Virtual reality and mental health in older adults: a systematic review.

IMPORTANCE: Virtual reality (VR) is a promising tool with the potential to enhance care of cognitive and affective disorders in the aging population. VR has been implemented in clinical settings with adolescents and children; however, it has been less studied in the geriatric population. OBJECTIVE: The objective of this study is to determine the existing levels of evidence for VR use in clinical settings and identify areas where more evidence may guide translation of existing VR interventions for older adults. DESIGN AND MEASUREMENTS: We conducted a systematic review in PubMed and Web of Science in November 2019 for peer-reviewed journal articles on VR technology and its applications in older adults. We reviewed article content and extracted the number of study participants, study population, goal of the investigation, the level of evidence, and categorized articles based on the indication of the VR technology and the study population. RESULTS: The database search yielded 1554 total results, and 55 articles were included in the final synthesis. The most represented study design was cross-sectional, and the most common study population was subjects with cognitive impairment. Articles fell into three categories for VR Indication: Testing, Training, and Screening. There was a wide variety of VR environments used across studies. CONCLUSIONS: Existing evidence offers support for VR as a screening and training tool for cognitive impairment in older adults. VR-based tasks demonstrated validity comparable to some paper-based assessments of cognition, though more work is needed to refine diagnostic specificity. The variety of VR environments used shows a need for standardization before comparisons can be made across VR simulations. Future studies should address key issues such as usability, data privacy, and confidentiality. Since most literature was generated from high-income countries (HICs), it remains unclear how this may be translated to other parts of the world.

Spiritual Psychotherapy for Inpatient, Residential, and Intensive Treatment.

In this article, a clinical protocol for delivering a flexible, spiritually integrated cognitive-behavioral therapy, called spiritual psychotherapy for inpatient, residential, and intensive treatment (SPIRIT), is presented, and its implementation is described.

Examining the outcomes and acceptability of a peer-led spiritual intervention for moral injury in a veteran service organization.

The purpose of this proof-of-concept study was to examine the outcomes and acceptability of a spiritual intervention for moral injury led by veteran peers in a Veteran Service Organization (VSO), called "Heroes to Heroes." From baseline to 1-year follow-up, 101 veterans who participated in the intervention completed the evaluation surveys at four time points assessing psychological outcomes (moral injury, posttraumatic stress disorder [PTSD] symptoms, and life satisfaction), spiritual outcomes (spiritual struggles and spiritual transcendence), and their perceived helpfulness of the program. In addition, we conducted four focus groups with six to eight alumni to more fully understand veterans' views and experiences of the program. Focusing on the longitudinal surveys, latent growth modeling analyses revealed veterans generally improved across the psychological and spiritual outcomes in the study. Specifically, veterans reported steady decreases in moral injury outcomes, PTSD symptoms, and spiritual struggles along with increased life satisfaction and spiritual transcendence over the 1-year period. An inductive content analysis of veterans' responses to open-ended items in the surveys and focus group interviews revealed four possible mechanisms or facilitators of these outcomes: (a) social connectivity and belonging (e.g., shared vulnerability and camaraderie); (b) behavioral engagement in core aspects of their spirituality (e.g., sacred practices and visiting sacred places); (c) spiritual transformation and growth (e.g., closeness with God and divine forgiveness); and (d) appreciation for diversity (e.g., religious and military). Overall, these findings affirm the potential effectiveness and acceptability of the VSO's peer-led spiritual intervention for promoting the holistic healing among veterans who are contending with emotional and spiritual wounds of war. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Predictors of Patients' Responses to Spiritual Psychotherapy for Inpatient, Residential, and Intensive Treatment (SPIRIT).

OBJECTIVE: Spiritual Psychotherapy for Inpatient, Residential, and Intensive Treatment (SPIRIT) is a flexible clinical protocol for delivering spiritually integrated group psychotherapy within acute psychiatric settings. The authors evaluated SPIRIT's feasibility by examining patients' perceptions of its benefits and clinical and spiritual predictors of observed effects associated with this intervention. METHODS: Over a 1-year period, 22 clinicians stationed on 10 clinical units provided SPIRIT to 1,443 self-referred patients with a broad range of demographic, clinical, and spiritual and religious characteristics. RESULTS: Overall, patients' perceptions of benefit from SPIRIT were not associated with demographic factors. Clinical factors similarly did not predict treatment responses, suggesting that SPIRIT is equally suitable for patients with mood, anxiety, traumatic, substance use, psychotic, feeding or eating, or personality disorders and for patients with high levels of acuity. Patients with high levels of religious belief responded better to treatment, but patients with low levels of spiritual and religious identity also reported significant benefits. Patients responded better to SPIRIT when it was delivered by clinicians who reported not being affiliated with a religion than did patients receiving the SPIRIT intervention through clinicians who reported a religious affiliation. CONCLUSIONS: Results indicate that SPIRIT is feasible in providing spiritually integrated treatment to diverse patients across multiple levels of acute psychiatric care.

Measuring and Quantifying Collateral Information in Psychiatry: Development and Preliminary Validation of the McLean Collateral Information and Clinical Actionability Scale.

BACKGROUND: The review of collateral information is an essential component of patient care. Although this is standard practice, minimal research has been done to quantify collateral information collection and to understand how collateral information translates to clinical decision making. To address this, we developed and piloted a novel measure (the McLean Collateral Information and Clinical Actionability Scale [M-CICAS]) to evaluate the types and number of collateral sources viewed and the resulting actions made in a psychiatric setting. OBJECTIVE: This study aims to test the feasibility of the M-CICAS, validate this measure against clinician notes via medical records, and evaluate whether reviewing a higher volume of collateral sources is associated with more clinical actions taken. METHODS: For the M-CICAS, we developed a three-part instrument, focusing on measuring collateral sources reviewed, clinical actions taken, and shared decision making between the clinician and patient. To determine feasibility and preliminary validity, we piloted this measure among clinicians providing psychotherapy at McLean Hospital. These clinicians (n=7) completed the M-CICAS after individual clinical sessions with 89 distinct patient encounters. Scales were completed by clinicians only once for each patient during routine follow-up visits. After clinicians completed these scales, researchers conducted chart reviews by completing the M-CICAS using only the clinician's corresponding note from that session. For the analyses, we generated summary scores for the number of collateral sources and clinical actions for each encounter. We examined Pearson correlation coefficients to assess interrater reliability between clinicians and chart reviewers, and simple univariate regression modeling followed by multilevel mixed effects regression modeling to test the relationship between collateral information accessed and clinical actions taken. RESULTS: The study staff had high interrater reliability on the M-CICAS for the sources reviewed (r=0.98; P<.001) and actions taken (r=0.97; P<.001). Clinician and study staff ratings were moderately correlated and statistically significant on the M-CICAS summary scores for the sources viewed (r=0.24, P=.02 and r=0.25, P=.02, respectively). Univariate regression modeling with a two-tailed test demonstrated a significant association between collateral sources and clinical actions taken when clinicians completed the M-CICAS (ß=.27; t87=2.47; P=.02). The multilevel fixed slopes random intercepts model confirmed a significant association even when accounting for clinician differences (ß=.23; t57=2.13; P=.04). CONCLUSIONS: This pilot study established the feasibility and preliminary validity of the M-CICAS in assessing collateral sources and clinical decision making in psychiatry. This study also indicated that reviewing more collateral sources may lead to an increased number of clinical actions following a session.