Virtual Therapeutics – Requirements to deliver value with virtual reality and biofeedback applications for alcohol addiction therapy

The application of virtual reality (VR) as a supportive tool in psychotherapy has gained great popularity in recent years. Especially for addiction therapy, a combination of virtual exposure and learning or training coping skills by using biofeedback has a high potential to improve conventional therapy. To add value, the new therapy system has to meet the needs of patients and practitioners likewise. Added values consistently named by experts included, but were not limited to, new possibilities of creating individual exposition or coping scenarios, enhanced psychoeducation, a shorter duration of treatment, telemedical aspects, the possibility of measuring and predicting craving and finally an improvement in abstinence. Besides literature research, we evaluated existing technical solutions in the field of virtual addiction treatment, surveyed experts and evolved a concept that led to a first prototype. The prototype consists of a wireless VR headset and a wireless multi-sensor system for measuring the physiological reaction to stimuli or the effectiveness of coping strategies by means of biofeedback. For further studies we developed both, a virtual exposure and a coping scenario and tested the hardware and software in a pilot study in order to elaborate factors that could negatively affect the therapy adherence, the effectiveness of exposition (immersion) and possible hurdles in practical use. Cybersickness and the lack of haptic feedback turned out to be the main limiting factors. Concepts for the next iteration of the therapy system will reflect these points for upcoming clinical studies. In our proof of concept, we demonstrated that virtual therapy can be implemented with a reasonable effort of time and costs. The combination of software and hardware, that supplements the traditional therapeutic approach, lays the foundation for upcoming clinical use and trials to prove the better outcome of VR enhanced addiction therapy.

Myoelectric Control: an alternative to Mirror Therapy

Evidence suggests that fifty to eighty percent (50-80%) of amputees conserve sensation in their missing limb after removal due to the presence of associated nerve endings. Most importantly, a large percentage of amputees experience episodic pain in the missing limb. This physiological phenomenon called phantom limb pain (PLP) has shown resistance to pharmaceutical treatments, but can be treated through mirror therapy. However, mirror therapy only yields temporary results and does not apply to bilateral amputees. Overcoming these challenges are the objectives of the present study. Using a surface electromyographic signal classification approach, this investigation intends to simulate the control of a missing limb within an immersive virtual environment. We predict that replacing mirror therapy with a more immersive “virtual therapy” can serve as a prolonged psychological solution to phantom limb pain.

The Use of Virtual Therapy in Cardiac Rehabilitation of Female Patients with Heart Disease

Background and Objectives: Cardiovascular disease (CVD) has become increasingly prevalent in women, and it is also in this group that the risk of developing depression is the highest. The most commonly applied therapeutic intervention in cardiac rehabilitation is Schultz’s autogenic training, which has proven to be of little efficacy in reducing depression and anxiety disorders. At the same time, a growing number of scientific reports have been looking at the use of virtual reality (VR) to treat mental health problems. This study aimed at assessing the efficacy of virtual therapy in reducing levels of depression, anxiety, and stress in female CVD patients. Materials and Methods: The study included 43 women who were randomly divided into two groups: experimental group (N = 17), where eight-week cardiac rehabilitation was enhanced with VR-based therapeutic sessions, and control group (N = 26), where the VR therapy was replaced with Schultz’s autogenic training. Mental state parameters were measured using the Perception of Stress Questionnaire and Hospital Anxiety and Depression Scale (HADS). Results: In the experimental group, the sole parameter which failed to improve was HADS-Anxiety, which remained at the baseline level. In the control group, there was a deterioration in nearly all tested parameters except for HADS-Depression. Statistically significant differences in the efficacy of rehabilitation were recorded in relation to the level of stress in the sub-scales: emotional tension (p = 0.005), external stress (p = 0.012), intrapsychic stress (p = 0.023) and the generalized stress scale (p = 0.004). Conclusions: VR therapy is an efficient and interesting complement to cardiac rehabilitation, with proven efficacy in reducing stress levels.

“That’s the Beauty of it”: Practitioners Describe the Affordances of Direct to Consumer Tele-Mental Health

Tele-mental health, or the provision of remote counseling services, has been available for decades. This qualitative study uses the framework of affordances, derived from Gibson, to examine what social work practitioners working on direct to consumer tele-mental health (DTCTMH) platforms are discovering about the features, benefits, and constraints of virtual therapy. An interpretive phenomenological approach was employed to document the lived experiences of social workers who practice in this manner. According to the practitioners interviewed, for a subset of individuals seeking treatment, DTCTMH can offer meaningful interpersonal interaction that confers benefit. Key affordances include accessibility, anonymity, meaningful work, autonomy, lifelong learning, and access by new populations. Practitioners simultaneously acknowledge the ethical complexities and structural challenges of DTCTMH practice. The article concludes with suggestions for future research, policy, and practice.

Music Therapy During COVID-19: Changes to the Practice, Use of Technology, and What to Carry Forward in the Future

In recent years, the field of music therapy (MT) has increasingly embraced the use of technology for conducting therapy sessions and enhancing patient outcomes. Amidst a worldwide pandemic, we sought to examine whether this is now true to an even greater extent, as many music therapists have had to approach and conduct their work differently. The purpose of this survey study is to observe trends in how music therapists from different regions around the world have had to alter their practice, especially in relation to their use of technology during the COVID-19 pandemic, because of limited options to conduct in-person therapy due to social distancing measures. Further, the findings aim to clarify music therapists’ perspectives on the benefits and limitations of technology in MT, as well as online MT. In addition, this survey investigated what changes have been necessary to administer MT during COVID-19, in terms of virtual therapy and online tools, and how the changes made now may affect MT in the future. We also explored music therapists’ views on whether special technology-focused training might be helpful to support the practice of MT in the future. This is the first survey, to our knowledge, to break down opinions of and trends in technology use based on geographical region (North America, Europe, and Asia), and several noteworthy differences were apparent across regions. We hope our findings provide useful information, guidance, and a global reference point for music therapists on effectively continuing the practice of MT during times of crisis, and can encourage reflection and improvement in administering MT.

Virtual Therapeutic Garden: A Promising Method Supporting the Treatment of Depressive Symptoms in Late-Life: A Randomized Pilot Study

The multifactorial genesis of old-age depression requires multi-professional therapy combining physical activity and psychosocial interventions; however, there is still a percentage of older people who do not exhibit satisfactory improvements. The aim of this study was to evaluate the effectiveness of virtual therapy in the elderly for whom the previous multimodal, biopsychosocial therapeutic programme had not brought the expected results. Twenty-five elderly women with depressive symptoms were randomly divided into a virtual reality group (VR, n = 13) and a control group (Control, n = 12). The average age was 70.73 and the average intensity of depression symptoms amounted to 12.26 in the Geriatric Depression Scale (GDS-30). As a virtual reality source, the VRTierOne (Stolgraf®) device was used. The therapeutic cycle consisted of eight virtual therapy sessions, twice a week for four weeks. As primary and secondary outcome measures, the GDS-30 was performed at three time points. In the VR group, the GDS-30 score was reduced by 36%, and the result persisted in the follow-up tests. Immersive virtual therapy significantly lowered the intensity of depressive symptoms, as well as stress and anxiety levels in older women taking part in the group-based multimodal therapeutic programme, whose earlier therapy had not brought the expected results.

A Nonprofit's Transition to Teletherapy Due to the COVID-19 Crisis: Learning How to Adapt

Due to the state of the COVID-19 in Florida, a community-based agency serving children and families had to transition abruptly to teletherapy. This agency adapted to pandemic-related challenges by transitioning from in-person to virtual therapy, which played a key role in safely serving community members. This article explores the unique benefits and difficulties of the transition to teletherapy under those circumstances. The agency clinical staff utilized their brief therapy skills and strengths-oriented perspective to aid in this abrupt transition, as illustrated by a case study. Ultimately, the agency's transition was a successful one as evidenced by a survey of both agency clinicians and clients, and by uninterrupted services at the same volume of cases and level of care. Suggestions are made for other providers seeking to cope with similar transitions.