Effect of premature ejaculation desensitisation therapy combined with dapoxetine hydrochloride on the treatment of primary premature ejaculation.

To evaluate the overall treatment benefits of premature ejaculation desensitisation therapy combined with 30 mg dapoxetine hydrochloride treatment on patients with primary premature ejaculation (PPE). Ninety-nine PPE patients were randomly divided into two groups at the ratio of 2:1. Sixty-six PPE patients received premature ejaculation desensitisation therapy accomplished by Weili Automatic Semen Collection-Penis Erection Detection and Analysis workstation (WLJY-2008) combined with 30 mg dapoxetine hydrochloride treatment (DTCD group), and another 33 patients received 30 mg dapoxetine hydrochloride-only treatment (DO group). Intravaginal ejaculation latency time (IELT) and premature ejaculation profile (PEP) were recorded before and during the treatment, and clinical global impression of change (CGIC) in PPE was recorded at the fourth week and the end of the treatment and the items. In both groups were significantly improved (p < 0.0001) in IELT, PEP and CGIC for premature ejaculation compared with baseline, and DTCD treatment showed a more significant improvement on PPE patients in the items compared with DO treatment (p < 0.05). Thus, premature ejaculation desensitisation combined with dapoxetine therapy may be a better choice for improving premature ejaculation with PPE.

Cue exposure treatment in a virtual environment to reduce nicotine craving: a functional MRI study.

Smokers show an increase in cue reactivity during exposure to smoking-related cues. CET aims at extinguishing cue reactivity by repeated presentation of substance-related cues and has been claimed a potentially effective method of treating addictive behaviors, including cigarette smoking. We applied CET to eight late-adolescent smokers in virtual environments (VEs). When comparing pre-CET regions to those of post-CET, the inferior frontal gyrus and superior frontal gyrus were detected. These regions are consistent with previous studies of activated brain regions related to nicotine craving, and VE-CET seems to be an effective method of treating nicotine craving.

Greater expectations: using hierarchical linear modeling to examine expectancy for treatment outcome as a predictor of treatment response.

A client's expectation that therapy will be beneficial has long been considered an important factor contributing to therapeutic outcomes, but recent empirical work examining this hypothesis has primarily yielded null findings. The present study examined the contribution of expectancies for treatment outcome to actual treatment outcome from the start of therapy through 12-month follow-up in a clinical sample of individuals (n=72) treated for fear of flying with either in vivo exposure or virtual reality exposure therapy. Using a piecewise hierarchical linear model, outcome expectancy predicted treatment gains made during therapy but not during follow-up. Compared to lower levels, higher expectations for treatment outcome yielded stronger rates of symptom reduction from the beginning to the end of treatment on 2 standardized self-report questionnaires on fear of flying. The analytic approach of the current study is one potential reason that findings contrast with prior literature. The advantages of using hierarchical linear modeling to assess interindividual differences in longitudinal data are discussed.

Comparing acceptance and refusal rates of virtual reality exposure vs. in vivo exposure by patients with specific phobias.

The present survey explored the acceptability of virtual reality (VR) exposure and in vivo exposure in 150 participants suffering from specific phobias. Seventy-six percent chose VR over in vivo exposure, and the refusal rate for in vivo exposure (27%) was higher than the refusal rate for VR exposure (3%). Results suggest that VR exposure could help increase the number of people who seek exposure therapy for phobias.

BusWorld: designing a virtual environment for post-traumatic stress disorder in Israel: a protocol.

A number of carefully controlled studies have documented the effectiveness of traditional imaginal exposure for the treatment of post-traumatic stress disorder (PTSD). Virtual reality (VR) exposure therapy is based on a similar logic but rather than self-generating imagery, patients wear a VR helmet and go into a three-dimensional (3-D) computer generated virtual world to help them gain access to their memory of the traumatic event. Recent preliminary research has shown that some patients who fail to respond to traditional therapy benefit from virtual reality exposure therapy, presumably because VR helps the patient become emotionally engaged while recollecting/recounting/re-interpreting/emotionally processing what happened during the traumatic event. The present paper presents a brief overview of a new VR World we developed to provide virtual reality therapy for terrorist bus bombing victims in Israel, and a brief description of our research protocol and measures (for details, see www.vrpain.com).

Preliminary research on the efficacy of virtual reality exposure therapy to treat driving phobia.

This article presents a review of preliminary research of two studies of the efficacy of virtual reality exposure therapy (VRET) to treat driving phobia. Study 1 describes a case study of a patient who completed a 7-day baseline followed by three sessions of VRET. Her peak anxiety decreased within and across sessions. At the post-treatment assessment, her phobic-related symptoms had diminished and she no longer met diagnostic criteria for driving phobia. Clinical improvement was maintained at 1-, 3-, and 7-month follow-up. In study 2, a multiple baseline across-subjects design was used to treat five patients over eight weekly VRET sessions. Visual and statistical analyses showed clear improvement in driving anxiety and avoidance in three patients between pre- and post-treatment assessments, and they no longer met criteria for driving phobia. There was marginal improvement in one patient, and the remaining individual showed no treatment gains. There was negligible change in actual driving frequency for any of the patients. Some gains were lost at the follow-up, particularly for the two individuals with poorer treatment responses. The results from these preliminary studies suggest that VRET may be a promising intervention for treating driving phobia. Avenues for improving treatment outcome are discussed.

Anxiety and presence during VR immersion: a comparative study of the reactions of phobic and non-phobic participants in therapeutic virtual environments derived from computer games.

Virtual reality can be used to provide phobic clients with therapeutic exposure to phobogenic stimuli. However, purpose-built therapeutic VR hardware and software can be expensive and difficult to adapt to individual client needs. In this study, inexpensive and readily adaptable PC computer games were used to provide exposure therapy to 13 phobic participants and 13 non-phobic control participants. It was found that anxiety could be induced in phobic participants by exposing them to phobogenic stimuli in therapeutic virtual environments derived from computer games (TVEDG). Assessments were made of the impact of simulator sickness and of sense of presence on the phobogenic effectiveness of TVEDGs. Participants reported low levels of simulator sickness, and the results indicate that simulator sickness had no significant impact on either anxiety or sense of presence. Group differences, correlations, and regression analyses indicate a synergistic relationship between presence and anxiety. These results do not support Slater's contention that presence and emotion are orthogonal.

The development of virtual reality therapy (VRT) system for the treatment of acrophobia and therapeutic case.

Virtual reality therapy (VRT), based on this sophisticated technology, has been recently used in the treatment of subjects diagnosed with acrophobia, a disorder that is characterized by marked anxiety upon exposure to heights and avoidance of heights. Conventional VR systems for the treatment of acrophobia have limitations, over-costly devices or somewhat unrealistic graphic scenes. The goal of this study was to develop an inexpensive and more realistic virtual environment (VE) in which to perform exposure therapy for acrophobia. It is based on a personal computer, and a virtual scene of a bunge-jump tower in the middle of a large city. The virtual scenario includes an open lift surrounded by props beside a tower, which allows the patient to feel a sense of heights. The effectiveness of the VE was evaluated through the clinical treatment of a subject who was suffering from the fear of heights. As a result, it was proved that this VR environment was effective and realistic at overcoming acrophobia according not only to the comparison results of a variety of questionnaires before and after treatment but also to the subject's comments that the VE seemed to evoke more fearful feelings than the real situation.

Comparing virtual and real worlds for acrophobia treatment.

Traditional treatment of phobias involves a process of gradual exposure to the feared object. Virtual Reality (VR) environments have been used to effectively treat phobias by simulating feared situations, yet these initial studies have been performed by comparing the effect to no-treatment conditions. We are in the process of comparing VR exposure treatment to "gold-standard" in-vivo exposure treatment by replicating an actual in-vivo exposure area in a VR model. The process of controlling for differences between the two environments highlights a general procedure of selecting elements in virtual environment design, targeted towards producing particular emotional effects. It also raises questions about the necessity for highly realistic simulation in VR phobia treatment.

From toy to tool: the development of immersive virtual reality environments for psychotherapy of specific phobias.

Virtual Reality (VR) entered the mental health field some years ago. While the technology itself has been available for more than ten years now, there is still a certain amount of uncertainty among researchers and users as to whether VR will one day fulfill all it's promises. In this chapter we are giving an overview of the implementation of the technology in our mental health research facility in Basel, Switzerland. The development of two applications for use with claustrophobic and acrophobic patients perspectively serves just as an example within this context. Some may say, the chapter is too much based on technical considerations. Strictly speaking, VR is pure technology, even knowing that this special form of technology has sensory, psychological and even philosophical implications not known from other human computer interfaces so far. As far as we are concerned, the development of the technology for use within the mental health sector has merely just begun. As today's mostly used immersive output devices (Head-mounted Displays, shutter glasses) do not have a satisfactory resolution, do restrict movements and prevent multi-user-capabilities, there will be a soar of mental health applications the day some or at least the most important of these obstacles have been overcome.

Virtual reality therapy: an effective treatment for phobias.

Behavioral therapy techniques for treating phobias often includes graded exposure of the patient to anxiety-producing stimuli (Systematic Desensitization). However, in utilizing systematic desensitization, research reviews demonstrate that many patients appear to have difficulty in applying imaginative techniques. This chapter describes the Virtual Reality Therapy (VRT), a new therapeutical approach that can be used to overcome some of the difficulties inherent in the traditional treatment of phobias. VRT, like current imaginal and in vivo modalities, can generate stimuli that could be utilized in desensitization therapy. Like systematic desensitization therapy, VRT can provide stimuli for patients who have difficulty in imagining scenes and/or are too phobic to experience real situations. As far as we know, the idea of using virtual reality technology to combat psychological disorders was first conceived within the Human-Computer Interaction Group at Clark Atlanta University in November 1992. Since then, we have successfully conducted the first known pilot experiments in the use of virtual reality technologies in the treatment of specific phobias: fear of flying, fear of heights, fear of being in certain situations (such as a dark barn, an enclosed bridge over a river, and in the presence of an animal [a black cat] in a dark room), and fear of public speaking. The results of these experiments are described.

Effectiveness of computer-generated (virtual reality) graded exposure in the treatment of acrophobia.

OBJECTIVE: The authors' goal was to examine the efficacy of computer-generated (virtual reality) graded exposure in the treatment of acrophobia (fear of heights). METHOD: Twenty college students with acrophobia were randomly assigned to virtual reality graded exposure treatment (N = 12) or to a waiting-list comparison group (N = 8). Seventeen students completed the study. Sessions were conducted individually over 8 weeks. Outcome was assessed by using measures of anxiety, avoidance, attitudes, and distress associated with exposure to heights before and after treatment. RESULTS: Significant differences between the students who completed the virtual reality treatment (N = 10) and those on the waiting list (N = 7) were found on all measures. The treatment group was significantly improved after 8 weeks, but the comparison group was unchanged. CONCLUSIONS: The authors conclude that treatment with virtual reality graded exposure was successful in reducing fear of heights.

Coping with test stress: microcomputer software for treatment of test anxiety.

Test anxiety, described as "the most virulent impediment to effective role functioning in an educational setting" (Myers, R. A. 1986, Research on educational and vocational counseling; Handbook of Psychotherapy and Behavior Change, pp. 728), is readily treatable through use of relaxation and desensitization strategies. To reduce clinician involvement, and thus potentially reduce costs to clients, a microcomputer program, Coping with Test Stress, was developed and tested. Initial case findings suggest that the Coping with Test Stress program may be useful in treating test anxiety among college graduate students.