Virtual reality exposure in anxiety disorders: Impact on psychophysiological reactivity

Diemer, Julia; Mühlberger, Andreas; Pauli, Paul; Zwanzger, Peter

doi:10.3109/15622975.2014.892632

Cited by 105 publications

(66 citation statements)

References 61 publications

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“…Among others, Moore et al (2002) showed significant changes in heart rate and electrical conductance following immersion in a potentially anxiogenic environment (e.g., elevator, grocery store with avatars) in a sample of non-phobic individuals. Similarly, Diemer et al (2014) documented major and significant changes in heart rate and other psychophysiological parameters when phobic and nonphobic participants were immersed in VR. In short, these results are congruent with ours and confirm that a virtual environment is capable of inducing an anxiety response in people suffering from anxiety disorders and OCD.…”

Section: Discussionmentioning

confidence: 80%

Inducing an Anxiety Response Using a Contaminated Virtual Environment: Validation of a Therapeutic Tool for Obsessive–Compulsive Disorder

et al. 2016

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Obsessive-compulsive disorder (OCD) is characterized by the presence of unwanted and repetitive thoughts triggering significant anxiety, as well as the presence of ritual behaviors or mental acts carried out in response to obsessions to reduce the associated distress. In the contamination subtype, individuals are scared of germs and bacteria, are excessively concerned with cleaning, fear contamination and the spread of disease, and may have a very strong aversion to bodily secretions. A few studies on virtual reality (VR) have been conducted with people suffering from OCD, but they all focus on the subtype characterized by checking rituals. The goal of this study is to confirm the potential of a "contaminated" virtual environment in inducing anxiety in 12 adults suffering from contamination-subtype OCD compar ed to 20 adults without OCD (N = 32) using a within-between protocol. Subjective (questionnaire) and objective (heart rate) measurements were compiled. Participants were immersed in a control virtual environment (empty and clean room) and a "contaminated" virtual environment (filthy public restroom) designed for the treatment of OCD. Immersions were conducted in a 6-wall CAVE-like system. As hypothesized, the results of repeated-measures ANCOVAs revealed the significant impact of immersion in a filthy public restroom for participants suffering from OCD on both measures. Presence was correlated with anxiety in OCD participants and no difference in presence was observed between groups. Unwanted negative side effects induced by immersions in VR were higher in the OCD group. The clinical implications of the results and directions for further studies are discussed.

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Section: Discussionmentioning

confidence: 80%

Inducing an Anxiety Response Using a Contaminated Virtual Environment: Validation of a Therapeutic Tool for Obsessive–Compulsive Disorder

et al. 2016

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“…Virtual reality exposure (VRE) therapy is believed to foster engagement and elevate patient arousal (Robison-Andrew et al, 2014) through the inclusion of computer-generated simulations of trauma-related stimuli that span sensory modalities, including the ambient sights, sounds, smells, and tactile stimuli present during a traumatic event. In addition to its clinical impact, VR technology has also been used successfully to elicit robust fear reactions in patients with anxiety disorders (Diemer, Muhlberger, Pauli, & Zwanzger, 2014). …”

Section: Introductionmentioning

confidence: 99%

Baseline psychophysiological and cortisol reactivity as a predictor of PTSD treatment outcome in virtual reality exposure therapy

Norrholm

Jovanović

Gerardi

et al. 2016

Behaviour Research and Therapy

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Baseline cue-dependent physiological reactivity may serve as an objective measure of posttraumatic stress disorder (PTSD) symptoms. Additionally, prior animal model and psychological studies would suggest that subjects with greatest symptoms at baseline may have the greatest violation of expectancy to danger when undergoing exposure based psychotherapy; thus treatment approaches which enhanced the learning under these conditions would be optimal for those with maximal baseline cue-dependent reactivity. However methods to study this hypothesis objectively are lacking. Virtual reality (VR) methodologies have been successfully employed as an enhanced form of imaginal prolonged exposure therapy for the treatment of PTSD. Our goal was to examine the predictive nature of initial psychophysiological (e.g., startle, skin conductance, heart rate) and stress hormone responses (e.g., cortisol) during presentation of VR-based combat-related stimuli on PTSD treatment outcome. Combat veterans with PTSD underwent 6 weeks of VR exposure therapy combined with either D-cycloserine (DCS), alprazolam (ALP), or placebo (PBO). In the DCS group, startle response to VR scenes prior to initiation of treatment accounted for 76% of the variance in CAPS change scores, p < 0.001, in that higher responses predicted greater changes in symptom severity over time. Additionally, baseline cortisol reactivity was inversely associated with treatment response in the ALP group, p = 0.04. We propose that baseline cue-activated physiological measures will be sensitive to predicting patients’ level of response to exposure therapy, in particular in the presence of enhancement (e.g., DCS).

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“…VRET has been shown to be effective for FP treatment in several meta-analyses and systematic reviews [28–31]. Regarding computer-assisted exposure programs for FP, the literature shows only one system that has efficacy data.…”

Section: Introductionmentioning

confidence: 99%

An Internet-based treatment for flying phobia (NO-FEAR Airlines): study protocol for a randomized controlled trial

et al. 2016

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BackgroundFlying phobia (FP) is a common and disabling mental disorder. Although in vivo exposure is the treatment of choice, it is linked to a number of limitations in its implementation. Particularly important, is the limited access to the feared stimulus (i.e., plane). Moreover, the economic cost of in vivo exposure should be specially considered as well as the difficulty of applying the exposure technique in an appropriate way; controlling important variables such as the duration of the exposure or the number of sessions. ICTs could help to reduce these limitations. Computer-assisted treatments have remarkable advantages in treating FP. Furthermore, they can be delivered through the Internet, increasing their advantages and reaching more people in need. The Internet has been established as an effective way to treat a wide range of mental disorders. However, as far as we know, no controlled studies exist on FP treatment via the Internet. This study aims to evaluate the efficacy of an Internet-based treatment for FP (NO-FEAR Airlines) versus a waiting list control group. Secondary objectives will be to explore two ways of delivering NO-FEAR Airlines, with or without therapist guidance, and study the patients’ acceptance of the program. This paper presents the study protocol.Methods/designThe study is a randomized controlled trial. A minimum of 57 participants will be randomly assigned to three conditions: a) NO-FEAR Airlines totally self-applied, b) NO-FEAR Airlines with therapist guidance, or c) a waiting list control group (6 weeks). Primary outcomes measures will be the Fear of Flying Questionnaire-II and the Fear of Flying Scale. Secondary outcomes will be included to assess other relevant clinical measures, such as the Fear and Avoidance Scales, Clinician Severity Scale, and Patient’s Improvement scale. Analyses of post-treatment flights will be conducted. Treatment acceptance and preference measures will also be included. Intention-to-treat and per protocol analyses will be conducted.DiscussionAn Internet-based treatment for FP could have considerable advantages in managing in vivo exposure limitations, specifically in terms of access to treatment, acceptance, adherence, and the cost-effectiveness of the intervention. This is the first randomized controlled trial to study this issue.Trial registrationClinicaltrials.gov: NCT02298478. Trial registration date 3 November 2014.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-016-0996-1) contains supplementary material, which is available to authorized users.

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Virtual reality exposure in anxiety disorders: Impact on psychophysiological reactivity

Cited by 105 publications

References 61 publications

Inducing an Anxiety Response Using a Contaminated Virtual Environment: Validation of a Therapeutic Tool for Obsessive–Compulsive Disorder

Inducing an Anxiety Response Using a Contaminated Virtual Environment: Validation of a Therapeutic Tool for Obsessive–Compulsive Disorder

Baseline psychophysiological and cortisol reactivity as a predictor of PTSD treatment outcome in virtual reality exposure therapy

An Internet-based treatment for flying phobia (NO-FEAR Airlines): study protocol for a randomized controlled trial

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