Virtual reality therapeutic ( VRT ), also known as virtual reality immersion therapy ( VRIT ), simulation for therapy ( SFT ), virtual reality exposure therapy ( VRET ), and computerized CBT ( CCBT ), is the use of virtual reality technology for psychological or occupational therapy. Patients who receive virtual reality therapy navigate through a digitally created environment and complete custom designed tasks are often adjusted to treat certain diseases. Technology can range from simple PC and keyboard settings, to modern virtual reality headsets. It is widely used as an alternative form of exposure therapy, where patients interact with harmless virtual representations of traumatic stimuli to reduce fear response. This has proven to be very effective in treating PTSD. 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.
Video Virtual reality therapy
Description
Virtual reality therapy (VRT) uses specially programmed computers, visual immersion devices and artificial environments designed to provide patients with simulated experiences that can be used to diagnose and treat psychological conditions that cause difficulties for patients. In many environmental phobias, reactions to perceived hazards, such as altitude, public speaking, flying, enclosed spaces, are usually triggered by visual and auditory stimuli. In VR-based therapy, cyberspace is a means of providing artificial and controlled stimulation in the context of treatment, and with therapists being able to monitor patient reactions. Unlike traditional cognitive behavioral therapy, VR-based treatments may involve adjusting virtual environments, such as adding odor-controlled intensity or adding and adjusting vibrations, and allowing physicians to pinpoint triggers and trigger levels for each patient's reaction. VR-based therapy systems can enable playback of virtual scenes, with or without adjustments, to familiarize patients into such environments. Therapists who apply virtual reality exposure therapy, just like those who apply in-vivo exposure therapy, can take one of two approaches to the intensity of exposure. The first approach is called flood, which refers to the most intense approach in which the stimuli that produce the most anxiety are presented first. For soldiers who have developed PTSD from combat, this could mean first exposing them to a virtual reality scene from their fellow troops being shot or wounded followed by a less stressful stimulus like just a war sound. On the other hand, what is termed a graded exposure requires a more relaxed approach where the most unfortunate stimulus is introduced first. Exposure-VR, as compared to in-vivo exposure has the advantage in giving the patient a clear experience, without any associated risks or costs. VRT has great promise because it historically produces "medicine" about 90% of the time about half the cost of traditional cognitive behavioral therapy authorities, and is very promising as a treatment for PTSD in which there are not enough psychologists and psychiatrists to treat all veterans with anxiety disorders diagnosed related to their military service.
Recently there has been some progress in the field of virtual reality medicine. Virtual reality is a complete immersion of the patient into the virtual world by wearing a headset with an LED screen on the headset lens. This is different from recent advances in augmented reality. Augmented reality differs in the sense that it improves the non-synthetic environment by introducing synthetic elements to the perceptions of world users. This in turn "adds" to the current reality and uses the virtual elements to build the existing environment. Augmented reality has additional benefits and has proven itself to be a medium in which individuals suffering from specific phobias can be exposed "safely" to the object (s) of their fear, at no cost associated with programming a complete virtual environment. Thus, augmented reality can offer a potent alternative to some less-favored exposure-based therapies.
Maps Virtual reality therapy
History
Virtual reality therapy (VRT) was initiated and initially termed by Max North as documented by the first known publication (Virtual Environments and Psychological Disorders, Max M. North, and Sarah M. North,
Initial exploration in 1993-1994 VRT was conducted by Ralph Lamson, a graduate of USC then at Kaiser Permanente Psychiatry Group. Lamson began publishing his work in 1993. As a psychologist, he was very concerned with the medical and therapeutic aspects of how to treat people using technology, rather than equipment, obtained from Division, Inc. Psychology Today reported in 1994 that the 1993-1994 treatment was successful in about 90% of Lamson's virtual psychotherapy patients. Lamson wrote in 1993 a book titled Virtual Therapy published in 1997 aimed primarily for a detailed explanation of the basic anatomical, medical and therapeutic for the success of VRT. In 1994-1995, he solved his own acrophobia in trials of third-party VR simulations and then prepared a 40-person test funded by Kaiser Permanente. Shortly after that, in 1994-1995, Larry Hodges, then a computer scientist at Georgia Tech who was active in VR, began studying VRT in collaboration with Max North who had reported anomalous behavior in a carpet VR simulation study and was associated with a phobic response that was not known to its nature.. Hodges tried to hire Lamson without success in 1994 and began working with Barbara Rothbaum, a psychologist at Emory University to test VRT in a controlled group test, experiencing about 70% success among the 50% of subjects completing the testing program.
In 2005, Skip Rizzo of the USC's Institute for Creative Technologies, with research funding from the Office of Naval Research (ONR), began validating the tools he made using the asset from the Full Spectrum Warrior game for post- trauma. Virtual Iraq is then evaluated and refined under ONR funding and supported by Virtually Better, Inc. They also support the application of VR-based therapies for aerophobia, acrophobia, glossophobia, and substance abuse. Virtual Iraq has proved successful in the normalization of more than 70% of patients with PTSD, and it has now become the standard treatment accepted by the Anxiety and Depression Association of America. However, the VA continues to emphasize traditional old exposure therapy as a treatment of choice, and VR-based therapy only gets limited adoption, despite active promotion by DOD. This is interesting considering the VRT has a much lower cost and apparently higher success rate, and the $ 12 million ONR-funded study is currently underway to definitively compare the efficacy of two methods, PET and VRT. Military laboratories have established dozens of VRT laboratories and treatment centers to treat PTSD and various other medical conditions. The use of VRT has been the main psychiatric treatment for anxiety disorders and found an increased use in the treatment of other cognitive disorders associated with various medical conditions such as addiction, depression and insomnia.
Apps
Psychological therapy
Exposure therapy
Virtual reality technology is very useful for exposure therapy - the method of treatment in which the patient is introduced and then slowly exposed to a traumatic stimulus. In a virtual environment, patients can safely interact with their phobic representation, and researchers need not have access to the real version of the phobia itself.
One of the most successful examples of virtual reality therapy exposure therapy is the treatment system of PTSD, Virtual Iraq. Using a screen mounted on the head and pedestal, the patient navigates the Humvee around the virtual recreation of Iraq, Afghanistan and the United States. Safely exposed to traumatic environments, patients learn to reduce their anxiety. According to a virtual history review of Iraq, one study found that it reduced the symptoms of PTSD by an average of fifty percent, and disqualified more than seventy-five percent of participants for PTSD after treatment. Therapeutic exposure to virtual reality is also commonly used to treat specific phobias, especially small animal phobias. The dreaded animals such as spiders can be easily produced in a virtual environment, rather than requiring a therapist or researcher to find real life counterparts. This technique has also been used experimentally to treat other fears such as public speaking and claustrophobia.
In 2011, three researchers at York University proposed an affordable virtual reality exposure therapy (VRET) therapy system for home-phobic maintenance.
Depression
In February 2006, the UK's National Institute of Health and Clinical Excellence (NICE) recommended that VRT be available for use in the NHS throughout England and Wales, for patients with mild/moderate depression, rather than directly choosing antidepressants. Some areas have evolved, or are conducting trials.
At Auckland University in New Zealand, a team led by Dr. Sally Merry has developed a computerized "serious" fantasy CBT game to help overcome depression among teenagers. The game, Sparx , has a number of features to help combat depression, where users take on character roles that travel through fantasy worlds, eradicate "negative" thinking and learning techniques to manage their depression.
Eating disorders and body dysmorphia
Therapeutic virtual reality has also been used to try to treat eating disorders and body dysmorphia. One study in 2013 has participants completing various tasks in a virtual reality environment that can not be easily replicated without technology. Tasks include showing the patient the implications for achieving the desired weight, comparing their actual body shape with the avatars made using the size of the body they feel, and changing the virtual reflection to fit their actual body size.
Occupational therapy
Autism
Virtual reality has been shown to improve the social skills of young adults with autism. In one study, participants controlled virtual avatars in different virtual environments and maneuvered through various social tasks such as interviewing, meeting new people, and handling arguments. Researchers found that participants increased in the field of emotional recognition in the voice and face and in considering the thoughts of others. Participants were also surveyed several months after the study for how effectively they thought of the treatment, and the response was very positive. Many other studies have also explored this occupational therapy option.
Post Traumatic Stress Disorder
It is also possible to use virtual reality to help those with PTSD. Virtual reality allows patients to relive their combat situations at different extremes as therapists can be there with them guiding them through the process. Some experts believe that this is a great way to treat these patients as it allows for recreation of what they experience. "This allows for greater involvement by patients and, consequently, greater activation of traumatic memory, which is necessary for the extinction of conditioned fears." (
Stroke patients
Virtual reality also has applications on the physical side of occupational therapy. For stroke patients, various virtual reality technologies can help bring good control back to different muscle groups. Therapy often includes games that are controlled with haptic-feedback controllers that require subtle movements, such as playing the piano with a virtual hand. The Wii game system has also been used in conjunction with virtual reality as a treatment method.
Benefits
Random, tightly controlled, acrophobia treatment trials at Kaiser Permanente provide & gt; 90% effectiveness, conducted in 1993-94. (Ext Ref.Ã, 2, pg.Ã, 71) Of the 40 treated patients, 38 showed a sharp decline in phobic reactions to altitude and self-reported achieving their goals. The study found that VRT allowed patients to achieve victory over virtual height situations they could not face in real life, and which gradually increased the height and dangers in a virtual environment resulting in increased victory and greater confidence in patients that they really can face the situation in real life. "Virtual therapy interventions empower people.Virtual reality simulation technology is suitable for mastery-oriented care... Instead of addressing threats, phobics manage the increasingly threatening aspects of the computer-generated environment... The range of applications can be extended by increasing the reality and interactivity so action elicits a reaction from the environment in which individuals immerse themselves "(Ext.Fl.a, 3, pg.Ã, 331-332).
Another study examined the effectiveness of virtual reality therapy in caring for military combat personnel who have recently returned from the current conflict in Iraq and Afghanistan. Rauch, Eftekhari and Ruzek conducted research with samples from 42 combat soldiers who had been diagnosed with chronic PTSD (post-traumatic stress disorder). These combat soldiers were previously filtered using several different diagnostic reports including the PTSD military checklist, a screening tool used by the military in determining the intensity of PTSD diagnosis by measuring the presence of PTSD symptoms. Although 22 of the soldiers left the study, the results of the research on the remaining 20 soldiers still had achievements. The soldiers were given the same diagnostic test after a study consisting of several sessions of virtual reality exposure and virtual reality presentation exposure. The soldiers showed much improvement in the diagnostic score, indicating a decrease in PTSD symptoms. Likewise, a further three-month diagnostic examination was also performed after the initial sessions experienced by the soldiers. The results of this study indicate that 15 out of 20 participants no longer meet the diagnostic criteria for PTSD and increase their PTSD military checklist score by 50% for assessment after the study. Although only 17 out of 20 participants participated in 3-month follow-up screening, 13 of 17 participants still did not meet the criteria for PTSD and maintained their 50% improvement in the PTSD military checklist scores. These results show promising effects and help validate virtual reality therapy as an effective therapeutic mode for the treatment of PTSD (McLay, et al., 2012).
Continuous development
Larry Hodges, formerly of Georgia Tech and now Clemson University and Barbara Rothbaum of Emory University, has done extensive work on VRT, and also owns several patents and founded the company, Virtually Better, Inc.
In the United States, the US Department of Defense (DOD) continues to fund VRT research and is actively using VRT in PTSD care.
Treatment for lesions
Therapeutic virtual reality has two promising potential benefits for the treatment of hemisocial waiver patients. These include improved diagnostic techniques and as supplements for rehabilitation techniques.
Current diagnostic techniques usually involve pen and paper tests such as line division tests. Although these tests have provided relatively accurate diagnostic results, progress in virtual reality therapy (VRT) has proven this test is not entirely comprehensive. Dvorkin et al. using a camera system that immerses the patient into a virtual reality world and requires the patient to hold or move objects in the world, through tracking hand and arm movements. These techniques reveal that pen and paper tests provide a relatively accurate qualitative diagnosis of the patient's hemispensial abandonment, but the VRT provides accurate mapping into 3-dimensional space, revealing a neglected area of ​​space but a patient with at least some consciousness. Patients were also retested 10 months from initial measurements, each of which underwent regular rehabilitation therapy, and most showed a measurable neglect in virtual reality testing whereas no measurable improvement was demonstrated in the line division test.
Therapeutic virtual reality has also proven effective in rehabilitating patients with lesions who suffer from negligence. A study was conducted with 24 people who suffered from hemisolate neglect. A control group of 12 people underwent conventional rehabilitation therapy including visual scanning training, while the virtual reality group (VR) sank into 3 virtual worlds, each with a specific task. The program consists of
- "Bird and Ball" where a patient touches a flying ball with his hand and turns it into a bird
- "Coconut", in which a patient catches a coconut falling from a tree while moving around
- "Container" where a patient moves a box carried in a container to the opposite side.
Each VR patient underwent 3 weeks 5-day-a-week interval of 30 minutes to appear in the program. Control passes the equivalent time in traditional rehabilitation therapy. Each patient took a stellar cancellation test, a line division test, and Catherine Bergego Scale (CBS) 24 hours before and after a three-week treatment to assess the severity of unilateral spatial abandonment. The VR group showed a higher increase in star cancellation tests and CBS scores after treatment than the control group (p <0.05), but the two groups showed no difference in the line bis and K-MBI tests before and after treatment. These results suggest that virtual reality programs can be more effective than conventional rehabilitation and thus should be further investigated.
Benefits
The therapeutic preferences of exposure to virtual reality through in-vivo exposure therapy are often debated, but there are many tangible benefits of virtual reality presentation exposure that make it more desirable. For example, the proximity between the client and the therapist can cause problems when in-vivo therapy is used and transportation is unreliable to clients or it is impractical for them to travel as far as necessary. However, virtual reality exposure therapy can be done from anywhere in the world if given the necessary tools. Along with the notion of transport and proximity that are not available, there are many individuals who need therapy but because of various forms of immobilization (paralysis, extreme obesity, etc.) they can not be physically transferred to the therapy site. Again, because virtual reality presentation exposure can be performed anywhere in the world, those with mobility problems will no longer be discriminated against. Another major advantage is that there are fewer ethical issues than in-vivo exposure therapy. Again, since the idea of ​​proximity is no longer a requirement, this reduces the likelihood of a relationship between an inappropriate client-therapist.
Another advantage to the rehabilitation of virtual reality over traditional methods is patient motivation. When presented with difficult tasks over a prolonged period, patients tend to lose interest in these tasks. This leads to decreased adherence due to decreased motivation to complete the assigned task. Rehabilitation of virtual reality is beneficial in such a way that challenges and motivates patients to do more. With simple things like high scores, in-game awards, and ratings not only are they motivated to do therapy every day they have fun doing it. Not only beneficial for the patient, it is beneficial for the physical therapist. With these high scores, and game or app data collected, the therapist can analyze data to see progress. These developments can be mapped and visually shown to patients to improve motivation on their performance and the developments they have made so far in their therapy. This data can then be mapped with other participants who perform similar tasks and can show how they are compared to people with similar therapeutic regimens. It maps the data in a program or game that can then be used by researchers and scientists for further evaluation of an optimal therapeutic regimen. A recent study was conducted in 2016 where a VR-based virtual simulation of a town called Reh @ City was created. This city in virtual reality evokes memory, attention, visuo-spatial ability and executive function tasks integrated in the performance of some daily routines. The study looked at daily life activities in post-stroke patients and found it had more impact than conventional methods of recovery.
Worries
There are some ethical issues regarding use and development using virtual reality simulations to help clients/patients with mental health problems. One example of this concern is the potential side effects and side effects of virtual reality exposure. Some side effects and side effects may include cybersickness, perceptual-motor disorders, flashbacks, and generally decrease arousal (Rizzo, Schultheis, & Rothbaum, 2003). If it is severe enough and widespread, this effect should be reduced through various methods by the therapist using virtual reality.
Another ethical concern is how doctors should receive VRT certification. Due to the relative novelty of virtual reality as a whole, there may not be many physicians who have experience with the feel of virtual reality exposure or the role that the VR program has in therapy. According to Rizzo et al. (2003), virtual reality technology should only be used as a tool for qualified physicians rather than being used to train individuals or collect interest for new clients/patients.
Some of the traditional problems with virtual reality therapy are the cost. Because virtual reality in the field of science and medicine is so primitive and new, the cost of virtual reality equipment will be much higher than some traditional methods. With medical costs growing at an exponential rate, this will be another charge added to the growing list of medical bills for the patient's recovery process. Apart from the benefits of rehabilitating virtual reality, the cost of equipment and resources for virtual reality settings will make it difficult to become mainstream and available to all patients including the poor.
References
External links
- Burn Victim Sam Brown Handled With Mayan SnowWorld Reality Game Game. GQ: Newsreader
- The Virtual Reality Pain Reduction Project from Seattle University of Seattle and U.W. Harborview Burn Center.
- PHOBOS Anxiety Management The Virtual Reality Project Platform from PsyTech LLC is currently in development to be used as a professional virtual reality reality exposure therapy tool to treat a wide range of generalized phobias and anxiety disorders of patients.
- ShahrbanianSh; Ma X; Aghaei N; Korner-Bitensky N; Moshiri K; Simmonds MJ. Use of virtual reality (immersive vs non immersive) for pain management in children and adults: A systematic review of evidence from randomized controlled trials. European Journal of Experimental Biology 2012, 2 (5): 1408-22.
Source of the article : Wikipedia
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