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.

Effect of Transcranial Direct Current Stimulation Combined with Rehabilitation on Arm and Hand Function in Stroke Patients: A Systematic Review and Meta-Analysis

Transcranial direct current stimulation (tDCS) is a noninvasive brain stimulation technique that may enhance motor recovery after stroke. We performed a systematic review and meta-analysis to assess the efficacy of tDCS combined with rehabilitation on arm and hand function after stroke. Electronic databases were searched from their inception to September 2021. We performed a systematic review of selected randomized controlled trials, and methodological qualities were measured using the PEDro (Physiotherapy Evidence Database) scale. We calculated the standardized mean difference for effect size using the Comprehensive Meta-Analysis 3.0 software. We selected 28 studies for the systematic review and 20 studies for the meta-analysis. The overall effect size was 0.480 (95% CI [0.307; 0.653], p < 0.05), indicating a moderate effect size of tDCS combined with rehabilitation for upper extremity function in stroke survivors. The tDCS with occupational therapy/physical therapy (0.696; 95% CI [0.390; 1.003], p < 0.05) or virtual reality therapy (0.510; 95% CI [0.111; 0.909], p < 0.05) was also significantly more effective than other treatments. This meta-analysis of 20 randomized controlled trials provides further evidence that tDCS combined with rehabilitation, especially occupational therapy/physical therapy and virtual reality therapy, may benefit upper extremity function of the paretic upper limb in stroke patients.

Efficacy of group reality therapy versus desipramine pharmacotherapy in drug craving and relapse of methamphetamine-dependent patients in yazd

Aims: In this comparative study, we aimed to investigate the effectiveness of group reality therapy versus desipramine pharmacotherapy in reducing the craving and relapse of methamphetamine-dependent patients. Methods: This semi-experimental research was conducted using a control group and two experimental groups of reality therapy and desipramine pharmacotherapy. The statistical population of this study included all methamphetamine-dependent patients under methadone treatment who were referred to the health clinics of Yazd city, Iran. We selected 30 patients using convenience sampling and then categorized them randomly into three groups of reality therapy, desipramine pharmacotherapy, and control. In the pre-test stage, the risk questionnaire was administered to evaluate the stimulants. The first experimental group attended 10 reality therapy sessions once a weak and was assessed immediately after the treatment. The data were analyzed using the covariance analysis. Results: The findings showed no significant difference between the total mean score of the reality therapy and desipramine pharmacotherapy groups (F= 3.289, P= 0.087). Hence, these two interventions did not affect attenuating craving to use the drugs. To check the homogeneity presumptions of the covariance matrix and variances of the two groups, the Box (6.241) and Levine (0.250) tests were applied, respectively. The results about the experimental groups (Reality therapy and Desipramine group) compared to the control group were meaningful. Conclusion: There was no significant difference between reality therapy and desipramine pharmacotherapy groups in reducing the craving to use the drugs. The scope of changes showed that craving for drug consumption reduced in reality therapy (51.0) and desipramine pharmacotherapy (36.0) groups.

Virtual reality therapy to control burn pain: systematic review of randomized controlled trials

Background Virtual reality therapy has been shown to be an excellent alternative to non-pharmacological treatment for the control of burn pain. Objective To evaluate the effects of virtual reality therapy on pain control in people who have suffered burns published in the scientific literature. Method Systematic review carried out as recommended by Cochrane®. The search was carried out in the Embase, PubMed, Lilacs and Cochrane Library databases, in the period from March 2021. Randomized clinical trials were included without language restriction and year of publication. The risk of bias was assessed using the Cochrane® tool. Results Of the 3755 articles found, only 17 articles were selected for reading in full. Of these, only four articles met the inclusion criteria. The results of the studies showed that the use of virtual reality therapy reduced the intensity of pain in children and adolescents with burns, despite the fact that most results are not statistically significant. No selected study had a high risk of bias. Conclusions Virtual reality therapy has been shown to be effective in controlling pain, reducing the time spent thinking about it and greater distraction during the procedures. However, most randomized clinical trials results were not statistically significant in at least one of the moments when pain was assessed. It is noteworthy that randomized clinical trials are still necessary to administer virtual reality therapy, especially in adults.

Recovering arm function in chronic stroke patients using combined anodal HD-tDCS and virtual reality therapy (ReArm): a study protocol for a randomized controlled trial

Background After a stroke, 80% of the chronic patients have difficulties to use their paretic upper limb (UL) in activities of daily life (ADL) even after rehabilitation. Virtual reality therapy (VRT) and anodal transcranial direct current stimulation (tDCS) are two innovative methods that have shown independently to positively impact functional recovery of the paretic UL when combined with conventional therapy. The objective of the project will be to evaluate the impact of adding anodal high-definition (HD)-tDCS during an intensive 3-week UL VRT and conventional therapy program on paretic UL function in chronic stroke. Methods The ReArm project is a quadruple-blinded, randomized, sham-controlled, bi-centre, two-arm parallel, and interventional study design. Fifty-eight chronic (> 3 months) stroke patients will be recruited from the Montpellier and Nimes University Hospitals. Patients will follow a standard 3-week in-patient rehabilitation program, which includes 13 days of VRT (Armeo Spring, 1 × 30 min session/day) and conventional therapy (3 × 30 min sessions/day). Twenty-nine patients will receive real stimulation (4x1 anodal HD-tDCS montage, 2 mA, 20 min) to the ipsilesional primary motor cortex during the VRT session and the other 29 patients will receive active sham stimulation (2 mA, 30 s). All outcome measures will be assessed at baseline, at the end of rehabilitation and again 3 months later. The primary outcome measure will be the wolf motor function test. Secondary outcomes will include measures of UL function (Box and Block Test), impairment (Fugl Meyer Upper Extremity), compensation (Proximal Arm Non-Use), ADL (Actimetry, Barthel Index). Other/exploratory outcomes will include pain, fatigue, effort and performance, kinematics, and motor cortical region activation during functional motor tasks. Discussion This will be the first trial to determine the impact of adding HD-tDCS during UL VRT and conventional therapy in chronic stroke patients. We hypothesize that improvements in UL function will be greater and longer-lasting with real stimulation than in those receiving sham. Trial registration The ReArm project was approved by The French Research Ethics Committee, (Comité de Protection des Personnes-CPP SUD-EST II, N°ID-RCB: 2019-A00506-51, http://www.cppsudest2.fr/). The ReArm project was registered on ClinicalTrials.gov (NCT04291573, 2nd March 2020.

A Comparative Study of the Effect of Group Reality Therapy Training and Group Cognitive-Behavioral Training on Empathy and Self-Control and Marital Satisfaction of Women with Marital Conflict

Aim: The aim of this study was to compare the effect of reality therapy and cognitive-behavioral training on empathy and self-control of women with marital conflicts. Methods: The design of the present study was a quasi-experimental with pre/post-test and follow-up, and included a control group. The statistical population of the study included all women with conflict with their husbands who referred to counseling centers in 7th district of Tehran in 2020. Among them, 60 people were selected by purposeful sampling method and randomly divided into two experimental groups and a control group (twenty individuals in each group). Initially, all three groups underwent a pre-test, followed by 8 sessions of reality therapy for the first experimental group (Glasser, 2012) and 8 sessions of cognitive-behavioral training (Free, 1999) for the second experimental group. At the end, post-test was performed for all three groups and after three months, a follow-up test was performed to confirm the results. Data collection tools included the Sanai and Barati Marital Conflict Questionnaire, the Julif and Farrington Empathy Questionnaire, and the self-control Questionnaire of Tanji et al. Findings: The results of multivariate analysis of covariance showed that both reality group therapy and cognitive-behavioral training had a significant effect on empathy and self-control of women with marital conflict (P<0.01). cognitive-behavioral training has been more effective on self-control than reality group therapy. However, reality group therapy has been more effective on empathy than cognitive-behavioral training. Conclusion: Due to the effectiveness of both methods on research variables, the use of these trainings by psychologists and counselors in the psychological education program for people with marital conflict is recommended. Also, due to the greater impact of each training on one variable, it is suggested that paired training programs be adjusted based on these findings.