Positive Technology Journal

Virtual reality hypnosis for pain associated with recovery from physical trauma.

Int J Clin Exp Hypn. 2010 Jul;58(3):288-300

Authors: Patterson DR, Jensen MP, Wiechman SA, Sharar SR

Pain following traumatic injuries is common, can impair injury recovery and is often inadequately treated. In particular, the role of adjunctive nonpharmacologic analgesic techniques is unclear. The authors report a randomized, controlled study of 21 hospitalized trauma patients to assess the analgesic efficacy of virtual reality hypnosis (VRH)-hypnotic induction and analgesic suggestion delivered by customized virtual reality (VR) hardware/software. Subjective pain ratings were obtained immediately and 8 hours after VRH (used as an adjunct to standard analgesic care) and compared to both adjunctive VR without hypnosis and standard care alone. VRH patients reported less pain intensity and less pain unpleasantness compared to control groups. These preliminary findings suggest that VRH analgesia is a novel technology worthy of further study, both to improve pain management and to increase availability of hypnotic analgesia to populations without access to therapist-provided hypnosis and suggestion.

Therapists' Perception of Benefits and Costs of Using Virtual Reality Treatments.

Cyberpsychol Behav Soc Netw. 2010 Jun 14;

Authors: Segal R, Bhatia M, Drapeau M

Abstract Research indicates that virtual reality is effective in the treatment of many psychological difficulties and is being used more frequently. However, little is known about therapists' perception of the benefits and costs related to the use of virtual therapy in treatment delivery. In the present study, 271 therapists completed an online questionnaire that assessed their perceptions about the potential benefits and costs of using virtual reality in psychotherapy. Results indicated that therapists perceived the potential benefits as outweighing the potential costs. Therapists' self-reported knowledge of virtual reality, theoretical orientation, and interest in using virtual reality were found to be associated with perceptual measures. These findings contribute to the current knowledge of the perception of virtual reality amongst psychotherapists.

An Adaptive Display for the Treatment of Diverse Trauma PTSD Victims.

Cyberpsychol Behav. 2009 Dec 20;

Authors: Botella C, García-Palacios A, Guillen V, Baños RM, Quero S, Alcaniz M

Abstract Posttraumatic stress disorder (PTSD) can develop after exposure to a terrifying event. People who suffer from PTSD experience hyperarousal and avoidance, and they reexperience symptoms that provoke distress and impairment in significant life areas. Cognitive behavior programs, including exposure therapy, are currently the treatment of choice for PTSD. Although these programs are effective, there is room for improvement; utilization of exposure therapy by clinicians is low, and attrition rates are high. Application of new technologies, especially virtual reality (VR), could help to overcome these issues. Several VR programs that address PTSD already exist. This study presents preliminary data on the efficacy of a VR adaptive display called EMMA's World, as applied in the treatment of diverse trauma PTSD victims. This VR program is unique; its flexibility allows it to be used to treat patients who suffer from PTSD due to different kinds of traumatic events. Results support the utility of EMMA's World in the treatment of PTSD.

Virtual reality for obsessive-compulsive disorder: past and the future.

Psychiatry Investig. 2009 Sep;6(3):115-21

Authors: Kim K, Kim CH, Kim SY, Roh D, Kim SI

The use of computers, especially for virtual reality (VR), to understand, assess, and treat various mental health problems has been developed for the last decade, including application for phobia, post-traumatic stress disorder, attention deficits, and schizophrenia. However, the number of VR tools addressing obsessive-compulsive disorder (OCD) is still lacking due to the heterogeneous symptoms of OCD and poor understanding of the relationship between VR and OCD. This article reviews the empirical literatures for VR tools in the future, which involve applications for both clinical work and experimental research in this area, including examining symptoms using VR according to OCD patients' individual symptoms, extending OCD research in the VR setting to also study behavioral and physiological correlations of the symptoms, and expanding the use of VR for OCD to cognitive-behavioral intervention.

Reactivity to cannabis cues in virtual reality environments.

J Psychoactive Drugs. 2009 Jun;41(2):105-12

Authors: Bordnick PS, Copp HL, Traylor A, Graap KM, Carter BL, Walton A, Ferrer M

Virtual reality (VR) cue environments have been developed and successfully tested in nicotine, cocaine, and alcohol abusers. Aims in the current article include the development and testing of a novel VR cannabis cue reactivity assessment system. It was hypothesized that subjective craving levels and attention to cannabis cues would be higher in VR environments with cannabis cues compared to VR neutral environments. Twenty nontreatment-seeking current cannabis smokers participated in the VR cue trial. During the VR cue trial, participants were exposed to four virtual environments that contained audio, visual, olfactory, and vibrotactile sensory stimuli. Two VR environments contained cannabis cues that consisted of a party room in which people were smoking cannabis and a room containing cannabis paraphernalia without people. Two VR neutral rooms without cannabis cues consisted of a digital art gallery with nature videos. Subjective craving and attention to cues were significantly higher in the VR cannabis environments compared to the VR neutral environments. These findings indicate that VR cannabis cue reactivity may offer a new technology-based method to advance addiction research and treatment.

Increased personal space of patients with schizophrenia in a virtual social environment.

Psychiatry Res. 2009 Sep 15;

Authors: Park SH, Ku J, Kim JJ, Jang HJ, Kim SY, Kim SH, Kim CH, Lee H, Kim IY, Kim SI

Virtual reality may be a good alternative method for measuring personal space and overcoming some limitations in previous studies on the social aspects of schizophrenia. Using this technology, we aimed to investigate the characteristics of personal space in patients with schizophrenia and evaluate the relationship between their social behaviors and schizophrenic symptoms. The distance from a virtual person and the angle of head orientation while talking to a virtual person in a virtual environment were measured in 30 patients with schizophrenia and 30 normal controls. It was found that patients with schizophrenia had longer distances and larger angles than did normal controls. The severity of the negative syndrome had significant inverse correlations with the distance from the angry and neutral virtual persons and with the angle of head orientation toward the happy and angry virtual persons, suggesting that negative symptoms may have a close relationship with personal space, including distancing and eye gaze. The larger personal space of patients may reflect their discomfort in close situations or cognitive deficits. Showing these profiles to patients could help them realize the amount of personal space they need.

The use of biofeedback in clinical virtual reality: the intrepid project.

Stud Health Technol Inform. 2009;144:128-32

Authors: Repetto C, Gorini A, Algeri D, Vigna C, Gaggioli A, Riva G

In our protocol for the treatment of Generalized Anxiety Disorders we use Virtual reality (VR) to facilitate emotional regulation and the relaxation process. Using a biofeedback biomonitoring system (GSR, HR, Thermal) the patient is made aware of his or her reactions through the modification of some features of the VR environment in real time. Using mental exercises the patient learns to control these physiological parameters and using the feedback provided by the virtual environment is able to gauge his or her success. To test this concept, we planned a randomized controlled trial (NCT00602212), including three groups of 15 patients each (for a total of 45 patients): (1) the VR group, (2) the non-VR group, and (3) the waiting list (WL) group.

A virtual reality-based system integrated with fmri to study neural mechanisms of action observation-execution: A proof of concept study.

Restor Neurol Neurosci. 2009;27(3):209-23

Authors: Adamovich SV, August K, Merians A, Tunik E

Purpose: Emerging evidence shows that interactive virtual environments (VEs) may be a promising tool for studying sensorimotor processes and for rehabilitation. However, the potential of VEs to recruit action observation-execution neural networks is largely unknown. For the first time, a functional MRI-compatible virtual reality system (VR) has been developed to provide a window into studying brain-behavior interactions. This system is capable of measuring the complex span of hand-finger movements and simultaneously streaming this kinematic data to control the motion of representations of human hands in virtual reality. Methods: In a blocked fMRI design, thirteen healthy subjects observed, with the intent to imitate (OTI), finger sequences performed by the virtual hand avatar seen in 1st person perspective and animated by pre-recorded kinematic data. Following this, subjects imitated the observed sequence while viewing the virtual hand avatar animated by their own movement in real-time. These blocks were interleaved with rest periods during which subjects viewed static virtual hand avatars and control trials in which the avatars were replaced with moving non-anthropomorphic objects. Results: We show three main findings. First, both observation with intent to imitate and imitation with real-time virtual avatar feedback, were associated with activation in a distributed frontoparietal network typically recruited for observation and execution of real-world actions. Second, we noted a time-variant increase in activation in the left insular cortex for observation with intent to imitate actions performed by the virtual avatar. Third, imitation with virtual avatar feedback (relative to the control condition) was associated with a localized recruitment of the angular gyrus, precuneus, and extrastriate body area, regions which are (along with insular cortex) associated with the sense of agency. Conclusions: Our data suggest that the virtual hand avatars may have served as disembodied training tools in the observation condition and as embodied "extensions" of the subject's own body (pseudo-tools) in the imitation. These data advance our understanding of the brain-behavior interactions when performing actions in VE and have implications in the development of observation- and imitation-based VR rehabilitation paradigms.

Scientists from the Universities of York and Warwick have developed the first Virtual Reality system that allows users to see, hear, smell taste and even touch. The prototype will be presented at Pioneers 09', an EPSRC showcase event to be held at London's Olympia Conference Centre on March 4

If the prototype can really do what it promises, it can have widespread applications in education, business, medical visualization and cybertherapy.

Virtual reality in acquired brain injury upper limb rehabilitation: evidence-based evaluation of clinical research.

Brain Inj. 2009 Mar;23(3):179-91

Authors: Mumford N, Wilson PH

PRIMARY OBJECTIVE: Acquired brain injury (ABI) is associated with significant cognitive, behavioural, psychological and physical impairment. Hence, it has been important to leverage assessment approaches in rehabilitation by using current and emerging technologies, including virtual reality (VR). A number of VR rehabilitation programmes have been designed in recent years, mainly to improve upper limb function. However, before this technology gains widespread use, evaluation of the scientific evidence supporting VR-assisted rehabilitation is needed. The present review aimed to assess the rationale, design and methodology of research investigating the clinical impact of VR on ABI upper-limb rehabilitation. RESEARCH DESIGN: A total of 22 studies were surveyed using a Cochrane-style review. RESEARCH METHODS: Studies were classified on a number of key criteria: theoretical bases and aims, sample populations and recruitment procedures, characteristics of the VR systems, evaluation design including control procedures and statistical analysis of results. Studies were rated using the Downs and Black (DB) scale. RESULTS: The review demonstrated that few studies used a conventional randomized controlled study design. Moderate support was shown for both teacher-animation and game-like systems. CONCLUSION: While VR-assisted rehabilitation shows early promise, clinicians are advised to be cautious about adopting these technologies before adequate data is available.

Assessing craving in young adult smokers using virtual reality.

Am J Addict. 2008 Sep-Oct;17(5):436-40

Authors: Traylor AC, Bordnick PS, Carter BL

Cigarette smokers, when confronted with cues associated with smoking, evidence strong reactions, including increased craving. These reactions have not been extensively studied in young adult smokers, a group that research suggests may respond differently than adults or adolescent smokers. We used virtual reality, which presents a complex array of smoking cues that may be particularly salient to young adult smokers, and measured self-report of craving. Young adult smokers responded strongly to these cues and, unlike adults, did not return to a baseline of craving following cue exposure, suggesting young adult smokers differ from other smokers in terms of cue responses.

Virtual reality exposure therapy for active duty soldiers.

J Clin Psychol. 2008 Jul 8;

Authors: Reger GM, Gahm GA

Virtual reality exposure therapy using a virtual Iraq: Case report.

J Trauma Stress. 2008 Apr 10;21(2):209-213

Authors: Gerardi M, Rothbaum BO, Ressler K, Heekin M, Rizzo A

Posttraumatic stress disorder (PTSD) has been estimated to affect up to 18% of returning Operation Iraqi Freedom (OIF) veterans. Soldiers need to maintain constant vigilance to deal with unpredictable threats, and an unprecedented number of soldiers are surviving serious wounds. These risk factors are significant for development of PTSD; therefore, early and efficient intervention options must be identified and presented in a form acceptable to military personnel. This case report presents the results of treatment utilizing virtual reality exposure (VRE) therapy (virtual Iraq) to treat an OIF veteran with PTSD. Following brief VRE treatment, the veteran demonstrated improvement in PTSD symptoms as indicated by clinically and statistically significant changes in scores on the Clinician Administered PTSD Scale (CAPS; Blake et al., 1990) and the PTSD Symptom Scale Self-Report (PSS-SR; Foa, Riggs, Dancu, & Rothbaum, 1993). These results indicate preliminary promise for this treatment.

The efficacy of an augmented virtual reality system to alleviate pain in children undergoing burns dressing changes: A randomised controlled trial.

Burns. 2008 Mar 4;

Authors: Mott J, Bucolo S, Cuttle L, Mill J, Hilder M, Miller K, Kimble RM

Assessing reactivity to virtual reality alcohol based cues.

Addict Behav. 2008 Jan 2

Authors: Bordnick PS, Traylor A, Copp HL, Graap KM, Carter B, Ferrer M, Walton AP

The use of virtual reality (VR) programs in behavioral science research has been gaining prominence over the past several years. In the field of substance abuse, VR cue reactivity programs have been successfully tested for feasibility in nicotine and cocaine dependent samples. Seeking to expand VR applications in alcohol cue research, a novel VR alcohol cue reactivity assessment system incorporating visual, auditory, and olfactory stimuli was developed and tested. In a controlled trial, 40 non-treatment-seeking drinkers with alcohol use disorders were exposed to VR alcohol cue environments. Subjective craving, attention to alcohol cues, and level of presence (realism of experience) in VR were assessed across the environments. Overall, subjective craving for alcohol increased across the VR alcohol-related cue environments versus VR neutral cue environments. Participants reported high levels of presence in VR, indicating that the environments were perceived as realistic and compelling. These initial findings support the use of VR based cue reactivity environments for use in alcohol cue-based treatment and research.

Development of symbolic play through the use of virtual reality tools in children with autistic spectrum disorders: Two case studies.

Autism. 2008 Mar;12(2):143-57

Authors: Herrera G, Alcantud F, Jordan R, Blanquer A, Labajo G, De Pablo C

Difficulties in understanding symbolism have been documented as characteristic of autistic spectrum disorders (ASDs). In general, virtual reality (VR) environments offer a set of potential advantages for educational intervention in ASD. In particular, VR offers the advantage, for teaching pretend play and for understanding imagination, of it being possible to show these imaginary transformations explicitly. This article reports two case studies of children with autism (aged 8:6 and 15:7, both male), examining the effectiveness of using a VR tool specifically designed to work on teaching understanding of pretend play. The results, confirmed by independent observers, showed a significant advance in pretend play abilities after the intervention period in both participants, and a high degree of generalization of the acquired teaching in one of them.

Validity of virtual reality as a method of exposure in the treatment of test anxiety.

Behav Res Methods. 2007 Nov;39(4):844-51

Authors: Alsina-Jurnet I, Carvallo-Beciu C, Gutiérez-Maldonado J

This is a validation study, aiming to explore the effectiveness of a set of virtual environments forproducing emotionally significant responses in students with high levels of test anxiety in order to be able to implement them later in treatment. Twenty-one students agreed to take part, 11 with high test anxiety and 10 with low test anxiety. The virtual environments were prepared in chronological order: the student's home, then the metro, and finally the corridor and lecture hall where the examination takes place. The results showed that the high-test-anxiety group presented higher levels of anxiety and depression than the low-test-anxiety group during exposure to the virtual environments. This study shows that virtual reality is able to provoke emotional responses in students with high test anxiety. This validation study should be followed up with treatment studies to evaluate the efficacy of virtual reality therapy for treating test anxiety.

Robot-based hand motor therapy after stroke.

Brain. 2007 Dec 20;

Authors: Takahashi CD, Der-Yeghiaian L, Le V, Motiwala RR, Cramer SC

Robots can improve motor status after stroke with certain advantages, but there has been less emphasis to date on robotic developments for the hand. The goal of this study was to determine whether a hand-wrist robot would improve motor function, and to evaluate the specificity of therapy effects on brain reorganization. Subjects with chronic stroke producing moderate right arm/hand weakness received 3 weeks therapy that emphasized intense active movement repetition as well as attention, speed, force, precision and timing, and included virtual reality games. Subjects initiated hand movements. If necessary, the robot completed movements, a feature available at all visits for seven of the subjects and at the latter half of visits for six of the subjects. Significant behavioural gains were found at end of treatment, for example, in Action Research Arm Test (34 +/- 20 to 38 +/- 19, P< 0.0005) and arm motor Fugl-Meyer score (45 +/- 10 to 52 +/- 10, P < 0.0001). Results suggest greater gains for subjects receiving robotic assistance in all sessions as compared to those receiving robotic assistance in half of sessions. The grasp task practiced during robotic therapy, when performed during functional MRI, showed increased sensorimotor cortex activation across the period of therapy, while a non-practiced task, supination/pronation, did not. A robot-based therapy showed improvements in hand motor function after chronic stroke. Reorganization of motor maps during the current therapy was task-specific, a finding useful when considering generalization of rehabilitation therapy.

Heading assessment by "tunnel vision" patients and control subjects standing or walking in a virtual reality environment.

ACM Trans Appl Percept. 2007 Jan;4(1):nihms21521

Authors: Apfelbaum H, Pelah A, Peli E

Virtual reality locomotion simulators are a promising tool for evaluating the effectiveness of vision aids to mobility for people with low vision. This study examined two factors to gain insight into the verisimilitude requirements of the test environment: the effects of treadmill walking and the suitability of using controls as surrogate patients. Ten "tunnel vision" patients with retinitis pigmentosa (RP) were tasked with identifying which side of a clearly visible obstacle their heading through the virtual environment would lead them, and were scored both on accuracy and on their distance from the obstacle when they responded. They were tested both while walking on a treadmill and while standing, as they viewed a scene representing progress through a shopping mall. Control subjects, each wearing a head-mounted field restriction to simulate the vision of a paired patient, were also tested. At wide angles of approach, controls and patients performed with a comparably high degree of accuracy, and made their choices at comparable distances from the obstacle. At narrow angles of approach, patients' accuracy increased when walking, while controls' accuracy decreased. When walking, both patients and controls delayed their decisions until closer to the obstacle. We conclude that a head-mounted field restriction is not sufficient for simulating tunnel vision, but that the improved performance observed for walking compared to standing suggests that a walking interface (such as a treadmill) may be essential for eliciting natural perceptually-guided behavior in virtual reality locomotion simulators.

Feasibility of Using the Sony PlayStation 2 Gaming Platform for an Individual Poststroke: A Case Report.

J Neurol Phys Ther. 2007 Dec;31(4):180-9

Authors: Flynn S, Palma P, Bender A

RATIONALE:: Many Americans live with physical functional limitations stemming from stroke. These functional limitations can be reduced by task-specific training that is repetitive, motivating, and augmented with feedback. Virtual reality (VR) is reported to offer an engaging environment that is repetitive, safe, motivating, and gives task-specific feedback. The purpose of this case report was to explore the use of a low-cost VR device [Sony PlayStation 2 (PS2) EyeToy] for an individual in the chronic phase of stroke recovery. CASE:: An individual two years poststroke with residual sensorimotor deficits completed 20 one-hour sessions using the PS2 EyeToy. The game's task requirements included target-based motion, dynamic balance, and motor planning. The feasibility of using the gaming platform was explored and a broad selection of outcomes was used to assess change in performance. OUTCOMES:: Device use was feasible. Clinically relevant improvements were found on the Dynamic Gait Index and trends toward improvement on the Fugl-Meyer Assesment, Berg Balance Scale, UE Functional Index, Motor Activity Log, and Beck Depression Inventory. CONCLUSION:: A low-cost VR system was easily used in the home. In the future it may be used to improve sensory/motor recovery following stroke as an adjunct to standard care physical therapy.