Long+Annotations

Opriş, David, Sebastian Pintea, Azucena García-Palacios, Cristina Botella, Ştefan Szamosközi, and Daniel David. “Virtual Reality Exposure Therapy in Anxiety Disorders: A Quantitative Meta-Analysis.” //Depression and Anxiety// 29, no. 2 (February 1, 2012): 85–93. doi:10.1002/da.20910.

“Virtual reality exposure therapy (VRET) is a new tool for conducting exposure therapy with the help of a computer-generated virtual environment, allowing for the systematic exposure to the feared stimuli within a contextually relevant setting. It is important to point out that the generalization of the VRET’s results to the patient’s real life is the ultimate measure for the success of this treatment form.”
 * 1) 1. Question 1

“Until now, for the anxiety disorders, there has been no meta-analysis in which the treatments combining a virtual reality exposure component with classical evidence-based interventions (e.g. cognitive-behavioral therapy and virtual reality, or behavioral therapy and virtual reality) were directly compared with the classical evidence-based interventions… The present study will also address whether VRET shows a dose—response relationship.”

“Our results show that, in the case of anxiety disorders, (1) VRET does far better than the waitlist control; (2) the post-treatment results show similar efficacy between the behavioral and the cognitive-behavioral interventions incorporating a virtual reality exposure component and the classical evidence-based interventions, with no virtual reality exposure component; (3) VRET has a powerful real-life impact, similar to that of the classical evidence-based treatments; (4) VRET has a good stability of results in time, similar to that of the classical evidence-based treatments; (5) there is a dose-response relationship for VRET; and (6) there is no difference in the dropout rate between the virtual reality exposure and the in vivo exposure.”


 * 1) 2. The purpose of this paper is to study the efficacy of VRET interventions/treatments in anxiety disorders. Really, however, the authors of this paper were more interested in how well treatments that incorporated a VR exposure component did compared to classic treatments—that is to say in this case VRET means behavioral therapy augmented by VR exposure, or cognitive-behavioral therapy augmented by virtual reality exposure.
 * 2) 3. 1) testing and comparing VRET and in vivo dropout rates in traditional interventions 2) efficacy of follow-up results 3) testing in various, specific disorders (fear of flying, panic disorder/agoraphobia, social phobia, arachnophobia, acrophobia, and PTSD) 3)measure of VRET vs waitlist control at post-treatment 4) dose-response relationship
 * 3) 4. One literature it expounds upon is Cohen’s “Statistical Power Analysis for Behavioral Sciences,” in which there are constants determined for measuring effects of behavioral treatments.
 * 4) 5. One challenge to my own work is that this suggests that it isn’t the bottom line, better option than traditional experiments; rather it is an excellent alternative to in vivo given the nature of the context of the phobia. It offers the same to slightly better long lasting effects after.
 * 5) 6. VR exposure can be very useful for PTSD treatment. In this study, they draw on the literature of Foa and Kozak’s emotional processing as being a mechanism of change. The authors state a fear structure which has to be activated, fear structure meaning fear based thoughts/behavior located in the patient’s memory. After the fear memory is activated, new information can be incorporated into this memory bank, which means a new behavioral set can be learned in order to deal with it. There are some types of PTSD patients who cannot access these memories, and VR can help them recall the traumatic memories and help facilitate the process of change through providing a similar context in which the event took place. In vivo exposure is not possible for patients who have gone through, for example, the September 11 attacks, or have served in Iraq.

With in vivo, there are high dropout rates because patients may consider the exposure to be too dangerous. VR could help the chance of a patient to be willing to start and complete an exposure treatment.

Cesa, Gian Luca, Gian Mauro Manzoni, Monica Bacchetta, Gianluca Castelnuovo, Sara Conti, Andrea Gaggioli, Fabrizia Mantovani, Enrico Molinari, Georgina Cárdenas-López, and Giuseppe Riva. “Virtual Reality for Enhancing the Cognitive Behavioral Treatment of Obesity With Binge Eating Disorder: Randomized Controlled Study With One-Year Follow-Up.” //Journal of Medical Internet Research// 15, no. 6 (June 12, 2013). doi:10.2196/jmir.2441.

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 * 1) 1. For the virtual reality sessions, NeuroVR open-source software was used [ [|25] - [|27] ]. NeuroVR includes 14 virtual environments used by the therapist during a 60-minute session with the patient (see Figure 2 ). The environments present critical situations related to the maintaining/relapse mechanisms (Home, Supermarket, Pub, Restaurant, Swimming Pool, Beach, Gymnasium) and two body image comparison areas. Through the VR experience, patients practiced both eating/emotional/relational management and general decision-making and problem-solving skills. By directly practicing these skills within the VR environment, patients were helped in developing specific strategies for avoiding and/or coping with triggering situations. [[image:http://figuringoutmethods.wikispaces.com/site/embedthumbnail/placeholder?w=624&h=330 width="624" height="330" caption="An external file that holds a picture, illustration, etc.
 * 1) 2. The integration of a VR-based treatment aimed at unlocking the negative memory of the body and at modifying its behavioral and emotional correlates, can improve the long-term outcome of a treatment for obese eating disorders. VRT was better at preventing weight regain, but not to better manage binge eating episodes.
 * 2) 3. In the VR CBT sessions expectations and emotions related to food and weight, strategies used to cope with difficult interpersonal and potential maintenance situations, and body experience of the subject.
 * 3) a. Expectations and Emotions Related to Food and Weight (Functional Analysis)—The therapist helped patience recognize why they eat and what they need to either avoid or cope with the specific emotional/behavioral triggers. Achieved by cog-behavioral methods such as countering, alternative interpretation, label shifting, and deactivating the illness belief.
 * 4) b. Strategies Used to Cope With Difficult Interpersonal and Potential Maintenance Situations—The patient practiced old behaviors and new ones. This was achieved both by using the Temptation Exposure with Response Prevention [ [|28], [|29] ] (skills training) and by working on these three empowering dimensions [ [|30] ]: perceived control, perceived competence, and goal internalization (fostering the motivation//).//
 * 5) c. Body Experience of the Subject—Virtual environment used in the same way as guided imagery is used in the cognitive and visual/motorial approach
 * 6) 4. Mostly on the fields of CBT, VR, and BED. It achieves nearly the same goal as the previous article, but in this specific vein. The data suggests that individuals with obesity might be locked to an allocentric negative memory of the body that is no longer updated but contrasting egocentric representations driven by perception. In this way, they include a VR technology aimed at unlocking the negative memory and modifying its behavioral side effects.
 * 7) a. Quote: In this study, we tested a modified CBT approach that included a VR-based treatment to target this issue. VR can be considered an “embodied technology” for its effects on body perceptions [48]. On one side, different authors showed that is possible to use VR both to induce illusory perceptions, eg, a fake limb [49], by altering the normal association between touch and its visual correlate. It is even possible to generate a body transfer illusion [50]: Slater and colleagues substituted the experience of male subjects’ own bodies with a life-sized virtual human female body. On the other side, it is also possible to use VR to improve body image [51,52], even in patients with eating disorders [23,53,54] or obesity [55,56]
 * 8) 5. This was a much better look at how VR is actually used with therapists. Was able to see a typical VE/VRT design and how it might be used.

Cognitive-behavioral Therapy and VR: The Body and VR

Murray, Craig D., and Judith Sixsmith. “The Corporeal Body in Virtual Reality.” //Ethos// 27, no. 3 (1999): 315–43.


 * Question 1: Three quotes that capture the critical import? **


 * However, not just our bodies are transported, but also our history and **
 * our social and cultural context. In terms of VR, there is clear evidence that **
 * people bring their everyday, real-world understandings and social experiences **
 * to new virtual encounters. For instance, a recent study (Murray, **
 * Bowers et al., in press) of how people navigate through a virtual cityscape, **
 * in which a computer allowed them to progress anywhere, found that they **
 * remained ground- and road-centered, avoiding obstacles such as buildings **
 * and trees. This indicates that people's experiences of VR are not purely **
 * cognitively oriented, but embodied. In real life, of course, one cannot **
 * travel through buildings and other objects. It is possible in cyberspace, but **
 * study participants rarely took advantage of this possibility. Thus, to walk **
 * along roads in cyberspace is to remain within the same embodied sociocultural **
 * patterns that exist in the real world. ( 7) **
 * We can extend this argument further by considering the gendered and **
 * ethnocentric nature of VR applications. Feminist cultural critics have written **
 * about the ways in which the body of white, Western males are inscribed **
 * upon and within the technological apparatus and narratives of **
 * virtual environments (Balsamo 1993, 1995; Franck 1995; Hayles 1994, **
 * 1996, 1997; Stone 1992). We argue here that VR is a cultural and gendered **
 * space, and because of this, the potential of the embodied sensory experience **
 * within it is prescribed by the confines of the predominantly white, **
 * Western, male world. If VR worlds had developed outside of the white, **
 * Western male model, which is predominantly visually based, they might **
 * have been configured very differently. For instance, one VR development **
 * that reflects a feminist understanding of the body is that of Char Davies. **
 * Her Osmose system is a virtual reality organized around a breathing **
 * mechanism rather than hand-held peripherals. Moving within this environment **
 * (an oceanscape) involves using a variety of breathing techniques, **
 * and, as such, brings into play a different sensory experience (Davies 1995). **
 * Clearly, this VR application has very different implications for experiences **
 * of embodiment, which are instantiated through the tactile-kinesthetic body (see Sheets-Johnstone 1988), rather than the purely visual one. (321) **

Bohil, Corey J., Bradly Alicea, and Frank A. Biocca. “Virtual Reality in Neuroscience Research and Therapy.” //Nature Reviews Neuroscience// 12, no. 12 (December 2011): 752–62. doi:10.1038/nrn3122.

Abstract | Virtual reality (VR) environments are increasingly being used by neuroscientists to simulate natural events and social interactions. VR creates interactive, multimodal sensory stimuli that offer unique advantages over other approaches to neuroscientific research and applications. VR’s compatibility with imaging technologies such as functional MRI allows researchers to present multimodal stimuli with a high degree of ecological validity and control while recording changes in brain activity. Therapists, too, stand to gain from progress in VR technology, which provides a high degree of control over the therapeutic experience. Here we review the latest advances in VR technology and its applications in neuroscience research.
 * 1) 1. “Why use VR? The use of VR in neuroscience research offers several unique advantages. First, and perhaps most importantly, VR allows naturalistic interactive behaviors to take place while brain activity is monitored via imaging or direct recording. This allows researxhers to address many questions in a controlled environment **__that would simply not be possible by studying performance ‘in the wild’.”__** Second, VR environments allow researchers to manipulate multimodal stimulus inputs, so the user’s sensorimotor illusion of being ‘present’ in the represented environment is maximized.”