scholarly journals The Effects of Virtual Reality (VR) Treatment on Prefrontal Cortex Activity in Patients with Social Anxiety Disorder: fNIRS measurement for VR-derived video exposure (Preprint)

Author(s):  
Hojun Lee ◽  
JongKwan Choi ◽  
Dooyoung Jung ◽  
Ji-Won Hur ◽  
Chul-Hyun Cho
2021 ◽  
Author(s):  
Hojun Lee ◽  
JongKwan Choi ◽  
Dooyoung Jung ◽  
Ji-Won Hur ◽  
Chul-Hyun Cho

BACKGROUND Attempts to use virtual reality (VR) as a treatment for various psychiatric disorders have been made recently, and many researchers have identified the effects of VR in psychiatric disorders. Studies have reported that VR therapy is effective in social anxiety disorder (SAD). However, there is no prior study on the neural correlates of VR therapy in patients with SAD. OBJECTIVE The aim of this study is to find the neural correlates of VR therapy by evaluating the treatment effectiveness of VR in patients with SAD using portable functional near-infrared spectroscopy (fNIRS). METHODS Patients with SAD (n=28) were provided with 6 sessions of VR treatment that was developed for exposure to social situations with a recording system of each participant’s self-introduction in VR. After each VR treatment session, the first-person view (video 1) and third-person view (video 2) clips of the participant’s self-introduction were automatically generated. The functional activities of prefrontal regions were measured by fNIRS while watching videos 1 and 2 with a cognitive task, before and after whole VR treatment sessions, and after the first session of VR treatment. We compared the data of fNIRS between patients with SAD and healthy controls (HCs; n=27). RESULTS We found that reduction in activities of the right frontopolar prefrontal cortex (FPPFC) in HCs was greater than in the SAD group at baseline (<i>t</i>=–2.01, <i>P</i>=.049). Comparing the frontal cortex activation before and after VR treatment sessions in the SAD group showed significant differences in activities of the FPPFC (right: <i>t</i>=–2.93, <i>P</i><.001; left: <i>t</i>=–2.25, <i>P</i>=.03) and the orbitofrontal cortex (OFC) (right: <i>t</i>=–2.10, <i>P</i>=.045; left: <i>t</i>=–2.21, <i>P</i>=.04) while watching video 2. CONCLUSIONS Activities of the FPPFC and OFC were associated with symptom reduction after VR treatment for SAD. Our study findings might provide a clue to understanding the mechanisms underlying VR treatment for SAD. CLINICALTRIAL Clinical Research Information Service (CRIS) KCT0003854; https://tinyurl.com/559jp2kp


2021 ◽  
Vol 10 (5) ◽  
pp. 915
Author(s):  
Hyu Seok Jeong ◽  
Jee Hyun Lee ◽  
Hesun Erin Kim ◽  
Jae-Jin Kim

Virtual reality (VR) was introduced to maximize the effect of cognitive behavioral therapy (CBT) by efficiently performing exposure therapy. The purpose of this study was to find out whether VR-based individual CBT with relatively few treatment sessions is effective in improving social anxiety disorder (SAD). This therapy was applied to 115 patients with SAD who were retrospectively classified into 43 patients who completed the nine or 10 sessions normally (normal termination group), 52 patients who finished the sessions early (early termination group), and 20 patients who had extended the sessions (session extension group). The Brief Fear of Negative Evaluation Scale (BFNE) scores tended to decrease in all groups as the session progressed, and the slope of decrease was the steepest in the early termination group and the least steep in the session extension group. Severity of social anxiety in the last session and symptom reduction rate showed no significant group difference. Our findings suggest that short-term VR-based individual CBT of nine to 10 sessions may be effective. When the therapeutic effect is insufficient during this period, the additional benefit may be minimal if the session is simply extended. The improvement in the early termination group suggests that even shorter sessions of five or six can also be effective.


2016 ◽  
Vol 26 (7) ◽  
pp. 825-835 ◽  
Author(s):  
Danielle E. Parrish ◽  
Holly K. Oxhandler ◽  
Jacuelynn F. Duron ◽  
Paul Swank ◽  
Patrick Bordnick

Author(s):  
Carlos Ramos-Galarza ◽  
Pamela Acosta-Rodas ◽  
Jaime Moscoso-Salazar ◽  
Omar Condor-Herrera ◽  
Jorge Cruz-Cárdenas

2013 ◽  
Vol 43 (2) ◽  
pp. 167-181 ◽  
Author(s):  
Irene Ngai ◽  
Erin C. Tully ◽  
Page L. Anderson

Background: Psychoanalytic theory and some empirical research suggest the working alliance follows a “rupture and repair” pattern over the course of therapy, but given its emphasis on collaboration, cognitive behavioral therapy may yield a different trajectory. Aims: The current study compares the trajectory of the working alliance during two types of cognitive behavioral therapy for social anxiety disorder – virtual reality exposure therapy (VRE) and exposure group therapy (EGT), one of which (VRE) has been proposed to show lower levels of working alliance due to the physical barriers posed by the technology (e.g. no eye contact with therapist during exposure). Method: Following randomization, participants (N = 63) diagnosed with social anxiety disorder received eight sessions of manualized EGT or individual VRE and completed a standardized self-report measure of working alliance after each session. Results: Hierarchical linear modeling showed overall high levels of working alliance that changed in rates of growth over time; that is, increases in working alliance scores were steeper at the beginning of therapy and slowed towards the end of therapy. There were no differences in working alliance between the two treatment groups. Conclusion: Results neither support a rupture/repair pattern nor the idea that the working alliance is lower for VRE participants. Findings are consistent with the idea that different therapeutic approaches may yield different working alliance trajectories.


2021 ◽  
Author(s):  
Mikael Rubin ◽  
Karl Muller ◽  
Mary Hayhoe ◽  
Michael J Telch

Biased attention to social threat has been implicated in social anxiety disorder. Modifying visual attention during exposure therapy offers a direct test of this mechanism. We developed and tested a brief virtual reality exposure therapy (VRET) protocol using 360º-video and eye tracking. Participants (N = 21) were randomized to either standard VRET or VRET + attention guidance training (AGT). Multi-level Bayesian models were used to test (1) whether there was an effect of condition over time and (2) whether post-treatment changes in gaze patterns mediated the effect of condition at follow-up. There was a large overall effect of the intervention on symptoms of social anxiety, as well as an effect of the AGT augmentation on changes in visual attention to audience members. There was weak evidence against an effect of condition on fear of public speaking and weak evidence supporting a mediation effect, however these estimates were strongly influenced by model priors. Taken together, our findings suggest that attention can be modified within and during VRET and that modification of visual gaze avoidance may be casually linked to reductions in social anxiety. Replication with a larger sample size is needed.


2021 ◽  
Author(s):  
Mikael Rubin ◽  
Karl Muller ◽  
Mary Hayhoe ◽  
Michael Telch

There is some evidence for heterogeneity in attentional processes among individuals with social anxiety. However, there is limited work considering how attentional processes may differ in a naturalistic task-based context (e.g., public speaking). In this secondary analysis we tested attentional heterogeneity among individuals (N = 21) with social anxiety disorder in the context of a virtual reality exposure treatment study. Participants completed a public speaking challenge in an immersive 360º-video virtual reality environment with eye tracking at pre-treatment, post-treatment, and at 1-week follow-up. Using a Hidden Markov Model (HMM) approach with clustering we tested whether there were distinct profiles of attention pre-treatment and whether there were changes following the intervention. As a secondary aim we tested whether the distinct attentional profiles at pre-treatment predicted differential treatment outcomes. We found two distinct attentional profiles pre-treatment that we characterized as vigilant/diffuse attention control and avoidant/high attention control. By the 1-week follow-up the two profiles were no longer meaningfully different. We found a difference between HMM groups for fear at public speaking at post-treatment b = -8.54, 95% Highest Density Interval (HDI) [-16.00, -0.90], Bayes Factor (BF) = 8.31 but not at one-week follow-up b = -5.83, 95% HDI [-13.25, 1.81], BF = 2.28. These findings provide support for heterogeneity in attentional processes among socially anxious individuals is likely, but that this may change following treatment. Moreover, our results provide evidence that attentional avoidance may be related to poorer treatment outcomes.


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