Eating Disorders And Body Dysmorphia
Virtual reality therapy has also been used to attempt to treat eating disorders and body dysmorphia. One study in 2013 had participants complete various tasks in virtual reality environments which could not have been easily replicated without the technology. Tasks included showing patients the implications of reaching their desired weight, comparing their actual body shape to an avatar created using their perceived body size, and altering a virtual reflection to match their actual body size.
Vr Advantages Over Ive
The preference of virtual reality exposure therapy over in-vivo exposure therapy is often debated, but there are many obvious advantages of virtual reality exposure therapy that make it more desirable. For example, the proximity between the client and therapist can cause problems when in-vivo therapy is used and transportation is not reliable for the client or it is impractical for them to travel as far as needed. However, virtual reality exposure therapy can be done from anywhere in the world if given the necessary tools. Going along with the idea of unavailable transportation and proximity, there are many individuals who require therapy but due to various forms of immobilizations they can not physically be moved to where the therapy is conducted. Again, because virtual reality exposure therapy can be conducted anywhere in the world, those with mobility issues will no longer be discriminated against. Another major advantage is fewer ethical concerns than in-vivo exposure therapy.
Can Virtual Reality Ever Be Implemented In Routine Clinical Settings A Systematic Narrative Review Of Clinical Procedures Contained Within Case Reports For The Treatment Of Ptsd
- 1School of Social Sciences Education and Social Work, Queen’s University Belfast, Belfast, United Kingdom
- 2The Immersive Technologies and Digital Mental Health Network, Queen’s University Belfast, Belfast, United Kingdom
- 3Expertise Unit Psychology, Technology & Society, Thomas More University of Applied Sciences, Antwerp, Belgium
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Clinical Outcomes And Adverse Events
All 15 studies reported positive outcomes in relation to the use of VR technology for the reduction of PTSD symptoms with Freedman et al. in particular showing a drop in CAPS score from 79 to 0. This was followed by Gerardi et al. , Wood et al. , McLay et al. , Cardenas-Lopez and Rosa-Gomez , and Arens who all reported a 50% or more reduction in pre and post treatment scores. There were no noticeable differences in outcomes in relation to gender, age, or other demographic variables.
The primary outcome measure used at baseline and post-treatment in nine of the 15 studies was the CAPS tool. This was followed by the PTSD Checklist for Military , the Impact of Events Scale , and the Post-traumatic Stress Disorder Scale . Tworus et al. did not provide any quantitative data regarding outcomes although the authors did report a drop in PTSD intensity. Evaluation time points varied across all studies with only Rothbaum et al. , and Freedman et al. reporting post treatment data at 6 months. Wood et al. and Miyahira et al. reported outcome data at 3 months post treatment but the remaining studies tended to report outcomes immediately post-treatment which varied from study to study. Physiological data was also collected in a number of studies, such as heart rate, skin conductance, respiratory rate, temperature etc. .
Efficacy Of Vret Regarding Depressive Symptoms
For the comparison between VRET and waitlist controls , we found a significant summary effect of g = 0.50 and low, non-significant heterogeneity of I2 = 0 = 3.25, p = .354), all in favour of VRET. Four effect sizes from the data of 110 participants were analysed to compare the efficacy of VR treatment against active controls with respect to the reduction of depressive symptoms . The meta-analysis yielded an effect of g = 0.24 and this comparison was not significant . Heterogeneity was considered as not important and non-significant = 4.92, p = .178) for these studies. A forest plot is provided in Figure 3.
Forest plot of the standardized mean difference in post-treatment depression scores of VR treatments compared to control conditions . A positive effect size indicates that the outcome was in favour of VR treatment. Average effect was calculated using a random-effects model.
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Icipants: Profile And Diagnosis
There were 27 participants represented within the final 15 studies, 10 were female and 17 were male. The majority of female participants came from one case series study involving VR based treatment for PTSD following a road traffic accident . All 15 studies stated that participants had PTSD although the justification and evidenced provided differed. The most common justification was that participant symptoms matched DSM-IV diagnostic criteria. The Clinician Administered PTSD Scale was also used as a justification for PTSD diagnosis as well as being used as a final outcome measure in 10 studies . Eight of the 15 included studies gave additional detail regarding symptomology in order to support the PTSD diagnosis . Single incident trauma cases were only reported in five of 15 studies and traumatic events were categorized as follows war/military terrorist attack road traffic accident and assault. Most of the military based studies reported participants as having complex PTSD although it is believed they were simply referring to a severe form of PTSD given that cPTSD has only recently emerged as a separated diagnostic category and does not appear in the DSM IV or V .
Virtual Reality Exposure Therapy
Virtual reality exposure therapy and augmented reality exposure therapy are digitally assisted psychotherapies that potentially enhance posttraumatic stress disorder treatment by increasing a patient’s sense of presence during exposure therapy.
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Efficacy Of Vret Regarding Anxiety Symptoms
Based on the data of 84 participants we compared VRET with waitlist controls regarding the reduction of anxiety symptoms. The meta-analysis revealed a non-significant effect of g = 0.47 .
For the comparison of VRET and active controls, the data of 82 participants was analysed to compare anxiety symptoms after VRET and active treatment. Again, no significant effect was found in this comparison: g = 0.26 .
What Are The Challenges Of Vret Therapy
VRET is still a growing field, and there are some barriers or challenges, such as:
Slow adoption of VRET as an effective therapy. Mental health professionals often prefer face-to-face therapy. They also often rely on human judgment to measure mental well-being.
Access and choice of VR equipment. VR equipment, software, apps, and information on how to use them are not yet readily available for all therapists. But on the other hand, the growing number of products might make it difficult to choose or buy and will depend on their needs and skills.
Lack of VRET training. While VRET grows in popularity, thereâs a lack of training available for therapists who want to use it during sessions. Therapists might need to update their skills and training each time a new version of the software is released.
More research is needed. Currently, VRET mostly covers anxiety disorders like phobias and PTSD. But with the growing demand and effectiveness of this therapy, thereâs a need for more types of clinical VR content to address the growing number of issues that can benefit from exposure therapy.
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Efficacy Of Vret Regarding Ptsd Symptom Severity
One hundred twenty-two participants were analysed to compare the efficacy of VRET and waitlist controls regarding PTSD symptom severity. The meta-analysis yielded an effect of g = 0.62 in favour of VR treatment over waitlist conditions. This effect was significant and heterogeneity was considered as not important = 4.32, p = .229).
Furthermore, data of 204 participants were analysed to calculate the effect of VRET on PTSD symptom severity in comparison with active control groups . The meta-analysis yielded a non-significant effect of g = 0.25 . Heterogeneity was significant and substantial for the six studies, I2 = 67 = 13.97, p = .016). A forest plot is provided in Figure 2.
Forest plot of the standardized mean difference in post-treatment CAPS scores of VR treatments compared to control conditions . A positive effect size indicates that the outcome was in favour of VR treatment. Average effect was calculated using a random-effects model.
Virtual Reality Ptsd Treatment Has ‘big Impact’ For Veterans
Could virtual reality help treat PTSD in veterans?
Virtual reality could be used to help military veterans with post-traumatic stress disorder who have struggled with mainstream treatment.
It involves patients walking on a treadmill in front of a screen which projects images depicting the type of trauma experienced.
A two-year trial found some patients could see almost a 40% improvement in their symptoms.
One veteran said it had given him the “biggest impact” out of any treatment.
Objective : To Explore The Areas Where Vr Technology Adds Value To Existing Approaches For Ptsd Treatment
VR technology was implemented successfully within studies using both TF-CBT and non TF-CBT treatment protocols. Prolonged Exposure has featured heavily with most studies using and encouraging a number of behavioral techniques and processes . There was little evidence of the use of cognitive based techniques during treatment associated with the trauma memory) although there were examples of when cognitive restructuring could have occurred and where other techniques could have been used, such as stimulus discrimination . Arens reported a number of cognitive distortions described by her participant , but failed to return to these in her post treatment analysis. Further to this, an apparent significant moment in the treatment of a young female with PTSD by Difede and Hoffman appeared to occur during VR exposure when the participant suddenly remembered believing that she would die. Again however, no detail was given on how this belief was challenged. CBT was specifically referenced within four studies however, its application was not consistent. In one study it was delivered in a group based format in parallel to a VR based intervention in another it was a standalone session in response to emerging client need . Miyahira et al. was the only study to report delivering both CBT and VR exposure therapy together.
Conclusion And Future Directions
This meta-analysis revealed a medium sized effect for VRET over waitlist controls and at least no significant difference between VRET and active interventions in terms of reducing PTSD symptom severity and depressive symptoms in adults with PTSD. However, VRET did not differ from controls in reducing anxiety symptoms, either for waitlist or for active comparators. Furthermore, VRET showed a lower efficacy in comparison to other meta-analyses which investigated improvement of PTSD symptoms due to in vivo exposure therapy. Past studies show that individuals differ in their ability to become immersed in or engaged with the virtual environment , which may hinder positive treatment outcome. Hence, future studies should further investigate specific user characteristics such as personality traits as they could potentially mediate treatment outcome in VRET.
Moreover, due to the rise of personalized medicine, future research should be encouraged to achieve a better understanding of the effect of moderating factors on the efficacy of VRET and to enable analyses of specific samples. In particular, children and adolescents with considerably high lifetime prevalence rates of PTSD should be included in trials evaluating VRET .
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Is Vr Therapy Effective
Virtual reality is not a new concept, even in therapeutic settings.
Virtual reality exposure therapy that places people in simulated environments related to combat developed by technology companies like Bravemind is being used at over 100 sites across the United States to treat combat-related post-traumatic stress disorder .
Though the process of reliving trauma may sound intense, 2021 research suggests that VRET can have benefits.
Research on the benefits of VR therapy for mental health conditions dates to at least 1995, when a small-scale study showed that virtual reality exposure could help people who have a fear of heights.
But the idea that a therapist-client relationship could occur in a virtual world is relatively new.
Communicating in VR transports you into another world, Rogers said. When you step outside the real world for a moment into the virtual one, for some people, this might feel like a safer space to process the negative feelings around negative experiences.
Rogers added that disclosing negative experiences to another person face-to-face may lead to feelings of shame or embarrassment. Interacting in VR provides an added layer of interpersonal distance, making disclosing feelings easier for some.
He was also surprised by how much participants seemed to enjoy their social interactions in the virtual setting, suggesting increasing acceptance of the technology.
Vr Therapy In The Real World
In a tech-driven world already grappling with Zoom fatigue, is metaverse burnout on the horizon?
I predict were going to witness VR social interaction becoming a lot more commonplace in the not too distant future, Rogers said.
Harnessing motion capture to make the avatars more faithfully mimic the body language of the person behind the avatar is the key ingredient to enhance the experience enough to bring VR communication into the mainstream.
Although the Edith Cowan study is preliminary and the technology still needs development, meeting your therapist in the metaverse, as proposed by the new research, could present a new pathway for those who might not feel comfortable in traditional therapy, be it in real life or online.
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New Virtual Reality Technology To Treat Ptsd Enters Clinical Trials
UCF RESTORES brings renewed sense of hope to those battling trauma
The American Psychiatric Association estimates that one in 11 people will be diagnosed with posttraumatic stress disorder in their lifetime, but new virtual reality technology is providing hope for the recovery of those suffering.
UCF RESTORES, a nonprofit trauma research center and treatment clinic at UCF, has developed a state-of-the-art VR treatment tool that can be used to dynamically recreate each patients traumatic experience an innovation that is now entering the clinical trial phase.
The tool will immerse participants in the sights, smells and sounds of their original trauma, all of which can be customized to the participants unique experience. Recreating the exact sensory stimuli that occurred in the context of the traumatic event is crucial to effective recovery. By re-introducing these sensory elements that now serve as triggers of fear and panic while undergoing therapy, the patient learns to no longer react fearfully or avoid the sights, sounds and places that used to generate their fear and are able to recover from PTSD.
The VR tool will be integral to the evidence-based approach of exposure therapy, which UCF RESTORES leverages as a key component of its successful treatment program. Through exposure therapy, clinicians can guide patients to face very specific elements of their traumatic memory, using customized stimuli, and help create a new physiological response.
Bravemind: Virtual Reality Exposure Therapy
In use across the country, this project provides relief from PTS through virtual reality exposure therapy. Patients, with the help of clinicians, confront their trauma memories in a virtual world.
ICTs virtual reality exposure therapy is aimed at providing relief from post-traumatic stress.
Currently found at over 60 sites, including VA hospitals, military bases and university centers, ICTs Virtual Iraq/Afghanistan exposure therapy approach has been shown to produce a meaningful reduction in PTS symptoms. Additional randomized controlled studies are ongoing.
The therapy requires well-trained clinical care providers that understand the unique challenges that they may face with service members and veterans suffering from the wounds of war. Stimulus presentation is controlled by the clinician via a separate wizard of Oz interface, with the clinician in full audio contact with the patient. ICT researchers are also adapting the system as a tool for stress resilience training and PTS assessment.
This basic and applied research effort has been funded by ONR, TATRC, USAMRMC and the Infinite Hero Foundation. Collaborators include JoAnn Difede, Weill Cornell Medical Center Barbara Rothbaum, Emory University and Virtually Better, Inc.
For more information, please contact the project PI, Dr. Skip Rizzo at: .
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Why Vr Why Now
The most significant disorders that virtual reality therapy has shown success in treating PTSD, anxiety, phobias are on the rise. An April survey by the Centers for Disease Control and Prevention cited significant increases in respondents showing symptoms of anxiety disorders. Health care workers have reported high rates of PTSD during the pandemic a of 1,000 frontline workers reported that nearly one-quarter showed likely signs of the disorder. In contrast, only 6.8 percent of the general population ever experiences PTSD in their lifetime, according to the National Comorbidty Survey estimates.
Covid has been traumatizing to so many people in so many ways, said Dr. Nomi Levy-Carrick, a psychiatrist who leads outpatient psychiatric services at Brigham and Womens Hospital in Boston. Grief, isolation, economic upheaval, housing and food insecurity, the toxic stress of lockdown and the surge in domestic violence during the pandemic can all be traumatic stressors, she said. And the constant uncertainty of the past pandemic year created conditions for widespread anxiety.
Recreational V.R. headset sales to the general public have grown during the pandemic, but the technology has yet to fully enter the mainstream. Experts who study the therapy argue thats about to change for the medical establishment, as clinicians look for effective and accessible ways to treat anxiety disorders.