scholarly journals Is Continued Improvement After Automated Virtual Reality Exposure Therapy for Spider Phobia Explained by Subsequent in-vivo Exposure? A First Test of the Lowered Threshold Hypothesis

2021 ◽  
Vol 12 ◽  
Author(s):  
Philip Lindner ◽  
Peter Dafgård ◽  
Alexander Miloff ◽  
Gerhard Andersson ◽  
Lena Reuterskiöld ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Structural Equation Models ◽  
Exposure Therapy ◽  
Post Treatment ◽  
Self Report ◽  
Behavioral Approach ◽  
Symptom Reduction ◽  
Spider Phobia ◽  
Longitudinal Outcome

Consumer Virtual Reality (VR) technology offers a powerful, immersive medium for scalable dissemination of mental health interventions. Decades of research has shown VR exposure therapy to be efficacious in the treatment of anxiety disorders and that the fear reduction generalizes to real-world stimuli. Many studies also report continued improvement over time, after discontinuing VR use. The lowered threshold hypothesis states that this continued improvement is moderated by lowering the threshold to conduct subsequent in-vivo exposure. The current study is the first to formally test this hypothesis, using data from a recent trial on automated VR exposure therapy for spider phobia, in which participants (n = 49) were followed for 1 year, completing assessments 1 week, 3 and 12 months post-treatment. The assessment included validated self-report of phobia symptoms, a standardized behavioral approach test featuring a real spider, and a questionnaire for self-reporting frequency of in-vivo exposures since last assessment. Number of in-vivo exposures was found to be independently associated with greater symptom decrease in longitudinal outcome models. In sequential structural equation models, immediate post-treatment symptom reduction was associated with subsequent in-vivo exposures, which in turn was associated with continued symptom reduction. However, this applied only to self-reported phobia symptoms (not behavioral avoidance) and no associations were found past 3 months. Our findings offer preliminary, partial support for the lowered threshold hypothesis, suggesting that VR exposure interventions may benefit from including explicit in-virtuo to in-vivo transitioning components.

scholarly journals Experiences of Gamified and Automated Virtual Reality Exposure Therapy for Spider Phobia: Qualitative Study

10.2196/17807 ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. e17807 ◽  
Author(s):  
Philip Lindner ◽  
Alexander Rozental ◽  
Alice Jurell ◽  
Lena Reuterskiöld ◽  
Gerhard Andersson ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Anxiety Disorders ◽  
Exposure Therapy ◽  
Real Life ◽  
Spider Phobia ◽  
Semistructured Interview ◽  
User Experiences ◽  
Virtual Reality Exposure Therapy ◽  
Virtual Reality Exposure

Background Virtual reality exposure therapy is an efficacious treatment of anxiety disorders, and recent research suggests that such treatments can be automated, relying on gamification elements instead of a real-life therapist directing treatment. Such automated, gamified treatments could be disseminated without restrictions, helping to close the treatment gap for anxiety disorders. Despite initial findings suggesting high efficacy, very is little is known about how users experience this type of intervention. Objective The aim of this study was to examine user experiences of automated, gamified virtual reality exposure therapy using in-depth qualitative methods. Methods Seven participants were recruited from a parallel clinical trial comparing automated, gamified virtual reality exposure therapy for spider phobia against an in vivo exposure equivalent. Participants received the same virtual reality treatment as in the trial and completed a semistructured interview afterward. The transcribed material was analyzed using thematic analysis. Results Many of the uncovered themes pertained directly or indirectly to a sense of presence in the virtual environment, both positive and negative. The automated format was perceived as natural and the gamification elements appear to have been successful in framing the experience not as psychotherapy devoid of a therapist but rather as a serious game with a psychotherapeutic goal. Conclusions Automated, gamified virtual reality exposure therapy appears to be an appealing treatment modality and to work by the intended mechanisms. Findings from the current study may guide the next generation of interventions and inform dissemination efforts and future qualitative research into user experiences.

scholarly journals Behavioral and Magnetoencephalographic Correlates of Fear Generalization Are Associated with Responses to Later Virtual Reality Exposure Therapy in Spider Phobia

2021 ◽  
Author(s):  
Kati Roesmann ◽  
Elisabeth J. Leehr ◽  
Joscha Boehnlein ◽  
Christian Steinberg ◽  
Fabian Seeger ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Exposure Therapy ◽  
Treatment Success ◽  
Post Treatment ◽  
Spider Phobia ◽  
Virtual Reality Exposure Therapy ◽  
Fear Generalization ◽  
Spatio Temporal ◽  
Pre Treatment ◽  
Virtual Reality Exposure

As overgeneralization of fear is a pathogenic marker of anxiety disorders, we investigated whether pre-treatment levels of fear generalization in spider-phobic patients are associated with their response to exposure-based treatment, in order to identify pre-treatment correlates of treatment success. Ninety patients with spider phobia completed pre-treatment clinical and magnetoencephalography (MEG) assessments, one session of virtual reality exposure therapy, and a post-treatment clinical assessment. Based on the primary outcome (30% symptom reduction in self-reported symptoms from pre- to post-treatment) they were categorized as responders or non-responders. In a pre-treatment MEG fear generalization paradigm involving fear conditioning with two unconditioned stimuli (UCS), we obtained fear ratings, UCS-expectancy ratings, and event-related fields to conditioned stimuli (CS+, CS-) and 7 different generalization stimuli (GS) on a perceptual continuum from CS+ to CS-. Prior to treatment, non-responders showed behavioral overgeneralization indicated by more linear generalization gradients in fear ratings. Analyses of MEG source estimations revealed that non-responders showed a decline of their (inhibitory) frontal activations to safety-signaling CS- and GS compared to CS+ over time, while responders maintained these activations at early (<300ms) and late processing stages. Results provide initial evidence that pre-treatment differences of behavioral and neural markers of fear generalization are associated with later responses to behavioral exposure. Findings demonstrate the relevance of inhibitory learning functions and their spatio-temporal neural reflections in this interplay. Findings stimulate research on mechanism-based augmentation strategies for behavioral therapies.

scholarly journals Experiences of Gamified and Automated Virtual Reality Exposure Therapy for Spider Phobia: Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Philip Lindner ◽  
Alexander Rozental ◽  
Alice Jurell ◽  
Lena Reuterskiöld ◽  
Gerhard Andersson ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Anxiety Disorders ◽  
Exposure Therapy ◽  
Real Life ◽  
Spider Phobia ◽  
Semistructured Interview ◽  
User Experiences ◽  
Virtual Reality Exposure Therapy ◽  
Virtual Reality Exposure

BACKGROUND Virtual reality exposure therapy is an efficacious treatment of anxiety disorders, and recent research suggests that such treatments can be automated, relying on gamification elements instead of a real-life therapist directing treatment. Such automated, gamified treatments could be disseminated without restrictions, helping to close the treatment gap for anxiety disorders. Despite initial findings suggesting high efficacy, very is little is known about how users experience this type of intervention. OBJECTIVE The aim of this study was to examine user experiences of automated, gamified virtual reality exposure therapy using in-depth qualitative methods. METHODS Seven participants were recruited from a parallel clinical trial comparing automated, gamified virtual reality exposure therapy for spider phobia against an in vivo exposure equivalent. Participants received the same virtual reality treatment as in the trial and completed a semistructured interview afterward. The transcribed material was analyzed using thematic analysis. RESULTS Many of the uncovered themes pertained directly or indirectly to a sense of presence in the virtual environment, both positive and negative. The automated format was perceived as natural and the gamification elements appear to have been successful in framing the experience not as psychotherapy devoid of a therapist but rather as a serious game with a psychotherapeutic goal. CONCLUSIONS Automated, gamified virtual reality exposure therapy appears to be an appealing treatment modality and to work by the intended mechanisms. Findings from the current study may guide the next generation of interventions and inform dissemination efforts and future qualitative research into user experiences.

Automated virtual reality exposure therapy for spider phobia vs. in-vivo one-session treatment: A randomized non-inferiority trial

2019 ◽  
Vol 118 ◽  
pp. 130-140 ◽  
Author(s):  
Alexander Miloff ◽  
Philip Lindner ◽  
Peter Dafgård ◽  
Stefan Deak ◽  
Maria Garke ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Exposure Therapy ◽  
Spider Phobia ◽  
Virtual Reality Exposure Therapy ◽  
Virtual Reality Exposure

scholarly journals Translating Virtual Reality Cue Exposure Therapy for Binge Eating into a Real-World Setting: An Uncontrolled Pilot Study

2021 ◽  
Vol 10 (7) ◽  
pp. 1511
Author(s):  
Katherine Nameth ◽  
Theresa Brown ◽  
Kim Bullock ◽  
Sarah Adler ◽  
Giuseppe Riva ◽  
...  
Keyword(s):  
Virtual Reality ◽  
Eating Disorder ◽  
Binge Eating ◽  
Real World ◽  
Exposure Therapy ◽  
Post Treatment ◽  
Cue Exposure ◽  
Treatment Gains ◽  
Intent To Treat

Binge-eating disorder (BED) and bulimia nervosa (BN) have adverse psychological and medical consequences. Innovative interventions, like the integration of virtual reality (VR) with cue-exposure therapy (VR-CET), enhance outcomes for refractory patients compared to cognitive behavior therapy (CBT). Little is known about the feasibility and acceptability of translating VR-CET into real-world settings. To investigate this question, adults previously treated for BED or BN with at least one objective or subjective binge episode/week were recruited from an outpatient university eating disorder clinic to receive up to eight weekly one-hour VR-CET sessions. Eleven of 16 (68.8%) eligible patients were enrolled; nine (82%) completed treatment; and 82% (9/11) provided follow-up data 7.1 (SD = 2.12) months post-treatment. Overall, participant and therapist acceptability of VR-CET was high. Intent-to-treat objective binge episodes (OBEs) decreased significantly from 3.3 to 0.9/week (p < 0.001). Post-treatment OBE 7-day abstinence rate for completers was 56%, with 22% abstinent for 28 days at follow-up. Among participants purging at baseline, episodes decreased from a mean of one to zero/week, with 100% abstinence maintained at follow-up. The adoption of VR-CET into real-world clinic settings appears feasible and acceptable, with a preliminary signal of effectiveness. Findings, including some loss of treatment gains during follow-up may inform future treatment development.

Treatment of Storm Fears Using Virtual Reality and Progressive Muscle Relaxation

2017 ◽  
Vol 46 (2) ◽  
pp. 251-256 ◽  
Author(s):  
Jessica Lima ◽  
Hanna McCabe-Bennett ◽  
Martin M. Antony
Keyword(s):  
Virtual Reality ◽  
Treatment Group ◽  
Exposure Therapy ◽  
Clinical Sample ◽  
Muscle Relaxation ◽  
Post Treatment ◽  
Progressive Muscle Relaxation ◽  
Exposure Condition ◽  
Pre Treatment

Background: The present study examined the efficacy of virtual reality (VR) exposure therapy for treating individuals with storm fears by comparing a one-session VR exposure treatment with a one-session progressive muscle relaxation (PMR) and psychoeducation session. Aims: It was predicted that there would be a reduction in storm-related fear post-treatment for individuals in both conditions, but that this reduction would be greater for those in the VR exposure condition. It was predicted that improvements would be maintained at 30-day follow-up only for those in the VR exposure condition. Method: Thirty-six participants each received one of the two treatment conditions. Those in the PMR treatment group received approximately 30 minutes of PMR and approximately 15 minutes of psychoeducation regarding storms. Those in the VR treatment group received approximately 1 hour of VR exposure. Additionally, participants were asked to complete a pre-treatment and post-treatment 5-minute behavioural approach test to assess changes in storm fears. They were also asked to complete a measure assessing storm phobia. Results: There was a significant interaction between treatment group and self-reported fear at post-treatment, such that fear decreased for both groups, although the reduction was stronger in the VR group. Results also showed that reductions in storm fear were maintained at 30-day follow-up for both groups. Conclusions: Although this study used a small non-clinical sample, these results offer preliminary support for the use of VR exposure therapy in the treatment of storm-related fear.

scholarly journals Self-report questionnaires, behavioral assessment tasks, and an implicit behavior measure: do they predict social anxiety in everyday life?

PeerJ ◽  
2018 ◽  
Vol 6 ◽  
pp. e5441 ◽  
Author(s):  
Isabel L. Kampmann ◽  
Paul M.G. Emmelkamp ◽  
Nexhmedin Morina
Keyword(s):  
Virtual Reality ◽  
Social Anxiety ◽  
Experiential Avoidance ◽  
Behavioral Assessment ◽  
Negative Evaluation ◽  
Self Report ◽  
Assessment Tasks ◽  
Implicit Approach ◽  
Approach Avoidance

Social anxiety is commonly assessed with self-report measures. This study aimed to investigate whether maximum anxiety levels during in vivo and virtual reality behavioral assessment tasks (BATs), and implicit approach-avoidance tendencies during the approach-avoidance task (AAT) explain more variation as predictors of daily social anxiety than self-report measures. A total of 62 university students (Mage = 20.79; SD = 4.91) with high levels of social anxiety completed self-report measures on fear of negative evaluation (FNE-B) as well as fear and avoidance in social situations (Liebowitz social anxiety scale-self report), in vivo and virtual reality BATs, and the AAT (independent variables) in the laboratory. On seven consecutive days, social anxiety, experiential avoidance, and negative social events (dependent variables) were assessed. The results revealed that fear of negative evaluation predicted everyday social anxiety and experiential avoidance. Fear and avoidance in social situations only predicted experiential avoidance. Neither implicit approach-avoidance tendencies during the AAT nor maximum anxiety levels during the in vivo and virtual reality BATs predicted any outcome variable. Our results support the use of self-report questionnaires in the assessment of social anxiety.

scholarly journals Virtual reality exposure therapy in the treatment of driving phobia

2010 ◽  
Vol 26 (1) ◽  
pp. 131-137 ◽  
Author(s):  
Rafael Thomaz da Costa ◽  
Marcele Regine de Carvalho ◽  
Antonio Egidio Nardi
Keyword(s):  
Clinical Trials ◽  
Virtual Reality ◽  
Web Of Science ◽  
Exposure Therapy ◽  
Controlled Clinical Trials ◽  
Virtual Reality Exposure Therapy ◽  
Randomized Controlled Clinical Trials ◽  
Randomized Controlled ◽  
Virtual Reality Exposure

A growing number of researches has appeared on virtual reality exposure therapy (VRET) to treat anxiety disorders. The purpose of this article was to review some evidences that support the VRET efficacy to treat driving phobia. The studies were identified through computerized search (PubMed/Medline, Web of Science, and Scielo databases) from 1984 to 2007. Some findings are promising. Anxiety/avoidance ratings declined from pre to post-treatment. VRET may be used as a first step in the treatment of driving phobia, as long as it may facilitate the in vivo exposure, thus reducing risks and high costs of such exposure. Notwithstanding, more randomized/controlled clinical trials are required to prove its efficacy.

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