Advances In Virtual Reality And Anxiety Disorders Pdf

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Yet many clinicians still think of VR technology as it was in the s—bulky, costly, technically difficult—with little knowledge of its evolution toward more modern, evidence-based, practice-friendly treatment. Chapters in the book's main section detail current techniques and review study findings for using VR in the treatment of:. An in-depth framework for effective and cost-effective therapeutic innovations for entrenched problems, Advances in Virtual Reality and Anxiety Disorders will find an engaged audience among psychologists, psychiatrists, social workers, and mental health counselors.

Advances in Virtual Reality and Anxiety Disorders

From another point of view, Augmented Reality can be defined as a set of techniques and tools that add information to the physical reality. To date, Augmented Reality has been used in many fields, such as medicine, entertainment, maintenance, architecture, education, and cognitive and motor rehabilitation but very few studies and applications of AR exist in clinical psychology.

In the treatment of psychological disorders, Augmented Reality has given preliminary evidence to be a useful tool due to its adaptability to the patient needs and therapeutic purposes and interactivity.

This experience could increase the AR ecological validity in the treatment of psychological disorders. This paper reviews the recent studies on the use of Augmented Reality in the evaluation and treatment of psychological disorders, focusing on current uses of this technology and on the specific features that delineate Augmented Reality a new technique useful for psychology. More precisely, Azuma et al. Furthermore, according to Milgram et al. In an AR system, users see an image made up of a real image and virtual elements that are superimposed over it.

The addition of virtual elements may also inhibit the perception of real elements by overimposing the virtual elements on the real elements. Nevertheless, the most important aspect in AR is that the virtual elements provide the real world with remarkable and valuable information. The addiction of virtual elements may involve not only the view but also the hearing, smell, and touch [ 9 ]. From the point of view of technology devices, AR can be defined as a set of techniques and tools that allow adding information to the physical reality.

Modern handheld mobile computing like smartphones and tablets contain these elements, which include a camera and sensors such as accelerometer, Global Positioning System GPS , and solid-state compass, making them a suitable AR platform.

The smartphone or tablet take in real time the surrounding environment and the virtual elements are superimposed to the real world. As regards the projection displays, the virtual elements are projected on the real objects in order to be augmented. The projector generates a virtual image on the room surface using an automated calibration procedure that takes into account the structure of the surface overlapping the virtual image. Furthermore, an AR platform requires a software application able to augment the real world by using one or more hardware devices.

Marker-based and markerless systems are the two main software applications used in AR system. The AR marker-based systems are stylized pictures in black and white that are recognized by the computer webcam and which are superimposed in real time multimedia contents: video, audio, 3D objects, and so forth. To date, AR has been used in medicine [ 11 ], entertainment [ 12 ], maintenance [ 13 ], architecture [ 14 ], education [ 15 , 16 ], and cognitive [ 17 , 18 ] and motor rehabilitation [ 19 — 24 ] but very few applications of AR exist in clinical psychology and, in particular, it is still underused in the treatment of psychological disorders [ 25 ].

Starting from these premises, the aim of this paper is to review the recent studies on the use of AR in the evaluation and treatment of psychological disorders, focusing on current uses of AR in psychology and the various factors that make a new technique useful for the treatment of psychological disorders, expanding the possible fields of use of AR.

A computer-based search in several databases was performed for relevant publications describing the use of AR in psychology. We excluded articles where the full text was not available or where the abstract lacked basic information for review. The first search was performed for publications in the English language, and then we decided to clean the results, considering only publications for the last ten years, from forward and eventually updated the search results through December Expert colleagues in the field were contacted for suggestion on further studies not considered in our search.

We have included articles on AR used for psychological settings in assessment or treatment studies. Excluded from the analysis were studies that omitted the inclusion criteria, non-English published studies, review articles, case reports, letters to the editor, research protocols, patents, and editorials.

We tried to contact corresponding authors of the included studies with the intent of obtaining incomplete or supplementary data. Three authors Irene Alice Chicchi Giglioli, Federica Pallavicini, and Silvia Serino independently selected paper abstracts and titles and analyzed the full papers that met the inclusion criteria, resolving disagreements through consensus.

The data extracted from each included study were sample type, study design, sample size, type of therapy or assessment, and selected findings. The flow chart of the systematic review is shown in Figure 2. A more in-depth investigation of the full papers resulted in an exclusion of articles. During the data extraction procedure, 2 additional full papers were excluded. In the end, 13 studies met full criteria and were included in this review see Table 1.

Despite a large volume of studies on AR, little has been done specifically to psychological assessment or treatment. In the current review we present a broad range of experimental and clinical studies. In the area of clinical psychology, a few but remarkable studies have met the DSM-IV-TR criteria [ 27 ], showing the usefulness of AR in the treatment of a specific phobia.

More specifically, the review of the literature showed that the phobia of small animals cockroaches and spiders and the acrophobia [ 28 — 38 ] are the current areas that used AR in the assessment and treatment of specific psychological disorders. The studies are presented in chronological order for showing the developments and advancements that occurred in the use of AR in this area. In addition, the selected final studies can be found in Tables 2 and 3.

Each of them is described below. Individuals make one single intensive exposure session that lasts up to three hours. The first analysed study that used an AR system to assess and treat specific phobias was conducted by Juan et al. The AR single exposure session consisted progressively in seeing, touching, and finally killing one or more virtual cockroaches.

The therapist chose in any moment how many cockroaches had to appear on the scene, their size, and if they had to move or not. During the treatment, the augmented cockroaches were able to arouse anxiety in patient that decreased after an hour of exposure. More specifically, before, during, and after treatment, the patient ranked her level of anxiety on a point scale where 0 represents no anxiety and 10 very high anxiety using the Subjective Units of Discomfort Scale SUDS [ 44 ].

In particular, after exposure, the patient was able to approach, interact, and kill real cockroaches. Botella et al. The AR system included the possibility for the therapist to choose the number of cockroaches, their size, and movements and for the patient to kill one or more cockroaches using two different instruments, a fly swatter or a cockroach killer.

Depending on the selected tool the system played a sound analogous to the real one. The results showed that, before the exposure, patient exhibited a considerable fear and avoidance behaviours and after exposure not only were there important decreases in the fear and avoidance scores, but also the patient was able to approach, interact, and kill cockroaches with a high degree of presence and reality judgment.

Similarly, at the beginning of the experiment, virtual cockroach induced anxiety in patient but after one hour of exposure the anxiety was significantly declined. Finally, the treatment gains were maintained in a follow-up conducted two months after the end of the treatment, showing decreases in the various scales of the BAT [ 42 ].

Juan et al. The AR system was the same used in the Botella et al. With respect to psychological measures, anxiety, fear, and avoidance behaviours were assessed using Fear and Avoidance Scales [ 45 ] and SUDS [ 44 ].

The degree of presence and reality judgment experienced by the users in the AR system were assessed using three ad hoc questions, created specifically for this study. Furthermore, as in the study of Botella et al. In Botella et al. The AR system was the same as that used in the preceding studies [ 31 , 35 ]. AR exposure has been led in a single extended session lasting up to three hours. Each participant faced with various scenarios, progressing from the easiest to the most difficult situation.

For example, at the beginning of the exposure, the program exhibited one cockroach to the participants, and more animals were added progressively. The purpose of the exposure was to interact with many cockroaches repeatedly, touch them, kill them, and remain in the situations until they experienced a considerable decrease in anxiety.

As above in Botella et al. More specifically, the AR system, at the beginning of the exposure, was able to induce anxiety in the participants and after treatment produced a significant decrease in the level of fear and avoidance behaviours in all participants. Furthermore, the treatment gains were maintained at three-, six-, and twelve-month follow-up periods. Unlike the study conducted in by Botella et al.

Moreover, the AR system included the possibility to vary the numbers of cockroaches on the scene and the movement and the size of cockroaches. The data showed that, at the start of AR immersion, the anxiety levels, measured through the SUDS questionnaire [ 44 ], ranged from 9 to 10 the highest levels of the scale but they decreased progressively during the exposure.

The levels and the duration of exposure needed for anxiety reduction were based on initial levels of fear and on the severity of the phobia. Furthermore, patients showed high scores in the PRJQ [ 48 ], representing high levels of presence and reality judgment experienced during the AR exposure. In , Botella et al. The subject conducted three therapeutic phases. In the second phase, the participant received the AR exposure treatment, assessing again the psychological measures.

In this study the experiential measures of presence and reality judgment have not been taken into account. The data showed that before and after the first phase a slight improvement is obtained in performance, fear, and avoidance, whereas there was an increased in the belief in the catastrophic thought.

After the AR exposure there were improvements in all BAT measures [ 42 ]: performance, fear, avoidance, and belief. After the third phase a significant decrease was obtained in all psychological measures, maintaining them at one, three-, six-, and twelve-month follow-up periods.

In , Juan and Calatrava [ 37 ] compared an AR optical see-through OST system with a video see-through VST for the treatment of spiders and cockroaches phobia in twenty-four nonphobic participants.

Before, during, and after exposure subjects were asked to rate their level of anxiety from 0 no anxiety to 10 very high anxiety. Presence experienced by participants was assessed using an adapted version of the Slater et al.

How similar is this memory to your memories of other places where there were these animals? Results showed that the VST system induced a higher sense of presence than the OST system and the two systems produced similar and significant anxiety before treatment that decreased after exposure. Juan and Joele [ 38 ] compared an AR visible marker-based system with an AR invisible marker system in twenty-four healthy subjects. Participants rated their intensity of anxiety level from 0 no anxiety to 10 very high anxiety at eight different moments during the AR exposure.

As in the previous study, after each AR exposure, individuals were asked to fill out an adapted Slater et al. Results showed that the AR invisible marker system elicited a higher sense of presence compared to the AR visible marker system. Furthermore, at the beginning of the treatment, the AR invisible marker system provokes a higher level of anxiety that decreases significantly during and at the end of the AR exposure. Wrzesien et al. The first study [ 29 ] compared the in vivo exposure therapy with the AR exposure therapy in twenty-two individuals with specific phobia for spiders and cockroaches [ 27 ].

The patients were randomly allocated to one of two groups. Before and after the exposure session, the participants were asked to fill out the behaviour avoidance test BAT [ 42 ]. The data showed that both in vivo and AR exposure are therapeutically effective in reducing anxiety, avoidance, and behavioural avoidance. In particular, the analysis of the pre- and posttest BAT scores showed no statistically significant differences between the in vivo group and the AR exposure group.

Furthermore, an intragroup analysis showed a statistically significant decline in the severity of avoidance under both conditions, suggesting that both exposures are effective in the reduction of avoidance behaviours after treatment.

In the second study [ 28 ], five patients were assessed and treated using only an AR therapeutic exposure [ 27 ]. Before, during, and after the exposure session, the participants were asked to rank their level of anxiety on a scale of 0 no anxiety to 10 very high anxiety , avoidance on a scale of 0 low degree of avoidance to 10 high degree of avoidance , behavioural avoidance on a scale of 0 low degree of behavioural avoidance to 13 very high degree of behavioural avoidance , and belief in catastrophic thoughts on a scale of 0 low degree of belief to 10 high degree of belief.

Virtual reality therapy

From another point of view, Augmented Reality can be defined as a set of techniques and tools that add information to the physical reality. To date, Augmented Reality has been used in many fields, such as medicine, entertainment, maintenance, architecture, education, and cognitive and motor rehabilitation but very few studies and applications of AR exist in clinical psychology. In the treatment of psychological disorders, Augmented Reality has given preliminary evidence to be a useful tool due to its adaptability to the patient needs and therapeutic purposes and interactivity. This experience could increase the AR ecological validity in the treatment of psychological disorders. This paper reviews the recent studies on the use of Augmented Reality in the evaluation and treatment of psychological disorders, focusing on current uses of this technology and on the specific features that delineate Augmented Reality a new technique useful for psychology.


Contains significant new information about VR and anxiety disorders, information that Included format: EPUB, PDF; ebooks can be used on all reading devices.


2019, Number 3

In this paper, we conduct a literature survey on various virtual reality VR treatments in psychiatry. We collected 36 studies that used VR to provide clinical trials or therapies for patients with psychiatric disorders. In order to gain a better understanding of the management of pain and stress, we first investigate VR applications for patients to alleviate pain and stress during immersive activities in a virtual environment.

Patients receiving virtual reality therapy navigate through digitally created environments and complete specially designed tasks often tailored to treat a specific ailment; and is designed to isolate the user from their surrounding sensory inputs and give the illusion of immersion inside a computer-generated, interactive virtual environment. This technology has a demonstrated clinical benefit as an adjunctive analgesic during burn wound dressing and other painful medical procedures [1] [2]. It is widely used as an alternative form of exposure therapy , in which patients interact with harmless virtual representations of traumatic stimuli in order to reduce fear responses. It has proven to be especially effective at treating PTSD, and shows considerable promise in treating a variety of neurological and physical conditions. Virtual reality therapy has also been used to help stroke patients regain muscle control, to treat other disorders such as body dysmorphia , and to improve social skills in those diagnosed with autism.

2019, Number 3

Key words:. Tesis de Grado. Universidad de Belgrano. Akiduki, H. Anderson, P.

Metrics details. Cognitive Behavioral Therapy CBT is recommended for treatment, but a substantial part of individuals with SAD either do not seek treatment or drop-out. CBT with Virtual Reality VR -based exposure has several advantages compared to traditional exposure methods, mainly due to increased control of situational elements. The intervention is targeted to adult patients suffering from SAD and treatment effect will be assessed by changes in SAD symptoms. There will be 30 participants in each arm with a crossover at the end of the treatment period during which the participants in the third group will be randomly re-allocated to one of the two former groups.


Request PDF | On Jan 1, , Brenda Wiederhold and others published Advances in Virtual Reality and Anxiety Disorders | Find, read and cite all the research.


Bibliographic Information

It seems that you're in Germany. We have a dedicated site for Germany. Authors: Wiederhold , Brenda K. Yet many clinicians still think of VR technology as it was in the s—bulky, costly, technically difficult—with little knowledge of its evolution toward more modern, evidence-based, practice-friendly treatment. Chapters in the book's main section detail current techniques and review study findings for using VR in the treatment of:.

The journal is oriented to the study of mental illnesses, their pathological processes, and their psychosocial consequences, and has as its aim to disseminate the scientific advances in all fields related to the illness and mental health. It accepts unpublished works on psychiatry and mental health, and its medical and social repercussions. For this reason, space is provided in the Journal for works in the biological, clinical and psychosocial field. Manuscripts are evaluated, before being accepted, by external reviewers peer-review. The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years. CiteScore measures average citations received per document published. Read more.

1 Response
  1. Martin R.

    Table of contents · Front Matter Pages i-vii PDF · General Concepts Front Matter Pages PDF Introduction · Anxiety Disorders Front Matter Pages PDF.

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