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Virtual Reality Exposure Therapy in the Treatment of Fear of Flying
Abstract
A new and innovative approach to treating fear of flying has been developed using Virtual Reality Exposure Therapy. This article discusses the development of Virtual Reality Exposure Therapy and reviews a case study of a fear of flying patient seen in our practice. Early results are very promising and may indicate that Virtual Reality Exposure Therapy may also lead to creative interventions with other anxiety disorders.
... Kaplan (2000) studied 40 individuals with aerophobia using virtual reality for treatment and reported that 31 individuals managed to attenuate the phobia. These results are consistent with studies by Richard Veklin (2000) on aerophobia of a female teacher at the age of 47. Virtual reality was considerably effective on attenuating subject's phobia [42]. Helen et al. (2007) studied 4 subjects and reported attenuation of aerophobia of the subject using virtual reality [43]. ...
... The patients are let to encounter their fears with no need to visualize phobic situations. Several senses of the patients are motivated, so that there is no need for mental visualizations [42]. ...
... Despite short academic history of virtual reality, it is one of the effective techniques to treat aerophobia. Still the short history indicates demands for more studies on the technique [42,43]. Beckham et al. [48] examined a researcher-design checklist including stress-inoculation training using control group settings. ...
Nowadays, due to the advances of many industries people tend to travel much more in compared to the past. Without any doubt, various types of climates and weathers, vemacular diseases, changes in life style and qualitative and quantitative changes of nutrition are all the factors of which many diseases occur during trips. Travel associated anxieties and fears are common. It has been suggested that enjoyment of travel depends upon a predisposition to cope well with a variety of physical and psychological stresses. In this study we have aimed to survey the cognitive and psychological factors effecting the passengers as they travel.
Keywords: Anxiety, Travel, Psychological, Stress
... The participant flew after the treatment and stated low anxiety during the real flight 13. Klein (2000) 1 ( Non-significant differences were observed among using or not motion simulations VRET with CT is more effective than CT at 6-month followup (Continued) The Cognitive Behaviour Therapist VRET treatment, and systematic desensitisation, were not always found (6,14,16,23,25,26,27,28). Three studies (11,15,16) considered different criteria to include participants in the experiment, so participants were presenting other phobias or anxiety disorders. ...
... Therefore, there is missing information in some of the reviewed studies (e.g. the characteristics of the sample or the hardware employed during the VRET) that could be important regarding the conclusions of this review. For instance, in Klein (2000), no evidence confirms the presence of a phobia diagnosis despite the presence of phobic symptoms. None of the articles described how the sample size was calculated and, in most of the reviewed studies is small, which leads to a reduction of statistical power and complicates the generalisation of the results found. ...
Previous research has shown that virtual reality (VR)-based exposure therapy is effective in the treatment of anxiety disorders. However, more information regarding the specific features of this intervention for the treatment of fear of flying (FoF) is needed. The primary aim of this systematic review was to update and analyse the existing data on the efficacy of VR exposure treatment (VRET) in FoF, providing information on the optimal methodological conditions for its administration. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method was employed to select the articles. PsycInfo, Medline and Web of Science were chosen as databases with a wide range of publications related to health and psychology. Thirty-three eligible articles were included in this review. Results showed that participants' anxiety decreased after being systematically exposed to flight-related VR environments. VRET is at least as effective as other evidence-based treatments, such as cognitive behavioural therapy (CBT) or in vivo exposure therapy (IVET), and therefore is a highly recommended alternative when IVET is difficult to administer, and an excellent complement to enhance CBT efficacy. Regarding sensory cues, the addition of motion feedback synchronised with visual and auditory cues during the exposure to VR environments might improve the efficacy of VRET for FoF, but more research supporting this statement is still needed.
... Rothbaum et al. (1996) was among the first researchers who employed virtual reality exposure therapy (VRET) for treating phobias. This intervention has proved effective in treating acrophobia (fear of heights) and claustrophobia (fear of confined places) (Klein, 2000;Rothbaum et al., 1995Rothbaum et al., , 1996. The VRET offers a higher sensation of presence and immersion than actual or imagined exposure and also makes it simpler to create virtual settings that are relevant to the targeted phobia. ...
... Some researchers argue that VR can explore impossible and dangerous events (Akkan et al., 2022;Levy et al., 2016). VR can also allow individuals to trust their emotional experiences and compare the important aspects of their experiences in relation to the main themes of emotions (Klein, 2000). In other words, the main features of VR, i.e., attractive environment, lack of fear of failure, lack of fear of disabilities, and imagination and observation of movements, can motivate and encourage individuals, improve their self-confidence, and increase their control over different situations. ...
Dentophobia can reduce visits to dental offices and, thereby endangering the oral health of individuals. The present study aimed to investigate the effects of virtual reality exposure therapy (VRET) on state-trait anxiety in individuals with dentophobia. This quasi-experimental research adopted a pretest-posttest control group design with a 45-day follow-up period. The statistical population included all individuals with dentophobia who visited dental offices in Isfahan, Tehran, and Shahrekord, Iran within 2020–21. The convenience sampling method was employed to select 40 participants as the research sample with respect to the inclusion and exclusion criteria. They were then randomly assigned to the experimental group and the control group equally (i.e., 20 participants per group). Participants in the experimental group attended eight 15-minute sessions of VRET, whereas those in the control group received no intervention. In fact, they were placed on a waiting list. To collect data, the state-trait anxiety inventory (STAI) was used. The multivariate analysis of covariance was used for data analysis. The results indicated the significant effect of the VRET on state-trait anxiety, as the posttest mean scores of state anxiety and trait anxiety decreased in the experimental group as opposed to the pretest scores (p < 0.01). Hence, the VRET can be considered an effective intervention in reducing state-trait anxiety in individuals with dentophobia.
... Junto con los resultados anteriores, la fobia a volar es la fobia específica en la que se han llevado a cabo más estudios sobre la eficacia de las técnicas de RV. Existen varios estudios acera de la eficacia de la RV en este problema (Baños, Botella, Perpiñá y Quero, 2001;Botella, Osma, García-Palacios, Quero y Baños, 2004;Klein, 1999;North, North y Coble, 1997;Rothbaum et al., 1995;Wiederhold, Gervitz y Wiederhold, 1998). De igual modo, y respecto a la fobia a las arañas, se han encontrado resultados que muestran la utilidad de las técnicas de RV. ...
... Además, la mayoría de los sistemas basados en PC, a pesar de que no tienen un alto coste y son fáciles de usar, aún sufren de una falta de flexibilidad como para permitir una individualización de los ambientes virtuales para cada paciente(Riva, 1997).En segundo lugar, está la falta de estandarización de los protocolos hace más difícil que puedan ser compartidos por distintos grupos. En las dos bases de datos clínicas, Medline y PsycInfo, existen bastantes trabajos centrados en eficacia y en resultados; pero únicamente hay publicados cinco protocolos clínicos, que corresponden al tratamiento de los TCA, miedo a volar(Klein, 1999;Rothbaum et al., 1999), miedo a hablar en público(Botella et al., 2000) y trastorno de pánico(Vincelli et al., 2001).En tercer lugar, está el importante coste que supone la organización y puesta en marcha de los ensayos clínicos de investigación. Tal y como se ha visto, la falta de sistemas inter-operables entre distintos grupos de investigación, añadido a la falta de protocolos clínicos, fuerza a que la mayoría de los investigadores inviertan mucho tiempo y dinero en el diseño y desarrollo de su propia aplicación de RV. ...
Virtual Reality (VR) is a new technology which consists in the generation of graphic environments which both produce in the users the feeling of being physically present in a virtual world and also allows them interaction in real time. At this moment a great expansion of this technology is taking place in several fields, including the area of health. Especially interesting for us is the use of VR as a therapeutic tool in the treatment of psychological disorders. The first case study that used virtual reality techniques was published in 1995. Since then, an increasing number of studies in the Clinical Psychology field centered on the therapeutic application of VR have been made, mainly on the treatment of anxiety disorders. There are already data on the effectiveness of these VR procedures for the treatment of different psychological disorders. This article reviews the different studies made in this field. Besides, the advantages and disadvantages of VR, and the future lines of work concerning this new technology are also analyzed.
... Other studies reported satisfying results, but mainly relied on subjective reports of anxiety (Botella, Osma, Garcia-Palacios, Quero & Banos, 2004;Botella et al., 1998;Carlin, Hoffman & Weghorst, 1997;Hoffman, Garcia-Palacios, Carlin & Botella-Arbona, 2003;Klein, 1998;Klein, 1999;North, North & Coble, 1997;Wiederhold, Gevirtz & Wiederhold, 1998) after treatment or during a test situation (e.g., a test flight for aviophobia). On the other hand, some studies relied principally on objective measures and reported a clinical and statistical difference after in virtuo exposure treatment (Botella, Villa, Banos, Perpiña & Garcia-Palacios, 1999;, which was maintained at follow-up. ...
... Phobia N Type of VR Acrophobia 7 Botella et al., 2004 Fear of flying 9 HMD Kahan et al., 2000 Fear of flying 31 HMD Klein, 1998 Fear of flying 1 HMD Klein, 1999 Fear of flying 3 HMD Klein, 2000 Fear of flying 1 HMD Maltby et al., 2002 Fear of flying 45 HMD Mühlberger et al., 2001 Fear of flying 30 HMD Mühlberger et al., 2003 Fear of flying 45 HMD North et al., 1997 Fear of flying 1 HMD Rothbaum et al., 1996 Fear of flying 1 HMD Rothbaum et al., 2000 Fear of flying 49 HMD Rothbaum et al., 2002 Fear of flying 24 HMD Rothbaum et al., (in press) Fear of flying 75 HMD Smith et al., 1999 Fear of flying 1 HMD Wiederhold et al., 1998 Fear of flying 1 HMD Fear of flying 30 HMD Fear of flying 30 HMD ...
... Several case studies have been reported, all of them providing results favoring the utility of VR therapy for the treatment of fear of flying (Baños et al. 2002;Hirsch 2012;Klein 1999;North et al. 1997;Rus-Calafell et al. 2013;Rothbaum et al. 1996;Wallach and Bar-Zvi 2007;). ...
... The second is the lack of standardized protocols that can be shared by the community of researchers. In the two clinical databases -Medline and PsycInfothere are only five published clinical protocols: for the treatment of eating disorders (Riva et al. 2001a, b), fear of flying (Klein 1999;Rothbaum et al. 1999), fear of public speaking (Botella et al. 2000), panic disorders (Vincelli et al. 2001a, b) and social phobia (Roy et al. 2003). ...
Presence inducing media have recently emerged as a potentially effective way to provide general and specialty mental health services, and they appear poised to enter mainstream clinical delivery. However, to ensure appropriate development and use of these technologies, clinicians must have a clear understanding of the opportunities and challenges they will provide to professional practice.
This chapter attempts to outline the current state of clinical research related to the use of presence-inducing technologies, virtual reality in particular. Through presence, virtual reality helps the patient both to confront his/her problems in a meaningful yet controlled and safe setting. Further, it opens the possibility of experiencing his/her life in another, more satisfactory, way. In fact, virtual reality therapists are using presence to provide meaningful experiences which are capable of inducing deep and permanent changes in their patients. Finally, the chapter discusses the possible evolution of presence-inducing media from virtual reality to augmented reality, to interreality.
... FOF sufferers are impeded in their ability to engage in air travel due to varying degrees of anxiety or stress. Around 20% of these passengers rely on alcohol or sedatives to help them deal with the anxiety and other symptoms caused by fear of flying [3] [4]. The frequency of diagnostic factors underlying fear of flying is broadly bimodal in distribution. ...
... Physical symptoms may include rapid heart-beat, tightness or pain in the chest, butterflies in the stomach, nausea or vomiting, and cold, weak or trembling hands or feet. Psychological symptoms may include difficulty in concentrating, worry, dread or fear that something terrible is going to happen, or the feeling of being trapped or powerless [4]. Aviophobia involves a marked and persistent fear that is excessive and unreasonable , and is cued by anticipation of, or actual, flying on an airplane. ...
Objectives: The scope of the study is to identify the leading “organization of meaning” in patients affected by aviophobia and the related attachment style. Specifically we hypothesized that participants with fear of flying would predominantly display a phobic organization of meaning, associated with an anxious-ambivalent attachment style.
Methods: 150 adults, divided between an experimental group (FOF) and a control group (CON), completed three research instruments: two self-report questionnaires assessing attachment style (AAQ and ASQ) and the self-characterization, a qualitative constructivist tool.
Results: The insecure attachment style prevailed in aviophobics rather than control group. Socio-economic and gender differences were found. The vocabulary used by the group with flying phobia featured a system of meaning referring to “freedom” family semantics.
Conclusions: Attachment style appears to be a necessary but insufficient condition for predicting fear of flying. A greater role in the disorder is played by the organization of patients’ personality, as argued by socio-constructionist and constructivist authors. Implication for clinical work and psychotherapy are discussed.
... Junto con los resultados anteriores, la fobia a volar es la fobia específica en la que se han llevado a cabo más estudios sobre la eficacia de las técnicas de RV. Existen varios estudios acera de la eficacia de la RV en este problema (Baños, Botella, Perpiñá y Quero, 2001; Botella, Osma, García-Palacios, Quero y Baños, 2004; Klein, 1999; North, North y Coble, 1997; Rothbaum et al., 1995; Wiederhold, Gervitz y Wiederhold, 1998). De igual modo, y respecto a la fobia a las arañas, se han encontrado resultados que muestran la utilidad de las técnicas de RV. ...
... La magia de los mundos virtuales y su importancia respecto al tratamiento radica precisamente ahí. Son contextos " seguros " (Bowlby, 1973Riva et al., 2001), miedo a volar (Klein, 1999; Rothbaum et al., 1999), miedo a hablar en público (Botella et al., 2000) y trastorno de pánico (Vincelli et al., 2001). ...
En: Análisis y Modificación de Conducta Valencia 1998, v. 24, n. 93; p. 5-26 Se presenta un estudio sobre la realidad virtual y su aplicación en tratamientos psicológicos. Se trata de una nueva tecnología consistente en un entorno gráfico en el que el usuario, no sólo tiene la sensación de encontrarse físicamente presente en el mundo virtual, sino que además puede interactuar con él. En estos momentos se está produciendo una gran expansión de esta tecnología en diversos ámbitos, entre ellos, la salud, y si concretamos más en el tratamiento de trastornos psicológicos. En comparación con los tratamientos tradicionales, la realidad virtual presente ventajas ya que se trata de un ambiente protegido que permite que el paciente conozca una situación que siempre ha considerado como amenazadora, permitiéndole hacerlo en la medida que él quiera y a su ritmo. Ya existen datos acerca de la eficacia de esta tecnología en el tratamiento de distintos trastornos de ansiedad y resultados preliminares en el caso de trastornos alimentarios. Finalmente se concluye con un comentario de las limitaciones que tiene esta técnica y a las que su desarrollo tendrá que ir dando respuesta, p. 23-26
... Junto con los resultados anteriores, la fobia a volar es la fobia específica en la que se han llevado a cabo más estudios sobre la eficacia de las técnicas de RV. Existen varios estudios acera de la eficacia de la RV en este problema (Baños, Botella, Perpiñá y Quero, 2001;Botella, Osma, García-Palacios, Quero y Baños, 2004;Klein, 1999;North, North y Coble, 1997;Rothbaum et al., 1995;Wiederhold, Gervitz y Wiederhold, 1998). De igual modo, y respecto a la fobia a las arañas, se han encontrado resultados que muestran la utilidad de las técnicas de RV. ...
... Además, la mayoría de los sistemas basados en PC, a pesar de que no tienen un alto coste y son fáciles de usar, aún sufren de una falta de flexibilidad como para permitir una individualización de los ambientes virtuales para cada paciente(Riva, 1997).En segundo lugar, está la falta de estandarización de los protocolos hace más difícil que puedan ser compartidos por distintos grupos. En las dos bases de datos clínicas, Medline y PsycInfo, existen bastantes trabajos centrados en eficacia y en resultados; pero únicamente hay publicados cinco protocolos clínicos, que corresponden al tratamiento de los TCA, miedo a volar(Klein, 1999;Rothbaum et al., 1999), miedo a hablar en público(Botella et al., 2000) y trastorno de pánico(Vincelli et al., 2001).En tercer lugar, está el importante coste que supone la organización y puesta en marcha de los ensayos clínicos de investigación. Tal y como se ha visto, la falta de sistemas inter-operables entre distintos grupos de investigación, añadido a la falta de protocolos clínicos, fuerza a que la mayoría de los investigadores inviertan mucho tiempo y dinero en el diseño y desarrollo de su propia aplicación de RV. ...
Virtual Reality (VR) is a new technology consisting on a graphic environment in which
the users, not only have the feeling of being physically present in a virtual world, but
they can interact with it in real time. At this moment a great expansion of this
technology is taking place in several fields, including the area of health. Especially
interesting for us is the use of VR as a therapeutic tool in the treatment of psychological
disorders. The first case study that used virtual reality techniques was published in
1995. Since then, an increasing number of studies in the Clinical Psychology field
centred on the therapeutic application of VR have been made, mainly on the treatment
of anxiety disorders. There are already data on the effectiveness of these VR procedures
for the treatment of different psychological disorders. In the present work a review of
the different studies made in this field is presented. Besides, the advantages and
disadvantages of VR, and the future lines of work concerning this new technology are
also analysed.
... La seconde étude a été menée auprès d'un homme de 42 ans, dont la peur de l'avion gênait ses activités professionnelles (North et al., 1997b Puis la troisième étude s'est intéressée à l'exploration de variables physiologiques et a mis en évidence la réduction de la conductance de la peau après une séance de 20 minutes pendant laquelle le sujet était exposé à des vols virtuels . Les deux dernières études de cas (Rothbaum et al., 1996;Klein, 2000) (Maltby et al., 2002). L'EV proposait dix niveaux hiérarchisés, débutant par l'arrivée dans l'aéroport, la marche vers l'avion, le vol et se terminant par le retour à l'aéroport. ...
... Efficacité du traitement sur les mesures d'anxiété, d'évitement et d'amélioration générale Étude de cas, traitement par ERV graduée (visiocasque) Mise en évidence de la réduction de la conductance de la peau après ERV (Klein, 2000) Étude de cas, description du protocole de traitement par ERV associée à de la relaxation (visiocasque) (Muhlberger et al., 2003) Étude contrôlée, comparaison de trois traitements avec ou sans ERV, avec ou sans mouvement (n=55) (visiocasque) Le mouvement augmente la peur mais n'accélère pas l'habituation. Importance de l'exposition aux stimuli visuels et auditifs dans ERV Suivi à 3 ans de patients (n=30) ayant subi 3 conditions de traitement Rôle du feedback visuel des signaux physiologiques dans le maintien des gains (Botella et al., 2004b) Étude contrôlée, efficacité à court et long terme (n=9) (visiocasque) Efficacité de l'ERV, maintien des gains Trouble panique et Agoraphobie (North et al., 1996a) Étude contrôlée (n=60), comparaison traitement ERV et pas de traitement (Visiocasque) Amélioration significative liée à l'ERV, diminution de l'anxiété liée à l'accoutumance (Moore et al., 2002) Exploration des réponses physiologiques de non phobiques (n=9) à des EVs (Visiocasque) Définition de niveaux de réponses pour les comparaisons ultérieures avec des personnes phobiques (Vincelli et al., 2003) Étude contrôlée ( (North et al., 1998b) Première étude contrôlée (n=16), prise de patients parole face à une audience (visiocasque) L'exposition sous RV peut réduire l'anxiété (Slater et al., 1999) Étude de l'influence sur des participants de l'attitude d'une audience d'agents virtuels (visiocasque) ...
Virtual reality technology allows the user to be an active participant, by means of various interfaces, in a three-dimensional world generated by the computer. Therapists became acquainted with the possibilities of this new interaction paradigm, and contributed to the development of virtual environments for diagnosis, therapy, rehabilitation and assessment. We chose to focus on the assessment and the treatment of the cognitive and behavioral disorders met in psychiatry and neuropsychology.
Virtual reality technology offers new means to evaluate and rehabilitate cognitive functions. It allows us to overcome some difficulties inherent in traditional methods and provides more appropriate solutions. Typically, “paper and pencil” tasks are replaced by simulations of daily life activities. The contribution of this research concerns the appropriacy of the virtual reality approach to diagnosis and therapy, and the resulting benefits.
Two little-researched subjects held our attention : the treatment of social phobia in psychiatry, and the assessment of action planning in neuropsychology. Our first objective was to design an application based on virtual reality for each of these subjects and to evaluate the feasibility. The second objective was to identify the contribution of virtual reality to the assessment and treatment of human dysfunctions.
The design and the implementation of a therapeutic treatment of social phobia, based on virtual reality, brought different challenges: the design of social interaction situations arousing emotional reactions among social phobic patients; the investigation of the various types of social phobia, showed the efficacy of the virtual reality therapy.
The design of a virtual system dedicated to human cognitive dysfunctions led us to tackle the assessment of action planning. It is based on the design of a planning task and a virtual environment, both of them called ecological. The application was unfolded in the context of aging and Parkinson's disease. The study, carried out among patients suffering from Parkinson's disease, helped us see the relevance and the potential of virtual reality approach.
According to the experiments we carried out, we are now able to identify the contribution of virtual reality to the assessment and treatment of cognitive and behavioral disorders. The contribution features, such as stimuli control, flexibility, etc. opens the way to new topics of reflection related to the role of virtual reality in the clinical process.
... F EAR OF FLYING (FOF) is a serious social and personal issue with growing fi nancial repercussions ( 24,30 ). It has been estimated that 10 -20% of the general population suffer from some degree of FOF ( 1,51,54 ) and 20% of airline passengers depend on alcohol or sedatives to deal with fl ight anxiety and other symptoms that occur as a result of FOF ( 1 ). ...
... All case studies that used cognitive and relaxation techniques in addition to VRE treatment proved to be effective ( 19,24,45,49 ). Patients were able to make a real fl ight after treatment with less fear or anxiety associated with fl ying. ...
Recently, a growing body of research has appeared on different aspects of virtual reality exposure (VRE) therapy applied to the treatment of anxiety disorders. The purpose of this article was to review with a systematic methodology the evidences that support the potential effectiveness of this therapy in the treatment of fear of flying (FOF), a problem that significantly affects patients' social functioning and personal welfare.
Potential studies were identified via computerized search using the PubMed/Medline and Web of Science databases, and additional review of their references. Articles ranged from 1969 to 2007 and the keywords used in the search were: "virtual reality" and "fear of flying"; "virtual reality" and "flying phobia"; or "virtual reality" and "flight phobia."
There were 40 studies using VRE in the treatment of FOF identified, mostly on the effectiveness of VRE therapy in group and case studies. Several components of the treatment protocols differed among the studies, which made the results comparison a challenging task. Nevertheless, controlled studies demonstrate that VRE treatment is effective with or without cognitive behavior therapy (CBT) and/or psychoeducation and that it is considered to be an effective component of the treatment of FOF.
All studies that used cognitive and relaxation techniques in addition to VRE treatment were effective. More randomized clinical trials are required in which VRE therapy could be compared with standard exposure therapy. Thus, we suggest that CBT, psychoeducation, and VRE could be combined to treat FOF.
... An additional direction for future research is the use of Virtual Environments (VE) for unconscious threat extinction. VE has been studied and used in psychotherapy for treatment of a variety of conditions, including phobias (Carlin et al., 1997;Klein, 2000;Mühlberger et al., 2006) and post-traumatic stress disorder (Difede et al., 2002;Rizzo et al., 2006). There seems to be a trend toward using VE to replicate any part of the real world during the therapeutic process. ...
... The second is the lack of standardized protocols that can be shared by the community of researchers. Current searches of the two clinical databases used in this review yielded only five published clinical protocols: for the treatment of eating disorders (Riva, Bacchetta, Cesa, 2001), fear of flying (Klein, 1999;Rothbaum, Hodges, Smith, 1999), fear of public speaking (Botella, Baños, Villa, 2000), and panic disorders (Vincelli, Choi, Molinari, 2001). The third barrier is the cost required for the set-up of these protocols' trial. ...
Background: Virtual Reality (VR) was defined as a collection of technological devices: “a computer capable of interactive 3D visualization, a head-mounted display and data gloves equipped with one or more position trackers”. Today, lots of scientists define VR as a simulation of the real world based on computer graphics, a three dimensional world in which communities of real people interact, create content, items and services, producing real economic value through e-Commerce.Objective: To report the results of a systematic review of articles and reviews published about the theme: “Virtual Reality in Medicine”.Methods: We used the search query string: “Virtual Reality”, “Metaverse”, “Second Life”, “Virtual World”, “Virtual Life” in order to find out how many articles were written about these themes. For the “Meta-review” we used only “Virtual Reality” AND “Review”. We searched the following databases: Psycinfo, Journal of Medical Internet Research, Isiknowledge till September 2011 and Pubmed till February 2012. We included any source published in either print format or on the Internet, available in all languages, and containing texts that define or attempt to define VR in explicit terms.Results: We retrieved 3,443 articles on Pubmed in 2012 and 8,237 on Isiknowledge in 2011. This large number of articles covered a wide range of themes, but showed no clear consensus about VR. We identified 4 general uses of VR in Medicine, and searched for the existing reviews about them. We found 364 reviews in 2011, although only 197 were pertinent to our aims: 1. Communication Interface (11 Reviews); 2. Medical Education (49 reviews); 3. Surgical Simulation (49 Reviews) and 4. Psychotherapy (88 Reviews).Conclusion: We found a large number of articles, but no clear consensus about the meaning of the term VR in Medicine. We found numerous articles published on these topics and many of them have been reviewed. We decided to group these reviews in 4 areas in order to provide a systematic overview of the subject matter, and to enable those interested to learn more about these particular topics.
... In clinical psychology, there are many works on the use of VR technology for the treatment of different of anxiety and psychological disorders, especially works that delve into its use as a tool for the exposure to phobias. There are important works that have proven the effectiveness of VR in the treatment of acrophobia (Choi, Jang, Ku, Shin and Kim, 2001;Emmelkamp, Bruynzeel, Drost and Van der Mast, 2001;Emmelkamp, Krijn, Hulsbosch, De Vries and Van Der Mast, 2002;Rothbaum et al., 1995aRothbaum et al., , 1995bNorth, 1994, 1996;North, North and Coble, 1996a), agoraphobia (North, North and Coble, 1996b), arachnophobia (Carlin, Hoffman and Weghorst, 1997;García-Palacios, Hoffman, Carlin, Furness and Botella, 2002;Hoffman, García-Palacios, Carlin and Botella, 2003), claustrophobia (Botella et al., 1998;Botella, Baños, Villa, Perpiñá and García-Palacios, 2000;Botella et al., 2002), aviophobia (Baños, Botella, Perpiñá and Quero, 2001;Botella, Osma, García-Palacios, Quero and Baños, 2004;Brinkman, Van der Mast, Sandino Gunawan and Emmelkamp, 2010;Klein, 1997;Maltby, Kirsch, Mayers and Allen, 2002;Mühlberger, Wiedemann and Pauli, 2003;Coble, 1997a, 1997b;Rothbaum, Hodges, Anderson, Price and Smith, 2002;Rothbaum, Hodges, Smith, Lee and Price, 2000;Wiederhold, 1999;Wiederhold, Gervitz and Wiederhold, 1998), vehophobia (Wald & Taylor, 2000;Wald & Taylor, 2003;Walshe, Lewis, Kim, O'Sullivan and Wiederhold, 2003) and clossophobia (Anderson, Rothbaum and Hodges, 2003;Harris Kemmerling and North, 2002;Pertaub, Slater and Baker, 2002;Slater, Pertaud and Steed, 1999). Also frequent are the studies of the application of VR in the treatment of social anxiety (García-García, Rosa-Alcázar, Olivares-Olivares, 2011; Klinger et al., 2005;Roy et al., 2003), dissociations of the body image in eating disorders (Gómez et al., 2013;Myers Swan-Kremeier, Wonderlich, Lancaster and Mitchell, 2004;Perpiñá, Botella and Baths, 2003;Perpiñá et al., 2009;Riva Bacchetta, Baruffi and Molinari, 2002;Riva Bacchetta, Cesa, Conti and Molinari, 2004;Riva, Melis and Bolzoni, 1997), addiction to certain substances (Bordnick et al., 2004;García-Rodríguez, Pericot-Valverde, Gutiérrez and Ferrer, 2009;Kuntze et al., 2001;Lee et al., 2003;Nemire, Beil and Swan, 1999) and compulsive gambling (Botella, 2004). ...
Developments in Virtual Reality (VR) technology are currently arousing great scientific interest because in just a few years, VR has found its niche not only in the specialised public, but also in society in general and in different contexts, thanks to its many uses in different contexts and the decreasing price of VR viewing devices. To many, this technology may appear to be a novelty of the 21 st century, but its origins go back several decades. Taking into account these aspects, this article aims to analyse the past and present of VR from two perspectives: one fo-cused on its technological development and one on its conceptual evolution. This historical overview, in turn, will allow us to address the future applications of VR in different disciplines. The study provides the reader with an in-depth analysis of VR that will contribute to the understanding of this technology and its uses.
... Rothbaum, Hodges, Kooper, Opdyke, Williford, & North (1995) published the first case study in which the patient overcame his fear of heights after being exposed to a virtual scenario which simulated acrophobic situations. Since then, numerous case studies with efficacy data about the use of VR for this or other specific phobias have been published: acrophobia (Choi, Jang, Ku, Shin, & Kim, 2001;North, North, & Coble, 1996); claustrophobia (Botella, Baños, Perpiña, Villa, Alcañiz, & Rey, 1998;Botella, Villa, Baños, Perpiñá, & García-Palacios, 1999); spiders phobia (Carlin, Hoffman, & Weghorst, 1997); flying phobia (Baños, Botella, Perpiñá, & Quero, 2001;Klein, 1999;North, North, & Coble, 1997;Rothbaum, Hodges, Watson, Kessler, & Opdyke, 1996;Wiederhold, Gervitz, & Wiederhold, 1998); driving phobia (Wald & Taylor, 2000), etc. Later controlled studies which demonstrate the efficacy of this new way of applying the exposure technique have been carried out: acrophobia (Emmelkamp, Bruynzeel, Drost, & Van der Mast, 2001;Emmelkamp, Krijn, Hulsbocsh, de Vries, Schummie & Van der Mast, 2002;Krijn, Emmelkamp, Olafsson & Biemond, 2004); claustrophobia (Botella, Baños, Villa, Perpiñá, & García-Palacios, 2000); spiders phobia (García-Palacios, Hoffman, Carlin, Furness, & Botella, 2002;Hoffman, García-Palacios, Carlin, & Botella, 2003); flying phobia (Botella, Osma, García-Palacios, Quero, & Baños, 2004;Maltby, Kirsch, Mayers, & Allen, 2002;Mühlberger, Wiedemann, & Pauli, 2003;Rothbaum, Hodges, Smith, Lee, & Price, 2000;Rothbaum, Hodges, Anderson, Price, & Smith, 2002;Wiederhold, 1999); driving phobia (Wald & Taylor, 2003;Walshe, Lewis, Kim, O'Sullivan, & Wiederhold, 2003). ...
In this paper, we outline opportunities within the video game environment for building skills applicable to real-world issues faced by some children. The game Minecraft is extremely popular and of particular interest to children diagnosed with autism spectrum disorder. Although the game has been used by support communities to facilitate the social interaction of children and peer support for their parents, little has been done to examine how social skills developed within the game environment generalize to the real world. Social Craft aims to establish a framework in which key social communication skills would be rehearsed in-game with a view to facilitating their replication in a similarly contained real-world environment. Central to this approach is an understanding of the basic principles of behavior and the engagement of a sound methodology for the collection of data inside and outside the respective environments.
... From a cognitive point of view, you know that there is nothing there, but, both consciously and unconsciously, you respond as if there is". The areas where clinical VR has been usefully applied includes fear reduction in persons with simple phobias [37][38], treatment for PTSD [39][40][41][42][43][44][45], stress management in career patients, acute pain reduction during would care and physical therapy with burn patients and in other painful procedures [46][47][48][49][50][51], body images [52][53][54], disturbances in-patients with eating disorders [55][56][57][58][59][60][61][62][63][64] acrophobia [65][66], aerophobia [67][68][69][70][71][72][73][74][75], erectile dysfunction [76][77], navigation and spatial training in children and skills adults with motor impairments, functional skill training and motor rehabilitation with patients having central nervous systems dysfunction [78] and for the assessment and rehabilitation of attention, memory, spatial skills and other cognitive functions in both clinical and unimpaired population [79]. Thus, VR scientists have constructed virtual airplanes, skyscrapers, spiders, battlefields, social settings, beaches, fantasy worlds and the mundane functional environments of schoolrooms, office, home, street and supermarket. ...
Virtual reality therapy came into existence in the mainstream of psychology in the last two decades. Virtual reality is a technology, a communication interface, and an artificial experience. VR has now emerged as the promising tool in many domains of clinical care and research as the capacity of this technology creates controllable, multisensory, interactive 3D stimulus offering clinical assessment, intervention and training. Virtual reality therapy is a medium of in-vivo exposure therapy that is unreal but relies on perceptual stimulation, visual cues, sounds, touch and smell to trigger emotions which is used for integrating and enhancing actual therapeutic approaches. The unique value of this technology has continued to grow and advanced the clinical areas that have long been mired in the methods of the past. The aim of the present study is to emphasize the potential offered by Virtual Reality (VR) in clinical psychology and its advances in therapeutic uses, in the treatment of numerous anxiety disorders, sexual dysfunctions and also for children with disabilities, also discussing the clinical rationale.
... Another possible barrier is the lack of standardized protocols shared by the scientific community, although this limitation is being corrected, and there are already some published protocols for the treatment of eating disorders (Riva et al., 2003), fear of flying (Klein, 1999), panic disorder (Vincelli et al., 2001;Botella et al., 2007), stress related disorders . Finally, there are ethical and safety issues (Durlach and Mayor, 1995;Botella et al., 2004). ...
This study aims to explore patients’ and therapists’ attitudes about the psychological treatment they received (patients) or applied (therapists). The treatments were standard CBT protocols for post-traumatic stress disorder (PTSD), complicated grief (CG), or adjustment disorders (ADs), depending on each patient diagnosis. The treatments were delivered following a traditional format or supported by a virtual reality (VR) system “EMMA’s WORLD” designed for the treatment of stress-related disorders. “EMMA’s WORLD” is a VR application in which patients can explore negative experiences using different virtual elements that can be customized to make them more meaningful to the user. The sample was composed of two groups: the “professionals” (N = 10) were all clinical psychologists who applied the same psychological treatment in both the traditional format (“traditional condition”) and using the VR system (“EMMA” condition). The second group consisted of a sample of patients (N = 50) who met the criteria for at least one of three different diagnoses: PTSD (N = 15), CG (N = 15), or AD (N = 20). 25 patients received treatment in the traditional format and 25 supported by the VR system. The patients were asked about their expectations (before treatment) and satisfaction (after treatment) with the treatment they received. All the therapists were asked their opinions about both treatment conditions. A mixed-methods approach using quantitative and qualitative methodologies was used. In both conditions, high scores were observed, and the patient’s opinions were even better when they have already received the treatments. A more pronounced pre-test–post-test change in the EMMA therapy group than in the traditional group was observed. EMMA’s World was well-accepted by both patients and therapists, and it helped to foster motivation in patients, while helping the therapist to apply the treatment. Thus, VR can be useful as an adjunct tool to enhance the treatment.
... -La peur de prendre l'avion [24] [25] [26] ; ...
Accès restreint aux membres de l'Université de Lorraine jusqu'au 2016-01-01
... Bu tür araştırmalar anksiyete yönetimi eğitimi ile sanal gerçekliğe dayalı maruz bırakmanın katılımcıların anksiyete ve kaçınma düzeylerindeki anlamlı düşüşle ilişkili olduğunu ortaya koymaktadır (Rothbaum ve ark. 1996, Klein 1999. Sanal gerçeklikte hareket simulasyonun rolünü inceleyen bir çalışmada ise hareket simülasyonunun bulunup bulunmaması arasında etkililik açısından anlamlı fark gözlenmemiştir (Mühlberger ve ark. ...
Virtual reality is a relatively new exposure tool that uses three-dimensional computer-graphics- based technologies which allow the individual to feel as if they are physically inside the virtual environment by misleading their senses. As virtual reality studies have become popular in the field of clinical psychology in recent years, it has been observed that virtual-reality-based therapies have a wide range of application areas, especially on anxiety disorders. Studies indicate that virtual reality can be more realistic than mental imagery and can create a stronger feeling of “presence”; that it is a safer starting point compared to in vivo exposure; and that it can be applied in a more practical and controlled manner. The aim of this review is to investigate exposure studies based on virtual reality in anxiety disorders (specific phobias, panic disorder and agoraphobias, generalized anxiety disorder, social phobia), posttraumatic stress disorder and obsessive-compulsive disorder.
... In this study, VR was found to be effective in treating subjects with acrophobia and fear of flying. The VR method has also been studied in individuals with fear of spiders, fear of public speaking and post-traumatic stress disorder (PTSD) (14). The literature on the effectiveness of VR in treating vestibular symptoms is in fact limited. ...
Balance disorder is a prevalent condition among adults and vestibular rehabilitation is the main non-medical option for treating the affected individuals. This paper provides the review of literature and discussion on the essential aspects of balance and vestibular rehabilitation. The advantages and limitations of the conventional vestibular rehabilitation methods are highlighted accordingly. The use of virtual reality system as a promising rehabilitative option is reviewed as intended, particularly in treating those with balance disorders. Finally, an emphasis is made on the importance of having culturally specific virtual reality systems for vestibular rehabilitation among patients from different ethnic groups.
... Phobia N Type of VR Acrophobia 7 Botella et al., 2004 Fear of flying 9 HMD Kahan et al., 2000 Fear of flying 31 HMD Klein, 1998 Fear of flying 1 HMD Klein, 1999 Fear of flying 3 HMD Klein, 2000 Fear of flying 1 HMD Maltby et al., 2002 Fear of flying 45 HMD Mühlberger et al., 2001 Fear of flying 30 HMD Mühlberger et al., 2003 Fear of flying 45 HMD North et al., 1997 Fear of flying 1 HMD Rothbaum et al., 1996 Fear of flying 1 HMD Rothbaum et al., 2000 Fear of flying 49 HMD Rothbaum et al., 2002 Fear of flying 24 HMD Rothbaum et al., (in press) Fear of flying 75 HMD Smith et al., 1999 Fear of flying 1 HMD Wiederhold et al., 1998 Fear of flying 1 HMD Fear of flying 30 HMD Fear of flying 30 HMD ...
The emerging approach of "embodied cognition" is redefining the nature of cognition: cognition is no longer a set of formal operations on abstract symbols, but rather a situated embodied activity. On one side, the characteristics of our perceptual and motor systems play a foundational role in concept definition and in rational inference. On the other side, practical activity plays a role in giving meaning to the particular experiences of, and the representations generated by, a given individual agent. Within this framework, virtual reality (VR) can be considered an embodied technology with potential that is wider than the simple reproduction of real worlds. By designing meaningful embodied activities, VR may be used to facilitate cognitive modeling and change. This paper will both discuss this claim and present a possible application of this approach: the therapeutic use of VR for the treatment of body image disturbances.
... [Klein99] [North97][Rothbaum96] [Wiederhold98]; y fobia a conducir[Wald00]. Posteriormente, fueron apareciendo estudios con un mayor número de sujetos y ensayos clínicos controlados que demostraron la eficacia de esta nueva forma de aplicar la técnica de ...
... The second is the lack of standardized protocols that can be shared by the community of researchers. Current searches of the two clinical databases used in this review yielded only five published clinical protocols: for the treatment of eating disorders (Riva, Bacchetta, Cesa, 2001), fear of flying (Klein, 1999;Rothbaum, Hodges, Smith, 1999), fear of public speaking (Botella, Baños, Villa, 2000), and panic disorders (Vincelli, Choi, Molinari, 2001). The third barrier is the cost required for the set-up of these protocols' trial. ...
... The second is the lack of standardized protocols that can be shared by the community of researchers. Current searches of the two clinical databases used in this review yielded only five published clinical protocols: for the treatment of eating disorders (Riva, Bacchetta, Cesa, 2001), fear of flying (Klein, 1999;Rothbaum, Hodges, Smith, 1999), fear of public speaking (Botella, Baños, Villa, 2000), and panic disorders (Vincelli, Choi, Molinari, 2001). The third barrier is the cost required for the set-up of these protocols' trial. ...
We have done a systematic review of articles and reviews published about the theme: “Virtual Reality in Medicine”. We used the search query string: “Virtual Reality”, “Metaverse”, “Second Life”, “Virtual World”, “Virtual Life” in order to find out how many articles were written about these themes. For the “Meta-review” we used only “Virtual Reality” AND “Review”. We searched the following databases: Psycinfo, Journal of Medical Internet Research, Isiknowledge till September 2011 and Pubmed till February 2012. We included any source published in either print format or on the Internet, available in all languages, and containing texts that define or attempt to define VR in explicit terms.
We retrieved 3443 articles on Pubmed in 2012 and 8237 on Isiknowledge in 2011. This large number of articles covered a wide range of themes, but showed no clear consensus about VR. We identified four general uses of VR in Medicine, and searched for the existing reviews about them. We found 364 reviews in 2011, although only 197 were pertinent to our aims.
We have found that there is not a clear consensus about the meaning of the term VR in Medicine. We found numerous articles published on these topics and we decided to group these reviews in four areas: 1. Communication Interface (11 Reviews); 2. Medical Education (49 reviews); 3. Surgical Simulation (49 Reviews) and 4. Psychotherapy (88 Reviews) in order to provide a systematic overview of the subject matter.
... Botella, Banos, Villa, Perpina, & Garcia-Palacios, 2000), acrophobia (e.g. Choi, Jang, Ku, Shin, & Kim, 2001), fear of flying (e.g. Klein, 2000), post-traumatic stress (e.g. Rothbaum et al., 1999), and fear of driving (e.g. ...
... Rothbaum, Hodges, Kooper, Opdyke, Williford, & North (1995) published the first case study in which the patient overcame his fear of heights after being exposed to a virtual scenario which simulated acrophobic situations. Since then, numerous case studies with efficacy data about the use of VR for this or other specific phobias have been published: acrophobia (Choi, Jang, Ku, Shin, & Kim, 2001; North, North, & Coble, 1996); claustrophobia (Botella, Baños, Perpiña, Villa, Alcañiz, & Rey, 1998; Botella, Villa, Baños, Perpiñá, & García-Palacios, 1999); spiders phobia (Carlin, Hoffman, & Weghorst, 1997); flying phobia (Baños, Botella, Perpiñá, & Quero, 2001; Klein, 1999; North, North, & Coble, 1997; Rothbaum, Hodges, Watson, Kessler, & Opdyke, 1996; Wiederhold, Gervitz, & Wiederhold, 1998); driving phobia (Wald & Taylor, 2000), etc. Later controlled studies which demonstrate the efficacy of this new way of applying the exposure technique have been carried out: acrophobia (Emmelkamp, Bruynzeel, Drost, & Van der Mast, 2001; Emmelkamp, Krijn, Hulsbocsh, de Vries, Schummie & Van der Mast, 2002; Krijn, Emmelkamp, Olafsson & Biemond, 2004); claustrophobia (Botella, Baños, Villa, Perpiñá, & García-Palacios, 2000); spiders phobia (García-Palacios, Hoffman, Carlin, Furness, & Botella, 2002; Hoffman, García Palacios, Carlin, & Botella, 2003); flying phobia (Botella, Osma, García-Palacios, Quero, & Baños, 2004; Maltby, Kirsch, Mayers, & Allen, 2002; Mühlberger, Wiedemann, & Pauli, 2003; Rothbaum, Hodges, Smith, Lee, & Price, 2000; Rothbaum, Hodges, Anderson, Price, & Smith, 2002; Wiederhold, 1999); driving phobia (Wald & Taylor, 2003; Walshe, Lewis, Kim, O'Sullivan, & Wiederhold, 2003). ...
ABSTRACT Most of the Virtual Environments (VE) currently available in the,field of psychological treatments are designed to solve a specific problem (acrophobia, flying phobia, claustrophobia, etc.). Our research group has developed a versatile Virtual Reality (VR) sys tem,(an adaptive,display) that could be,useful for different problems. In previous studies, a VR application called “EMMA’s world” was developed for the treatment of PTSD and pathological grief. The aim of the present work is to show,the utility of this sy stem,for the treatment of a storm phobia. The patient was a 70 year -old woman, who was not familiar at all with computer technologies. As the patient was,not able to confront even,a virtual storm, the treatment was applied in two phases: In vivo exposure ( exploding balloons), and exposure to VE simulating storms, rain, thunders and lightings. Results showed,changes,in the expected direction and were maintained at 6 -month,follow -up.
... A successful therapy often requires the induction of fear or other intense and inconvenient emotions, and VR systems are useful tools to evoke such responses in clients and can therefore lead to a therapeutic effect (Riva, 2003). Such effects have been shown for many different phobias, such as the fear of heights (Hodges et al., 1995;Kuntze, Stoermer, Mager, Mueller-Spahn, & Bullinger, 2003), the fear of flying (Klein, 2000;Rothbaum, Hodges, Smith, Lee, & Price, 2000), arachnophobia (Carlin, Hoffman, & Weghorst, 1997;Garcia-Palacios, Hoffmann, Carlin, Furness, & Botella, 2002), or driving phobia (Wald & Taylor, 2000). Besides the positive effects of virtual reality exposure therapy, negative effects like sickness symptoms were found to be serious for five percent of participants (Cobb, Nichols, Ramsey, & Wilson, 1999). ...
As scientific laboratories are an important domain of application of VR technology, ethical issues of VR have to be discussed with respect to research and the treatment of research subjects. Exposing participants to VR systems may raise ethical problems due to motion sickness, information overload, intensification of experience, and difficulties with reentry into the real world. The ethical guidelines which are typically applied to psychological research do not cover all of these problems in detail and have to be reconsidered, since they have not been developed with regard to the use of VR systems. Therefore, practical strategies to cope with the addressed ethical problems in VR research are recommended.
... Psicosom, Nº 81 -2007 además, especialmente indicados para ser aplicados mediante programas informáticos interactivos , como ya se ha apuntado antes. El uso de los programas de exposición asistida por ordenador es una alternativa a la realidad virtual –que ha probado repetidamente su eficacia en el tratamiento del miedo a volar (Botella, Osma, García-Palacios, Quero, & Baños, 2004; Maltby, Kirsch, Mayeres, & Allen, 2002; Mühlberger, Herrmann, Wiedemann, Ellgring, & Pauli, 2001; Mühlberger, Weik, Pauli, & Wiedemann, 2006; Mühlberger, Wiedemann, & Pauli, 2003; Rothbaum, Hodges, Smith, Lee, & Price, 2000 )– para la simulación de configuraciones estimulares fóbicas, en el caso que nos ocupa , pero que podrían ser de otro tipo. Los tratamientos de exposición asistida por ordenador, como ya hemos dicho antes, se sirven de un programario específico para confrontar a los pacientes , de manera jerarquizada, a imágenes y sonidos reales relacionadas con las condiciones estimulares temidas, presentadas en la pantalla de un ordenador personal. ...
... The first studies using VRET with phobic disorders were single-case designs (Botella et al., 1998;Klein, 2000;North, and Coble. 1998;Wiederhold, Gevirtz, and Wiederhold, 1998). ...
La exposición a estímulos virtuales se ha verificado como un procedimiento
útil en el tratamiento de los trastornos fóbicos. Sin embargo, existe una serie
de problemas en la aplicación a la agorafobia (estímulos a utilizar, presencia de avatares,
etc.). El propósito de este estudio experimental consiste en comparar la eficacia
de un tratamiento combinado, exposición a la realidad virtual y tratamiento cognitivo
conductual (VRET), con un acercamiento tradicional cognitivo-conductual (CBT). Quince
pacientes con agorafobia crónica recibieron un tratamiento VRET en 3D y 13 pacientes
recibieron un tratamiento CBT. Los dos grupos recibieron 11 sesiones. Las medidas
postratamiento incluyeron un breve test de evitación conductual (BAT). Los resultados
mostraron una significativa mejoría en los síntomas de la agorafobia (cogniciones,
sensaciones corporales, nivel de ansiedad y depresión) para los dos grupos que, en
general, permanecieron en un seguimiento a tres meses. Los BAT mostraron la capacidad
de los pacientes para exponerse a los estímulos fóbicos. Adicionalmente, el grupo
VRET mostró mayores mejorías, aunque ligeras, en comparación con el grupo CBT.
Estos resultados se discuten en relación con las dificultades del VRET para la agorafobia
y en relación con la viabilidad de los siete ambientes fóbicos virtuales para
generar una exposición aceptable a los estímulos fóbicos.
... As an example, one study involved a forty-two year old woman who had avoided flying for two years and who was sufficiently motivated to seek therapy[14]. Initially the patient was subjected to standard anxiety management techniques such as breathing exercises and thoughtstopping . ...
This paper describes recent research that proposes virtual reality techniques as a therapy for patients with cognitive and psychological problems. Specifically this applies to victims of conditions such as traumatic brain injury, Alzheimers and Parkinsons. Additionally virtual reality therapy offers an alternative to current desensitization techniques for the treatment of phobias Some important issues are examined including means of user interaction, skills transfer to the real world, and side-effects of virtual reality exposure.
... First, there exists a lack of standardized protocols that can be shared by the community of researchers. If we check the two databases, we can find only four published clinical protocols: for the treatment of eating disorders, 17 for the fear of flying, 18 for the fear of public speaking, 19 and for the treatment of panic disorders. 20 Second, there is a lack of standardization in VR devices and software. ...
As information technology has advanced and costs have declined over the past decade, there has been a steady growth in the use of virtual reality (VR) in health care. According to the data of the two leading clinical databases--MEDLINE and PSYCINFO--the research in the virtual reality field is moving fast: under the "virtual reality" keyword, there are 739 papers listed in MEDLINE and 569 in PSYCINFO (accessed 6 December 2001). Much of this growth, however, has been in the form of feasibility studies and pilot trials. In fact, many researchers tried to use VR, but only a few were able to deepen their study. According to MEDLINE, only 16 research groups published more than three papers related to health care applications of VR. This number lowers to 12 for papers included in PSYCLIT. Therefore, apart from surgical training and some behavioral treatments, there is little convincing evidence coming from controlled studies of the clinical and economical advantages of this approach. This paper discusses recent evidence and outlines some guidelines for future research in this area.
... The third and last case studies involved a treatment package, including anxiety management training (AMT), in addition to VRET. The case study by Klein (2000) showed that the combination of AMT (three sessions) and VRET (about 18 sessions) was effective for a 47-year-old woman. AMT consisted of relaxation training and thought-stopping techniques; VRET consisted of sitting in an aircraft, engines off/on, taxiing, take-off, flying, landing, thunderstorms, and turbulence. ...
Virtual reality exposure therapy (VRET) is an altered form of behavioral therapy and may be a possible alternative to standard in vivo exposure. Virtual reality integrates real-time computer graphics, body tracking devices, visual displays, and other sensory input devices to immerse patients in a computer-generated virtual environment. Research on this type of treatment for anxiety disorders is discussed in this article, and the mediating and moderating variables that influence VR treatment effectiveness as well. Evidence is found that VRET is effective for participants with fear of heights and of flying. For other phobias, research to date is not conclusive. More randomized clinical trials in which VRET is compared with standard exposure are required. Furthermore, studies are needed in which VRET is not just a component of the treatment package evaluated, but in which VRET should be assessed as a stand-alone treatment.
Several studies investigate empathy as the ability to understand and share a person's emotional states. Recent researches explore phenomenological peculiarity of empathy. The present work is a review of existing scientific literature about the construct of empathy, paying specific attention to new methods to explore it. Particularly, the study presents a new form of measurement: the virtual reality (VR). This work proposes a hypothesis of research, in order to test the possibility to increase empathy, using VR in subjects with a diagnosis of Personality Disorder (Antisocial, or Narcissist). The proposal includes the possibility for psychotherapist to share a series of emotional experiences with the patient, through a mobile app linked to multiple VR viewers.
Several studies investigate empathy as the ability to understand and share a person’s emotional states. Recent researches explore phenomenological peculiarity of empathy. The present work is a review of existing scientific literature about the construct of empathy, paying specific attention to new methods to explore it. Particularly, the study presents a new form of measurement: the virtual reality (VR). This work proposes a hypothesis of research, in order to test the possibility to increase empathy, using VR in subjects with a diagnosis of Personality Disorder (Antisocial, or Narcissist). The proposal includes the possibility for psychotherapist to share a series of emotional experiences with the patient, through a mobile app linked to multiple VR viewers.
Several studies investigate empathy as the ability to understand and share a person's emotional states. Recent researches explore phenomenological peculiarity of empathy. The present work is a review of existing scientific literature about the construct of empathy, paying specific attention to new methods to explore it. Particularly, the study presents a new form of measurement: the virtual reality (VR). This work proposes a hypothesis of research, in order to test the possibility to increase empathy, using VR in subjects with a diagnosis of Personality Disorder (Antisocial, or Narcissist). The proposal includes the possibility for psychotherapist to share a series of emotional experiences with the patient, through a mobile app linked to multiple VR viewers.
Annual Review of CyberTherapy and Telemedicine (ARCTT) ISSN: 1554-8716 is published annually by the Interactive Media Institute (IMI), a 501c3 non-profit organisation, dedicated to the collaboration of interdisciplinary researchers from around the world to create, test, and develop clinical tools and protocols for the medical and psychological community. IMI realises that the mind and body work in concert to affect quality of life in individuals and works to develop technology that can be effectively used to improve the standards and reduce the cost of healthcare delivery worldwide.
The pathological fear of flying, also called aviophobia, falls under the subtype of specific situational phobias in the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) or under specific (isolated) phobia in the International Classification of Diseases (ICD)-10. The term fear of flying was actually coined during World War II and referred to the mixture of fear and anxiety seen in aviators involved in combat. People presenting for treatment for the pathological fear of flying may have either a well-defined specific phobia or their fear of flying may be part of another anxiety disorder such as panic disorder with agoraphobia, post-traumatic stress disorder, or claustrophobia. People suffering from the specific phobia of flying are afraid of events directly related to the flying experience (crashing, losing control of themselves, not having control over the situation, having a panic attack in planes, turbulence, etc.), whereas those with panic disorder with agoraphobia suffer from a more general fear of having an uncued and unexpected panic attack, those with claustrophobia are more afraid of suffocating or being confined to an enclosed space, and people with post-traumatic stress disorder have a more complex pattern of fears following exposure to a traumatic event (such as a plane crash) characterized by re-experiencing the traumatic event (flashbacks, distressing dreams, etc.), persistent avoidance of stimuli associated with the trauma, and hyperarousal. Some people suffering from aviophobia do actually fly, but with extreme discomfort or by using drugs like benzodiazepines or alcohol to deal with their anxiety. Aviophobia is also characterized by negative cognitions when thinking about the flying experience, unproductive coping strategies such as self-blame, rumination, or catastrophizing, and significant anticipatory anxiety observed, for example, when planning trips and vacations, buying plane tickets, going to the airport, or waiting in the boarding area.
This article is a review of the literature on efficacy and outcome studies using in virtuo exposure treatments to treat specific phobias. Thirty-nine studies were examined for this review: 56% were case studies or small sample studies, 13% were studies using larger samples, but no control or comparison condition, 13% used a comparison group (waiting list, placebo), 8% used a comparative treatment condition (usually in vivo expo- sure) and 13% used both. The specific phobias that were treated in these studies were acrophobia, aviophobia, claustrophobia, arachnophobia and fear of driving. The majority of these studies demonstrated that in virtuo exposure is effective and constitutes an interesting alternative to in vivo exposure. However, as the area is still taking its first steps, more studies with stronger methodological validity (control and comparative treatment conditions) are needed.
An unmanned mining technology for the fully mechanized longwall face automation production is proposed and studied. The essential technology will bring the longwall face production into visualization through the Virtual Reality (VR) and Augmented Reality (AR) union. Based on the visual theoretical model of the longwall face, the combination of virtual and reality, the real-time interactive and the 3D registration function were realized. The Key technology and Alpha channel are used to the combination of the real long wall face and the virtual user.
The classical psychophysical approach to human perception has been to study isolated aspects of perception using well-controlled and strongly simplified laboratory stimuli. This so-called cue reduction technique has successfully led to the identification of numerous perceptual mechanisms, and has in many cases guided the uncoverage of neural correlates (see chapters elsewhere in this volume). Its limitations, however, lie in the almost complete ignorance of the intimate relationship among action, perception, and the environment in which we live. Real world situations are so different from the stimuli used in classical psychophysics and the context in which they are presented that applying laboratory results to daily life situations often becomes impractical, if not impossible. At the Max-PlanckInstitute for Biological Cybernetics in Tübingen, we pursue a behavioral approach to human action and perception that proves especially well-suited for studying more complex cognitive functions, such as object recognition and spatial cognition. The recent availability of high-fidelity “virtual reality” environments enables us to provide subjects a level of sensory realism and dynamic sensory feedback that approaches their experiences in the real world. At the same time, we can keep the ultimate control over all stimulus aspects that are required by the rules of psychophysics. In this chapter, we take a closer look at these developments in spatial cognition research and present results from several different experimental studies that we have conducted using this approach.
This chapter describes the deployment of Virtual Reality (VR) for Cognitive Behavioral Therapy (CBT) to treat anxiety and
other psychological disorders. Regarding anxiety, the most common technique is constituted of Exposure Therapy that, transposed
to Virtual Reality, allows the patient to face a digital version of the feared object or situation, instead of a real or imaginal
one. Virtual Reality Exposure Therapy (VRET) has proved effective in the treatment of anxiety disorders such as social phobia,
Post-Traumatic Stress Disorder (PTSD), and panic disorder with agoraphobia and has shown an efficacy comparable to traditional
in-vivo exposure with various specific phobias such as arachnophobia, acrophobia, and fear of flying. Thanks to its versatility,
VR has also found an employment within the CBT framework with other psychological disorders, such as substance abuse, eating
disorders, and in inducing non-pharmacological analgesia in patients undergoing painful medical procedures. Even when VR-based
therapy does not lead to better results than traditional CBT in terms of efficacy, there are several reasons for preferring
it over in-vivo exposure, including patient’s comfort and safety, as well as the possibility to create complex or delicate
scenarios (e.g. PTSD scenarios). In addition, VRET can be employed to facilitate the transition toward fearful objects in
the real world in patients who would otherwise refuse to face real stimuli.
An unmanned mining technology for the fully mechanized longwall face automation production is proposed and studied. The essential technology will bring the longwall face production into visualization through the VR (Virtual Reality) and AR (Augmented Reality) combination. Based on the visual theoretical model of the longwall face, the combination of virtual and reality, the real-time interactive and the 3D registration function were realized. The 3D image of the longwall face may be scaled and viewed from free angles. Using the overall affine coordinate system, the stereoscopic impression for the longwall face was enhanced; the video image is matched to 3D characteristics; the occlusion issue is resolved with the depth information solution; and the simplification visualization interactive method is proposed. The Key technology and Alpha channel are used to the combination of the real longwall face and the virtual user.
This is the second of a two part review which critically evaluates research published in disparate sources into the psychological treatment of fear of flying. Part I established fear of flying as a complex heterogeneous clinical phenomenon. This paper discusses the way in which evidence from clinical trials translates to best practice in treating fear of flying. Published research on psychological interventions uses terminology which bears a close resemblance to cognitive behavioural therapy. It is, however, questionable whether some treatment approaches reflect the implementation of the cognitive behavioural model as it is described in the wider literature on the treatment of anxiety disorders. This review evaluates a synthesis of published research which considers fear of flying and related anxiety disorders with the aim of deriving best practice. It concludes that the most effective psychological interventions will be those based on an accurate functional assessment of an individual and their social context relevant to fear of flying and not merely a set of standard and invariant protocols. Most published research has been carried out on participants who self refer or volunteer for treatment and it is probable that this is a biased clinical group which may distort reported efficacy and treatment outcomes. It concludes by highlighting directions for future research and the development of psychological treatments for fear of flying.
Fear of flying, its nature, prevalence, etiology and treatment, has been the subject of a substantial quantity of research over the past 30 years. With the exception of a dated review of treatment methods however, there has been no evaluation of this expanding body of evidence, its contribution to theory and influence on clinical practice. Published research has also generally failed to apply developments in the understanding and treatment of anxiety disorders generally to fear of flying. This review provides a critical evaluation of the existing literature and what it reveals about theory and practice. It does this from the perspective of Cognitive Behavioural Therapy. The evidence reviewed demonstrates that fear of flying is a heterogeneous phenomenon which is acquired under the influence of complex psychological, social and physiological factors unique to each affected individual. Effective psychological interventions must therefore be founded on a comprehensive functional assessment of each individual, a finding which is considered in detail in the second part of this review.
Flying phobia (FP) might become a very incapacitating and disturbing problem in a person's social, working, and private areas. Psychological interventions based on exposure therapy have proved to be effective, but given the particular nature of this disorder they bear important limitations. Exposure therapy for FP might be excessively costly in terms of time, money, and efforts. Virtual reality (VR) overcomes these difficulties as different significant environments might be created, where the patient can interact with what he or she fears while in a totally safe and protected environment-the therapist's consulting room. This paper intends, on one hand, to show the different scenarios designed by our team for the VR treatment of FP, and on the other, to present the first results supporting the effectiveness of this new tool for the treatment of FP in a multiple baseline study.
Virtual reality (VR) has recently emerged as a potentially effective way to provide general and specialty health care services, and appears poised to enter mainstream psychotherapy delivery. Because VR could be part of the future of clinical psychology, it is critical to all psychotherapists that it be defined broadly. To ensure appropriate development of VR applications, clinicians must have a clear understanding of the opportunities and challenges it will provide in professional practice. This review outlines the current state of clinical research relevant to the development of virtual environments for use in psychotherapy. In particular, the paper focuses its analysis on both actual applications of VR in clinical psychology and how different clinical perspectives can use this approach to improve the process of therapeutic change.
In recent years, a considerable number of publications have appeared on different aspects of virtual reality exposure therapy in the treatment of anxiety disorders. The purpose of the present article is to review the evidence that has emerged to support the potential of this therapy in the treatment of anxiety disorders.
Case histories and open comparative studies, as well as randomized controlled studies, have been published on the use of virtual reality exposure therapy in the treatment of anxiety disorders. Most studies in the field have been on specific phobias, in particular on fear of flying, acrophobia, fear of driving, claustrophobia and fear of spiders. In addition, several studies have been published on the use of virtual reality exposure therapy for social anxiety disorders, posttraumatic stress disorder and panic disorder with or without agoraphobia.
Recent studies provide evidence that virtual reality exposure therapy is a promising tool for the treatment of several anxiety disorders.
One of the most effective treatments of anxiety is exposure therapy: a person is exposed to specific feared situations or objects that trigger anxiety. This exposure process may be done through actual exposure, with visualization, by imagination or using virtual reality (VR), that provides users with computer simulated environments with and within which they can interact. VR is made possible by the capability of computers to synthesize a 3D graphical environment from numerical data. Furthermore, because input devices sense the subject's reactions and motions, the computer can modify the synthetic environment accordingly, creating the illusion of interacting with, and thus being immersed within the environment. Starting from 1995, different experimental studies have been conducted in order to investigate the effect of VR exposure in the treatment of subclinical fears and anxiety disorders. This review will discuss their outcome and provide guidelines for the use of VR exposure for the treatment of anxious patients.
The authors' goal was to examine the efficacy of computer-generated (virtual reality) graded exposure in the treatment of acrophobia (fear of heights).
Twenty college students with acrophobia were randomly assigned to virtual reality graded exposure treatment (N = 12) or to a waiting-list comparison group (N = 8). Seventeen students completed the study. Sessions were conducted individually over 8 weeks. Outcome was assessed by using measures of anxiety, avoidance, attitudes, and distress associated with exposure to heights before and after treatment.
Significant differences between the students who completed the virtual reality treatment (N = 10) and those on the waiting list (N = 7) were found on all measures. The treatment group was significantly improved after 8 weeks, but the comparison group was unchanged.
The authors conclude that treatment with virtual reality graded exposure was successful in reducing fear of heights.
We have conducted a controlled study on the use of virtual reality for the treatment of acrophobia--the fear of heights. Subjects experienced a range of physical anxiety symptoms consistent with the apparent threat they encountered from virtual height situations. Pre and post-testing data indicate that a person's perceptions of physical-world situations and behavior in the physical world may be modified based on his experiences within a virtual world. Results of this study provide initial support for the application of virtual reality in psychology/psychopathology and the treatment of psychological disorders. Contact Author Larry F. Hodges, Ph.D. Associate Professor College of Computing Georgia Tech Atlanta, GA 30332-0280 404.894.8787 hodges@cc.gatech.edu VIRTUAL ENVIRONMENTS FOR EXPOSURE THERAPY Larry F. Hodges , Barbara O. Rothbaum, Rob Kooper, Dan Opdyke Thomas Meyer, Johannes J. de Graaff, James S. Williford, Max M. North Abstract We have conducted a controlled study on the ...
A new treatment modality has been introduced recently as an alternative to standard in vivo exposure therapy or other traditional therapeutic approaches. The Phobia Center™ is the first non-affiliated private practice in the United States to treat fear of flying (FOF) patients with VR exposure therapy. The preliminary results are very encouraging and support the efficacy of VR exposure therapy. The rationale for VR treatment for fear of flying and other anxiety disorders are examined, and factors incorporating the utilization of VR treatment in a private practice setting are explored.
One of every six adult Americans—25,000,000—is afraid to fly. These people make two-thirds fewer trips on commercial aircraft than those who are not afraid. The 1978 impact on the U. S. air travel industry is estimated to be a $1.6 billion revenue loss and a 9% reduction in air travel. These are the conclusions drawnfromfive surveys conducted between 1976 and 1979 to measure how fear of flying affects the air travel industry.
Fifty-six volunteer subjects with a fear of flying were allocated to systematic desensitization, flooding, implosion, relaxation, and no-treatment groups. After an 8-week program, subjects and therapists took a plane flight. The measures used during the flight failed to distinguish among any of the groups. However, the four treatment groups displayed a significantly greater decrease in a self-report flying-fear questionnaire after treatment and at follow-up than did the no-treatment group. The results also indicated that fear of flying is not a unitary phenomenon, but rather is composed of a number of separate fears.
This study describes the combination of desensitization, modeling and positive reinforcement in a totally automated audiovisual program designed for use by non-professionals to treat flight phobics. Of 51 subjects who completed the program, 40 were able to fly after treatment. Also, significant positive change was noted on the Taylor Manifest Anxiety Scale for those subjects who overcome their fear of flying.
We conducted structured interviews with 17 agoraphobics and 17 simple phobics, all of whom were seeking behavioral treatment for fear of flying. Although all subjects had a flying phobia, the groups differed in their motivation for flight avoidance. In general, agoraphobics avoided flying because they feared having panic attacks while in flight, whereas simple phobics avoided flying because they feared crashing. Conversely, agoraphobics worried little about plane crashes, and simple phobics worried little about panic per se. These data support the retention of apprehension about panic as a diagnostic criterion for panic disorder in DSM-IV, and underscore the nosological significance of the fear of anxiety concept.
Current computer and display technology allows the creation of virtual environment scenes that can be utilized for treating a variety of psychological disorders. This case study demonstrates the effectiveness of virtual environment desensitization (VED) in the treatment of a subject who suffered from fear of flying, a disorder that affects a large number of people. The subject, accompanied by a virtual therapist, was placed in the cockpit of a virtual helicopter and flown over a simulated city for five sessions. The VED treatment resulted in both a significant reduction of anxiety symptoms and the ability to face the phobic situations in the real world.
Using the advantages of the sense of presence generated by virtual reality, a system to help children with autism was developed. Two case studies with children showed virtual reality has the potential to provide a safer, customized learning environment for individuals with autism. A model of reality that discusses historical and perceptual rules as well as input stimuli in forming a sense of presence is described.
Investigated the effectiveness of 2 cognitive coping strategies, singly and in combination, in 56 undergraduate females with a reported fear of flying. Ss were assigned to 4 groups: preparatory information training, self-statement training, combined training, and pseudotreatment control and were flown aboard an 11-passenger aircraft for 2 flights. Half of the Ss flew with the door to the cockpit open, and the other half flew with the door closed. Each flight encountered a planned unexpected missed landing. Self-reports of anxiety were obtained before takeoff, during the flight, and after landing. Even though the cognitive-coping strategies were not differentially effective in reducing anxiety during the ongoing stress of flying, under serious threat (unexpected event), with the cockpit door open, self-talk and combined Ss coped better than information and control Ss. With the door closed, all groups increased in anxiety. At the final landing, with the door closed, self-statement-trained Ss increased in their self-reported anxiety. Results of a 4.5-mo follow-up on flight apprehension are discussed in terms of the effects of the treatment manipulations. (17 ref)
Minimal-therapist-involvement stress inoculation training was used to treat flying phobics. Relative to no-treatment controls, treatment subjects reported more fear reduction, were more likely to participate in an exposure session, and flew more during a two-month follow-up period. Subjects who exhibited synchronous changes in heart rate and report of anxiety during exposure had greater fear reduction than subjects showing less synchrony. Subjects who voluntarily took plane flights in the two months following treatment showed greater indications of emotional processing during in vivo exposure. Relative to flight avoiders, fliers had higher mean heart rate in the plane, a greater reduction in heart rate from the beginning to the end of the flight, and greater reported fear reduction from pre- to post-flight.
The techniques used in the treatment of passenger fear of flying are described. They include behaviour modification techniques (relaxation, systematic desensitization, and cognitive restructuring), an educational programme, high in-vivo exposure, and group support. Results from self-rating scales and qualitative feedback from course participants during 1979-1985, show that the collective use of these techniques contribute significantly to a reduction of fear and discomfort associated with passenger flying.
Ten patients with a fear of flying were treated either with Stress-inoculation training (SIT) or with Applied relaxation (AR). In accordance with a Three-Systems model of phobic fear, five subjects were classified as physiological responders and five subjects were classified as cognitive responders. It was assumed that SIT would be a consonant treatment method for the cognitive responders and a non-consonant method for the physiological responders. AR was assumed to be consonant for the physiological responders but non-consonant for the cognitive responders. The aims of the study were: (1) to investigate the efficacy of behavioral treatment methods for fear of flying with adequate pre- and post-treatment behavioral measures (2) to assess the relative efficacy of a consonant vs a non-consonant treatment. The results showed improvement on all dependent measures (physiological, subjective, behavioral) from pre- to post-treatment and follow-up. Furthermore, the consonant treatment method was superior to the non-consonant method on subjective experience of physiological arousal and the ratings of fear of flying, but not for changes in heart-rate, and self-rating of anxiety.
Incidence and prevalence data for common fears and phobia based on a probability sample of the general population show the frequency of mild phobia to be 76:9/1000 and of severe phobia to be 2.2/1000. Clinical samples are not representative of the distribution of phobia in the general population, agoraphobia being over-represented. The most frequent reason for consulting a physician is for him to minimize a severe fear or phobia of a medical procedure. Psychiatrists tend to see only the more severe phobics, although only a quarter of this group were found to be in treatment.
The efficacy of virtual reality (VR) exposure therapy was examined for the fear of flying. Virtual reality exposure involved six sessions of graded exposure to flying in a virtual airplane. The specific contribution of anxiety management techniques (AMT) and the VR exposure was examined in a single case design. The subject was a 42-year-old female with a debilitating fear and avoidance of flying. All self-report measures of the fear and avoidance of flying decreased following AMT and decreased still further following VR exposure. A planned post-treatment flight was completed with anxiety measures indicating comfortable flight. The implications of this new medium for exposure therapy are discussed.
This is the first case report to demonstrate the efficacy of immersive computer-generated virtual reality (VR) and mixed reality (touching real objects which patients also saw in VR) for the treatment of spider phobia. The subject was a 37-yr-old female with severe and incapacitating fear of spiders. Twelve weekly 1-hr sessions were conducted over a 3-month period. Outcome was assessed on measures of anxiety, avoidance, and changes in behavior toward real spiders. VR graded exposure therapy was successful for reducing fear of spiders providing converging evidence for a growing literature showing the effectiveness of VR as a new medium for exposure therapy.
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