Positive Technology Journal

Using FMRI to study the neural correlates of virtual reality analgesia.

CNS Spectr. 2006 Jan;11(1):45-51

Authors: Hoffman HG, Richards TL, Bills AR, Van Oostrom T, Magula J, Seibel EJ, Sharar SR

Excessive pain during medical procedures, such as burn wound dressing changes, is a widespread medical problem and is especially challenging for children. This article describes the rationale behind virtual reality (VR) pain distraction, a new non-pharmacologic adjunctive analgesia, and gives a brief summary of empirical studies exploring whether VR reduces clinical procedural pain. Results indicate that patients using VR during painful medical procedures report large reductions in subjective pain. A neuroimaging study measuring the neural correlates of VR analgesia is described in detail. This functional magnetic resonance imaging pain study in healthy volunteers shows that the large drops in subjective pain ratings during VR are accompanied by large drops in pain-related brain activity. Together the clinical and laboratory studies provide converging evidence that VR distraction is a promising new non-pharmacologic pain control technique.

Urology. 2005 Dec;66(6):1320

Authors: Wright JL, Hoffman HG, Sweet RM

The management of pain during clinic transurethral microwave thermotherapy (TUMT) can be challenging. Pain can lead to increased pelvic blood flow, which dissipates the energy delivered, limiting the amount of heat delivered to the prostate. In this report, we describe the novel use of virtual reality distraction as an adjunctive mechanism for local anesthesia during TUMT in a 67-year-old man. This report is novel in being, to our knowledge, the first to demonstrate the efficacy of virtual reality in an elderly patient and the first documented use for a urologic clinic procedure. We believe it is also the first to demonstrate efficacy for the control of thermally induced pain.

Via Pasta and Vinegar

amBX is a Philips project for a system that should provide gamers with a full ‘sensory surround experience’ allowing them to use light, colour, sound, heat and even airflow in the real world during gameplay.

A light year leap in ambient experience – to the world of computer gaming, spotlighting a technology that will revolutionize the game play experience and extend the gaming world out of the screen and into the real world.

Due for release in May 2006 and coming from the Surrey-based Philips amBX Group, amBX is a step towards a full ‘sensory surround experience’ and enabled games will provide gamers with the ability to use light, colour, sound, heat and even airflow in the real world during gameplay.

Ann Behav Med. 2005;30(3):268-278

Authors: Wismeijer AA, Vingerhoets AJ

Background: This review focuses on the application of technologically advanced methods of audiovisual distraction as adjunct analgesic techniques; more specifically, (a) virtual reality (VR) and (b) audiovisual (A/V) eyeglass systems (A/V distraction). Purpose: It is assumed that distraction taxes the patient's limited attention capacity, resulting in the withdrawal of attention from the noxious stimulus with a subsequent reduction in pain. Methods: Twenty studies evaluating the analgesic potential of both methods in different patient groups and in healthy volunteers were identified in the scientific literature. Results: Although the majority of these studies are hampered by serious methodological drawbacks, particularly a small number of participants, the results nevertheless strongly suggest that both VR and A/V distraction can be a very promising analgesic technique that may be used safely and effectively for the reduction of pain and discomfort during medical procedures. An additional important aspect is that few negative side effects have been reported. Conclusions: Directions for future research are presented.

A paper published on Proceedings of National Academy of Science describes results of an experiment, in which virtual reality is used in combination with fMRI to teach subjects to control pain perception. A display inside the fMRImachine depicted a flame whose intensity reflected the activity of participants rostral anterior cingulate cortex (rACC), a brain region that is known to be involved in pain perception. Results showed that the better participants controlled their rACC activity, the better they controlled their pain. By contrast, participants included in a control group without fMRI feedback, failed to control their pain.

Read the full article in PDF format

Ann Behav Med. 2005;30(3):268-278

Authors: Wismeijer AA, Vingerhoets AJ

Cyberpsychol Behav. 2005 Dec;8(6):532-537

Authors: Walshe D, Lewis E, O'sullivan K, Kim SI

There is a small but growing body of research supporting the effectiveness of computergenerated environments in exposure therapy for driving phobia. However, research also suggests that difficulties can readily arise whereby patients do not immerse in simulated driving scenes. The simulated driving environments are not "real enough" to undertake exposure therapy. This sets a limitation to the use of virtual reality (VR) exposure therapy as a treatment modality for driving phobia. The aim of this study was to investigate if a clinically acceptable immersion/presence rate of >80% could be achieved for driving phobia subjects in computer generated environments by modifying external factors in the driving environment. Eleven patients referred from the Accident and Emergency Department of a general hospital or from their General Practitioner following a motor vehicle accident, who met DSM-IV criteria for Specific Phobia-driving were exposed to a computer-generated driving environment using computer driving games (London Racer/Midtown Madness). In an attempt to make the driving environments "real enough," external factors were modified by (a) projection of images onto a large screen, (b) viewing the scene through a windscreen, (c) using car seats for both driver and passenger, and (d) increasing vibration sense through use of more powerful subwoofers. Patients undertook a trial session involving driving through computer environments with graded risk of an accident. "Immersion/presence" was operationally defined as a subjective rating by the subject that the environment "feels real," together with an increase in subjective units of distress (SUD) ratings of >3 and/or an increase of heart rate of >15 beats per minute (BPM). Ten of 11 (91%) of the driving phobic subjects met the criteria for immersion/presence in the driving environment enabling progression to VR exposure therapy. These provisional findings suggest that the paradigm adopted in this study might be an effective and relatively inexpensive means of developing driving environments "real enough," to make VR exposure therapy a viable treatment modality for driving phobia following a motor vehicle accident (MVA).

Biol Psychiatry. 2005 Nov 30;

Authors: Cornwell BR, Johnson L, Berardi L, Grillon C

Startle reflex modification has become valuable to the study of fear and anxiety, but few studies have explored startle reactivity in socially threatening situations. METHODS: Healthy participants ranging in trait social anxiety entered virtual reality (VR) that simulates standing center-stage in front of an audience to anticipate giving a speech and count backward. We measured startle and autonomic reactivity during anticipation of both tasks inside VR after a single baseline recording outside VR. RESULTS: Trait social anxiety, but not general trait anxiety, was positively correlated with startle before entering VR and most clearly during speech anticipation inside VR. Speech anticipation inside VR also elicited stronger physiologic responses relative to anticipation of counting. CONCLUSIONS: Under social-evaluative threat, startle reactivity showed robust relationships with fear of negative evaluation, a central aspect of social anxiety and clinical social phobia. Context-specific startle modification may be an endophenotype for subtypes of pathological anxiety.

From The Birmingham News

When pilots learn to fly and surgeons to cut, virtual reality comes in handy where blunders can be fatal.

Learning to cross the street is no different, so David Schwebel, associate professor of psychology at UAB, is developing a virtual reality game to teach school children how to cross safely. Of 4,641 pedestrians who died nationwide last year, 363 were 14 and younger, according to the National Highway Traffic Safety Administration...
read the full article here

By Katz N, Ring H, Naveh Y, Kizony R, Feintuch U, Weiss PL

Disabil Rehabil. 2005 Oct 21;27(20):1235-44

Authors: Katz N, Ring H, Naveh Y, Kizony R, Feintuch U, Weiss PL

Abstract. Purpose. The goal of this study was to determine whether non immersive interactive virtual environments are an effective medium for training individuals who suffer from Unilateral Spatial Neglect (USN) as a result of a right hemisphere stroke, and to compare it to a standard computer visual scanning training.Method. Participants included 19 patients with right hemisphere stroke in two groups, 11 in an experimental group were given computer desktop-based Virtual Reality (VR) street crossing training and 8 in a control group who were given computer based visual scanning tasks, both for a total of twelve sessions, 9 hours total, over four weeks. Measures included: 1. Standard USN assessments, paper and pencil and ADL checklist; 2. Test on the VR street program; and 3. Actual street crossing videotaped. Testing was performed pre and post intervention.Results. The VR group achieved on the USN measures results that equaled those achieved by the control group treated with conventional visual scanning tasks. They improved more on the VR test and they did better on some measures of the real street crossing.Conclusions. Despite several limitations in this study the present results support the effectiveness of the VR street program in the treatment of participants with USN, and further development of the program.

Authors: Crosbie J, McDonough S, Lennon S, McNeill M

Virtual reality (VR) provides a three-dimensional computer representation of a real world or imaginary space through which a person can navigate and interact with objects to carry out specific tasks. One novel application of VR technology is in rehabilitation following stroke, particularly of the upper limb. This paper describes the development of a VR system for use in this field. This system gives the user the ability to interact with objects by touching, grasping and moving their upper limb.

Cortical reorganization and associated functional motor recovery after virtual reality in patients with chronic stroke: an experimenter-blind preliminary study

Arch Phys Med Rehabil. 2005 Nov;86(11):2218-23

Authors: Jang SH, You SH, Hallett M, Cho YW, Park CM, Cho SH, Lee HY, Kim TH

A study recently published by Andersson and co-workers in British Journal of Psychiatry has found that psychological treatment for depression, delivered over the internet, is reliable and effective.
117 people with mild to moderate depression who met a number of inclusion criteria were included in this randomised controlled trial. The majority came from smaller cities, villages and places outside the larger cities (where university clinics are usually based). 36 participants in the treatment group and 49 in the control group completed post-treatment measures. In total the rate of withdrawal from the programme was 27%. The main reason given was that the treatment was too demanding. Thus the rates of withdrawal differed between the treatment group (37%) and the control group (18%).

It was found that the active treatment, which included standard cognitive-behavioural approaches and behavioural changes, resulted in decreased depressive symptoms immediately after treatment and at the six-month follow-up. There were also benefits in terms of anxiety symptoms and quality of life.

Reference

Andersson G, Bergstrom J, Hollandare F, Carlbring P, Kaldo V and Ekselius L (2005) Internet based self-help for depression: randomised controlled trial, British Journal of Psychiatry, 187, 456-461.

Brain Inj. 2005 Nov;19(12):989-1000

Authors: Thornton M, Marshall S, McComas J, Finestone H, McCormick A, Sveistrup H

via Extremetech

Good news for virtual reality therapy. eMagin offers stereoscopic headset for under $1,000.

The Z800 has 800x600 active matrix OLED displays including a pair of sharp OLED displays which supports 8 bits per pixel (16.67 million colors) and 200:1 contrast ratio.

The price includes the head-tracker (six-degrees-of-freedom MEMS sensor, with independent gyroscopes and accelerometers for the X-Y-Z axes), a pair of stereo audio earbuds, and an integrated microphone. But the most interesting feature of the Z800 is that it is USB powered. This reduces the number of wires and gives the user more freedom of movement.

Via BBC news

Results of a review study conducted by Elizabeth Murray and co-workers from University College London suggest that the use of interactive websites can help people with chronic illnesses such as depression, heart disease and HIV/Aids.

The review was based on a total of 24 studies involving 3,739 participants who all had chronic (long-term) health conditions. UCL researchers looked at these patients' use of interactive computer websites and programmes, which contained information services plus online support groups, chatrooms, or tailored advice based on a person's details, affected people with such chronic diseases.

The authors of the research found that interactive sites were of greater benefit to people than those with information alone, or not using sites at all. Moreover, researchers found that such sites made patients feel better informed, more socially supported, and helped them to improve self-efficacy - a person's belief in their ability to carry out potentially-beneficial actions.

Psychother Psychosom. 2005;74(6):336-43

Authors: Emmelkamp PM

In this paper the application of computer technology and the use of the Internet in mental health care are critically reviewed. A number of on-line screening devices have been developed for anxiety disorders, mood disorders, and substance abuse disorders, with great potential for clinical practice. On line assessment is generally equivalent to clinical assessment. A number of studies have shown that self-help treatment programmes on stand-alone computers are as effective as routine clinical care. The Internet enhances the therapeutic possibilities of computers by offering feedback of therapists and more tailor-made treatment. A number of randomized clinical trials (RCTs) have shown that Internet-based treatment is more effective than no-treatment and as effective as face-to-face treatment. Research so far has been limited to anxiety disorders, burn-out, depression, headache, insomnia, tinnitus and obesity. Further, exposure through virtual reality has been found effective in a number of RCTs in specific phobias, but results with respect to the effects of the use of virtual reality techniques to other disorders are inconclusive. It is concluded that computer-driven assessment and treatment has many advantages and few disadvantages. A number of reasons are discussed which will preclude large-scale implementation of computer-driven assessment and therapy in the near future.

PMID: 16244509 [PubMed - in process]

Authors: Anderson PL, Zimand E, Hodges LF, Rothbaum BO

This study used an open clinical trial to test a cognitive-behavioral treatment for public-speaking anxiety that utilized virtual reality as a tool for exposure therapy. Treatment was completed by participants (n=10) meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria for social phobia, or panic disorder with agoraphobia in which public speaking was the predominantly feared stimulus. Treatment was conducted by a licensed psychologist in an outpatient clinic. Treatment consisted of eight individual therapy sessions, including four sessions of anxiety management training and four sessions of exposure therapy using a virtual audience, according to a standardized treatment manual. Participants completed standardized self-report questionnaires assessing public-speaking anxiety at pre-treatment, post-treatment, and 3-month follow-up. Participants were asked to give a speech to an actual audience at pre- and post-treatment. Results showed decreases on all self-report measures of public-speaking anxiety from pre- to post-treatment, which were maintained at follow-up (n=8; all P<.05). Participants were no more likely to complete a speech post-treatment than at pre-treatment. This study provides preliminary evidence that a cognitive-behavioral treatment using virtual reality for exposure to public speaking may reduce public-speaking anxiety and suggests that further research with a controlled design is needed. Depression and Anxiety 0:1-3, 2005. (c) 2005 Wiley-Liss, Inc.

Cyberpsychol Behav. 2005 Oct;8(5):487-92

Authors: Bordnick PS, Graap KM, Copp HL, Brooks J, Ferrer M

Abstract. Drug craving has purportedly been linked to relapse and to substance use. For over two decades, cue reactivity has been a viable method to assess craving and physiological reactions to drug stimuli. However, traditional cue reactivity has faced the following limitations: austere situations or stimuli, lack of complex cues, lack of standardization, and limited generalization outside of the lab setting. In order to improve cue methodologies, a virtual reality (VR) nicotine cue reactivity assessment system (VR-NCRAS) was developed and tested in a controlled experimental trial. Ten nicotine dependent smokers were exposed to VR smoking cues and VR neutral cues in a standardized, timed, computer controlled experiment. Subjective craving and physiological responses were recorded and compared across VR-NCRAS stimuli. Subjective cigarette craving increased significantly and corresponding physiological reactivity was observed in response to VR smoking cues. VR neutral cues did not result in subjective or physiological changes consistent with craving. Implications of these findings on substance abuse research and treatment are discussed.