Virtual Reality Exposure Therapy and Physiological Data Analysis for Treatment of Stress Disorders

Anxiety disorders are diagnosed when people become overreactive, disassociated, and feel emotionally unable to control feelings to the extent that their daily lifes are affected. Driving phobia is one of the widespread anxiety disorders in modern society, which cause problematic disruptions of a patient's daily activities. Exposure therapy is an approach gaining popularity for treating patients with stress disorders. Virtual reality (VR) technology allows people to interact with objects and stimuli in an immersive way. The VR for phobic therapy using indirect exposure, which can be safely discontinued or lowed in terms of intensity, is the area of research with literature published and patents granted. This research focuses on reviewing virtual reality exposure therapy (VRET) literature and patents. The chapter also presents the research and development of a novel driving phobia VRET system with the detailed experiments to demonstrate the design, development, implementation, enhancement, and verification of VRET.

Virtual Reality Exposure Therapy for Armed Forces Veterans with Post-Traumatic Stress Disorder: A Systematic Review and Focus Group

Virtual reality exposure therapy (VRET) is an emerging treatment for people diagnosed with Post-Traumatic Stress Disorder (PTSD) due to the limited accessibility of psychotherapies. This research aims to determine the guidelines for developing a Virtual Reality–War Scenario program for Armed Forces veterans with PTSD and encompasses two studies: Study 1, a systematic electronic database review; Study 2, a focus group of twenty-two Portuguese Armed Forces veterans. Results showed a positive impact of VRET on PTSD; however, there were no group differences in most of the studies. Further, according to veterans, new VRET programs should be combined with the traditional therapy and must consider as requirements the sense of presence, dynamic scenarios, realistic feeling, and multisensorial experience. Regardless, these findings suggest VRET as a co-creation process, which requires more controlled, personalized, and in-depth research on its clinical applicability.

Virtual Reality Exposure Therapy for treating social anxiety in stuttering: A scoping review

Virtual Reality Exposure Therapy (VRET) has been shown to be an effective technique for reducing social anxiety. People who stutter are at greater risk of developing heightened social anxiety. Cognitive behavior therapy protocols have shown promise in reducing social anxiety in people who stutter, but no studies have investigated VRET targeting social anxiety associated with stuttering. The aim of the current review is to provide an overview of VRET techniques used to treat social anxiety and insights into how VRET might be adopted in the case of comorbid stuttering and social anxiety. Twelve studies were reviewed to understand key distinctions in VRET protocols used to treat social anxiety. Distinctions include exercises targeting public speaking vs. general social anxiety, computer-generated virtual environments vs. 360 video, and therapist guided vs. automated VRET. An overview of wider research questions surrounding VRET is then presented to aid the understanding of treatment success and outline important directions for future research. Based on the review findings, suggestions are made regarding VRET design for stuttering. In sum, VRET should be tailored to situations and cognitive-behavioral processes that underlie the experience of social anxiety amongst people who stutter, with automated VRET using a virtual therapist a potentially suitable format for delivering treatment.

The Simulation Game—Virtual Reality Therapy for the Treatment of Social Anxiety Disorder: A Systematic Review

(1) Background: With the term Virtual reality (VR) we refer to a three-dimensional environment generated by the computer, in which subjects interact with the environment as if they were really inside it. The most used VR tools are the so-called HMD (head-mounted display) which make it possible to achieve what theorists define “direct mediated action”. The aim of our systematic review is specifically to investigate the applications of virtual reality therapy for the treatment of social anxiety disorder, also known as social phobia. The most common treatment for social anxiety disorder is represented by “in vivo exposure therapy” (iVET). This method consists of exposing the participant, in a gradual and controlled way, to anxious stimuli, with the goal to change the subject’s response to the object or situation that is causing the fear. However, the main flaw of “in Vivo therapies” is represented by both the huge costs involved and the possible disturbance variables that can hinder the execution of the therapeutic treatment. Virtual reality exposure therapy could therefore, if confirmed in its effectiveness, constitute a solution to eliminate these two defects demonstrated by “in vivo exposure therapy”. The goal is to use VR as a means for the clinician to build a tailor-made path for the participant in order to make him acquire “in virtual” those skills necessary for a good adaptation in the “real” world. (2) Methods: From February 2021 until the date of submission of the article (September 2021), we conducted a systematic review aiming to verify the effectiveness of virtual reality exposure therapy (VRET) for the treatment of SAD. (3) Results: We identified a total of 205 unique articles. Among these, 20 full-text articles were assessed for eligibility and 5 of these met the eligibility criteria and were, therefore, included in the final systematic review. (4) Conclusions: Virtual reality therapies proved to be a valid alternative to the acquisition of social skills suitable for improving the symptoms of SAD. Although there has not been a significant difference between VRET and iVET, the low costs and flexibility of VRET open up new scenarios for achieving greater psychophysical well-being.

Feasibility trial of virtual reality exposure therapy for selective mutism

Virtual reality exposure therapy (VRET) has been commonly utilised as an extension of cognitive behavioural therapy (CBT). However, most studies examined its effectiveness among adults, with no study focusing on children with selective mutism (SM). We aimed to examine its feasibility and acceptability among children with SM. Twenty children aged 6–12 with SM diagnosis were recruited and completed six therapist-guided VRET sessions. Parents and clinicians completed measures at pre-VRET, post-VRET, 1-month and 3-month follow-up visits. At post-VRET, parent and child participants completed the acceptability questionnaires. Findings suggested the feasibility of VRET as all participants completed the programme with no attrition. Parents and child participants also reported VRET to be an acceptable and effective treatment for SM. Significant improvement in overall functioning were found at post-treatment and follow-up measures, but there were no significant changes in parent-rated speech frequency and anxiety measures. These support the acceptability of VRET as an adjunct modality (and not substitute) of CBT in SM treatment. Future studies, with more robust experimental designs and larger sample sizes, can be conducted to confirm its efficacy. As technology becomes more sophisticated, tools such as virtual environments can be explored to enhance evidence-based care for children and their families.

Efficacy of Virtual Reality Exposure Therapy for Post-Traumatic Stress Disorder: A Systematic Review

Background: Post-traumatic stress disorder (PTSD) develops as a result of directly experiencing, witnessing, or being repeatedly exposed to aversive details of, a potentially traumatic event such as death, combat, sexual assault, or serious injury. It involves a persistent feeling of fear that results from inadequate consolidation of trauma memory. PTSD negatively impacts patients' daily lives and is associated with a higher risk of death. The downside of trauma-focused imaginal exposure therapy is the inability of patients to recall the underlying traumatic event and its effects. The development of modern technology has made it possible to overcome the downside. Virtual reality exposure therapy (VRET) is now available for alternative choice of PTSD therapy. VRET is allowing to create traumatic stimuli that are more controlled and realistic. VRET supports wider methodologies in clinical studies because it supports standardization duration and type of exposure for all patients. This study aimed to verify the efficacy of Virtual Reality Exposure Therapy (VRET) for Post-Traumatic Stress Disorder (PTSD).Methods: The search strategy was conducted through PubMed, LinkSpringer, and LIVIVO. About 71 articles were retrieved using ‘post-traumatic stress disorder’ and ‘virtual reality exposure’ keywords. Further, screening was carried out and resulted in 8 articles. In the end, four articles were included. To be eligible, the articles should be randomized controlled trial articles, published from 2011-2121, and published in English.Results: Four RCTs included in this study reported that VRET has a significant effect in reducing CAPS and PTSD symptoms. One study also reported that VRET could help with depressive symptoms and reduce autonomic symptoms such as heart rate as a response to trauma cues. Conclusions: VRET has an obvious and significant impact on alleviating PTSD symptoms, even though if there were a more standardized protocol or more diverse RCT the effect and use of VRET could be even more promising thus making VRET has more ground to be applied to the general population.

Effects of Virtual Reality Exposure Therapy on Dentophobia in Clients of Dental Offices in Isfahan, Tehran, and Shahrekord (Iran)

Background: Dentophobia can reduce the number of regular visits to dentists and endanger the oral health of people. New technologies such as virtual reality (VR) can be used in the treatment of psychological problems such as dentophobia. Objectives: The present study aimed to investigate the effectiveness of virtual reality exposure therapy (VRET) on dentophobia in clients of dental offices in the cities of Isfahan, Tehran, and Shahrekord in 2020. Methods: The research method was quasi-experimental with a pre-test, post-test, and follow-up design and a control group. The statistical population of this study consisted of all clients with dentophobia visiting private dental clinics of Isfahan, Tehran, and Shahrekord in 2020. Thirty clients with dentophobia who were willing to participate in the research were selected as the sample using convenience sampling and randomly divided into experimental and control groups (n = 15 per group). The experimental group underwent eight sessions (15-minutes sessions per week) of virtual reality exposure therapy, while the control group received no intervention. The follow-up was performed after 45 days. The research instruments included the Modified Dental Anxiety Scale (MDAS), Samsung Gear 360 (2017 Edition), and HTC VIVE Pro Virtual Reality Headset. Data were analyzed using repeated-measures ANOVA. Results: The results showed that virtual reality exposure therapy effectively decreased dentophobia in clients of dental offices in the experimental group (P = 0.0001). Conclusions: According to research findings, virtual reality exposure therapy was an efficient therapy for improving dentophobia and reducing phobia symptoms in clients of dental offices.