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NeuroVR 2 - A free virtual reality platform for the assessment and treatment in behavioral health care

DOI:10.3233/978-1-60750-706-2-493
Authors:
Giuseppe Riva at Catholic University of the Sacred Heart
Giuseppe Riva
Andrea Gaggioli at Catholic University of the Sacred Heart
Andrea Gaggioli
Alessandra Grassi at Catholic University of the Sacred Heart
Alessandra Grassi
Simona Raspelli at I.R.C.C.S. Istituto Auxologico Italiano
Simona Raspelli
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Abstract

At MMVR 2007 we presented NeuroVR (http://www.neurovr.org) a free virtual reality platform based on open-source software. The software allows non-expert users to adapt the content of 14 pre-designed virtual environments to the specific needs of the clinical or experimental setting. Following the feedbacks of the 2000 users who downloaded the first versions (1 and 1.5), we developed a new version--NeuroVR 2 (http://www.neurovr2.org)--that improves the possibility for the therapist to enhance the patient's feeling of familiarity and intimacy with the virtual scene, by using external sounds, photos or videos. More, when running a simulation, the system offers a set of standard features that contribute to increase the realism of the simulated scene. These include collision detection to control movements in the environment, realistic walk-style motion, advanced lighting techniques for enhanced image quality, and streaming of video textures using alpha channel for transparency.
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NeuroVR 2 - A Free Virtual Reality
Platform for the Assessment and Treatment
in Behavioral Health Care
Giuseppe RIVA 1-3, Andrea GAGGIOLI 1-2, Alessandra GRASSI 1-2,
Simona RASPELLI 1, Pietro CIPRESSO 1, Federica PALLAVICINI 1,
Cinzia VIGNA1, Andrea GAGLIATI 3 Stefano GASCO 3, Giuseppe DONVITO 3
1 Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano,
Milan, Italy
2 Psychology Department, Catholic University of Milan, Italy
3 Virtual Reality & Multimedia Park, Turin, Italy
Abstract. At MMVR 2007 we presented NeuroVR (http://www.neurovr.org) a
free virtual reality platform based on open-source software. The software allows
non-expert users to adapt the content of 14 pre-designed virtual environments to
the specific needs of the clinical or experimental setting. Following the feedbacks
of the 2000 users who downloaded the first versions (1 and 1.5), we developed a
new version – NeuroVR 2 (http://www.neurovr2.org) – that improves the
possibility for the therapist to enhance the patient’s feeling of familiarity and
intimacy with the virtual scene, by using external sounds, photos or videos. More,
when running a simulation, the system offers a set of standard features that
contribute to increase the realism of the simulated scene. These include collision
detection to control movements in the environment, realistic walk-style motion,
advanced lighting techniques for enhanced image quality, and streaming of video
textures using alpha channel for transparency.
Keywords: Virtual Reality, Assessment, Therapy, NeuroVR, Open Source
1. Introduction
The use of virtual reality (VR) in medicine and behavioral neurosciences has become
more widespread. This growing interest is also highlighted by the increasing number of
scientific articles published each year on this topic: searching Medline with the
keyword “virtual reality”, we found that the total number of publications has increased
from 45 in 1995 to 3203 in 2010, showing an average annual growth rate of nearly
15%. Although it is undisputable that VR has come of age for clinical and research
applications [1-3] the majority of them are still in the laboratory or investigation stage.
In a recent review [4], Riva identified four major issues that limit the use of VR in
psychotherapy and behavioral neuroscience:
• the lack of standardization in VR hardware and software, and the limited
possibility of tailoring the virtual environments (VEs);
• the low availability of standardized protocols;
• the high costs (up to 200,000 US$) required for designing and testing a clinical
VR application;
• most VEs in use today are not user-friendly.
To address these challenges, we presented At MMVR 2007 NeuroVR
(http://www.neurovr.org) a free virtual reality platform based on open-source software
[5]. The software allows non-expert users to adapt the content of 14 pre-designed
virtual environments to the specific needs of the clinical or experimental setting.
Following the feedbacks of the 1000 users who downloaded the first version, we
developed a new version – NeuroVR 2 (http://www.neurovr2.org) – that improves the
possibility for the therapist to enhance the patient’s feeling of familiarity and intimacy
with the virtual scene, by using external sounds, photos or videos.
2. NeuroVR 2
Using NeuroVR 2, the user can choose the appropriate psychological stimuli/stressors
from a database of objects (both 2D and 3D) and videos, and easily place them into the
virtual environment. The edited scene can then be visualized in the Player using either
immersive or non-immersive displays. Currently, the NeuroVR library includes 18
different virtual scenes (apartment, office, square, supermarket, park, classroom, etc.),
covering some of the most studied clinical applications of VR: specific phobias,
cognitive rehabilitation, panic disorders and eating disorders. Specifically, the new
version now includes full sound support and the ability of triggering external sounds
and videos using three different approaches: the keyboard, timeline or proximity.
The VR suite leverages two major open-source projects in the VR field: Delta3D
(http://www.delta3d.org) and OpenSceneGraph (http:// www.openscenegraph.org).
Both are building components that integrates with ad-hoc code to handle the editing
and the simulation.The NeuroVR2 Editor's GUI is now based on the QT cross-platform
application and UI framework from Nokia (http://qt.nokia.com/) that grants an higher
level of editing and customization over the editor functionalities, while the graphical
rendering is done using OpenSceneGraph, an open source high performance 3D
graphics toolkit (http://www.openscenegraph.org/projects/osg).
All the scenes building can now be done by the therapists using a cleaner and
simpler interface, and through a powerful "Action and Trigger" system and an easy to
use interface exposed by the editor. The scene creator can now also define how the
scene reacts to the patients behavior, when he is using the scene in the VR Player.
The NeuroVR2 Player too has been largely rewritten to grant a more efficient
workflow for the scenes playback and has a brand new startup interface written in QT.
The whole suite is developed in C++ language, targeted for the Microsoft Windows
platform but fully portable to other systems if needed.
The key characteristics that make NeuroVR suitable for most clinical applications
are the high level of control of the interaction with the tool, and the enriched
experience provided to the patient. These features transform NeuroVR in an
“empowering environment”, a special, sheltered setting where patients can start to
explore and act without feeling threatened. Nothing the patient fears can “really”
happen to them in VR. With such assurance, they can freely explore, experiment, feel,
live, and experience feelings and/or thoughts. NeuroVR thus becomes a very useful
intermediate step between the therapist’s office and the real world. Actually, NeuroVR
is used in the assessment and treatment of Obesity [6], Alcohol Abuse [7], Anxiety
Disorders [1], Generalized Anxiety Disorders [8] and Cognitive Rehabilitation [9; 10].
3. Conclusions
In this chapter, we introduced NeuroVR 2, the new version of an advanced platform
designed for the creation and customization of highly flexible VEs for clinical
psychology and behavioral neurosciences. A future goal is to provide software
compatibility with instruments that allow collection and analysis of behavioral data,
such as eye-tracking devices and sensors for psycho-physiological monitoring. Beyond
clinical applications, NeuroVR provides the VR research community with a free “VR
lab”, which allows the creation of highly-controlled experimental simulations for
different of behavioral, clinical and neuroscience applications
4. Acknowledgments
The NeuroVR development was partially supported by the European funded project
“Interstress” – Interreality in the management and treatment of stress-related disorders
(FP7-247685).
5. References
[1] A. Gorini and G. Riva, Virtual reality in anxiety disorders: the past and the future, Expert Review of
Neurotherapeutics 8 (2008), 215-233.
[2] T.D. Parsons and A.A. Rizzo, Affective outcomes of virtual reality exposure therapy for anxiety and
specific phobias: A meta-analysis, Journal of Behavior Therapy and Experimental Psychiatry 39 (2008),
250-261.
[3] G. Riva and A. Gaggioli, Virtual clinical therapy, Lecture Notes in Computer Sciences 4650 (2008), 90-
107.
[4] G. Riva, Virtual reality in psychotherapy: review, Cyberpsychology & Behavior 8 (2005), 220-230;
discussion 231-240.
[5] G. Riva, A. Gaggioli, D. Villani, A. Preziosa, F. Morganti, R. Corsi, G. Faletti, and L. Vezzadini,
NeuroVR: an open source virtual reality platform for clinical psychology and behavioral neurosciences,
Studies in Health Technology and Informatics 125 (2007), 394-399.
[6] G. Riva, M. Bacchetta, G. Cesa, S. Conti, G. Castelnuovo, F. Mantovani, and E. Molinari, Is severe
obesity a form of addiction? Rationale, clinical approach, and controlled clinical trial, CyberPsychology and
Behavior 9 (2006), 457-479.
[7] E. Gatti, R. Massari, C. Sacchelli, T. Lops, R. Gatti, and G. Riva, Why do you drink? Virtual reality as
an experiential medium for the assessment of alcohol-dependent individuals, Studies in Health Technology
and Informatics 132 (2008), 132-137.
[8] F. Pallavicini, D. Algeri, C. Repetto, A. Gorini, and G. Riva, Biofeedback, VR and Mobile Phones in the
treatment of Generalized Anxiety Disorders: A phase-2 controlled trial, Journal of CyberTherapy &
Rehabilitation 2 (2009), 315-328.
[9] S. Raspelli, L. Carelli, F. Morganti, B. Poletti, B. Corra, V. Silani, and G. Riva, Implementation of the
multiple errands test in a NeuroVR-supermarket: a possible approach, Studies in Health Technology and
Informatics 154, 115-119.
[10] G. Albani, S. Raspelli, L. Carelli, F. Morganti, P.L. Weiss, R. Kizony, N. Katz, A. Mauro, and G. Riva,
Executive functions in a virtual world: a study in Parkinson's disease, Studies in Health Technology and
Informatics 154, 92-96.
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  • Jul 2005
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.
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Is Severe Obesity a Form of Addiction?: Rationale, Clinical Approach, and Controlled Clinical Trial
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  • Aug 2006
For many, obesity is just a problem of energy input and expenditure: more energy input than expenditure. However, the clinical practice and epidemiological data clearly show that weight control is more complex than expected by this simple equation. This is particularly true in morbid obesity, a form of severe obesity in which a person's Body Mass Index (BMI, kg/m(2)) is over 40. If we compare the definitions and diagnostic criteria for "dependence" and "addiction" with the situation of many severe obese subjects, it is apparent that they match very well. Further, different neurological studies confirm this similarity: both addiction and obesity patients have a deficiency of dopamine receptors. Nevertheless, when we compare many of the actual obesity treatments with the ones used in the area of addictions it is possible to find relevant differences: obesity treatments neither consider different levels of type and intensity of care, nor a multidimensional approach. To overcome these limitations, in this paper we propose a bio-psychosocial approach in which the genetic influence (lack of dopamine receptors) is matched by psychosocial issues (pressure for thinness and diet as main body image dissatisfaction treatment). Further, the paper outlines how this approach may influence the treatment options, by focusing both on the lessons coming from actual addiction treatment and the opportunities offered by virtual reality. Finally, the paper presents and discusses the outcome of a controlled trial, based on the proposed approach, including a 6-month follow-up (211 morbid obese females with a BMI of >40 and a documented history of failures.
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NeuroVR: an open source virtual reality platform for clinical psychology and behavioral neurosciences
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In the past decade, the use of virtual reality for clinical and research applications has become more widespread. However, the diffusion of this approach is still limited by three main issues: poor usability, lack of technical expertise among clinical professionals, and high costs. To address these challenges, we introduce NeuroVR (http://www.neurovr.org--http://www.neurotiv.org), a cost-free virtual reality platform based on open-source software, that allows non-expert users to adapt the content of a pre-designed virtual environment to meet the specific needs of the clinical or experimental setting. Using the NeuroVR Editor, the user can choose the appropriate psychological stimuli/stressors from a database of objects (both 2D and 3D) and videos, and easily place them into the virtual environment. The edited scene can then be visualized in the NeuroVR Player using either immersive or non-immersive displays. Currently, the NeuroVR library includes different virtual scenes (apartment, office, square, supermarket, park, classroom, etc.), covering two of the most studied clinical applications of VR: specific phobias and eating disorders. The NeuroVR Editor is based on Blender (http://www.blender.org), the open source, cross-platform suite of tools for 3D creation, and is available as a completely free resource. An interesting feature of the NeuroVR Editor is the possibility to add new objects to the database. This feature allows the therapist to enhance the patient's feeling of familiarity and intimacy with the virtual scene, i.e., by using photos or movies of objects/people that are part of the patient's daily life, thereby improving the efficacy of the exposure. The NeuroVR platform runs on standard personal computers with Microsoft Windows; the only requirement for the hardware is related to the graphics card, which must support OpenGL.
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Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: A meta-analysis
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Virtual reality exposure therapy (VRET) is an increasingly common treatment for anxiety and specific phobias. Lacking is a quantitative meta-analysis that enhances understanding of the variability and clinical significance of anxiety reduction outcomes after VRET. Searches of electronic databases yielded 52 studies, and of these, 21 studies (300 subjects) met inclusion criteria. Although meta-analysis revealed large declines in anxiety symptoms following VRET, moderator analyses were limited due to inconsistent reporting in the VRET literature. This highlights the need for future research studies that report uniform and detailed information regarding presence, immersion, anxiety and/or phobia duration, and demographics.
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Virtual Reality in Anxiety Disorders: the past and the future
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  • Mar 2008
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.
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