Wednesday, September 13, 2006

Virtual Reality and mental health applications

Working on haptics for psychotherapy, I found interesting the past work on Virtual Reality for psychotherapy.

There is a lot of systems being developped for therapy, especially phobic disorders for instance when it involves panic disorders associated with acrophobia. The basic idea is to provide the patient with a virtual scenario where he/she can feel a sense height. The results of the studies proved that VR environments are effective and realistic at overcoming acrophobia

[Virtual environments for treating the fear of heights (1995) by Hodges, L.F. Kooper, R. Meyer, T.C. Rothbaum, B.O. Opdyke, D. de Graaff, J.J. Williford, J.S. North, The development of virtual reality therapy (VRT) system for the treatment of acrophobia and therapeutic case (2002) by Jang, D.P. Ku, J.H. Choi, Y.H. Wiederhold, B.K. Nam, S.W. Kim, I.Y. Kim, S.I. ].

More specifically related to neuropsychology, Dorothy Strickland has used Virtual reality for the treatment of autism. She also tested her system with children with attention deficit disorders. She concludes that because autism and attention disorders involve abnormal stimulus response to the external world, Virtual reality offers the potential to regulate an artificial computer environment to better match the expectations and needs of individuals with these problems.

Reference of her paper Virtual Reality for the Treatment of Autism. By Strickland D. In GIUSEPPE RIVA, BRENDA K. WIEDERHOLD, ENRICO MOLINARI (Eds.), Virtual Environments in Clinical Psychology and Neuroscience 1997, 1998 Los Press: Amsterdam, Netherlands.

I also found a critical paper about basic theoretical and pragmatic issues that need to be considered while designing a VR system in the areas of clinical psychology and neuropsychology. For instance Basic VE Cost/Benefit Issues for Mental Health Applications

1) Can the same objective be accomplished using a simpler approach?
2) How well do the current attributes of a VE fit the needs of the psychological approach
or target?
3) How does a VE approach match the characteristics of the target clinical population?
4) What is the optimal level of presence necessary for the application?
5) Will the target users be able to learn to navigate in and interact with the environment in
an effective manner?
6) What is the potential for side-effects (cybersickness and aftereffects) in light of the
characteristics of different clinical groups?
7) Will assessment results and treatment effects generalize to the “real world”?
8) How should VE studies be designed and how will the data be analyzed?

These questions should be also addressed while designing and testing haptic systems for psychotherapy.

The paper also proposes areas where the immersion component can be crutial:
1. Systems designed to produce active distraction where the goal is to “remove” the
person’s ability to view conditioned (and unconditioned) pain related stimuli
Anticipated pain reduction may also serve to motivate a patient to become “involved” in
this alternative experience, with a higher level of presence resulting.
2. Systems designed to allow comparisons and ratings of full-sized humans for purposes
of assessing and treating body image disturbances, or for other applications that
may require some interaction with virtual “actors”.
3. Systems that target the assessment and rehabilitation of attention processes (as well as
other cognitive domains) whereby HMD fostered immersion would be needed to eliminate
external “distractions” that would intrude on the controlled environment .
4. Systems designed to assess and rehabilitate functional activities where transfer to the
real world is highly valued. An example where a higher level of the sense of presence
may be needed to maximize ecological validity, is when the objective is the assessment
or training of a complex procedurally-based functional skill (i.e., driving ability).
However, it should be noted that non-HMD approaches have shown some success for
this purpose for simple navigation-based activities.

The authors of the paper concludes positively on this work. They particularly states that these considerations for the development of virtual technology is necessary to maximize the potential usefulness of virtual environment for mental health applications. They remark that this is key to consider the standards that should be applied to research-based and clinically-oriented mental health applications.

Reference of the paper Basic issues in the use of virtual environments for mental health applications. By AA Rizzo, M Wiederhold, JG Buckwalter, GIUSEPPE RIVA, BRENDA K. WIEDERHOLD, ENRICO MOLINARI (Eds.), Virtual Environments in Clinical Psychology and Neuroscience 1998, Los Press: Amsterdam, Netherlands.

Later in 2003 another review is published. It presents the state of the art of virtual reality therapy (VRT) in phobic disorders and conclude: Possibilities offered by VR in the field of the cognitive-behavioral therapies are numerous. Immersion, guide by the therapist, leads the patient to live this experiment in a more realistic way. But this “technicization” of the psychotherapy, as attractive as it is, does not modify the theoretical and methodological bases on which VRT rests. VRT has not replaced the role played by therapist. Indeed, his/her presence near to the patient remains essential. It seems that VR reinforces the therapeutic relation between patient and therapist on a collaborative mode.

Replacing the therapist is now the fear of the psychologists ;) but I did not interpret in any of my readings that these VR projects offered a replacement of a therapist. I certainly agree with the conclusion that if we design for the patient, we also design for the therapist. VR and haptic systems could be introduced by therapists for patients to gain both import and control on their own therapy.

Reference of this last paper State of the art of virtual reality therapy (VRT) in phobic disorders. By Stéphane Roy. In PsychNology Journal, 2003, Volume 1, Number 2, 176 - 183.

In Virtual Reality for clinical psychology and neuropsychology

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