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 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.

Imagery Rescripting Versus Extinction: Distinct and Combined Effects on Expectancy and Revaluation Learning

Anxiety disorders are effectively treated with exposure therapy, but relapse remains high. Fear may reinstate after reoccurrence of the negative event because the expectancy of the aversive outcome (unconditioned stimulus [US]) is adjusted but not its evaluation. Imagery rescripting (ImRs) is an intervention that is proposed to work through revaluation of the US. The aim of our preregistered study was to test the effects of ImRs and extinction on US expectancy and US revaluation. Day 1 ( n = 106) consisted of acquisition with an aversive film clip as US. The manipulation (ImRs + extinction, extinction-only, or ImRs-only) took place on Day 2. Reinstatement of fear was tested on Day 3. Results showed expectancy learning in both extinction conditions but not in the ImRs-only condition and no enhanced revaluation learning in ImRs. The combination of ImRs and extinction slowed down extinction but did not protect against reinstatement, which pleads in favor of stand-alone interventions in clinical practice.

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.

Effects of acute stress on exposure therapy outcome and generalization in woman: considering the modulatory role of hormonal contraceptive use

The administration of glucocorticoids (GC) as an adjunct to exposure might represent a promising strategy to improve exposure therapy outcome in anxiety disorders (AD). The beneficial effects, however, might be sex-dependent and/or further modulated by hormonal factors (e.g., contraceptive usage in women). In the present study, we investigated whether acute stress before exposure therapy affects its efficacy in women using oral contraceptives (OC) relative to free-cycling (FC) women. In addition, possible effects of stress on generalization of therapy effects towards untreated stimuli were examined. Women with fears of spiders and cockroaches were randomly assigned to a stress (n=24) or no-stress (n=24) group prior to a standardized one-session exposure. Acute stress did not influence exposure-induced reduction in fear and avoidance of the treated stimuli (spiders). However, stress led to a less pronounced beneficial exposure outcome for treated stimuli in OC women relative to FC women. This effect occurred on the level of subjective fear and self-report questionnaires at post-treatment (24 hours after exposure) and follow-up (4 weeks after exposure). No effects of stress on generalization of therapy effects towards untreated stimuli (cockroaches) were found. Our findings suggest that OC usage diminishes the beneficial effects of stress on exposure therapy outcome seen in FC women. We present first clinical findings regarding the interaction of stress (and possibly GCs) and OC in exposure therapy of AD. OC intake in women constitutes a crucial factor to be considered in augmentation studies using stress and GCs.

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.