Virtual Reality-Based Psychotherapy in Social Anxiety Disorder: fMRI Study Using a Self-Referential Task.

BACKGROUND: Although it has been well demonstrated that the efficacy of virtual reality therapy for social anxiety disorder is comparable to that of traditional cognitive behavioral therapy, little is known about the effect of virtual reality on pathological self-referential processes in individuals with social anxiety disorder. OBJECTIVE: We aimed to determine changes in self-referential processing and their neural mechanisms following virtual reality treatment. METHODS: We recruited participants with and without a primary diagnosis of social anxiety disorder to undergo clinical assessments (Social Phobia Scale and Post-Event Rumination Scale) and functional magnetic resonance imaging (fMRI) scans. Participants with social anxiety disorder received virtual reality-based exposure treatment for 6 sessions starting immediately after baseline testing. After the sixth session, participants with social anxiety disorder completed follow-up scans during which they were asked to judge whether a series of words (positive, negative, neutral) was relevant to them. RESULTS: Of 25 individuals with social anxiety disorder who participated in the study, 21 completed the sessions and follow-up; 22 control individuals also participated. There were no significant differences in age (P=.36), sex (P=.71), or handedness (P=.51) between the groups. Whole-brain analysis revealed that participants in the social anxiety disorder group had increased neural responses during positive self-referential processing in the medial temporal and frontal cortexes compared with those in the control group. Participants in the social anxiety disorder group also showed increased left insular activation and decreased right middle frontal gyrus activation during negative self-referential processing. After undergoing virtual reality-based therapy, overall symptoms of the participants with social anxiety disorder were reduced, and these participants exhibited greater activity in a brain regions responsible for self-referential and autobiographical memory processes while viewing positive words during postintervention fMRI scans. Interestingly, the greater the blood oxygen level dependent changes related to positive self-referential processing, the lower the tendency to ruminate on the negative events and the lower the social anxiety following the virtual reality session. Compared with that at baseline, higher activation was also found within broad somatosensory areas in individuals with social anxiety disorder during negative self-referential processing following virtual reality therapy. CONCLUSIONS: These fMRI findings might reflect the enhanced physiological and cognitive processing in individuals with social anxiety disorder in response to self-referential information. They also provide neural evidence of the effect of virtual reality exposure therapy on social anxiety and self-derogation.

Effectiveness of a Participatory and Interactive Virtual Reality Intervention in Patients With Social Anxiety Disorder: Longitudinal Questionnaire Study.

BACKGROUND: Social anxiety disorder (SAD) is characterized by excessive fear of negative evaluation and humiliation in social interactions and situations. Virtual reality (VR) treatment is a promising intervention option for SAD. OBJECTIVE: The purpose of this study was to create a participatory and interactive VR intervention for SAD. Treatment progress, including the severity of symptoms and the cognitive and emotional aspects of SAD, was analyzed to evaluate the effectiveness of the intervention. METHODS: In total, 32 individuals with SAD and 34 healthy control participants were enrolled in the study through advertisements for online bulletin boards at universities. A VR intervention was designed consisting of three stages (introduction, core, and finishing) and three difficulty levels (easy, medium, and hard) that could be selected by the participants. The core stage was the exposure intervention in which participants engaged in social situations. The effectiveness of treatment was assessed through Beck Anxiety inventory (BAI), State-Trait Anxiety Inventory (STAI), Internalized Shame Scale (ISS), Post-Event Rumination Scale (PERS), Social Phobia Scale (SPS), Social Interaction Anxiety Scale (SIAS), Brief-Fear of Negative Evaluation Scale (BFNE), and Liebowitz Social Anxiety Scale (LSAS). RESULTS: In the SAD group, scores on the BAI (F=4.616, P=.009), STAI-Trait (F=4.670, P=.004), ISS (F=6.924, P=.001), PERS-negative (F=1.008, P<.001), SPS (F=8.456, P<.001), BFNE (F=6.117, P=.004), KSAD (F=13.259, P<.001), and LSAS (F=4.103, P=.009) significantly improved over the treatment process. Compared with the healthy control group before treatment, the SAD group showed significantly higher scores on all scales (P<.001), and these significant differences persisted even after treatment (P<.001). In the comparison between the VR treatment responder and nonresponder subgroups, there was no significant difference across the course of the VR session. CONCLUSIONS: These findings indicated that a participatory and interactive VR intervention had a significant effect on alleviation of the clinical symptoms of SAD, confirming the usefulness of VR for the treatment of SAD. VR treatment is expected to be one of various beneficial therapeutic approaches in the future. TRIAL REGISTRATION: Clinical Research Information Service (CRIS) KCT0003854; https://cris.nih.go.kr/cris/search/search_result_st01.jsp?seq=13508.

Visuo-Haptic-Based Multimodal Feedback Virtual Reality Solution to Improve Anxiety Symptoms: A Proof-of-Concept Study.

With proper guidance, virtual reality (VR) can provide psychiatric therapeutic strategies within a simulated environment. The visuo-haptic-based multimodal feedback VR solution has been developed to improve anxiety symptoms through immersive experience and feedback. A proof-of-concept study was performed to investigate this VR solution. Nine subjects recently diagnosed with panic disorder were recruited, and seven of them eventually completed the trial. Two VR sessions were provided to each subject. Depression, anxiety, and VR sickness were evaluated before and after each session. Although there was no significant effect of the VR sessions on psychiatric symptoms, we could observe a trend of improvement in depression, anxiety, and VR sickness. The VR solution was effective in relieving subjective anxiety, especially in panic disorder without comorbidity. VR sickness decreased over time. This study is a new proof-of-concept trial to evaluate the therapeutic effect of VR solutions on anxiety symptoms using visuo-haptic-based multimodal feedback simultaneously.

Brain process for perception of the "out of the body" tactile illusion for virtual object interaction.

"Out of the body" tactile illusion refers to the phenomenon in which one can perceive tactility as if emanating from a location external to the body without any stimulator present there. Taking advantage of such a tactile illusion is one way to provide and realize richer interaction feedback without employing and placing actuators directly at all stimulation target points. However, to further explore its potential, it is important to better understand the underlying physiological and neural mechanism. As such, we measured the brain wave patterns during such tactile illusion and mapped out the corresponding brain activation areas. Participants were given stimulations at different levels with the intention to create veridical (i.e., non-illusory) and phantom sensations at different locations along an external hand-held virtual ruler. The experimental data and analysis indicate that both veridical and illusory sensations involve, among others, the parietal lobe, one of the most important components in the tactile information pathway. In addition, we found that as for the illusory sensation, there is an additional processing resulting in the delay for the ERP (event-related potential) and involvement by the limbic lobe. These point to regarding illusion as a memory and recognition task as a possible explanation. The present study demonstrated some basic understanding; how humans process "virtual" objects and the way associated tactile illusion is generated will be valuable for HCI (Human-Computer Interaction).

Body-based interfaces.

This research explores different ways to use features of one's own body for interacting with computers. Such "body-based" interfaces may find good uses in wearable computing or virtual reality systems as part of a 3D multi-modal interface in the future, freeing the user from holding interaction devices. Four types of body-based interfaces have been identified: Body-inspired metaphor (BIM); Body-as-interaction-surface (BAIS); Mixed mode (MM); and Object mapping (OM). These four body-based interfaces were applied to a few different applications (and associated tasks) and were tested for their performance and preference. It was generally found that, among the four, the BIM exhibited low error rates, but produced relatively longer task completion times and significant fatigue. The BAIS method had the contrasting character of higher error rates, but shorter task completion times and lower intuitiveness. The OM method exhibited high error rates, longer completion times, and much fatigue. Overall, the MM was superior in terms of both performance and preference as it combined the merits of the above three methods. Thus, it is expected, for applications with many associated tasks, a careful division of tasks among those that have natural semantic links to body parts and those that do not, is necessary to design the most performing body-based interface.