Positive Technology Journal

High sensitivity to multisensory conflicts in agoraphobia exhibited by virtual reality.

Eur Psychiatry. 2006 Oct;21(7):501-8

Authors: Viaud-Delmon I, Warusfel O, Seguelas A, Rio E, Jouvent R

The primary aim of this study was to evaluate the effect of auditory feedback in a VR system planned for clinical use and to address the different factors that should be taken into account in building a bimodal virtual environment (VE). We conducted an experiment in which we assessed spatial performances in agoraphobic patients and normal subjects comparing two kinds of VEs, visual alone (Vis) and auditory-visual (AVis), during separate sessions. Subjects were equipped with a head-mounted display coupled with an electromagnetic sensor system and immersed in a virtual town. Their task was to locate different landmarks and become familiar with the town. In the AVis condition subjects were equipped with the head-mounted display and headphones, which delivered a soundscape updated in real-time according to their movement in the virtual town. While general performances remained comparable across the conditions, the reported feeling of immersion was more compelling in the AVis environment. However, patients exhibited more cybersickness symptoms in this condition. The result of this study points to the multisensory integration deficit of agoraphobic patients and underline the need for further research on multimodal VR systems for clinical use.

Virtual reality helmet display quality influences the magnitude of virtual reality analgesia.

J Pain. 2006 Nov;7(11):843-50

Authors: Hoffman HG, Seibel EJ, Richards TL, Furness TA, Patterson DR, Sharar SR

Immersive Virtual Reality (VR) distraction can be used in addition to traditional opioids to reduce procedural pain. The current study explored whether a High-Tech-VR helmet (ie, a 60-degree field-of-view head-mounted display) reduces pain more effectively than a Low-Tech-VR helmet (a 35-degree field-of-view head-mounted display). Using a double-blind between-groups design, 77 healthy volunteers (no patients) aged 18-23 were randomly assigned to 1 of 3 groups. Each subject received a brief baseline thermal pain stimulus, and the same stimulus again minutes later while in SnowWorld using a Low-Tech-VR helmet (Group 1), using a High-Tech-VR helmet (Group 2), or receiving no distraction (Group 3, control group). Each participant provided subjective 0-10 ratings of cognitive, sensory, and affective components of pain, and amount of fun during the pain stimulus. Compared to the Low-Tech-VR helmet group, subjects in the High-Tech-VR helmet group reported 34% more reduction in worst pain (P < .05), 46% more reduction in pain unpleasantness (P = .001), 29% more reduction in "time spent thinking about pain" (P < .05), and 32% more fun during the pain stimulus in VR (P < .05). Only 29% of participants in the Low-Tech helmet group, as opposed to 65% of participants in the High-Tech-VR helmet group, showed a clinically significant reduction in pain intensity during virtual reality. These results highlight the importance of using an appropriately designed VR helmet to achieve effective VR analgesia (see ). PERSPECTIVE: Pain during medical procedures (eg, burn wound care) is often excessive. Adjunctive virtual reality distraction can substantially reduce procedural pain. The results of the present study show that a higher quality VR helmet was more effective at reducing pain than a lower quality VR helmet.

Via Human Productivity Lab

Toshiba has unveiled a new head-mounted display - the "Hyper-Reality Head-Dome Projector" that allows the wearer to experience a full 360-degree view on a 40 centimetre dome-shaped screen... here are some technical details (from SID2006)

the system consists of a compact dome-shaped screen with a radius of 40 cm, a mobile projector with ultra-wide projection lens, and LED light sources. The system exhibits a wide viewing angle of 120° horizontally by 70° vertically without head tracking, and 360° × 360° with head tracking.

 

Assessment of emotional reactivity produced by exposure to virtual environments in patients with eating disorders.

Cyberpsychol Behav. 2006 Oct;9(5):507-13

Authors: Gutiérrez-Maldonado J, Ferrer-García M, Caqueo-Urízar A, Letosa-Porta A

The aim of this study was to assess the usefulness of virtual environments representing situations that are emotionally significant to subjects with eating disorders (ED). These environments may be applied with both evaluative and therapeutic aims and in simulation procedures to carry out a range of experimental studies. This paper is part of a wider research project analyzing the influence of the situation to which subjects are exposed on their performance on body image estimation tasks. Thirty female patients with eating disorders were exposed to six virtual environments: a living-room (neutral situation), a kitchen with highcalorie food, a kitchen with low-calorie food, a restaurant with high-calorie food, a restaurant with low-calorie food, and a swimming-pool. After exposure to each environment the STAI-S (a measurement of state anxiety) and the CDB (a measurement of depression) were administered to all subjects. The results show that virtual reality instruments are particularly useful for simulating everyday situations that may provoke emotional reactions such as anxiety and depression, in patients with ED. Virtual environments in which subjects are obliged to ingest high-calorie food provoke the highest levels of state anxiety and depression.

Head-Mounted Displays for Clinical Virtual Reality Applications: Pitfalls in Understanding User Behavior while Using Technology.

Cyberpsychol Behav. 2006 Oct;9(5):591-602

Authors: Simone LK, Schultheis MT, Rebimbas J, Millis SR

The use of virtual environments with head-mounted displays (HMDs) offers unique assets to the evaluation and therapy of clinical populations. However, research examining the effects of this technology on clinical populations is sparse. Understanding how wearers interact with the HMD is vital. Discomfort leads to altered use of the HMD that could confound performance measures; the very measures which might be used as tools for clinical decision making. The current study is a post-hoc analysis of the relationship between HMD use and HMD comfort. The analysis was conducted to examine contributing factors for a high incidence of simulator sickness observed in an HMD-based driving simulator. Pearson correlation analysis was used to evaluate objective and subjective measures of HMD performance and self-reported user comfort ratings. The results indicated weak correlations between these variables, indicating the complexity of quantifying user discomfort and HMD performance. Comparison of two case studies detailing user behavior in the virtual environment demonstrates that selected variables may not capture how individuals use the HMD. The validity and usefulness of the HMD-based virtual environments must be understood to fully reap the benefits of virtual reality (VR) in rehabilitation medicine.

Via Networked Performance

Saturday 21 October 2006, Erasmus Medical Center, Rotterdam: 11.00 - 12.30: Bioinformatics dept., Faculty building, 15th floor 12.30 - 18.00: Sophia Children's Hospital, Cinema 3rd floor.

Test_Lab:/ Immersive Mixed Reality Environments/ is the product of a unique collaboration between the Erasmus Medical Centre and V2_, Institute for the Unstable Media with the aim of opening the dialogue between scientists and artists that apply Virtual Reality in their research and art practice. The event consists of demonstrations by Virtual Reality artists and scientists providing hands-on experiences with Immersive Mixed Reality Environments, and presentations by renowned international speakers presenting the latest in Virtual Reality in science and art. See below for the program details, a description of the projects that will be demonstrated, and the invited speakers that will present their work in the seminar.

Test_Lab is a bi-monthly public event hosted by V2_ that provides an informal setting to demonstrate, test, present, and/or discuss artistic research and development (aRt&D).

The event is free of charge, but registration is required before the 19th of October. For further information and registration please contact Remco Beeskow at press@v2.nl (tel: +31 (0)10 206 72 72) or Fred Balvert at f.balvert[at]erasmusmc.nl (tel: +31(0)6 41431721). Also visit www.v2.nl and www.erasmusmc.nl

Spatial updating in virtual reality: the sufficiency of visual information.

Psychol Res. 2006 Sep 23;

Authors: Riecke BE, Cunningham DW, Bülthoff HH

Robust and effortless spatial orientation critically relies on "automatic and obligatory spatial updating", a largely automatized and reflex-like process that transforms our mental egocentric representation of the immediate surroundings during ego-motions. A rapid pointing paradigm was used to assess automatic/obligatory spatial updating after visually displayed upright rotations with or without concomitant physical rotations using a motion platform. Visual stimuli displaying a natural, subject-known scene proved sufficient for enabling automatic and obligatory spatial updating, irrespective of concurrent physical motions. This challenges the prevailing notion that visual cues alone are insufficient for enabling such spatial updating of rotations, and that vestibular/proprioceptive cues are both required and sufficient. Displaying optic flow devoid of landmarks during the motion and pointing phase was insufficient for enabling automatic spatial updating, but could not be entirely ignored either. Interestingly, additional physical motion cues hardly improved performance, and were insufficient for affording automatic spatial updating. The results are discussed in the context of the mental transformation hypothesis and the sensorimotor interference hypothesis, which associates difficulties in imagined perspective switches to interference between the sensorimotor and cognitive (to-be-imagined) perspective.

New equipment and techniques for airway management in trauma.

Curr Opin Anaesthesiol. 2001 Apr;14(2):197-209

Authors: Smith CE, Dejoy SJ

A patent, unobstructed airway is fundamental in the care of the trauma patient, and is most often obtained by placing a cuffed tube in the trachea. The presence of shock, respiratory distress, a full stomach, maxillofacial trauma, neck hematoma, laryngeal disruption, cervical spine instability, and head injury all combine to increase tracheal intubation difficulty in the trauma patient. Complications resulting from intubation difficulties include brain injury, aspiration, trauma to the airway, and death. The use of devices such as the gum-elastic bougie, McCoy laryngoscope, flexible and rigid fiberscopes, intubating laryngeal mask, light wand, and techniques such as rapid-sequence intubation, manual in-line axial stabilization, retrograde intubation, and cricothyroidotomy, enhance the ability to obtain a definitive airway safely. The management of the failed airway includes calling for assistance, optimal two-person bag-mask ventilation, and the use of the laryngeal mask airway, Combitube, or surgical airway. The simulation of airway management using realistic simulator tools (e.g. full-scale simulators, virtual reality airway simulators) is a promising modality for teaching physicians and advanced life support personnel emergency airway management skills.

Frequency of stuttering during challenging and supportive virtual reality job interviews.

J Fluency Disord. 2006 Sep 23;

Authors: Brundage SB, Graap K, Gibbons KF, Ferrer M, Brooks J

This paper seeks to demonstrate the possibility of manipulating the frequency of stuttering using virtual reality environments (VREs). If stuttering manifests itself in VREs similarly to the way it manifests itself in real world interactions, then VREs can provide a controlled, safe, and confidential method for treatment practice and generalization. Though many researchers and clinicians recognize the need for generalization activities in the treatment of stuttering, achieving generalization in a clinical setting poses challenges to client confidentiality, safety, and the efficient use of a professionals' time. Virtual reality (VR) technology may allow professionals the opportunity to enhance and assess treatment generalization while protecting the safety and confidentiality of their clients. In this study, we developed a VR job interview environment which allowed experimental control over communication style and gender of interviewers. In this first trial, persons who stutter (PWS) experienced both challenging and supportive VR job interview conditions. The percentage of stuttered syllables was calculated for both interviews for each participant. Self-reported ratings of communication apprehension and confidence were also obtained, and were not significantly correlated with stuttering severity. Results indicated that interviewer communication style affected the amount of stuttering produced by participants, with more stuttering observed during challenging virtual interviews. Additionally, the amount of stuttering observed during the VR job interviews was significantly, positively correlated with the amount of stuttering observed during an interview with the investigator prior to VR exposure. Participants' subjective reports of the VR experience indicate reactions similar to those they report experiencing in the real world. Possible implications for the use of VR in the assessment and treatment of stuttering are discussed. Educational objectives: After reading this article, the reader will be able to-(1) list some of the challenges to treatment generalization; (2) describe how virtual reality technology can assist in alleviating some of these challenges; (3) describe how the frequency of stuttering varies across two different virtual environments.

Via VR Geek

The Gametrak is a real 3DOF tracker, which can be used with both hands. According to the company, the system is able to calculate the exact position in 3D space, with a spatial resolution of 1 millimetre anywhere within a 3m cube around the unit, with no processor overhead or time delay (that seems quite unrealistic to me, but if they write it...)

Strings attached to the user's hands allows the system to measure the distance and angles from the base item on the ground; these information are used to calculate the x,y, and z coordinates of the hands.

Given these features, the Gametrack system could be effectively applied in post-stroke rehabilitation of the upper limb and in other computer-based programs for neurorehabilitation. In fact, the Gametrack can be easily programmed and adapted to existing applications. Further, the cost of the device is very cheap (about 30€) if compared to other virtual rehabilitation hardware.    

If any Positive Technology reader wishes to try the system for rehabilitation purposes, we would be very interested in knowing the results  

See The Original Gametrak Promotional Video

Virtual Reality Exposure Therapy and Standard (in Vivo) Exposure Therapy in the Treatment of Fear of Flying.

Behav Ther. 2006 Mar;37(1):80-90

Authors: Rothbaum BO, Anderson P, Zimand E, Hodges L, Lang D, Wilson J

This controlled clinical trial tested virtual reality exposure (VRE) therapy for the fear of flying (FOF), a relatively new and innovative way to do exposure therapy, and compared it to standard (in vivo) exposure therapy (SE) and a wait list (WL) control with a 6- and 12-month follow-up. Eighty-three participants with FOF were randomly assigned to VRE, SE, or WL. Seventy-five participants, 25 per group, completed the study. Twenty-three WL participants completed randomly assigned treatment following the waiting period. Treatment consisted of 4 sessions of anxiety management training followed either by exposure to a virtual airplane (VRE) or an actual airplane at the airport (SE) conducted over 6 weeks. Results indicate that VRE was superior to WL on all measures, including willingness to fly on the posttreatment flight (76% for VRE and SE; 20% for WL). VRE and SE were essentially equivalent on standardized questionnaires, willingness to fly, anxiety ratings during the flight, self-ratings of improvement, and patient satisfaction with treatment. Follow-up assessments at 6 and 12 months indicated that treatment gains were maintained, with more than 70% of respondents from both groups reporting continued flying at follow-up. Based on these findings, the use of VRE in the treatment of FOF was supported in this controlled study, suggesting that experiences in the virtual world can change experiences in the real world.

Motion sickness susceptibility.

Auton Neurosci. 2006 Aug 22;

Authors: Golding JF

Motion sickness can be caused by a variety of motion environments (e.g., cars, boats, planes, tilting trains, funfair rides, space, virtual reality) and given a sufficiently provocative motion stimulus almost anyone with a functioning vestibular system can be made motion sick. Current hypotheses of the 'Why?' of motion sickness are still under investigation, the two most important being 'toxin detector' and the 'vestibular-cardiovascular reflex'. By contrast, the 'How?' of motion sickness is better understood in terms of mechanisms (e.g., 'sensory conflict' or similar) and stimulus properties (e.g., acceleration, frequency, duration, visual-vestibular time-lag). Factors governing motion sickness susceptibility may be divided broadly into two groups: (i) those related to the stimulus (motion type and provocative property of stimulus); and (ii) those related to the individual person (habituation or sensitisation, individual differences, protective behaviours, administration of anti-motion sickness drugs). The aim of this paper is to review some of the more important factors governing motion sickness susceptibility, with an emphasis on the personal rather than physical stimulus factors.

Pseudoneglect in back space.

Brain Cogn. 2006 Aug 23;

Authors: Cocchini G, Watling R, Sala SD, Jansari A

Successful interaction with the environment depends upon our ability to retain and update visuo-spatial information of both front and back egocentric space. Several studies have observed that healthy people tend to show a displacement of the egocentric frame of reference towards the left. However representation of space behind us (back space) has never been systematically investigated in healthy people. In this study, by means of a novel visual imagery task performed within a virtual reality environment, we found that representation of right back space is perceived as smaller than the left. These results suggest that there is a selective compression or distortion for mental representation related to the right space behind us.

Context Conditioning and Behavioral Avoidance in a Virtual Reality Environment: Effect of Predictability.

Biol Psychiatry. 2006 Aug 31;

Authors: Grillon C, Baas JM, Cornwell B, Johnson L

BACKGROUND: Sustained anxiety can be modeled using context conditioning, which can be studied in a virtual reality environment. Unpredictable stressors increase context conditioning in animals. This study examined context conditioning to predictable and unpredictable shocks in humans using behavioral avoidance, potentiated startle, and subjective reports of anxiety. METHODS: Subjects were guided through three virtual rooms (no-shock, predictable, unpredictable contexts). Eight-sec duration colored lights served as conditioned stimuli (CS). During acquisition, no shock was administered in the no-shock context. Shocks were paired with the CS in the predictable context and were administered randomly in the unpredictable context. No shock was administered during extinction. Startle stimuli were delivered during CS and between CS to assess cued and context conditioning, respectively. To assess avoidance, subjects freely navigated into two of the three contexts to retrieve money. RESULTS: Startle between CS was potentiated in the unpredictable context compared to the two other contexts. Following acquisition, subjects showed a strong preference for the no-shock context and avoidance of the unpredictable context. CONCLUSIONS: Consistent with animal data, context conditioning is increased by unpredictability. These data support virtual reality as a tool to extend research on physiological and behavioral signs of fear and anxiety in humans.

Cognitive behavior therapy for fear of flying: sustainability of treatment gains after september 11.

Behav Ther. 2006 Mar;37(1):91-7

Authors: Anderson P, Jacobs CH, Lindner GK, Edwards S, Zimand E, Hodges L, Rothbaum BO

This study examines the long-term efficacy of cognitive-behavioral therapy (CBT) for fear of flying (FOF) after a catastrophic fear-relevant event, the September 11, 2001, terrorist attacks. Participants (N = 115) were randomly assigned to and completed treatment for FOF using 8 sessions of either virtual reality exposure therapy (VRE) or standard exposure therapy (SE) prior to September 11, 2001. Individuals were reassessed in June, 2002, an average of 2.3 years after treatment, with a response rate of 48% (n = 55). Analyses were run on the original data and, using multiple imputation procedures, on imputed data for the full sample. Individuals maintained or improved upon gains made in treatment as measured by standardized FOF questionnaires and by number of flights taken. There were no differences between VRE and SE. Thus, results suggest that individuals previously treated for FOF with cognitive-behavioral therapy can maintain treatment gains in the face of a catastrophic fear-relevant event, even years after treatment is completed.

Cognitive behavior therapy for fear of flying: sustainability of treatment gains after september 11.

Behav Ther. 2006 Mar;37(1):91-7

Authors: Anderson P, Jacobs CH, Lindner GK, Edwards S, Zimand E, Hodges L, Rothbaum BO

This study examines the long-term efficacy of cognitive-behavioral therapy (CBT) for fear of flying (FOF) after a catastrophic fear-relevant event, the September 11, 2001, terrorist attacks. Participants (N = 115) were randomly assigned to and completed treatment for FOF using 8 sessions of either virtual reality exposure therapy (VRE) or standard exposure therapy (SE) prior to September 11, 2001. Individuals were reassessed in June, 2002, an average of 2.3 years after treatment, with a response rate of 48% (n = 55). Analyses were run on the original data and, using multiple imputation procedures, on imputed data for the full sample. Individuals maintained or improved upon gains made in treatment as measured by standardized FOF questionnaires and by number of flights taken. There were no differences between VRE and SE. Thus, results suggest that individuals previously treated for FOF with cognitive-behavioral therapy can maintain treatment gains in the face of a catastrophic fear-relevant event, even years after treatment is completed.

A Virtual Reality Apartment as a Measure of Medication Management Skills in Patients With Schizophrenia: A Pilot Study.

Schizophr Bull. 2006 Sep 6;

Authors: Kurtz MM, Baker E, Pearlson GD, Astur RS

Performance on a novel, virtual reality (VR) assessment of medication management skills, the Virtual Reality Apartment Medication Management Assessment (VRAMMA), was investigated in 25 patients with schizophrenia and 18 matched healthy controls. The VRAMMA is a virtual 4-room apartment consisting of a living room with an interactive clock and TV, a bedroom, a kitchen, and a bathroom with an interactive medicine cabinet. After an exploratory phase, participants were given a mock prescription regimen to be taken 15 minutes later from pill bottles located in the medicine cabinet in the bathroom of the virtual environment. The VRAMMA was administered with a validated measure of medication management skills, several neurocognitive tests, and a symptom scale. Results revealed that (1) schizophrenic patients made significantly more quantitative errors in the number of pills taken, were less accurate at taking the prescribed medications at the designated time, and checked the interactive clock less frequently than healthy controls; (2) in patients with schizophrenia, there was significant agreement in classification of adherence vs nonadherence between a validated measure of medication management skills and the VRAMMA; and (3) in patients with schizophrenia, years of education and a measure of verbal learning and memory were linked to quantitative errors on the VRAMMA, while positive symptoms, specifically delusional symptoms, were inversely linked to distance traveled within the VRAMMA. This is the first study, to our knowledge, to provide evidence for the utility of VR technology in the assessment of instrumental role functioning in patients with schizophrenia.

Transformation of flow in rehabilitation: the role of advanced communication technologies.

Behav Res Methods. 2006 May;38(2):237-44

Authors: Riva G, Castelnuovo G, Mantovani F

Authentic rehabilitation requires the active participation of patients and their involvement with opportunities for action and development. Within this framework, in this article we outline the possibility of using two emerging computing and communication technologies-ambient intelligence (AmI) and virtual reality (VR)--for a new breed of rehabilitative and clinical applications based on a strategy defined as transformation of flow. Transformation of flow is a person's ability to exploit an optimal (flow) experience to identify and use new and unexpected psychological resources as sources of involvement. We identify the feeling of presence--the feeling of being in a world that exists outside oneself--as the theoretical link between the technology and rehabilitation. AmI and VR are used to trigger broad empowerment processes induced by a strong sense of presence, leading to greater agency and control over one's actions and environment.

The Application of Virtual Reality to the Treatment of PTSD Following the WTC Attack.

Ann N Y Acad Sci. 2006 Jul;1071:500-1

Authors: Difede J, Cukor J, Patt I, Giosan C, Hoffman H

Recent research suggests that virtual reality (VR) enhanced exposure therapy may enhance the efficacy of treatment through increasing patient engagement in the exposure. This study evaluated the use of VR in the treatment of PTSD following the WTC attack of September 11, 2001. Individuals in a 14 session VR-enhanced treatment (n=9) were compared to a waitlist (WL) control group (n=8). ANOVA showed a significant interaction of time by group (p<.01) with a large effect size of 1.53. The VR group showed significantly greater post-treatment decline in CAPS scores compared to the WL. Our preliminary data suggests that VR is an effective tool for enhancing exposure therapy for both civilians and disaster workers who suffer from PTSD.