Positive Technology Journal

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.

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.

Via Mindware

QuitKey is a small portable device that promises to help quit smoking:

By J Liu, SC Cramer and DJ Reinkensmeyer

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.

Video game-based exercises for balance rehabilitation: a single-subject design.

Arch Phys Med Rehabil. 2006 Aug;87(8):1141-9

Authors: Betker AL, Szturm T, Moussavi ZK, Nett C

OBJECTIVES: To investigate whether coupling foot center of pressure (COP)-controlled video games to standing balance exercises will improve dynamic balance control and to determine whether the motivational and challenging aspects of the video games would increase a subject's desire to perform the exercises and complete the rehabilitation process. DESIGN: Case study, pre- and postexercise. SETTING: University hospital outpatient clinic. PARTICIPANTS: A young adult with excised cerebellar tumor, 1 middle-aged adult with single right cerebrovascular accident, and 1 middle-aged adult with traumatic brain injury. INTERVENTION: A COP-controlled, video game-based exercise system. MAIN OUTCOME MEASURES: The following were calculated during 12 different tasks: the number of falls, range of COP excursion, and COP path length. RESULTS: Postexercise, subjects exhibited a lower fall count, decreased COP excursion limits for some tasks, increased practice volume, and increased attention span during training. CONCLUSIONS: The COP-controlled video game-based exercise regime motivated subjects to increase their practice volume and attention span during training. This in turn improved subjects' dynamic balance control.

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.

Using Virtual Environments for Teaching Social Understanding to 6 Adolescents with Autistic Spectrum Disorders.

J Autism Dev Disord. 2006 Aug 10;

Authors: Mitchell P, Parsons S, Leonard A

Six teenagers with Autistic Spectrum Disorders (ASDs) experienced a Virtual Environment (VE) of a café. They also watched three sets of videos of real cafés and buses and judged where they would sit and explained why. Half of the participants received their VE experience between the first and second sets of videos, and half experienced it between the second and third. Ten naïve raters independently coded participants' judgments and reasoning. In direct relation to the timing of VE use, there were several instances of significant improvement in judgments and explanations about where to sit, both in a video of a café and a bus. The results demonstrate the potential of Virtual Reality for teaching social skills.

Virtual Reality Exposure Therapy: 150-Degree Screen to Desktop PC.

Cyberpsychol Behav. 2006 Aug;9(4):480-9

Authors: Tichon J, Banks J

Virtual reality exposure therapy (VRET) developed using immersive or semi-immersive virtual environments present a usability problem for practitioners. To meet practitioner requirements for lower cost and portability VRET programs must often be ported onto desktop environments such as the personal computer (PC). However, success of VRET has been shown to be linked to presence, and the environment's ability to evoke the same reactions and emotions as a real experience. It is generally accepted that high-end virtual environments (VEs) are more immersive than desktop PCs, but level of immersion does not always predict level of presence. This paper reports on the impact on presence of porting a therapeutic VR application for Schizophrenia from the initial research environment of a semi-immersive curved screen to PC. Presence in these two environments is measured both introspectively and across a number of causal factors thought to underlie the experience of presence. Results show that the VR exposure program successfully made users feel they were "present" in both platforms. While the desktop PC achieved higher scores on presence across causal factors participants reported they felt more present in the curved screen environment. While comparison of the two groups was statistically significant for the PQ but not for the IPQ, subjective reports of experiences in the environments should be considered in future research as the success of VRET relies heavily on the emotional response of patients to the therapeutic program.

Via Siggraph2006 Emerging Technology website

The Huggable is a robotic pet developed by MIT researchers for therapy applications in children's hospitals and nursing homes, where pets are not always available. The robotic teddy has full-body sensate skin and smooth, quiet voice coil actuators that is able to relate to people through touch. Further features include "temperature, electric field, and force sensors which it uses to sense the interactions that people have with it. This information is then processed for its affective content, such as, for example, whether the Huggable is being petted, tickled, or patted; the bear then responds appropriately".

The Huggable has been unveiled at the Siggraph2006 conference in Boston. From the conference website:

Enhanced Life
Over the past few years, the Robotic Life Group at the MIT Media Lab has been developing "sensitive skin" and novel actuator technologies in addition to our artificial-intelligence research. The Huggable combines these technologies in a portable robotic platform that is specifically designed to leave the lab and move to healthcare applications.

Goals
The ultimate goal of this project is to evaluate the Huggable's usefulness as a therapy for those who have limited or no access to companion-animal therapy. In collaboration with nurses, doctors, and staff, the technology will soon be applied in pilot studies at hospitals and nursing homes. By combining Huggable's data-collection capabilities with its sensing and behavior, it may be possible to determine early onset of a person's behavior change or detect the onset of depression. The Huggable may also improve day-to-day life for those who may spend many hours in a nursing home alone staring out a window, and, like companion-animal therapy, it could increase their interaction with other people in the facility.

Innovations
The core technical innovation is the "sensitive skin" technology, which consists of temperature, electric-field, and force sensors all over the surface of the robot. Unlike other robotic applications where the sense of touch is concerned with manipulation or obstacle avoidance, the sense of touch in the Huggable is used to determine the affective content of the tactile interaction. The Huggable's algorithms can distinguish petting, tickling, scratching, slapping, and poking, among other types of tactile interactions. By combining the sense of touch with other sensors, the Huggable detects where a person is in relation to itself and responds with relational touch behaviors such as nuzzling.

Most robotic companions use geared DC motors, which are noisy and easily damaged. The Huggable uses custom voice-coil actuators, which provide soft, quiet, and smooth motion. Most importantly, if the Huggable encounters a person when it tries to move, there is no risk of injury to the person.

Another core technical innovation is the Huggable' combination of 802.11g networking with a robotic companion. This allows the Huggable to be much more than a fun, interactive robot. It can send live video and data about the person's interactions to the nursing staff. In this mode, the Huggable functions as a team member working with the nursing home or hospital staff and the patient or resident to promote the Huggable owner's overall health.

Vision
As poorly staffed nursing homes and hospitals become larger and more overcrowded, new methods must be invented to improve the daily lives of patients or residents. The Huggable is one of these technological innovations. Its ability to gather information and share it with the nursing staff can detect problems and report emergencies. The information can also be stored for later analysis by, for example, researchers who are studying pet therapy.

Via Medgadget

Miles Cox, professor of the psychology of addictive behaviors at the University of Wales, is experimenting a computer-based approach to get alcoholics to ignore the potent cues that trigger their craving. The study has been covered by MIT Technology Review:

Find more on the ESRC study page

 

The January 2006 CNS Spectrums included an article about virtual reality (VR) technology as a treatment option in psychiatry and Dr. Gorman welcomed letters discussing novel applications of VR in psychiatry. Much of the published work in this area is treatment-related. It appears that a limited number of researchers have considered using this technology for clinical assessment and research purposes. This is likely to change as immersive VR shows promise for increasing  ecological validity in assessment  and providing a much richer set of behavioural data.

In collaboration with the Informatics Research Institute (IRI) at Newcastle University in Newcastle upon Tyne, England, we are assessing the validity of this approach. The IRI manages an immersive VR suite, and our collaboration has allowed us to develop a novel paradigm to test spatial memory in patients with mood disorders. Our interest in spatial memory in this group stems from neuroimaging research reporting atrophy in the hippocampal region for patients with major depressive disorder and bipolar disorder. The hippocampus is involved in spatial memory, and individuals with hippocampal lesions are impaired on tasks of spatial memory.

from BBC NEWS

By Gareth Mitchell
Presenter, Digital Planet, BBC World Service

Playing virtual reality computer games may help treat the condition known as amblyopia, or lazy eye, say researchers. In patients with amblyopia, one eye works better than the other. Because the amblyopic eye is inferior for some reason, the brain decides to use the good eye. Over time, the neural connection to the bad eye becomes gradually weaker in favour of the good eye. The traditional way of fixing the problem is for patients to force the bad eye to work harder by wearing a patch over the good eye. The treatment usually involves patching for around 400 hours and can cause the eyes not to work together, resulting in double vision.

Read the full story from BBC NEWS

Intelligent inferencing and haptic simulation for Chinese acupuncture learning and training.

IEEE Trans Inf Technol Biomed. 2006 Jan;10(1):28-41

Authors: Heng PA, Wong TT, Yang R, Chui YP, Xie YM, Leung KS, Leung PC

This paper presents an intelligent virtual environment for Chinese acupuncture learning and training using state-of-the-art virtual reality technology. It is the first step toward developing a comprehensive virtual human model for studying Chinese medicine. Students can learn and practice acupuncture in the proposed 3-D interactive virtual environment that supports a force feedback interface for needle insertion. Thus, students not only "see" but also "touch" the virtual patient. With high performance computers, highly informative and flexible visualization of acupuncture points of various related meridian and collateral can be highlighted to guide the students during training. A computer-based expert system using our newly proposed intelligent fuzzy petri net is designed and implemented to train the students to treat different diseases using acupuncture. Such an intelligent virtual reality system can provide an interesting and effective learning environment for Chinese acupuncture.