Correspondence to Antici et al. Salivary CRP predicts treatment response to virtual reality exposure therapy for social anxiety disorder.

The study by Antici et al. (2024) investigates the effects of virtual reality exposure therapy on social anxiety disorder (SAD), focusing on the relationship between C-reactive protein (CRP) levels in saliva and therapy outcomes. Findings indicate that this therapy not only reduces SAD symptoms and discomfort but also correlates with decreased systemic inflammation, as evidenced by lowered CRP levels. Remarkably, higher baseline CRP levels predicted a greater reduction in anxiety symptoms, suggesting a unique response pattern in SAD compared to other psychological disorders. This study highlights systemic inflammation's significance in SAD and the promise of non-invasive biomarkers like salivary CRP for managing psychological disorders. It calls for more research to understand the underlying mechanisms and validate these initial findings.

Effects of a Stimulus Response Task Using Virtual Reality on Unilateral Spatial Neglect: A Randomized Controlled Trial.

OBJECTIVE: To investigate the effects of a stimulus response task using virtual reality (VR) for unilateral spatial neglect (USN). DESIGN: Double-blind randomized controlled trial. SETTING: Acute phase hospital where stroke patients are hospitalized. PARTICIPANTS: The participants were 42 patients (N=42) with right-hemisphere cerebral damage who had been experiencing USN in their daily lives. They were randomly assigned to 3 groups: a stimulus response task with a background shift (SR+BS group), a stimulus response task without a background shift (SR group), and an object gazing task (control group). INTERVENTIONS: The stimulus response task was to search for balloons that suddenly appeared on the VR screen. A background shift was added to highlight the search in the neglected space. The control task was to maintain a controlled gaze on a balloon that appeared on the VR screen. The intervention period was 5 days. MAIN OUTCOME MEASURES: The primary outcome was the participants' scores on a stimulus-driven attention test (SAT) using the reaction time. The stimuli of the SAT were divided into 6 blocks of 3 lines on each side (-3 to +3). The secondary outcomes were their scores on the Behavioral Intention Test conventional, Catherine Bergego Scale, and straight ahead pointing tests. RESULTS: In the SAT, there were significant interaction effects of reaction time between time and group factors in left-2, right+2, and right+3. The SR+BS and SR groups showed significant improvements in the reaction time of left-2 and right+3 compared with the control group. Moreover, the SR+BS group showed a significant improvement in the reaction time of left-2, which was the neglected space, compared with the SR group. However, there were no significant interaction effects of Behavioral Intention Test conventional, Catherine Bergego Scale, and straight ahead pointing. CONCLUSIONS: Our results suggest that the use of stimulus response tasks using VR combined with background shifts may improve left-sided USN.

Perfectionism as a predictor of change in digital self-guided interventions for public speaking anxiety in adolescents: A secondary analysis of a four-armed randomized controlled trial.

Public Speaking Anxiety (PSA) interventions targeting adolescents exist; however, not all gain improvement. This exploratory study investigated whether PSA interventions resulted in a decrease in perfectionism and whether pre-treatment level and changes in perfectionism moderated the effects on PSA and social anxiety. The sample consisted of 100 adolescents from junior high schools randomized to four groups: 1) VR only (n = 20), 2) VR + online exposure program (n = 20), 3) online psychoeducation and online exposure program (n = 40), 4) waitlist and online psychoeducation program (n = 20). Self-reported symptoms of PSA, social anxiety, and perfectionism were measured at pre, week 3, post, and 3-months follow-up. Level and change in outcome variables were analyzed using latent growth curve modeling. Results revealed that the interventions did not lead to a reduction in perfectionism. Reduction in perfectionism was associated with a larger reduction in all outcome measures from post to follow-up. No interaction was found between pre-treatment perfectionism and PSA symptoms. High pre-treatment levels of perfectionism were associated with poorer outcomes on social anxiety symptoms from post to follow-up for online exposure groups. The results indicate that one should assess and address high pre-treatment levels of perfectionism during PSA interventions.

180-degree immersive VR motion visualization in the treatment of haemophilic ankle arthropathy.

BACKGROUND: Patients with haemophilic arthropathy suffer chronic pain that affects and restricts their quality of life. Visualization of movement through immersive virtual reality is used for pain management. AIM: To evaluate the efficacy of 180-degree immersive VR motion visualization therapy in patients with haemophilic ankle arthropathy. METHODS: Prospective, multicentre pilot study. Fifteen adult patients with bilateral haemophilic ankle arthropathy were recruited (mean age: 42.73 ± 12.36 years). The intervention lasted 4 weeks, with daily home sessions of 180-degree immersive motion visualization. The patients were given virtual reality glasses to use with their smartphones. From the YouTube mobile app® they accessed the recorded video with access from the He-Mirror App®. The study variables were joint state (Haemophilia Joint Health Score), pressure pain threshold (pressure algometer), muscle strength (dynamometry) and range of motion (goniometry). Three evaluations were performed: at baseline (T0), after the intervention (T1) and at the end of a 16-week follow-up period (T2). RESULTS: No patient developed ankle hemarthrosis during the experimental phase. In the repeated measures analysis we found statistically significant differences in joint state (F = 51.38; η2 p = .63), pressure pain threshold of the lateral malleolus (F = 12.34; η2 p = .29) and range of motion (F = 11.7; η2 p = .28). CONCLUSIONS: Therapy using immersive motion visualization does not cause hemarthrosis. This intervention can improve joint condition, pressure pain threshold and range of motion in patients with ankle arthropathy. Changes greater than the MDC were reported in more than 40% of patients for the variables pressure pain threshold, anterior tibialis strength and range of motion, which were considered clinically relevant.

The application of virtual reality exposure versus relaxation training in music performance anxiety: a randomized controlled study.

BACKGROUND: Performance anxiety is the most frequently reported anxiety disorder among professional musicians. Typical symptoms are - on a physical level - the consequences of an increase in sympathetic tone with cardiac stress, such as acceleration of heartbeat, increase in blood pressure, increased respiratory rate and tremor up to nausea or flush reactions. These symptoms can cause emotional distress, a reduced musical and artistical performance up to an impaired functioning. While anxiety disorders are preferably treated using cognitive-behavioral therapy with exposure, this approach is rather difficult for treating music performance anxiety since the presence of a public or professional jury is required and not easily available. The use of virtual reality (VR) could therefore display an alternative. So far, no therapy studies on music performance anxiety applying virtual reality exposure therapy have investigated the therapy outcome including cardiovascular changes as outcome parameters. METHODS: This mono-center, prospective, randomized and controlled clinical trial has a pre-post design with a follow-up period of 6 months. 46 professional and semi-professional musicians will be recruited and allocated randomly to an VR exposure group or a control group receiving progressive muscle relaxation training. Both groups will be treated over 4 single sessions. Music performance anxiety will be diagnosed based on a clinical interview using ICD-10 and DSM-5 criteria for specific phobia or social anxiety. A behavioral assessment test is conducted three times (pre, post, follow-up) in VR through an audition in a concert hall. Primary outcomes are the changes in music performance anxiety measured by the German Bühnenangstfragebogen and the cardiovascular reactivity reflected by heart rate variability (HRV). Secondary outcomes are changes in blood pressure, stress parameters such as cortisol in the blood and saliva, neuropeptides, and DNA-methylation. DISCUSSION: The trial investigates the effect of VR exposure in musicians with performance anxiety compared to a relaxation technique on anxiety symptoms and corresponding cardiovascular parameters. We expect a reduction of anxiety but also a consecutive improvement of HRV with cardiovascular protective effects. TRIAL REGISTRATION: This study was registered on clinicaltrials.gov. (ClinicalTrials.gov Number: NCT05735860).

Immersive Virtual Reality Reaction Time Test and Relationship with the Risk of Falling in Parkinson's Disease.

Immersive virtual reality (IVR) uses customized and advanced software and hardware to create a digital 3D reality in which all of the user's senses are stimulated with computer-generated sensations and feedback. This technology is a promising tool that has already proven useful in Parkinson's disease (PD). The risk of falls is very high in people with PD, and reaction times and processing speed may be markers of postural instability and functionality, cognitive impairment and disease progression. An exploratory study was conducted to explore the feasibility of reaction time tests performed in IVR as predictors of falls. A total of 26 volunteers (79.2% male; 69.73 ± 6.32 years) diagnosed with PD (1.54 ± 0.90 H&Y stage; 26.92 ± 2.64 MMSE) took part in the study. IVR intervention was feasible, with no adverse effects (no Simulator Sickness Questionnaire symptoms). IVR reaction times were related (Spearman's rho) to functionality (timed up and go test (TUG) (rho = 0.537, p = 0.005); TUG-Cognitive (rho = 0.576, p = 0.020); cognitive impairment mini mental state exam (MMSE) (rho = -0.576, p = 0.002)) and the years of the patients (rho = 0.399, p = 0.043) but not with the first PD symptom or disease stage. IVR test is a complementary assessment tool that may contribute to preventing falls in the proposed sample. Additionally, based on the relationship between TUG and reaction times, a cut-off time is suggested that would be effective at predicting the risk of suffering a fall in PD patients using a simple and quick IVR test.

Efficacy of nonpharmacologic interventions in preoperative anxiety: A systematic review of systematic reviews.

AIMS AND OBJECTIVES: Evidence suggests that preparing patients for surgery using nonpharmacological strategies reduces their anxiety. However, there is no consensus on what the best practices are. This study aims to answer the question: Are interventions using nonpharmacological therapies effective in reducing preoperative anxiety? BACKGROUND: Preoperative anxiety causes physiological and psychological adverse effects, with a negative effect on postoperative recovery. INTRODUCTION: According to the World Health Organization, between 266 and 360 million surgical procedures are performed annually worldwide, and it is estimated that more than 50% of patients will experience some degree of preoperative anxiety. DESIGN: Systematic review of systematic reviews with results of interventions aimed at mitigating preoperative anxiety. METHODS: A search was conducted for systematic reviews with meta-analyses published between 2012 and 2021 in Medline, Scopus, Web of Science and Cochrane Library. Quality was assessed using the AMSTAR-2 scale. The protocol was registered in PROSPERO. RESULTS: A total of 1016 studies were examined, of which 17 systematic reviews were selected, yielding 188 controlled trials with 16,884 participants. In adults, the most common intervention included music, followed by massage, in children virtual reality and clowns. Almost all controlled trials reported a reduction in preoperative anxiety after the intervention, of which almost half had statistically significant results. CONCLUSION: Interventions that include music, massage and virtual reality reduce preoperative anxiety and have shown that they are cost-effective, minimally invasive and with a low risk of adverse effects. Preoperative anxiety can be reduced through a short-term intervention involving nursing professionals as an alternative or complement to drugs. RELEVANCE TO CLINICAL PRACTICE: This review suggests that nursing professionals, in collaboration with other health professionals, should continue to conduct research on the reduction in preoperative anxiety. Further research in this area is needed, to reduce heterogeneity and consolidate the results. NO PATIENT OR PUBLIC CONTRIBUTION: Not applied to our study, as it is a systematic review of systematic reviews.

The Effectiveness of Virtual Reality Exposure-Based Cognitive Behavioral Therapy for Severe Anxiety Disorders, Obsessive-Compulsive Disorder, and Posttraumatic Stress Disorder: Meta-analysis.

BACKGROUND: In recent years, virtual reality exposure-based cognitive behavioral therapy (VRE-CBT) has shown good treatment results in (subclinical) anxiety disorders and seems to be a good alternative to exposure in vivo in regular cognitive behavioral therapy (CBT). However, previous meta-analyses on the efficacy of VRE-CBT on anxiety disorders have included studies on specific phobias and subthreshold anxiety; therefore, these results may not be generalizable to patients with more severe and disabling anxiety disorders. OBJECTIVE: The objective of our study is to determine the efficacy of VRE-CBT on more severe anxiety disorders, excluding specific phobias and subthreshold anxiety disorders. Meta-analyses will be conducted to examine the efficacy of VRE-CBT versus waitlist and regular CBT. Our secondary objectives are to examine whether the efficacy differs according to the type of anxiety disorder, type of recruitment, and type of VRE-CBT (virtual reality exposure either with or without regular CBT). Furthermore, attrition in VRE-CBT and CBT will be compared. METHODS: Studies published until August 20, 2020, were retrieved through systematic literature searches in PubMed, PsycINFO, and Embase. We calculated the effect sizes (Hedges g) for the difference between the conditions and their 95% CIs for posttest and follow-up measurements in a random effects model. A separate meta-analysis was performed to compare attrition between the VRE-CBT and CBT conditions. RESULTS: A total of 16 trials with 817 participants were included. We identified 10 comparisons between VRE-CBT and a waitlist condition and 13 comparisons between VRE-CBT and a CBT condition. With regard to risk of bias, information on random sequence generation, allocation concealment, and risk of bias for selective outcome reporting was often absent or unclear. The mean effect size of VRE-CBT compared with waitlist (nco=10) was medium and significant, favoring VRE-CBT (Hedges g=-0.490, 95% CI -0.82 to -0.16; P=.003). The mean effect size of VRE-CBT compared with CBT (nco=13) was small and nonsignificant, favoring CBT (Hedges g=0.083, 95% CI -0.13 to 0.30; P=.45). The dropout rates between VRE-CBT and CBT (nco=10) showed no significant difference (odds ratio 0.79, 95% CI 0.49-1.27; P=.32). There were no indications of small study effects or publication bias. CONCLUSIONS: The results of our study show that VRE-CBT is more effective than waitlist and as effective as CBT in the treatment of more severe anxiety disorders. Therefore, VRE-CBT may be considered a promising alternative to CBT for patients with more severe anxiety disorders. Higher-quality randomized controlled trials are needed to verify the robustness of these findings.

Wearable Immersive Virtual Reality Device for Promoting Physical Activity in Parkinson's Disease Patients.

Parkinson's disease (PD) is a neurological disorder that usually appears in the 6th decade of life and affects up to 2% of older people (65 years and older). Its therapeutic management is complex and includes not only pharmacological therapies but also physiotherapy. Exercise therapies have shown good results in disease management in terms of rehabilitation and/or maintenance of physical and functional capacities, which is important in PD. Virtual reality (VR) could promote physical activity in this population. We explore whether a commercial wearable head-mounted display (HMD) and the selected VR exergame could be suitable for people with mild-moderate PD. In all, 32 patients (78.1% men; 71.50 ± 11.80 years) were a part of the study. Outcomes were evaluated using the Simulator Sickness Questionnaire (SSQ), the System Usability Scale (SUS), the Game Experience Questionnaire (GEQ post-game module), an ad hoc satisfaction questionnaire, and perceived effort. A total of 60 sessions were completed safely (without adverse effects (no SSQ symptoms) and with low scores in the negative experiences of the GEQ (0.01-0.09/4)), satisfaction opinions were positive (88% considered the training "good" or "very good"), and the average usability of the wearable HMD was good (75.16/100). Our outcomes support the feasibility of a boxing exergame combined with a wearable commercial HMD as a suitable physical activity for PD and its applicability in different environments due to its safety, usability, low cost, and small size. Future research is needed focusing on postural instability, because it seems to be a symptom that could have an impact on the success of exergaming programs aimed at PD.

Feasibility and Effects of an Immersive Virtual Reality Exergame Program on Physical Functions in Institutionalized Older Adults: A Randomized Clinical Trial.

One of the pillars which underpins active aging is found in the performance of physical activity. While adherence to physical activity programs has traditionally been low in older people, immersive virtual reality (IVR) could provide an alternative and complementary training mode. A randomized clinical trial was conducted to explore the feasibility and effects of a 10-week IVR exergame program on physical functions of 24 institutionalized older adults who were allocated to an experimental group (EG n = 13; 85.08 ± 8.48 years) and control group (CG n = 11; 84.82 ± 8.10 years). The IVR intervention was feasible, with no adverse effects being reported (no Simulator Sickness Questionnaire symptoms; low negative experience scores on the Game Experience Questionnaire < 0.34/4), no dropouts, high adherence, and good post-gaming usability (System Usability Scale > 73.96%). The EG showed significant improvements: Tinetti scores for balance (1.84 ± 1.06; p < 0.001), gait (1.00 ± 1.08; p < 0.001), total score (2.84 ± 1.67; p < 0.001), and handgrip (4.96 ± 4.22; p < 0.001) (pre−post assessment). The CG showed significantly worsened compared to the EG: Five times sit-to-stand test, Tinetti scores for balance, gait, and total score, and the Timed Up and Go test total score (post-assessment). The findings show that the IVR intervention is a feasible method to approach a personalized exercise program and an effective way by which to improve physical function in the target population.

Psychophysiology during exposure to trauma memories: Comparative effects of virtual reality and imaginal exposure for posttraumatic stress disorder.

BACKGROUND: This investigation involved an in-depth examination of psychophysiological responses during exposure to the trauma memory across 10 sessions among active duty soldiers with combat-related posttraumatic stress disorder (PTSD) treated by Prolonged Exposure (PE) or Virtual Reality Exposure (VRE). We compared psychophysiological changes, session-by-session, between VRE and traditional imaginal exposure. METHODS: Heart rate (HR), galvanic skin response (GSR), and peripheral skin temperature were collected every 5 min during exposure sessions with 61 combat veterans of Iraq/Afghanistan and compared to the PTSD Checklist (PCL-C) and Clinician-Administered PTSD Scale (CAPS) outcomes using multilevel modeling. RESULTS: Over the course of treatment, participants in the PE group had higher HR arousal compared to participants in the VRE group. With reference to GSR, in earlier sessions, participants demonstrated a within-session increase, whereas, in later sessions, participants showed a within-session habituation response. A significant interaction was found for GSR and treatment assignment for within-session change, within-person effect, predicting CAPS (d = 0.70) and PCL-C (d = 0.66) outcomes. CONCLUSION: Overall, these findings suggest that exposure to traumatic memories activates arousal across sessions, with GSR being most associated with reductions in PTSD symptoms for participants in the PE group.

Effect of sensorimotor rehabilitation based on an immersive virtual reality model on mental health.

The aim of this study was to determine the immersive virtual reality-based sensorimotor rehabilitation (IVR-SRB) effect on mental health (global mental health, depression, anxiety and well-being) in older adults. METHODS: This study was experimental, with a sample of 111 older adults (control-experimental), considering an application of IVR-SRB in four different virtual settings with exteroceptive synchronization, proprioceptive and vestibular stimuli, for 6 weeks. OUTCOME VARIABLES: symptoms associated with depression and anxiety; positive mental health (psychological well-being). A descriptive and inferential approach was used to analyze the data, and the ANCOVA test was used to compare the post-intervention groups, controlled by the baseline; In case of baseline moderation, a linear regression model was applied to identify the level of moderation and a region of significance analysis. RESULTS: An IVR-SRB positive net effect was found in the reduction of symptoms of global mental health (p < 0.0001) and depression (p < 0.0001), without baseline moderation. The anxiety scores showed moderation at the beginning (p < 0.0001; b = -0.53), identifying that the greater the presence of anxiety symptoms, the greater the effect of IVR-SRB in reducing these symptoms; its effect is present from scores of 2.9 (Goldberg-12). There were no changes in well-being. CONCLUSION: IVR-SRB is recognized as a great intervention tool among elderly population, showing its multidimensional approach capacity, properly responding to the reduction of symptoms associated with mental disorders.

Virtual Reality Therapy in Mental Health.

Initially designed for the treatment of phobias, the use of virtual reality in phobic disorders has expanded to other mental health disorders such as posttraumatic stress disorder, substance-related disorders, eating disorders, psychosis, and autism spectrum disorder. The goal of this review is to provide an accessible understanding of why this approach is important for future practice, given its potential to provide clinically relevant information associated with the assessment and treatment of people suffering from mental illness. Most of the evidence is available for the use of virtual reality exposure therapy in anxiety disorders and posttraumatic stress disorder. There is hardly any evidence that virtual reality therapy is effective in generalized anxiety disorder and obsessive-compulsive disorder. There is increasing evidence that cue exposure therapy is effective in addiction and eating disorders. Studies into the use of virtual reality therapy in psychosis, autism spectrum disorder, and attention deficit hyperactivity disorder (ADHD) are promising.

Development of an 360-degree virtual reality video-based immersive cycle training system for physical enhancement in older adults: a feasibility study : Development of immersive virtual cycle for older adults.

BACKGROUND: Recently, there is an increased number of studies that use 360° virtual reality (VR) video for medical and rehabilitative purposes. However, the 360° VR video experience for older adults has not yet been investigated. This study aimed to examine the validity of an 360° VR video-based immersive cycling training system (360° VRCTS) for older adults and to provide preliminary evidence of efficacy. METHODS: We developed a new virtual reality training system using an immersive environment 360° VRCTS. Five healthy older adults (2 males and 3 females) participated in this study. The system was tested in a single training session (biking for 20 min while viewing a 360° VR video scene through a large curved screen) to identify its strengths and weakness. The usability and acceptability of our system were measured using the system usability scale (SUS) and the simulator sickness questionnaire (SSQ). RESULTS: All participants successfully completed the session without any discomfort. The average score for the SUS was 94.60 (range, 90-100), indicating high usability of the technology. The average score for the SSQ was 2.24 (standard deviation = 2.05), indicating that the system is well tolerated and has few side effects. CONCLUSIONS: The 360° VRCTS may be a useful indoor training system for older adults due to its easy manipulation, high usability, and limited cybersickness. TRIAL REGISTRATION NUMBER: Clinical Research Information Services (CRiS), KCT0003555 , Registered February 25, 2019, https://cris.nih.go.kr/cris/index/index.do .

Integrating virtual realities and psychotherapy: SWOT analysis on VR and MR based treatments of anxiety and stress-related disorders.

The use of virtual reality (VR) and mixed reality (MR) technology in clinical psychology is growing. Efficacious VR-based treatments for a variety of disorders have been developed. However, the field of technology-assisted psychotherapy is constantly changing with the advancement in technology. Factors such as interdisciplinary collaboration, consumer familiarity and adoption of VR products, and progress in clinical science all need to be taken into consideration when integrating virtual technologies into psychotherapies. We aim to present an overview of current expert opinions on the use of virtual technologies in the treatment of anxiety and stress-related disorders. An anonymous survey was distributed to a select group of researchers and clinicians, using an analytic framework known as Strengths, Weaknesses, Opportunities, and Threats (SWOT). Overall, the respondents had an optimistic outlook regarding the current use as well as future development and implementation of technology-assisted interventions. VR and MR psychotherapies offer distinct advantages that can overcome shortcomings associated with traditional therapy. The respondents acknowledged and discussed current limitations of VR and MR psychotherapies. They recommended consolidation of existing knowledge and encouraged standardisation in both theory and practice. Continued research is needed to leverage the strengths of VR and MR to develop better treatments.Abbreviations: AR: Augmented Reality; MR: Mixed Reality; RCT: Randomised Controlled Trial; SWOT: Strengths, Weaknesses, Opportunities, and Threats; VR: Virtual Reality; VR-EBT: Virtual Reality Exposure-Based Therapy.

Can Immersive Virtual Reality Videogames Help Parkinson's Disease Patients? A Case Study.

Video games have proven useful in physical rehabilitation therapy. Accessibility, however, is limited for some groups such as the elderly or patients with Parkinson's disease (PD). We explore the potential of fully immersive video games as a rehabilitation tool in PD patients. Four patients with mild-moderate PD (3 males:1 female, 53-71 years) participated in the study. Training consisted in two immersive virtual reality video gaming sessions. Outcomes were evaluated using System Usability Scale (SUS), Simulator Sickness Questionnaire (SSQ), Game Experience Questionnaire-post game (GEQ), an ad hoc satisfaction questionnaire and perceived effort. All participants completed the sessions without adverse effects (100%), without SSQ symptoms reported. Post-gaming SUS was >75% in both sessions (range 75-80%). Post-gaming GEQ scores were 3.3-4.0/4 in both sessions. Immersive virtual reality video gaming is feasible in patients with mild-moderate PD, with positive usability and patient satisfaction, and no adverse effects.

The use of virtual reality in assessment and treatment of anxiety and related disorders.

In recent years the development of new virtual environments has been qualitatively high and fast at the same time, but the dissemination of virtual reality (VR) in clinical practice is still scarce. The aim of this review is to give an insight into the state of the art of the use of VR as an assessment tool and treatment intervention in anxiety and related disorders as posttraumatic stress disorder and obsessive-compulsive disorders. Besides an overview into the efficacy of VR, a summary will be given on assumed working mechanisms in virtual reality exposure therapy and how this aligns with current theoretical models. Further, it will be discussed how VR is accepted by patients and research into the reluctance of therapist to use this technology during treatment with focus on the therapeutic alliance and how it may be influenced by the use of VR. Finally, we discuss clinical and future issues as, for example, dissemination into clinical practice and what VR has to offer therapists in future. This not only in adult population but as well in younger patients, as young adolescents VR has a great potential as it connects easily with its playful elements to this population and might be a low threshold step to offer treatment or preventive interventions.

A Mobile Healing Program Using Virtual Reality for Sexual Violence Survivors: A Randomized Controlled Pilot Study.

BACKGROUND: Many young women suffer from sexual violence, but few practice self-healing activities. AIMS: This study evaluated the feasibility and preliminary effects of a mobile virtual intervention, Sister, I will tell you!©, to heal young women after sexual violence in South Korea. METHODS: A mobile virtual intervention, Sister, I will tell you!©, was developed based on a literature review and preliminary studies. In collaboration with sexual violence survivors and experts, eight modules for reflective writing and six modules for mindfulness meditation were included in this 4-week mobile virtual intervention. Thirty-four female sexual violence survivors were randomly assigned to either experimental (n = 19) or control groups (n = 15). The experimental group practiced reflective writing and mindfulness meditation, guided by the mobile virtual intervention. The control group practiced audio-guided mindfulness meditation. Pretest, posttest, and post-4-week evaluations with standardized instruments measured perceived support, negative impact from sexual violence, and suicidal ideation. Descriptive and inferential statistics were used to analyze survey data and content analysis to analyze reflective writing. RESULTS: Among 34 enrolled participants, 26 completed the 4-week intervention and posttest evaluations; 24 completed post-4-week evaluations. Significant improvements were found among participants in the areas of perceived support, negative impact from sexual violence, and suicidal ideation. The effect size of the intervention was moderate. Four themes that emerged from reflective writings were objectifying sexual violence, healing beginning with action, confronting issues, and sharing experiences. LINKING EVIDENCE TO ACTION: The intervention showed potential for initiating young women's engagement in healing from sexual violence. A simple mobile audio intervention without human interaction could benefit sexual violence survivors.

Virtual reality exposure therapy for social anxiety disorder: a systematic review and meta-analysis.

BACKGROUND: Virtual reality exposure therapy (VRET) is currently being used to treat social anxiety disorder (SAD); however, VRET's magnitude of efficacy, duration of efficacy, and impact on treatment discontinuation are still unclear. METHODS: We conducted a meta-analysis of studies that investigated the efficacy of VRET for SAD. The search strategy and analysis method are registered at PROSPERO (#CRD42019121097). Inclusion criteria were: (1) studies that targeted patients with SAD or related phobias; (2) studies where VRET was conducted for at least three sessions; (3) studies that included at least 10 participants. The primary outcome was social anxiety evaluation score change. Hedges' g and its 95% confidence intervals were calculated using random-effect models. The secondary outcome was the risk ratio for treatment discontinuation. RESULTS: Twenty-two studies (n = 703) met the inclusion criteria and were analyzed. The efficacy of VRET for SAD was significant and continued over a long-term follow-up period: Hedges' g for effect size at post-intervention, -0.86 (-1.04 to -0.68); three months post-intervention, -1.03 (-1.35 to -0.72); 6 months post-intervention, -1.14 (-1.39 to -0.89); and 12 months post-intervention, -0.74 (-1.05 to -0.43). When compared to in vivo exposure, the efficacy of VRET was similar at post-intervention but became inferior at later follow-up points. Participant dropout rates showed no significant difference compared to in vivo exposure. CONCLUSION: VRET is an acceptable treatment for SAD patients that has significant, long-lasting efficacy, although it is possible that during long-term follow-up, VRET efficacy lessens as compared to in vivo exposure.

Virtual Reality Therapy in Social Anxiety Disorder.

PURPOSE OF REVIEW: This review provides an overview of current methods and important aspects to consider when applying virtual worlds in the treatment of social anxiety disorder (SAD). RECENT FINDINGS: Different aspects such as dialogs between avatars and patients have been investigated as well as virtual audiences, emotional facial expression, and verbal interaction with avatars. Results of these studies are promising. Few randomized controlled trials (RCTs) have investigated the efficacy of virtual reality exposure therapy (VRET) in SAD. Unfortunately, most RCTs into the efficacy of VRET in comparison with exposure in vivo in SAD have been conducted with a combination of cognitive interventions and VRET. No differences between these conditions were found, but the pure effect of VRET as a stand-alone treatment has only been investigated in one RCT, wherein VRET was not superior to exposure in vivo. Current research into different facets of SAD and VRET has produced promising results with respect to technological aspects. No differences in efficacy between cognitive behavior therapy and VRET were found, but there is a clear need for studies investigating the efficacy of VRET as a stand-alone treatment and the therapeutic processes involved before this therapy can be disseminated in routine clinical practice.