - Hajar Torkan
- Department of Psychology, Faculty of Psychology and Education, Islamic Azad University, Isfahan (Khorasgan) Branch, Isfahan, Iran
| |
Collapse
|
30
|
Abstract
PURPOSE OF REVIEW This examines significant trends and developments in the utilization of virtual reality (VR) and augmented reality (AR) simulations in the field of mental health and education. The objective is to gain insights into the emerging applications of VR/AR in mental health interventions and their potential impact on patient outcomes. The review also includes personal observations on the effectiveness and challenges associated with VR/AR simulations and the rise of exciting, disruptive artificial intelligence large language models. The findings of this review contribute to the understanding of the current state of VR/AR technology in mental health and highlight potential future directions in this rapidly evolving field. RECENT FINDINGS Recent studies have shown that VR/AR simulation is an effective and promising approach for treating various anxiety disorders, including specific phobias, social anxiety disorder, and post-traumatic stress disorder (PTSD). Simulated environments can be tailored to induce provoking situations, allowing individuals to learn from and gradually confront and grow in controlled and safe environments. Recent findings in the field of virtual reality simulations in mental health indicate that VR/AR exposure therapy is effective for treating anxiety disorders, while interventions show promise in improving social skills in individuals working with patients. In a broader sense, the use of VR/AR as an educational tool shows enormous potential now that functional generative artificial intelligence (AI) is recently available.
Collapse
Affiliation(s)
- Clint G Carlson
- Fitzsimons Building, University of Colorado, School of Medicine, 13001 East 17Th Place, Room E1354, Campus Box C290, CO, 80045, Aurora, USA.
| |
Collapse
|
31
|
Ezawa ID, Hollon SD, Robinson N. Examining Predictors of Depression and Anxiety Symptom Change in Cognitive Behavioral Immersion: Observational Study. JMIR Ment Health 2023; 10:e42377. [PMID: 37450322 PMCID: PMC10382949 DOI: 10.2196/42377] [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: 09/01/2022] [Revised: 03/20/2023] [Accepted: 04/26/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Depressive and anxiety disorders are the most common mental disorders, and there is a critical need for effective, affordable, and accessible interventions. Cognitive Behavioral Immersion (CBI) is a novel group-based cognitive behavioral skills training program delivered by lay coaches in the metaverse that can be accessed through various modalities including virtual reality (VR) head-mounted displays or flat-screen devices. Combining its ability to offer empirically supported therapy skills in a digital setting that can still facilitate interpersonal variables (eg, working alliance and sense of social support) with the aid of lay coaches, CBI has the potential to help fill this critical need. OBJECTIVE This study had 2 primary aims. First, we aimed to examine changes in depression and anxiety symptoms in a sample of individuals who participated in CBI. Second, we aimed to examine 2 interpersonal process variables (working alliance and web-based social support) as predictors of symptom changes. We predicted CBI participants would experience depression and anxiety symptom improvements and that such improvements would be associated with an increase in both interpersonal process variables. METHODS The study sample consists of 127 participants who endorsed clinical levels of depression or anxiety symptoms during their first CBI session and attended at least 2 sessions. Participants were asked to complete self-report measures of depression symptoms, anxiety symptoms, alliance, and web-based social support throughout their participation in CBI. RESULTS Repeated measures ANOVAs determined that depression and anxiety symptom scores differed significantly across sessions (Ps<.01). We also found participants' web-based social support predicted improvement in depression symptoms (P=.01), but neither the alliance nor web-based social support predicted change in anxiety symptoms (Ps>.05). We also observed a significant difference in anxiety symptoms between participants who used a VR head-mounted display to access CBI and those who did not, such that participants who used VR head-mounted displays endorsed lower anxiety symptoms than those who did not at nearly every session (P=.04). CONCLUSIONS Participation in CBI is associated with both depression and anxiety symptom improvement. Web-based social support may play an important role in fostering changes in depression symptoms. Future studies are encouraged to continue examining the process of change in CBI with special attention paid to methods that can elucidate causal mechanisms of change.
Collapse
Affiliation(s)
- Iony D Ezawa
- Department of Psychology, University of Southern California, Los Angeles, CA, United States
| | - Steven D Hollon
- Department of Psychology, Vanderbilt University, Nashville, TN, United States
| | - Noah Robinson
- Department of Psychology, Vanderbilt University, Nashville, TN, United States
| |
Collapse
|
32
|
Folke S, Roitmann N, Poulsen S, Andersen SB. Feasibility of Virtual Reality Exposure Therapy in the Treatment of Danish Veterans with Post-Traumatic Stress Disorder: A Mixed Method Pilot Study. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2023; 26:425-431. [PMID: 37307409 DOI: 10.1089/cyber.2022.0236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The BraveMind virtual reality exposure therapy (VRET) has been developed and has shown efficacy for U.S. service members and veterans. As the first study to date, the present study examined the feasibility of BraveMind VRET for non-U.S. military veterans. Moreover, the study sought to explore in-depth the participants' experiences with BraveMind VRET. Nine Danish veterans with post-traumatic stress disorder (PTSD) after deployment to Afghanistan participated in the study. PTSD, depression, and quality of life were assessed at pretreatment, post-treatment, and 3-month followup. The treatment consisted of 10 BraveMind VRET sessions. Semistructured interviews with treatment completers were conducted post-treatment to ascertain views about the treatment, in general, and the BraveMind VR system in particular. Thematic qualitative analysis was conducted at the semantic level using an inductive approach. There were significant reductions in pre- to post-treatment self-reported PTSD and significant improvements in quality of life. Treatment gains were maintained at 3-month followup. Pre- to post-treatment Cohen's d effect sizes were large for self-reported PTSD (PTSD Checklist-Civilian Version [PCL-C]: d = 1.55). Qualitative results indicated that the virtual environment of the BraveMind VR system does not entirely map the reality of Danish soldiers in Afghanistan. However, this was not experienced as a hindering factor in therapy. Findings indicate that BraveMind VRET is an acceptable, safe, and effective treatment for Danish veterans with PTSD. The qualitative results emphasize the importance of a strong therapeutic alliance, as VRET is experienced as more emotional straining than regular trauma-focused therapy.
Collapse
Affiliation(s)
- Sofie Folke
- Department of Military Psychology, Danish Veterans Centre, Copenhagen, Denmark
- Research and Knowledge Centre, Danish Veterans Centre, Ringsted, Denmark
| | - Nikolai Roitmann
- Stolpegaard Psychotherapy Centre, Mental Health Services, Capital Region of Denmark, Denmark
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Søren B Andersen
- Research and Knowledge Centre, Danish Veterans Centre, Ringsted, Denmark
| |
Collapse
|
33
|
Monti L, Marconi E, Bocci MG, Kotzalidis GD, Mazza M, Galliani C, Tranquilli S, Vento G, Conti G, Sani G, Antonelli M, Chieffo DPR. COVID-19 pandemic in the intensive care unit: Psychological implications and interventions, a systematic review. World J Psychiatry 2023; 13:191-217. [PMID: 37123099 PMCID: PMC10130962 DOI: 10.5498/wjp.v13.i4.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/06/2023] [Accepted: 03/27/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic produced changes in intensive care units (ICUs) in patient care and health organizations. The pandemic event increased patients' risk of developing psychological symptoms during and after hospitalisation. These consequences also affected those family members who could not access the hospital. In addition, the initial lack of knowledge about the virus and its management, the climate of fear and uncertainty, the increased workload and the risk of becoming infected and being contagious, had a strong impact on healthcare staff and organizations. This highlighted the importance of interventions aimed at providing psychological support to ICUs, involving patients, their relatives, and the staff; this might involve the reorganisation of the daily routine and rearrangement of ICU staff duties. AIM To conduct a systematic review of psychological issues in ICUs during the COVID-19 pandemic involving patients, their relatives, and ICU staff. METHODS We investigated the PubMed and the ClinicalTrials.gov databases and found 65 eligible articles, upon which we commented. RESULTS Our results point to increased perceived stress and psychological distress in staff, patients and their relatives and increased worry for being infected with severe acute respiratory syndrome coronavirus-2 in patients and relatives. Furthermore, promising results were obtained for some psychological programmes aiming at improving psychological measures in all ICU categories. CONCLUSION As the pandemic limited direct inter-individual interactions, the role of interventions using digital tools and virtual reality is becoming increasingly important. All considered, our results indicate an essential role for psychologists in ICUs.
Collapse
Affiliation(s)
- Laura Monti
- UOS Psicologia Clinica, Governo Clinico, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Elisa Marconi
- UOS Psicologia Clinica, Governo Clinico, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Maria Grazia Bocci
- UOC Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica, Dipartimento di Scienze Dell’Emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
| | - Georgios Demetrios Kotzalidis
- UOC Psichiatria Clinica e d’Urgenza, Dipartimento di Scienze Dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- NESMOS Department, Facoltà di Medicina e Psicologia, Sant’Andrea University Hospital, Rome 00189, Italy
| | - Marianna Mazza
- UOC Psichiatria Clinica e d’Urgenza, Dipartimento di Scienze Dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Carolina Galliani
- Department of Psychology, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Sara Tranquilli
- Department of Psychology, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giovanni Vento
- UOC Neonatologia, Dipartimento di Scienze Della Salute Della Donna, Del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- UOC Neonatologia, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giorgio Conti
- UOC Terapia Intensiva Pediatrica e Trauma Center Pediatrico, Dipartimento di Scienze Dell’Emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- UOC Terapia Intensiva Pediatrica e Trauma Center Pediatrico, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Gabriele Sani
- UOC Psichiatria Clinica e d’Urgenza, Dipartimento di Scienze Dell’Invecchiamento, Neurologiche, Ortopediche e Della Testa-collo, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Psychiatry, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Massimo Antonelli
- UOC Anestesia, Rianimazione, Terapia Intensiva e Tossicologia Clinica, Dipartimento di Scienze Dell’Emergenza, Anestesiologiche e Della Rianimazione, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Anesthesiology and Intensive Care Medicine, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Daniela Pia Rosaria Chieffo
- UOS Psicologia Clinica, Governo Clinico, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Psychology, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| |
Collapse
|
34
|
Hawajri O, Lindberg J, Suominen S. Virtual Reality Exposure Therapy as a Treatment Method Against Anxiety Disorders and Depression-A Structured Literature Review. Issues Ment Health Nurs 2023; 44:245-269. [PMID: 37075308 DOI: 10.1080/01612840.2023.2190051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Mental illness is a growing global health problem affecting individuals and society. In Sweden, the number of people suffering from mental health illnesses, such as anxiety and depression, is increasing and is expected to be one of the largest public health challenges in 2030. As mental illness increases, the area also needs effective forms of treatment. This study aims to investigate if Virtual Reality Exposure Therapy (VRET) works as a treatment method for adults suffering from anxiety disorders and depression. A structured literature review based on 24 articles found in the databases PubMed, MEDLINE, CINAHL and PsycInfo. Two reviewers independently reviewed and collectively extracted data from the included articles. The articles have been analyzed by using thematic analysis. The results suggest that Virtual reality exposure therapy can work as an effective treatment method for adults with anxiety disorders. It also indicates that VRET may act as a health-promoting intervention to reduce anxiety disorders, phobias, and depression symptoms. Virtual reality exposure therapy can be an effective treatment method and health-promoting effort against anxiety disorders in adults. An essential factor for the patients who accept VRET as a treatment is the initial information therapists give.
Collapse
Affiliation(s)
- Omar Hawajri
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | | | - Sakari Suominen
- School of Health Sciences, University of Skövde, Skövde, Sweden
- Department of Public Health, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
| |
Collapse
|
35
|
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: 2] [Impact Index Per Article: 1.0] [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
|
36
|
Yuan J, Hassan SS, Wu J, Koger CR, Packard RRS, Shi F, Fei B, Ding Y. Extended reality for biomedicine. NATURE REVIEWS. METHODS PRIMERS 2023; 3:15. [PMID: 37051227 PMCID: PMC10088349 DOI: 10.1038/s43586-023-00208-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Extended reality (XR) refers to an umbrella of methods that allows users to be immersed in a three-dimensional (3D) or a 4D (spatial + temporal) virtual environment to different extents, including virtual reality (VR), augmented reality (AR), and mixed reality (MR). While VR allows a user to be fully immersed in a virtual environment, AR and MR overlay virtual objects over the real physical world. The immersion and interaction of XR provide unparalleled opportunities to extend our world beyond conventional lifestyles. While XR has extensive applications in fields such as entertainment and education, its numerous applications in biomedicine create transformative opportunities in both fundamental research and healthcare. This Primer outlines XR technology from instrumentation to software computation methods, delineating the biomedical applications that have been advanced by state-of-the-art techniques. We further describe the technical advances overcoming current limitations in XR and its applications, providing an entry point for professionals and trainees to thrive in this emerging field.
Collapse
Affiliation(s)
- Jie Yuan
- Department of Bioengineering, Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX, United States
| | - Sohail S. Hassan
- Department of Bioengineering, Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX, United States
| | - Jiaojiao Wu
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Casey R. Koger
- Department of Bioengineering, Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX, United States
| | - René R. Sevag Packard
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
- Ronald Reagan UCLA Medical Center, Los Angeles, CA United States
- Veterans Affairs West Los Angeles Medical Center, Los Angeles, CA, United States
| | - Feng Shi
- Department of Research and Development, Shanghai United Imaging Intelligence Co., Ltd., Shanghai, China
| | - Baowei Fei
- Department of Bioengineering, Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX, United States
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, United States
- Center for Imaging and Surgical Innovation, The University of Texas at Dallas, Richardson, TX, United States
| | - Yichen Ding
- Department of Bioengineering, Erik Jonsson School of Engineering and Computer Science, The University of Texas at Dallas, Richardson, TX, United States
- Center for Imaging and Surgical Innovation, The University of Texas at Dallas, Richardson, TX, United States
- Hamon Center for Regenerative Science and Medicine, UT Southwestern Medical Center, Dallas, TX, United States
| |
Collapse
|
37
|
Comparison of behavioral and brain indices of fear renewal during a standard vs. novel immersive reality Pavlovian fear extinction paradigm in healthy adults. Behav Brain Res 2023; 437:114154. [PMID: 36244544 DOI: 10.1016/j.bbr.2022.114154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 11/13/2022]
Abstract
Pavlovian conditioning paradigms model the learned fear associations inherent in posttraumatic stress disorder, including the renewal of inappropriate fear responses following extinction learning. However, very few studies in humans investigate the underlying neural mechanisms involved in fear renewal despite its clinical importance. To address this issue, our lab designed a novel, immersive-reality Pavlovian fear acquisition, extinction, recall, and renewal paradigm. We utilized an ecological threat - a snake striking towards the participant - as the unconditioned stimulus (US). Context and background were dynamic and included both visual and auditory cues that are relevant to everyday life. Using functional magnetic resonance imaging and behavioral measures (US expectancy ratings), we examined the validity of this Novel paradigm in healthy adults (n = 49) and compared it to a Standard, well-validated 2D paradigm (n = 28). The Novel paradigm, compared to the Standard, was associated with greater hippocampal activation throughout the task. Participants who underwent the Standard paradigm, compared to the Novel, also displayed insula activation; however, this was not specific to stimulus or time. During fear renewal, the Novel paradigm was associated with dorsal anterior cingulate cortex activation to CS+ (> CS-). Overall, we found that our Novel, immersive-reality paradigm, which features an ecologically relevant US, elicited greater corticolimbic activation. These results suggest that immersive Pavlovian fear conditioning paradigms paired with innately fearful stimuli may improve translatability of preclinical paradigms to clinical interventions for fear-based disorders.
Collapse
|
38
|
Volovik M, Belova A, Kuznetsov A, Polevaia A, Vorobyova O, Khalak M. Use of Virtual Reality Techniques to Rehabilitate Military Veterans with Post-Traumatic Stress Disorder (Review). Sovrem Tekhnologii Med 2023; 15:74-85. [PMID: 37388756 PMCID: PMC10306958 DOI: 10.17691/stm2023.15.1.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Indexed: 09/22/2024] Open
Abstract
Post-traumatic stress disorder (PTSD) is a mental and behavioral disorder developing after a traumatic event like participation in combat activities. Objective diagnosis of combat PTSD and effective rehabilitation of war veterans is a current multifaceted problem with particularly high social costs. This review aims to evaluate the potential of virtual reality technique used as exposure therapy tool (VRET) to rehabilitate combat veterans and service members with PTSD. The review was written following the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The final analysis includes 75 articles published in 2017-2022. VRET therapeutic effect mechanisms were examined along with protocols and scenarios of VRET combined with other interventions influencing PTSD treatment like pharmacotherapy, motion-assisted multi-modular memory desensitization and reconsolidation (3MDR), transcranial magnetic stimulation. The necessity is substantiated of psychophysiological measurements for objectification of PTSD clinical criteria and its dynamics during treatment. It was shown that inclusion of VRET to the package of PTSD rehabilitation interventions positively affects the results due to the enhanced effect of presence and greater experience personalization. Thus, VRET may be an effective, controlled, and cost-effective alternative for PTSD treatment in combatants, including those not responding to conventional therapy.
Collapse
Affiliation(s)
- M.G. Volovik
- Leading Researcher, University Clinic; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - A.N. Belova
- Professor, Head of the Medical Rehabilitation Department; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - A.N. Kuznetsov
- Head of the Laboratory of Immersive and Remote Technologies; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - A.V. Polevaia
- Junior Researcher, University Clinic; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - O.V. Vorobyova
- Junior Researcher, University Clinic; Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| | - M.E. Khalak
- Associate Professor, Department of General and Clinical Psychology Privolzhsky Research Medical University, 10/1 Minin and Pozharsky Square, Nizhny Novgorod, 603005, Russia
| |
Collapse
|
39
|
Kothgassner OD, Reichmann A, Bock MM. Virtual Reality Interventions for Mental Health. Curr Top Behav Neurosci 2023; 65:371-387. [PMID: 37106223 DOI: 10.1007/7854_2023_419] [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: 04/29/2023]
Abstract
Virtual Reality (VR) is a growing field in psychological research and therapy. While there is strong evidence for the efficacy of exposure therapy in VR (VRET) to treat anxiety disorders, new opportunities for using VR to treat mental health disorders are emerging. In this chapter, we first describe the value of VRET for the treatment of several anxiety disorders. Next, we introduce some recent developments in research using VR investigating schizophrenia, neurodevelopmental disorders, and eating disorders. This includes therapeutic strategies beyond VRET, including avatar-based therapies or those combining VR with biofeedback approaches. Although VR offers many convincing advantages, contraindications in treatment must be considered when implementing VR-supported therapy in clinical practice. Finally, we provide an outlook for future research, highlighting the integration of augmented reality and automation processes in VR environments to create more efficient and tailored therapeutic tools. Further, future treatments will benefit from the gamification approach, which integrates elements of computer games and narratives that promote patients' motivation and enables methods to reduce drop-outs during psychological therapy.
Collapse
Affiliation(s)
- Oswald D Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.
| | - Adelais Reichmann
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Mercedes M Bock
- Child and Adolescent Psychiatry, Social Psychiatric Services Vienna, Vienna, Austria
| |
Collapse
|
40
|
Lee HY, Hyun SE, Oh BM. Rehabilitation for Impaired Attention in the Acute and Post-Acute Phase After Traumatic Brain Injury: A Narrative Review. Korean J Neurotrauma 2023; 19:20-31. [PMID: 37051033 PMCID: PMC10083445 DOI: 10.13004/kjnt.2023.19.e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/12/2022] [Accepted: 11/03/2022] [Indexed: 12/03/2022] Open
Abstract
Impaired attention is the most common and debilitating cognitive deficit following a traumatic brain injury (TBI). Attention is a fundamental function that profoundly influences the performance of other cognitive components such as memory and execution. Intriguingly, attention can be improved through cognitive rehabilitation. This narrative review summarizes the essential elements of rehabilitation for attention problems in acute and post-acute TBI. In the acute phase of mild TBI, investigations into the medical history and daily life performance, neurological examination, screening and management of concomitant sleep-wake disorders or neuropsychiatric disorders, and support and education on the natural course of concussion are covered. Rehabilitation for patients with moderate-to-severe TBI consists of serial assessment for patients with disorders of consciousness and a post-traumatic confusion state. In the post-acute phase after TBI, components of rehabilitation include investigating medical history; neurological, imaging, and electrophysiological tests; evaluation and treatment of factors that may impact attention, including sleep-wake, emotional, and behavioral disorders; evaluation of attention function; and cognitive rehabilitation as a matter of course. We summarized metacognitive strategy, direct attention training, computer-based cognitive interventions, medication, and environmental control as interventions to enhance attention.
Collapse
Affiliation(s)
- Hoo Young Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
| | - Sung Eun Hyun
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Byung-Mo Oh
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- National Traffic Injury Rehabilitation Hospital, Yangpyeong, Korea
- Institute on Aging, Seoul National University, Seoul, Korea
| |
Collapse
|
41
|
Goel R, Tse T, Smith LJ, Floren A, Naylor B, Williams MW, Salas R, Rizzo AS, Ress D. Framework for Accurate Classification of Self-Reported Stress From Multisession Functional MRI Data of Veterans With Posttraumatic Stress. CHRONIC STRESS (THOUSAND OAKS, CALIF.) 2023; 7:24705470231203655. [PMID: 37780807 PMCID: PMC10540591 DOI: 10.1177/24705470231203655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/11/2023] [Indexed: 10/03/2023]
Abstract
Background: Posttraumatic stress disorder (PTSD) is a significant burden among combat Veterans returning from the wars in Iraq and Afghanistan. While empirically supported treatments have demonstrated reductions in PTSD symptomatology, there remains a need to improve treatment effectiveness. Functional magnetic resonance imaging (fMRI) neurofeedback has emerged as a possible treatment to ameliorate PTSD symptom severity. Virtual reality (VR) approaches have also shown promise in increasing treatment compliance and outcomes. To facilitate fMRI neurofeedback-associated therapies, it would be advantageous to accurately classify internal brain stress levels while Veterans are exposed to trauma-associated VR imagery. Methods: Across 2 sessions, we used fMRI to collect neural responses to trauma-associated VR-like stimuli among male combat Veterans with PTSD symptoms (N = 8). Veterans reported their self-perceived stress level on a scale from 1 to 8 every 15 s throughout the fMRI sessions. In our proposed framework, we precisely sample the fMRI data on cortical gray matter, blurring the data along the gray-matter manifold to reduce noise and dimensionality while preserving maximum neural information. Then, we independently applied 3 machine learning (ML) algorithms to this fMRI data collected across 2 sessions, separately for each Veteran, to build individualized ML models that predicted their internal brain states (self-reported stress responses). Results: We accurately classified the 8-class self-reported stress responses with a mean (± standard error) root mean square error of 0.6 (± 0.1) across all Veterans using the best ML approach. Conclusions: The findings demonstrate the predictive ability of ML algorithms applied to whole-brain cortical fMRI data collected during individual Veteran sessions. The framework we have developed to preprocess whole-brain cortical fMRI data and train ML models across sessions would provide a valuable tool to enable individualized real-time fMRI neurofeedback during VR-like exposure therapy for PTSD.
Collapse
Affiliation(s)
- Rahul Goel
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Teresa Tse
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Lia J. Smith
- Department of Psychology, University of Houston, Houston, TX, USA
- Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Andrew Floren
- Department of Electrical and Computer Engineering, University of Texas at Austin, Austin, TX, USA
| | - Bruce Naylor
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
- Department of Electrical and Computer Engineering, University of Texas at Austin, Austin, TX, USA
| | - M. Wright Williams
- Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Ramiro Salas
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
- Center for Translational Research on Inflammatory Diseases, Michael E. DeBakey VA Medical Center, Houston, TX, USA
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- The Menninger Clinic, Houston, TX, USA
| | - Albert S. Rizzo
- Institute for Creative Technologies, University of Southern California, Los Angeles, CA, USA
| | - David Ress
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
42
|
Cooper SE, Dunsmoor JE, Koval KA, Pino ER, Steinman SA. Test–retest
reliability of human threat conditioning and generalization across a
1‐to‐2‐week
interval. Psychophysiology 2022; 60:e14242. [PMID: 36546410 DOI: 10.1111/psyp.14242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
Given the increasing use of threat conditioning and generalization for clinical-translational research efforts, establishing test-retest reliability of these paradigms is necessary. Specifically, it is an empirical question whether the same participant evinces a similar generalization gradient of conditioned responses across two sessions with the identical contingencies and stimuli. Here, 46 human volunteers participated in an identical auditory threat acquisition and generalization protocol at two sessions separated by 1-to-2 weeks. Skin conductance responses (SCR) and trial-by-trial shock risk ratings served as primary measures. We used linear mixed effects modeling to test differential threat responses and generalization gradients, and Generalizability (G) theory coefficients as our primary formal assessment of test-retest reliability of intraindividual stability and change across time. Results showed largely invariant differential conditioning and generalization gradients across time. G coefficients indicated fair reliability for acquisition and generalization SCR. In contrast, risk rating reliabilities were mixed, and reliability was particularly low for acquisition risk ratings. Our findings generally support reliability of the threat conditioning and generalization paradigm for shorter test-retest intervals and highlight their utility for assessments of behavioral interventions in mental health research, but challenges remain and further work is needed. Threat conditioning and generalization tasks are increasingly used for translational efforts to improve behavioral interventions, and thus test-retest reliability for these tasks needs to be established. Our results support the test-retest reliability of threat conditioning and generalization over a relatively short (1-to-2 week) interval, but this depends on the measure used (physiological vs. self-report). Overall, these tasks could be appropriate for repeated testing over the course of a short-duration intervention study, but more research is needed, particularly in regard to longer-duration studies.
Collapse
Affiliation(s)
- Samuel E. Cooper
- Department of Psychiatry and Behavioral Sciences University of Texas at Austin Austin Texas USA
| | - Joseph E. Dunsmoor
- Department of Psychiatry and Behavioral Sciences University of Texas at Austin Austin Texas USA
- Institute for Neuroscience University of Texas at Austin Austin Texas USA
| | - Kathleen A. Koval
- Department of Psychology West Virginia University Morgantown West Virginia USA
| | - Emma R. Pino
- Department of Psychology West Virginia University Morgantown West Virginia USA
| | - Shari A. Steinman
- Department of Psychology West Virginia University Morgantown West Virginia USA
| |
Collapse
|
43
|
Yang AHX, Kasabov N, Cakmak YO. Machine learning methods for the study of cybersickness: a systematic review. Brain Inform 2022; 9:24. [PMID: 36209445 PMCID: PMC9548085 DOI: 10.1186/s40708-022-00172-6] [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: 06/03/2022] [Accepted: 09/15/2022] [Indexed: 12/02/2022] Open
Abstract
This systematic review offers a world-first critical analysis of machine learning methods and systems, along with future directions for the study of cybersickness induced by virtual reality (VR). VR is becoming increasingly popular and is an important part of current advances in human training, therapies, entertainment, and access to the metaverse. Usage of this technology is limited by cybersickness, a common debilitating condition experienced upon VR immersion. Cybersickness is accompanied by a mix of symptoms including nausea, dizziness, fatigue and oculomotor disturbances. Machine learning can be used to identify cybersickness and is a step towards overcoming these physiological limitations. Practical implementation of this is possible with optimised data collection from wearable devices and appropriate algorithms that incorporate advanced machine learning approaches. The present systematic review focuses on 26 selected studies. These concern machine learning of biometric and neuro-physiological signals obtained from wearable devices for the automatic identification of cybersickness. The methods, data processing and machine learning architecture, as well as suggestions for future exploration on detection and prediction of cybersickness are explored. A wide range of immersion environments, participant activity, features and machine learning architectures were identified. Although models for cybersickness detection have been developed, literature still lacks a model for the prediction of first-instance events. Future research is pointed towards goal-oriented data selection and labelling, as well as the use of brain-inspired spiking neural network models to achieve better accuracy and understanding of complex spatio-temporal brain processes related to cybersickness.
Collapse
|
44
|
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: 55] [Impact Index Per Article: 18.3] [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
|
45
|
Heo S, Park JH. Effects of Virtual Reality-Based Graded Exposure Therapy on PTSD Symptoms: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15911. [PMID: 36497989 PMCID: PMC9735589 DOI: 10.3390/ijerph192315911] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 06/17/2023]
Abstract
Previous studies reported that virtual reality (VR)-based exposure therapy (VRET) was a clinically beneficial intervention for specific phobias. However, among VRET, VR-based graded exposure therapy (VR-GET) is little known about its efficacy on posttraumatic stress disorder (PTSD) symptoms. Therefore, this meta-analysis investigated the effects of VR-GET for PTSD symptoms. A literature search yielded seven randomized controlled trials. The differences between conditions regarding the primary outcome of PTSD symptoms in the effect size of the individual study were calculated using Hedges' g. The findings showed VR-GET showed a significantly larger effect size for PTSD symptoms (g = 1.100, p = 0.001), compared to controls. However, no significant difference between conventional VRET and controls was found for PTSD symptoms (g = -0.279, p = 0.970). These findings indicated the superiority of VR-GET for PTSD symptoms compared to controls, supporting the importance of immersive PTSD treatments. Nevertheless, the results need to be interpreted with caution due to the substantial number of military service personnel studies. Future trials, considering individually tailored scenarios in virtual environments to cover a wider range of trauma types, are required to investigate its evidence on treating PTSD.
Collapse
Affiliation(s)
- Seoyoon Heo
- Department of Occupational Therapy, College of Medical and Health Science, Kyungbok University, Namyangju-si 42517, Republic of Korea
| | - Jin-Hyuck Park
- Department of Occupational Therapy, College of Medical Science, Soonchunhyang University, Asan-si 31538, Republic of Korea
| |
Collapse
|
46
|
Tan J, Kannis-Dymand L, Jones C. Examining the potential of VR program Tilt Brush in reducing anxiety. VIRTUAL REALITY 2022; 27:1-13. [PMID: 36405877 PMCID: PMC9647245 DOI: 10.1007/s10055-022-00711-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
Recent advancement in technology has made virtual reality (VR) more accessible and immersive than ever before, resulting in its increasing utility in various industries. Despite this, VR has remained an underutilised tool within clinical psychology. This study aimed to explore the potential of using VR for therapeutic benefits through examining the level of flow and anxiety-reducing effects of freeform drawing in real life (on paper) versus drawing in VR (using Tilt Brush) via a randomised-controlled trial with 40 participants. State and trait anxiety was measured using the State-Trait Anxiety Inventory, level of flow was measured using the Long Flow State Scale, and level of presence was measured using the iGroup Presence Questionnaire. Overall level of flow was not significantly different between both groups, implying drawing in VR induces as much flow as drawing in real life. Level of flow was positively correlated to level of presence experienced in the VR group (p < .01). Although there was no significant interaction effect, both groups experienced an overall decrease in state anxiety, with the VR group experiencing a significant reduction of state anxiety from pre- to post-test (p < .01).
Collapse
Affiliation(s)
- Janice Tan
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Maroochydore, QLD Australia
| | - Lee Kannis-Dymand
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Maroochydore, QLD Australia
| | - Christian Jones
- School of Law and Society, University of the Sunshine Coast, Maroochydore, QLD Australia
| |
Collapse
|
47
|
Kim SY, Park H, Kim H, Kim J, Seo K. Technostress causes cognitive overload in high-stress people: Eye tracking analysis in a virtual kiosk test. Inf Process Manag 2022; 59:103093. [PMID: 36119755 PMCID: PMC9464304 DOI: 10.1016/j.ipm.2022.103093] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/12/2022] [Accepted: 09/03/2022] [Indexed: 11/05/2022]
Abstract
In the midst of the COVID-19 pandemic, the use of non-face-to-face information and communication technology (ICT) such as kiosks has increased. While kiosks are useful overall, those who do not adapt well to these technologies experience technostress. The two most serious technostressors are inclusion and overload issues, which indicate a sense of inferiority due to a perceived inability to use ICT well and a sense of being overwhelmed by too much information, respectively. This study investigated the different effects of hybrid technostress-induced by both inclusion and overload issues-on the cognitive load among low-stress and high-stress people when using kiosks to complete daily life tasks. We developed a 'virtual kiosk test' to evaluate participants' cognitive load with eye tracking features and performance features when ordering burgers, sides, and drinks using the kiosk. Twelve low-stress participants and 13 high-stress participants performed the virtual kiosk test. As a result, regarding eye tracking features, high-stress participants generated a larger number of blinks, a longer scanpath length, a more distracted heatmap, and a more complex gaze plot than low-stress participants. Regarding performance features, high-stress participants took significantly longer to order and made more errors than low-stress participants. A support-vector machine (SVM) using both eye tracking features (i.e., number of blinks, scanpath length) and a performance feature (i.e., time to completion) best differentiated between low-stress and high-stress participants (89% accuracy, 100% sensitivity, 83.3% specificity, 75% precision, 85.7% F1 score). Overall, under technostress, high-stress participants experienced cognitive overload and consequently decreased performance; whereas, low-stress participants felt moderate arousal and improved performance. These varying effects of technostress can be interpreted through the Yerkes-Dodson law. Based on our findings, we proposed an adaptive interface, multimodal interaction, and virtual reality training as three implications for technostress relief in non-face-to-face ICT.
Collapse
Affiliation(s)
- Se Young Kim
- Department of Applied Artificial Intelligence, Seoul National University of Science and Technology, 232 Gongneung-ro, Gongneung-dong, Nowon-gu, Seoul 01811, Republic of Korea
| | - Hahyeon Park
- Department of Applied Artificial Intelligence, Seoul National University of Science and Technology, 232 Gongneung-ro, Gongneung-dong, Nowon-gu, Seoul 01811, Republic of Korea
| | - Hongbum Kim
- College of Business, Gachon University, Gyeonggi-do, Republic of Korea
| | - Joon Kim
- Korea Institute of Industrial Technology, Gyeonggi-do, Republic of Korea
| | - Kyoungwon Seo
- Department of Applied Artificial Intelligence, Seoul National University of Science and Technology, 232 Gongneung-ro, Gongneung-dong, Nowon-gu, Seoul 01811, Republic of Korea
| |
Collapse
|
48
|
Benrimoh D, Chheda FD, Margolese HC. The Best Predictor of the Future-the Metaverse, Mental Health, and Lessons Learned From Current Technologies. JMIR Ment Health 2022; 9:e40410. [PMID: 36306155 PMCID: PMC9652728 DOI: 10.2196/40410] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/13/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022] Open
Abstract
The metaverse-a virtual world accessed via virtual reality technology-has been heralded as the next key digital experience. It is meant to provide the next evolution of human interaction after social media and telework. However, in the context of the growing awareness of the risks to mental health posed by current social media technologies, there is a great deal of uncertainty as to the potential effects of this new technology on mental health. This uncertainty is compounded by a lack of clarity regarding what form the metaverse will ultimately take and how widespread its application will be. Despite this, given the nascent state of the metaverse, there is an opportunity to plan the research and regulatory approaches needed to understand it and promote its positive effects while protecting vulnerable groups. In this viewpoint, we examine the following three current technologies whose functions comprise a portion of what the metaverse seeks to accomplish: teleworking, virtual reality, and social media. We attempted to understand in what ways the metaverse may have similar benefits and pitfalls to these technologies but also how it may fundamentally differ from them. These differences suggest potential research questions to be addressed in future work. We found that current technologies have enabled tools such as virtual reality-assisted therapy, avatar therapy, and teletherapy, which have had positive effects on mental health care, and that the metaverse may provide meaningful improvements to these tools. However, given its similarities to social media and its expansion upon the social media experience, the metaverse raises some of the same concerns that we have with social media, such as the possible exacerbation of certain mental health problems. These concerns led us to consider questions such as how the users will be protected and what regulatory mechanisms will be put in place to ensure user safety. Although clear answers to these questions are challenging in this early phase of metaverse research, in this viewpoint, we use the context provided by comparator technologies to provide recommendations to maximize the potential benefits and limit the putative harms of the metaverse. We hope that this paper encourages discussions among researchers and policy makers.
Collapse
Affiliation(s)
- David Benrimoh
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Forum D Chheda
- McGill University Healthcare Center, Montreal, QC, Canada
| | - Howard C Margolese
- Department of Psychiatry, McGill University, Montreal, QC, Canada.,McGill University Healthcare Center, Montreal, QC, Canada
| |
Collapse
|
49
|
Vlake JH, van Bommel J, Wils EJ, Korevaar TI, Taccone F, Schut AF, Elderman JH, Labout JA, Raben AM, Dijkstra A, Achterberg S, Jurriens AL, Van Mol MM, Gommers D, Van Genderen ME. Effect of intensive care unit-specific virtual reality (ICU-VR) to improve psychological well-being in ICU survivors: study protocol for an international, multicentre, randomised controlled trial-the HORIZON-IC study. BMJ Open 2022; 12:e061876. [PMID: 36127077 PMCID: PMC9490570 DOI: 10.1136/bmjopen-2022-061876] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION A substantial proportion of intensive care unit (ICU) survivors develop psychological impairments after ICU treatment, part of the postintensive care syndrome, resulting in a decreased quality of life. Recent data suggest that an ICU-specific virtual reality intervention (ICU-VR) for post-ICU patients is feasible and safe, improves satisfaction with ICU aftercare, and might improve psychological sequelae. In the present trial, we firstly aim to determine whether ICU-VR is effective in mitigating post-traumatic stress disorder (PTSD)-related symptoms and secondly to determine the optimal timing for initiation with ICU-VR. METHODS AND ANALYSIS This international, multicentre, randomised controlled trial will be conducted in 10 hospitals. Between December 2021 and April 2023, we aim to include 300 patients who have been admitted to the ICU ≥72 hours and were mechanically ventilated ≥24 hours. Patients will be followed for 12 consecutive months. Patients will be randomised in a 1:1:1 ratio to the early ICU-VR group, the late ICU-VR group, or the usual care group. All patients will receive usual care, including a mandatory ICU follow-up clinic visit 3 months after ICU discharge. Patients in the early ICU-VR group will receive ICU-VR within 2 weeks after ICU discharge. Patients in the late VR group will receive ICU-VR during the post-ICU follow-up visit. The primary objective is to assess the effect of ICU-VR on PTSD-related symptoms. Secondary objectives are to determine optimal timing for ICU-VR, to assess the effects on anxiety-related and depression-related symptoms and health-related quality of life, and to assess patient satisfaction with ICU aftercare and perspectives on ICU-VR. ETHICS AND DISSEMINATION The Medical Ethics Committee United, Nieuwegein, the Netherlands, approved this study and local approval was obtained from each participating centre (NL78555.100.21). Our findings will be disseminated by presentation of the results at (inter)national conferences and publication in scientific, peer-reviewed journals. TRIAL REGISTRATION NUMBER NL9812.
Collapse
Affiliation(s)
- Johan Hendrik Vlake
- Intensive Care, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
- Intensive Care, Franciscus Gasthuis en Vlietland, Rotterdam, Zuid-Holland, Netherlands
| | | | - Evert-Jan Wils
- Intensive Care, Franciscus Gasthuis en Vlietland, Rotterdam, Zuid-Holland, Netherlands
| | - Tim Im Korevaar
- Internal Medicine, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
- Academic Centre for Thyroid Diseases, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
| | - Fabio Taccone
- Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Anna Fc Schut
- Intensive Care, Ikazia Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Jan H Elderman
- Intensive Care, IJsselland Hospital, Capelle aan den IJssel, Zuid-Holland, Netherlands
| | - Joost Am Labout
- Intensive Care, Maasstad Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Adrienne Mtj Raben
- Intensive Care, Groene Hart Ziekenhuis, Gouda, Zuid-Holland, Netherlands
| | - Annemieke Dijkstra
- Intensive Care, Van Weel-Bethesda Hospital, Middelharnis, Goeree-Overflakkee, Netherlands
| | | | - Amber L Jurriens
- Intensive Care, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
| | - Margo Mc Van Mol
- Intensive Care, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
| | - Diederik Gommers
- Intensive Care, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
| | | |
Collapse
|
50
|
Shi Z. Commentary: Virtual Reality, Real Emotions: A Novel Analogue for the Assessment of Risk Factors of Post-traumatic Stress Disorder. Front Psychol 2022; 13:936930. [PMID: 35756289 PMCID: PMC9218340 DOI: 10.3389/fpsyg.2022.936930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Zhongyu Shi
- College of Creative Culture and Communication, Zhejiang Normal University, Jinhua, China
| |
Collapse
|