Journal of Clinical Medicine

Editorial

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8 pages, 242 KiB

Open AccessEditorial

The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders

by José Gutiérrez-Maldonado

J. Clin. Med. 2022, 11(18), 5358; https://doi.org/10.3390/jcm11185358 - 13 Sep 2022

Cited by 4 | Viewed by 1274

Abstract

Jaron Lanier proposed the name “Virtual Reality” to refer to interactive simulations produced through the use of computer technology, although the idea was formulated in the sixties by a pioneer of computer graphics, Ivan Sutherland [...] Full article

(This article belongs to the Special Issue The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders)

Research

Jump to: Editorial, Review, Other

10 pages, 674 KiB

Open AccessArticle

The Influence of State and Trait Anxiety on the Achievement of a Virtual Reality Continuous Performance Test in Children and Adolescents with ADHD Symptoms

by Débora Areces, Celestino Rodríguez, Trinidad García, Marisol Cueli and Paloma González-Castro

J. Clin. Med. 2021, 10(12), 2534; https://doi.org/10.3390/jcm10122534 - 08 Jun 2021

Cited by 2 | Viewed by 2381

Abstract

The three types of presentations of ADHD often co-occur with other disorders, anxiety being one of the most prevalent. For this reason and because there are few studies that have examined the influence of anxiety on attentional activities, this study aims to determine [...] Read more.

The three types of presentations of ADHD often co-occur with other disorders, anxiety being one of the most prevalent. For this reason and because there are few studies that have examined the influence of anxiety on attentional activities, this study aims to determine how internalizing difficulties (anxiety levels) can influence performance in a virtual reality continuous performance test. The study used a non-probabilistic clinical sample comprising 68 boys (66%) and 35 girls (34%) aged between 6 and 16 (M = 12.24; SD = 2.45) who had been referred to clinical services for the evaluation of ADHD symptoms. Once informed consent was given, the children were administered the STAI-C scale and a virtual reality continuous performance test by expert researchers. Hierarchical regression models showed that only state anxiety demonstrated significant explanatory power over attentional variables. These findings confirm how important it is for children to feel relaxed when they undergo psychological evaluation tests, as otherwise the individual’s intervention design would be based on biased data. Similarly, the findings also suggested an effect of IQ in the interpretation of continuous performance scores. Full article

(This article belongs to the Special Issue The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders)

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17 pages, 1615 KiB

Open AccessArticle

Determinants of Cue-Elicited Alcohol Craving and Perceived Realism in Virtual Reality Environments among Patients with Alcohol Use Disorder

by Olga Hernández-Serrano, Alexandra Ghiţă, Jolanda Fernández-Ruiz, Miquel Monràs, Antoni Gual, Mariano Gacto, Bruno Porras-García, Marta Ferrer-García and José Gutiérrez-Maldonado

J. Clin. Med. 2021, 10(11), 2241; https://doi.org/10.3390/jcm10112241 - 21 May 2021

Cited by 4 | Viewed by 2695

Abstract

The identification of variables that can modulate the efficacy of cue exposure using virtual reality (VR) is crucial. This study aimed to explore determinant variables of cue-elicited alcohol craving and perceived realism (PR) of environments and alcoholic beverages during a VR cue-exposure session [...] Read more.

The identification of variables that can modulate the efficacy of cue exposure using virtual reality (VR) is crucial. This study aimed to explore determinant variables of cue-elicited alcohol craving and perceived realism (PR) of environments and alcoholic beverages during a VR cue-exposure session among alcohol use disorder (AUD) outpatients. A prospective cohort study was conducted amongst 72 outpatients with AUD from a clinical setting. Alcohol craving experienced during VR exposure and PR of virtual environments and alcoholic drinks were evaluated after a VR session of exposure to alcohol-related contexts and cues. Sociodemographic, psychological and consumption characteristics were examined as possible predicting variables. Multiple linear regression analyses showed that the AUD severity and PR of beverages were predictors of cue-elicited alcohol craving. Educational level, PR of beverages and age were predictors of the PR of VR environments. In relation to the PR of VR beverages, cue-elicited alcohol craving and the PR of environments were predictors. A simple mediational model was also performed to analyze the influence of the PR of beverages on the relationship between the AUD severity and alcohol craving experienced during VR exposure: an indirect or mediational effect was found. PR of alcoholic beverages was (1) a key predictor of the PR of VR environments (and vice versa) and the alcohol craving (and vice versa) experienced during VR cue-exposure sessions using ALCO-VR software among AUD patients and (2) a mediator between AUD severity and cue-elicited alcohol craving. Full article

(This article belongs to the Special Issue The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders)

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13 pages, 637 KiB

Open AccessArticle

Evaluation of the Impact of Virtual Reality-Enhanced Cardiac Rehabilitation on Depressive and Anxiety Symptoms in Patients with Coronary Artery Disease: A Randomised Controlled Trial

by Sandra Jóźwik, Błażej Cieślik, Robert Gajda and Joanna Szczepańska-Gieracha

J. Clin. Med. 2021, 10(10), 2148; https://doi.org/10.3390/jcm10102148 - 16 May 2021

Cited by 24 | Viewed by 2912

Abstract

The aim of this study was to assess the efficacy of virtual reality (VR)-enhanced cardiac rehabilitation (CR) in reducing the intensity of depression and anxiety symptoms in patients undergoing phase II of CR in ambulatory conditions. One hundred participants (mean age 65.7 years) [...] Read more.

The aim of this study was to assess the efficacy of virtual reality (VR)-enhanced cardiac rehabilitation (CR) in reducing the intensity of depression and anxiety symptoms in patients undergoing phase II of CR in ambulatory conditions. One hundred participants (mean age 65.7 years) were divided randomly into two groups. Both groups took part in eight sessions of standard CR (three times per week). The experimental group was additionally supported by eight sessions of VR therapy using the VR TierOne device and the control group by eight sessions of Schultz Autogenic Training. The Hospital Anxiety and Depression Scale (HADS) was used as the primary outcome measure. The Perception of Stress Questionnaire was used as the secondary outcome measure. The data from 77 participants were subject to analysis. Post-intervention, in the experimental group, the overall HADS score was statistically significantly reduced by 13.5%, HADS-Depression by 20.8%, and the general stress level by 12.8% (p < 0.05). In the control group, the scores of the HADS, HADS-Anxiety and the general stress level were statistically significantly higher, by 4.8%, 6.5%, and 4.9%, respectively. VR-enhanced CR for individuals with cardiovascular disease reduced the level of anxiety and depression symptoms compared to standard CR. Full article

(This article belongs to the Special Issue The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders)

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13 pages, 1468 KiB

Open AccessArticle

Virtual Therapeutic Garden: A Promising Method Supporting the Treatment of Depressive Symptoms in Late-Life: A Randomized Pilot Study

by Joanna Szczepańska-Gieracha, Błażej Cieślik, Anna Serweta and Krzysztof Klajs

J. Clin. Med. 2021, 10(9), 1942; https://doi.org/10.3390/jcm10091942 - 01 May 2021

Cited by 29 | Viewed by 3542

Abstract

The multifactorial genesis of old-age depression requires multi-professional therapy combining physical activity and psychosocial interventions; however, there is still a percentage of older people who do not exhibit satisfactory improvements. The aim of this study was to evaluate the effectiveness of virtual therapy [...] Read more.

The multifactorial genesis of old-age depression requires multi-professional therapy combining physical activity and psychosocial interventions; however, there is still a percentage of older people who do not exhibit satisfactory improvements. The aim of this study was to evaluate the effectiveness of virtual therapy in the elderly for whom the previous multimodal, biopsychosocial therapeutic programme had not brought the expected results. Twenty-five elderly women with depressive symptoms were randomly divided into a virtual reality group (VR, n = 13) and a control group (Control, n = 12). The average age was 70.73 and the average intensity of depression symptoms amounted to 12.26 in the Geriatric Depression Scale (GDS-30). As a virtual reality source, the VRTierOne (Stolgraf^®) device was used. The therapeutic cycle consisted of eight virtual therapy sessions, twice a week for four weeks. As primary and secondary outcome measures, the GDS-30 was performed at three time points. In the VR group, the GDS-30 score was reduced by 36%, and the result persisted in the follow-up tests. Immersive virtual therapy significantly lowered the intensity of depressive symptoms, as well as stress and anxiety levels in older women taking part in the group-based multimodal therapeutic programme, whose earlier therapy had not brought the expected results. Full article

(This article belongs to the Special Issue The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders)

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18 pages, 558 KiB

Open AccessArticle

Facial Affect Recognition by Patients with Schizophrenia Using Human Avatars

by Nora I. Muros, Arturo S. García, Cristina Forner, Pablo López-Arcas, Guillermo Lahera, Roberto Rodriguez-Jimenez, Karen N. Nieto, José Miguel Latorre, Antonio Fernández-Caballero and Patricia Fernández-Sotos

J. Clin. Med. 2021, 10(9), 1904; https://doi.org/10.3390/jcm10091904 - 28 Apr 2021

Cited by 13 | Viewed by 2089

Abstract

People with schizophrenia have difficulty recognizing the emotions in the facial expressions of others, which affects their social interaction and functioning in the community. Static stimuli such as photographs have been used traditionally to examine deficiencies in the recognition of emotions in patients [...] Read more.

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

(This article belongs to the Special Issue The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders)

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11 pages, 950 KiB

Open AccessArticle

Appropriate Number of Treatment Sessions in Virtual Reality-Based Individual Cognitive Behavioral Therapy for Social Anxiety Disorder

by Hyu Seok Jeong, Jee Hyun Lee, Hesun Erin Kim and Jae-Jin Kim

J. Clin. Med. 2021, 10(5), 915; https://doi.org/10.3390/jcm10050915 - 26 Feb 2021

Cited by 12 | Viewed by 3358

Abstract

Virtual reality (VR) was introduced to maximize the effect of cognitive behavioral therapy (CBT) by efficiently performing exposure therapy. The purpose of this study was to find out whether VR-based individual CBT with relatively few treatment sessions is effective in improving social anxiety [...] Read more.

Virtual reality (VR) was introduced to maximize the effect of cognitive behavioral therapy (CBT) by efficiently performing exposure therapy. The purpose of this study was to find out whether VR-based individual CBT with relatively few treatment sessions is effective in improving social anxiety disorder (SAD). This therapy was applied to 115 patients with SAD who were retrospectively classified into 43 patients who completed the nine or 10 sessions normally (normal termination group), 52 patients who finished the sessions early (early termination group), and 20 patients who had extended the sessions (session extension group). The Brief Fear of Negative Evaluation Scale (BFNE) scores tended to decrease in all groups as the session progressed, and the slope of decrease was the steepest in the early termination group and the least steep in the session extension group. Severity of social anxiety in the last session and symptom reduction rate showed no significant group difference. Our findings suggest that short-term VR-based individual CBT of nine to 10 sessions may be effective. When the therapeutic effect is insufficient during this period, the additional benefit may be minimal if the session is simply extended. The improvement in the early termination group suggests that even shorter sessions of five or six can also be effective. Full article

(This article belongs to the Special Issue The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders)

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23 pages, 2629 KiB

Open AccessArticle

AN-VR-BE. A Randomized Controlled Trial for Reducing Fear of Gaining Weight and Other Eating Disorder Symptoms in Anorexia Nervosa through Virtual Reality-Based Body Exposure

by Bruno Porras-Garcia, Marta Ferrer-Garcia, Eduardo Serrano-Troncoso, Marta Carulla-Roig, Pau Soto-Usera, Helena Miquel-Nabau, Laura Fernández-Del castillo Olivares, Rosa Marnet-Fiol, Isabel de la Montaña Santos-Carrasco, Bianca Borszewski, Marina Díaz-Marsá, Isabel Sánchez-Díaz, Fernando Fernández-Aranda and José Gutiérrez-Maldonado

J. Clin. Med. 2021, 10(4), 682; https://doi.org/10.3390/jcm10040682 - 10 Feb 2021

Cited by 34 | Viewed by 5740

Abstract

In vivo body exposure therapy is considered an effective and suitable intervention to help patients with anorexia nervosa (AN) reduce their body image disturbances (BIDs). However, these interventions have notable limitations and cannot effectively reproduce certain fears usually found in AN, such as [...] Read more.

In vivo body exposure therapy is considered an effective and suitable intervention to help patients with anorexia nervosa (AN) reduce their body image disturbances (BIDs). However, these interventions have notable limitations and cannot effectively reproduce certain fears usually found in AN, such as the fear of gaining weight (FGW). The latest developments in virtual reality (VR) technology and embodiment-based procedures could overcome these limitations and allow AN patients to confront their FGW and BIDs. This study aimed to provide further evidence of the efficacy of an enhanced (by means of embodiment) VR-based body exposure therapy for the treatment of AN. Thirty-five AN patients (16 in the experimental group, 19 in the control group) participated in the study. FGW, BIDs, and other body-related and ED measures were assessed before and after the intervention and three months later. The experimental group received treatment as usual (TAU) and five additional sessions of VR-based body exposure therapy, while the control group received only TAU. After the intervention, ED symptoms were clearly reduced in both groups, with most of the changes being more noticeable in the experimental group. Specifically, after the intervention and at follow-up, significant group differences were found in the FGW and BIDs, with the experimental group showing significantly lower values than the control group. The current study provides new insights and encouraging findings in the field of exposure-based therapies in AN. VR technology might improve research and clinical practice in AN by providing new tools to help patients confront their core fears (i.e., food- or weight-related cues) and improve their emotional, cognitive, and behavioral responses to their body image. Full article

(This article belongs to the Special Issue The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders)

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12 pages, 2858 KiB

Open AccessArticle

Evaluation of the Efficacy of Immersive Virtual Reality Therapy as a Method Supporting Pulmonary Rehabilitation: A Randomized Controlled Trial

by Sebastian Rutkowski, Jan Szczegielniak and Joanna Szczepańska-Gieracha

J. Clin. Med. 2021, 10(2), 352; https://doi.org/10.3390/jcm10020352 - 18 Jan 2021

Cited by 45 | Viewed by 5565

Abstract

Anxiety has been estimated to occur in 21–96% and depression in 27–79% of patients with chronic obstructive pulmonary disorder (COPD). We found a scarcity of literature providing evidence on how virtual reality (VR) therapy affects the intensity of depressive and anxiety symptoms and [...] Read more.

Anxiety has been estimated to occur in 21–96% and depression in 27–79% of patients with chronic obstructive pulmonary disorder (COPD). We found a scarcity of literature providing evidence on how virtual reality (VR) therapy affects the intensity of depressive and anxiety symptoms and stress levels in COPD patients undergoing in-hospital pulmonary rehabilitation (PR). This study enrolled 50 COPD patients with symptoms of stress, depression, and anxiety, randomly assigned to one of two groups. The two groups participated in the traditional PR programme additionally: the VR-group performed 10 sessions of immersive VR-therapy and the control group performed 10 sessions of Schultz autogenic training. Comparison of the changes in stress levels and depressive and anxiety symptoms was the primary outcome. Analysis of the results showed a reduction in stress levels only in the VR-group (p < 0.0069), with a medium effect size (d = 0.353). The symptoms of depression (p < 0.001, d = 0.836) and anxiety (p < 0.0009, d = 0.631) were statistically significantly reduced only in the VR-group, with a strong effect size. The enrichment of pulmonary rehabilitation with immersive VR therapy brings benefits in terms of mood improvement and reduction in anxiety and stress in patients with COPD. Full article

(This article belongs to the Special Issue The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders)

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15 pages, 317 KiB

Open AccessArticle

Exploring the Benefits of Virtual Reality-Assisted Therapy Following Cognitive-Behavioral Therapy for Auditory Hallucinations in Patients with Treatment-Resistant Schizophrenia: A Proof of Concept

by Laura Dellazizzo, Stéphane Potvin, Kingsada Phraxayavong and Alexandre Dumais

J. Clin. Med. 2020, 9(10), 3169; https://doi.org/10.3390/jcm9103169 - 30 Sep 2020

Cited by 15 | Viewed by 5247

Abstract

Background: Combining cognitive behavioral therapy (CBT) for psychosis with another psychosocial intervention comprising virtual reality (VR)-assisted therapy (VRT) may improve targeted outcomes in treatment-resistant schizophrenia patients. Methods: Ten participants having followed CBT were part of our comparative clinical trial comparing VRT to CBT [...] Read more.

Background: Combining cognitive behavioral therapy (CBT) for psychosis with another psychosocial intervention comprising virtual reality (VR)-assisted therapy (VRT) may improve targeted outcomes in treatment-resistant schizophrenia patients. Methods: Ten participants having followed CBT were part of our comparative clinical trial comparing VRT to CBT and were selected at the end of the study as they desired to continue to achieve improvements with VRT (CBT + VRT). Clinical assessments were administered before/after treatments and at follow-ups. Changes in outcomes were examined using linear mixed-effects models. To gain a more in depth understanding on CBT + VRT, therapists’ notes, and open interviews on a sub-group of patients were qualitatively analyzed. Results: Findings showed that the sequence of both interventions was appreciated by all patients. Several significant improvements were found throughout time points on auditory verbal hallucinations, beliefs about voices, depressive symptoms, symptoms of schizophrenia and quality of life. Although most of these improvements were in similar range to those observed in our comparative trial, effects of CBT + VRT on depressive symptoms and symptoms of schizophrenia were larger than those found for either intervention alone. Conclusion: This proof of concept is the first to merge gold-standard CBT with VRT for treatment refractory voices and to suggest a certain synergistic effect. Full article

(This article belongs to the Special Issue The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders)

15 pages, 954 KiB

Open AccessArticle

Use of Virtual Reality for the Management of Anxiety and Pain in Dental Treatments: Systematic Review and Meta-Analysis

by Nansi López-Valverde, Jorge Muriel-Fernández, Antonio López-Valverde, Luis Francisco Valero-Juan, Juan Manuel Ramírez, Javier Flores-Fraile, Julio Herrero-Payo, Leticia Alejandra Blanco-Antona, Bruno Macedo-de-Sousa and Manuel Bravo

J. Clin. Med. 2020, 9(10), 3086; https://doi.org/10.3390/jcm9103086 - 24 Sep 2020

Cited by 15 | Viewed by 3116

Abstract

(1) Background: Dental treatments often cause pain and anxiety in patients. Virtual reality (VR) is a novel procedure that can provide distraction during dental procedures or prepare patients to receive such type of treatments. This meta-analysis is the first to gather evidence on [...] Read more.

(1) Background: Dental treatments often cause pain and anxiety in patients. Virtual reality (VR) is a novel procedure that can provide distraction during dental procedures or prepare patients to receive such type of treatments. This meta-analysis is the first to gather evidence on the effectiveness of VR on the reduction of pain (P) and dental anxiety (DA) in patients undergoing dental treatment, regardless of age. (2) Methods: MEDLINE, CENTRAL, PubMed, EMBASE, Wiley Library and Web of Science were searched for scientific articles in November 2019. The keywords used were: “virtual reality”, “distraction systems”, “dental anxiety” and “pain”. Studies where VR was used for children and adults as a measure against anxiety and pain during dental treatments were included. VR was defined as a three-dimensional environment that provides patients with a sense of immersion, transporting them to appealing and interactive settings. Anxiety and pain results were assessed during dental treatments where VR was used and in standard care situations. (3) Results: 32 studies were identified, of which 8 met the inclusion criteria. The effect of VR in children was significant, both for anxiety (standardized mean difference (SMD) = −1.75) and pain (SMD = −1.46). (4) Conclusions: The findings of the meta-analysis show that VR is an effective distraction method to reduce pain and anxiety in patients undergoing a variety of dental treatments; however, further research on VR as a tool to prepare patients for dental treatment is required because of the scarcity of studies in this area. Full article

(This article belongs to the Special Issue The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders)

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19 pages, 1978 KiB

Open AccessArticle

Predictors of Changes in Alcohol Craving Levels during a Virtual Reality Cue Exposure Treatment among Patients with Alcohol Use Disorder

by Olga Hernández-Serrano, Alexandra Ghiţă, Natàlia Figueras-Puigderrajols, Jolanda Fernández-Ruiz, Miquel Monras, Lluïsa Ortega, Silvia Mondon, Lidia Teixidor, Antoni Gual, Lidia Ugas-Ballester, Maribel Fernández, Roger Montserrat, Bruno Porras-Garcia, Marta Ferrer-Garcia and José Gutiérrez-Maldonado

J. Clin. Med. 2020, 9(9), 3018; https://doi.org/10.3390/jcm9093018 - 18 Sep 2020

Cited by 22 | Viewed by 4937

Abstract

Background/Objective: Determining the predictive variables associated with levels of alcohol craving can ease the identification of patients who can benefit from treatments. This study aimed to describe changes (improvement or no change/deterioration) in alcohol craving levels and explore the predictors of these changes [...] Read more.

Background/Objective: Determining the predictive variables associated with levels of alcohol craving can ease the identification of patients who can benefit from treatments. This study aimed to describe changes (improvement or no change/deterioration) in alcohol craving levels and explore the predictors of these changes from admission to discharge in outpatients with alcohol use disorder (AUD) undergoing treatment-as-usual (TAU), or treatment-as-usual supplemented with virtual reality cue-exposure therapy (TAU + VR-CET). Method: A prospective cohort study was conducted amongst 42 outpatients with AUD (n = 15 TAU + VR-CET and n = 27 TAU) from a clinical setting. Changes in the levels of alcohol craving between admission and discharge were assessed with the Multidimensional Alcohol Craving Scale. Sociodemographic characteristics (age, gender, education, and socioeconomic and civil status), cognitive-affective behavioral patterns (AUD severity, abstinence duration, psychiatric comorbidity, state anxiety, attentional bias, and substance use), and type of treatment (TAU + VR-CET and only TAU) were also evaluated. Results: The TAU + VR-CET group showed greater changes of improvement in the levels of alcohol craving than the TAU group (χ² = 10.996; p = 0.001). Intragroup changes in alcohol craving from pre to post-treatment were significant in the TAU + VR-CET group (χ² = 13.818; p = 0.003) but not within the TAU group (χ² = 2.349; p = 0.503). The odds of an improvement in any of the craving levels between pre- and post-test was 18.18 (1/0.055) times higher in the TAU + VR-CET group with respect to the TAU group. The use of illicit drugs in the month prior to the test increased the odds of having a positive change by 18.18 (1/0.055) with respect to not having consumed. Conclusions: Including VR-CET in TAU programs may provide benefits in the treatment of AUDs mainly among patients with intense alcohol craving and individuals having used illicit substances prior to treatment. Full article

(This article belongs to the Special Issue The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders)

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18 pages, 1821 KiB

Open AccessArticle

“eLoriCorps Immersive Body Rating Scale”: Exploring the Assessment of Body Image Disturbances from Allocentric and Egocentric Perspectives

by Johana Monthuy-Blanc, Stéphane Bouchard, Marilou Ouellet, Giulia Corno, Sylvain Iceta and Michel Rousseau

J. Clin. Med. 2020, 9(9), 2926; https://doi.org/10.3390/jcm9092926 - 10 Sep 2020

Cited by 11 | Viewed by 4030

Abstract

The first objective of this study was to test the convergent and discriminant validity between the “eLoriCorps Immersive Body Rating Scale” and the traditional paper-based figure rating scale (FRS). The second objective was to explore the contribution of the egocentric virtual [...] Read more.

The first objective of this study was to test the convergent and discriminant validity between the “eLoriCorps Immersive Body Rating Scale” and the traditional paper-based figure rating scale (FRS). The second objective was to explore the contribution of the egocentric virtual reality (VR) perspective of eLoriCorps to understanding body image disturbances (BIDs). The sample consisted of 53 female and 13 male adults. Body size dissatisfaction, body size distortion, perceived body size, and ideal body size were assessed. Overall, outcomes showed good agreement between allocentric perspectives as measured via VR and the FRS. The egocentric VR perspective produced different results compared to both the allocentric VR perspective and the FRS. This difference revealed discriminant validity and suggested that eLoricorps’ egocentric VR perspective might assess something different from the traditional conception of body dissatisfaction, which an allocentric VR perspective generally assesses. Finally, the egocentric VR perspective in assessing BIDs deserves to be studied more extensively to explore the possibility of finding two types of body image distortion: (a) an egocentric perceptual body distortion, referring to internal body sensation affected by intra-individual changes, and (b) an allocentric perceptual body distortion, referring to external body benchmarks constructed by inter-individual comparison occurring in a given cultural context. Full article

(This article belongs to the Special Issue The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders)

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12 pages, 462 KiB

Open AccessArticle

The Role of Sense of Voice Presence and Anxiety Reduction in AVATAR Therapy

by Mar Rus-Calafell, Thomas Ward, Xiao Chi Zhang, Clementine J. Edwards, Philippa Garety and Tom Craig

J. Clin. Med. 2020, 9(9), 2748; https://doi.org/10.3390/jcm9092748 - 25 Aug 2020

Cited by 11 | Viewed by 4033

Abstract

AVATAR therapy offers a unique therapeutic context that uses virtual reality technology to create a virtual embodiment of the voice-hearing experience, enabling the person to visualize their persecutory voice and engage in real-time “face-to-face” dialogue. The present study explores, for the first time, [...] Read more.

AVATAR therapy offers a unique therapeutic context that uses virtual reality technology to create a virtual embodiment of the voice-hearing experience, enabling the person to visualize their persecutory voice and engage in real-time “face-to-face” dialogue. The present study explores, for the first time, the contribution of sense of voice presence, together with session-by-session reduction of anxiety and paranoid attributions about the avatar, to changes in primary outcomes following AVATAR therapy. Data from 39 participants, who completed AVATAR therapy and attended a 12-week follow-up assessment, were analysed. Mid- to high-levels of sense of voice presence were reported across the therapy sessions, along with significant reductions of anxiety levels and paranoid attributions about the avatar. The interaction of sense of voice presence and reduction of anxiety was associated with two of the significant therapy outcomes: PSYRATS total and frequency of voices. The findings suggest that improvements in voice severity and frequency at post AVATAR therapy may be influenced by the combination of feeling less anxious in the context of a realistic simulation of the voice, while voice-related distress may involve additional cognitive and relational processes. Full article

(This article belongs to the Special Issue The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders)

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18 pages, 2329 KiB

Open AccessArticle

Virtual Reality Aggression Prevention Therapy (VRAPT) versus Waiting List Control for Forensic Psychiatric Inpatients: A Multicenter Randomized Controlled Trial

by Stéphanie Klein Tuente, Stefan Bogaerts, Erik Bulten, Marije Keulen-de Vos, Maarten Vos, Hein Bokern, Sarah van IJzendoorn, Chris N. W. Geraets and Wim Veling

J. Clin. Med. 2020, 9(7), 2258; https://doi.org/10.3390/jcm9072258 - 16 Jul 2020

Cited by 43 | Viewed by 6510

Abstract

Many forensic psychiatric inpatients have difficulties regulating aggressive behavior. Evidence of effective aggression treatments is limited. We designed and investigated the effectiveness of a transdiagnostic application of a virtual reality aggression prevention training (VRAPT). In this randomized controlled trial at four Dutch forensic [...] Read more.

Many forensic psychiatric inpatients have difficulties regulating aggressive behavior. Evidence of effective aggression treatments is limited. We designed and investigated the effectiveness of a transdiagnostic application of a virtual reality aggression prevention training (VRAPT). In this randomized controlled trial at four Dutch forensic psychiatric centers, 128 inpatients with aggressive behavior were randomly assigned to VRAPT (N = 64) or waiting list control group (N = 64). VRAPT consisted of 16 one-hour individual treatment sessions twice a week. Assessments were done at baseline, post-treatment and at 3-month follow-up. Primary outcome measures were aggressive behavior observed by staff and self-reported aggressive behavior. Analysis was by intention to treat. This trial was registered in the Dutch Trial Register (NTR, TC = 6340). Participants were included between 1 March 2017, and 31 December 2018. Compared to waiting list, VRAPT did not significantly decrease in self-reported or observed aggressive behavior (primary outcomes). Hostility, anger control, and non-planning impulsiveness improved significantly in the VRAPT group compared to the control group at post-treatment. Improvements were not maintained at 3-month follow-up. Results suggest that VRAPT does not decrease aggressive behavior in forensic inpatients. However, there are indications that VRAPT temporarily influences anger control skills, impulsivity and hostility. Full article

(This article belongs to the Special Issue The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders)

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14 pages, 3104 KiB

Open AccessArticle

by Bruno Porras-Garcia, Erik Exposito-Sanz, Marta Ferrer-Garcia, Oscar Castillero-Mimenza and José Gutiérrez-Maldonado

J. Clin. Med. 2020, 9(6), 1736; https://doi.org/10.3390/jcm9061736 - 04 Jun 2020

Cited by 8 | Viewed by 3622

Abstract

Previous studies have found gender differences in body-related attentional bias (AB), with women showing AB towards weight-related body parts. However, few studies have assessed the relationship between body-related AB and muscularity dissatisfaction (MD) in men. This study aimed to assess the presence of [...] Read more.

Previous studies have found gender differences in body-related attentional bias (AB), with women showing AB towards weight-related body parts. However, few studies have assessed the relationship between body-related AB and muscularity dissatisfaction (MD) in men. This study aimed to assess the presence of muscle-related AB in men, using a combination of a virtual reality (VR) embodiment-based technique and eye-tracking (ET) technology. Twenty men with high MD and 20 with low MD, owned a virtual avatar that had the same silhouette and body mass index as the participant. To analyze the gaze data, muscle-related areas of interest (M-AOIs) and nonmuscle-related areas of interest (NM-AOIs) were defined. The complete fixation time and the number of fixations on each AOI were recorded. Mixed between (group)-within (AOI_condition) analyses of variance showed a statistically significant interaction between group and time (p < 0.05) in both AB measures. Follow-up analyses revealed an AB towards M-AOIs only in men with high MD. Overall, men with high MD spent more time looking and displayed a higher number of fixations on M-AOIs, specifically the chest and shoulders, compared to men with low MD. This study provides new information about the relationship between MD and body-related AB in men. Combining VR with ET technologies presents interesting opportunities in the study of body image in men. Full article

(This article belongs to the Special Issue The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders)

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11 pages, 279 KiB

Open AccessReview

Is Virtual Reality Cue Exposure a Promising Adjunctive Treatment for Alcohol Use Disorder?

by Zofia Lebiecka, Tomasz Skoneczny, Ernest Tyburski, Jerzy Samochowiec and Jolanta Kucharska-Mazur

J. Clin. Med. 2021, 10(13), 2972; https://doi.org/10.3390/jcm10132972 - 01 Jul 2021

Cited by 9 | Viewed by 3857

Abstract

This narrative review presents recent developments in virtual reality (VR)-based interventions for alcohol use disorders (AUDs). The latest advances in mental healthcare hail an imminent cyber revolution, ushering in novel treatment options, with immersive virtual technology at the very forefront of expected change. [...] Read more.

This narrative review presents recent developments in virtual reality (VR)-based interventions for alcohol use disorders (AUDs). The latest advances in mental healthcare hail an imminent cyber revolution, ushering in novel treatment options, with immersive virtual technology at the very forefront of expected change. With an aim to (a) provide a background on VR use in mental healthcare of AUD patients, (b) summarize existing evidence on conventional approaches to the treatment of AUDs and a trending paradigm shift towards VR applications in their management, and (c) describe key issues and future directions in research on craving assessment and VR cue-induced therapy in AUDs, a search for experimental and meta-analytic evidence was performed in six databases: PubMed and EBSCO (Medline, ERIC, PsychINFO, Academic Search Ultimate, and Health Source: Nursing/Academic Edition). Pooled results were screened for eligibility, and relevant papers were selected for inclusion. The analysis revealed VR’s promising effects in the treatment of AUDs. Its remarkable potential to simulate cues underlying subsequent addictive behaviors makes its application in the assessment and treatment of AUDs an attractive alternative to researchers and clinicians alike. Nevertheless, more evidence is needed before virtual reality cue exposure therapy (VR-CET) can become a clinical standard of care. Full article

(This article belongs to the Special Issue The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders)

26 pages, 1805 KiB

Open AccessReview

Executive Dysfunctions in Schizophrenia: A Critical Review of Traditional, Ecological, and Virtual Reality Assessments

by Ernest Tyburski, Monika Mak, Andrzej Sokołowski, Anna Starkowska, Ewa Karabanowicz, Magdalena Kerestey, Zofia Lebiecka, Joanna Preś, Leszek Sagan, Jerzy Samochowiec and Ashok S. Jansari

J. Clin. Med. 2021, 10(13), 2782; https://doi.org/10.3390/jcm10132782 - 24 Jun 2021

Cited by 6 | Viewed by 4182

Abstract

In recent years, interest has grown in measuring executive function in schizophrenia with ecological and virtual reality (VR) tools. However, there is a lack of critical analysis comparing those tools with traditional ones. This paper aims to characterize executive dysfunction in schizophrenia by [...] Read more.

In recent years, interest has grown in measuring executive function in schizophrenia with ecological and virtual reality (VR) tools. However, there is a lack of critical analysis comparing those tools with traditional ones. This paper aims to characterize executive dysfunction in schizophrenia by comparing ecological and virtual reality assessments with traditional tools, and to describe the neurobiological and psychopathological correlates. The analysis revealed that ecological and VR tests have higher levels of verisimilitude and similar levels of veridicality compared to traditional tools. Both negative symptoms and disorganization correlate significantly with executive dysfunction as measured by traditional tools, but their relationships with measures based on ecological and VR methods are still unclear. Although there is much research on brain correlates of executive impairments in schizophrenia with traditional tools, it is uncertain if these results will be confirmed with the use of ecological and VR tools. In the diagnosis of executive dysfunction, it is important to use a variety of neuropsychological methods—especially those with confirmed ecological validity—to properly recognize the underlying characteristics of the observed deficits and to implement effective forms of therapy. Full article

(This article belongs to the Special Issue The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders)

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16 pages, 305 KiB

Open AccessReview

Ethical Challenges of Using Virtual Environments in the Assessment and Treatment of Psychopathological Disorders

by Thomas D. Parsons

J. Clin. Med. 2021, 10(3), 378; https://doi.org/10.3390/jcm10030378 - 20 Jan 2021

Cited by 17 | Viewed by 4575

Abstract

Clinicians are increasingly interested in the potential of virtual environments for research and praxes. Virtual environments include both immersive and non-immersive simulations of everyday activities. Moreover, algorithmic devices and adaptive virtual environments allow clinicians a medium for personalizing technologies to their patients. There [...] Read more.

Clinicians are increasingly interested in the potential of virtual environments for research and praxes. Virtual environments include both immersive and non-immersive simulations of everyday activities. Moreover, algorithmic devices and adaptive virtual environments allow clinicians a medium for personalizing technologies to their patients. There is also increasing recognition of social virtual environments that connect virtual environments to social networks. Although there has been a great deal of deliberation on these novel technologies for assessment and treatment, less discourse has occurred around the ethical challenges that may ensue when these technologies are applied clinically. In this paper, some of the ethical issues involved in the clinical use of novel technologies are discussed. Full article

(This article belongs to the Special Issue The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders)

17 pages, 343 KiB

Open AccessReview

Virtual Body Ownership Illusions for Mental Health: A Narrative Review

by Marta Matamala-Gomez, Antonella Maselli, Clelia Malighetti, Olivia Realdon, Fabrizia Mantovani and Giuseppe Riva

J. Clin. Med. 2021, 10(1), 139; https://doi.org/10.3390/jcm10010139 - 03 Jan 2021

Cited by 45 | Viewed by 6673

Abstract

Over the last 20 years, virtual reality (VR) has been widely used to promote mental health in populations presenting different clinical conditions. Mental health does not refer only to the absence of psychiatric disorders but to the absence of a wide range of [...] Read more.

Over the last 20 years, virtual reality (VR) has been widely used to promote mental health in populations presenting different clinical conditions. Mental health does not refer only to the absence of psychiatric disorders but to the absence of a wide range of clinical conditions that influence people’s general and social well-being such as chronic pain, neurological disorders that lead to motor o perceptual impairments, psychological disorders that alter behaviour and social cognition, or physical conditions like eating disorders or present in amputees. It is known that an accurate perception of oneself and of the surrounding environment are both key elements to enjoy mental health and well-being, and that both can be distorted in patients suffering from the clinical conditions mentioned above. In the past few years, multiple studies have shown the effectiveness of VR to modulate such perceptual distortions of oneself and of the surrounding environment through virtual body ownership illusions. This narrative review aims to review clinical studies that have explored the manipulation of embodied virtual bodies in VR for improving mental health, and to discuss the current state of the art and the challenges for future research in the context of clinical care. Full article

(This article belongs to the Special Issue The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders)

Other

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17 pages, 3823 KiB

Open AccessBrief Report

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

by Katherine Nameth, Theresa Brown, Kim Bullock, Sarah Adler, Giuseppe Riva, Debra Safer and Cristin Runfola

J. Clin. Med. 2021, 10(7), 1511; https://doi.org/10.3390/jcm10071511 - 05 Apr 2021

Cited by 8 | Viewed by 3336

Abstract

Binge-eating disorder (BED) and bulimia nervosa (BN) have adverse psychological and medical consequences. Innovative interventions, like the integration of virtual reality (VR) with cue-exposure therapy (VR-CET), enhance outcomes for refractory patients compared to cognitive behavior therapy (CBT). Little is known about the feasibility [...] Read more.

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

(This article belongs to the Special Issue The Use of Virtual Reality Technology in the Treatment of Psychopathological Disorders)

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