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Physical–cognitive stimulation has emerged as a promising strategy for improving the quality of life of patients with amyotrophic lateral sclerosis (ALS). This case study reports on the use of immersive virtual reality (IVR) as a tool for multisensory stimulation in a woman with ALS (76 years old; 11 years since diagnosis; stage 2). The program consisted of IVR stimulation sessions (three sessions per week for 12 weeks). The results showed that the implementation of the program was feasible and safe (no adverse symptoms on the Simulator Sickness Questionnaire), as well as easy to execute (>80% on the System Usability Scale). Additionally, the participant reported improvements in aspects related to her mental health (44% depression and 20% anxiety) and improvements in her quality of life, and she also maintained her values in her functional capacity. This study presents novel and important findings by demonstrating the feasibility of implementing physical–cognitive stimulation programs with IVR in a person with ALS, allowing for multisensory stimulation with commercially available hardware and software and the generation of benefits in their health-related quality of life and mental health. [ABSTRACT FROM AUTHOR]

Background: Multiple sclerosis is a chronic, inflammatory, neurodegenerative autoimmune disease caused by myelin loss in the central nervous system, which leads to motor and non-motor problems. The main objective of this study was to explore whether an immersive virtual reality (IVR) exercise programme would be feasible as a form of physical therapy for people with MS (pwMS). Methods: 18 participants (13 women; 45.06 years) were assigned to an experimental group (EG, n = 8) and a control group (CG, n = 10). The EG took part in a twice-weekly IVR exergame physical therapy programme—ExeRVIEM programme. A randomised, single-blind clinical trial was conducted and was registered in clinicaltrials (NCT05870254). Results: The intervention was feasible and safe. The participants completed the programme with no adverse effects (no symptoms on the Simulator Sickness Questionnaire), high usability (System Usability Scale 90.31%), and outstandingly positive post-game experiences (Game Experience Questionnaire 3.10/4). In addition, the GE significantly improved several of their functional capacities: increased lower limb strength (Five Times Sit-to-Stand Test p = 0.042), improved functional mobility, and reduced fall risk (Timed Up and Go Test-simple p = 0.009; Timed Up and Go Test-cognitive p = 0.003). There were no statistically significant differences between the groups. Conclusions: The findings support that the use of exergames and IVR as physical therapy in pwMS is feasible and safe. Furthermore, there is the suggestion of possible benefits to participants' functional abilities, all of which position IVR as a promising tool for the rehabilitation of this neurodegenerative pathology affecting young adults. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and methodsResultsConclusionsTo evaluate the efficacy of an immersive movement visualization intervention in patients with hemophilia and hemophilic knee arthropathy.Randomized, single-blind clinical study. Twenty-eight patients with hemophilia were recruited. Patients were randomized to an experimental group (four weeks of immersive movement visualization) and a control group (no intervention). The intensity of pain, pressure pain threshold in the knee, tibialis anterior muscle, lower back level, conditioned pain modulation, range of knee motion, and lower limb functionality were evaluated.There were statistically significant differences in the intergroup effect on knee pain intensity (F = 23.71; p < 0.001) and lower limb functionality (F = 7.11; p = 0.003). 42.86% of the patients in the experimental group exhibited changes greater than the minimum detectable change (MDC) in functionality. 39.29% of the patients subject to the intervention experienced changes greater than the MDC in the knee pressure pain threshold.Immersive motion visualization can improve the intensity of joint pain and functionality in patients with hemophilic knee arthropathy. Functionality, pressure pain threshold, and pain intensity improved in those patients who conducted immersive movement visualization.Implications for rehabilitationImmersive visualization of movement significantly improves intensity of joint pain, functionality, pressure pain threshold, joint health, and conditioned pain modulation in patients with hemophilic knee arthropathy.The fact that it is a therapy without potential aversive stimuli makes it a possible access pathway for patients with high levels of kinesiophobia and/or catastrophism.This low-cost, home-based technology allows its use in patients far from hemophilia reference centers or with difficult access to physiotherapy treatments.The immersive visualization of movement influences the democratization of treatment, in accordance with the WHO's Sustainable Development Goal 3 (health and well-being for all).Immersive visualization of movement significantly improves intensity of joint pain, functionality, pressure pain threshold, joint health, and conditioned pain modulation in patients with hemophilic knee arthropathy.The fact that it is a therapy without potential aversive stimuli makes it a possible access pathway for patients with high levels of kinesiophobia and/or catastrophism.This low-cost, home-based technology allows its use in patients far from hemophilia reference centers or with difficult access to physiotherapy treatments.The immersive visualization of movement influences the democratization of treatment, in accordance with the WHO's Sustainable Development Goal 3 (health and well-being for all). [ABSTRACT FROM AUTHOR]

Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system with unknown etiology, resulting in various impairments that necessitate continuous rehabilitation to enhance functionality, quality of life, and motor function, including through Virtual Reality (VR) therapy. Comparing tasks in virtual environments and their potential skill transfer to real-world settings could aid in optimizing treatment programs to improve motor performance in individuals with MS. This study aimed to determine whether practicing acquisition and retention phases using two distinct interfaces (concrete—Touch Screen or abstract—Kinect system) affects performance in a subsequent task using a different interface (transfer phase). A randomized clinical trial was conducted with 56 volunteers with MS and 41 controls. Participants engaged in a computer game where they burst as many bubbles as possible within 10 s per attempt. After the acquisition and retention phases, all participants switched interfaces (e.g., those using Kinect switched to Touchscreen and vice versa). Significant performance improvements were observed in both groups during the acquisition phase, which were maintained in the retention phase. Although the abstract interface was more challenging for both groups, only the MS group that practiced with the abstract interface successfully transferred their improvements to the concrete interface. Thus, despite the increased difficulty of the abstract task during practice, it led to better performance transfer when required to complete a subsequent concrete task, suggesting that abstract devices may be beneficial in clinical practice for improving motor function in people with MS. [ABSTRACT FROM AUTHOR]

Introduction: Innovative technologies, including virtual reality (VR), can be used for conducting VR exposure therapy (VRET) for individuals with psychiatric disorders, including claustrophobia. Unfortunately, there is a lack of studies on the effect of VR in treating claustrophobia in Arab countries, including Jordan. Therefore, this study aimed to evaluate the effect of VRET on minimising anxiety symptoms at 1 week post‐therapy and the physiological arousal measures (heart rate, O2 saturation and mean arterial pressure) of participants before and following therapy. Methods: A pre‐/post‐test one‐group design was used, and participants (N = 44) who suffered from claustrophobia from Al‐Zaytoonah University of Jordan were recruited. VRET was conducted using the Cave experience, which consists of four stages and was carried out in 4 to 6 sessions during the period from April to September 2023. Results: The findings revealed a significant difference between pre‐ and post‐VR simulation intervention for anxiety symptoms and physiological measures; in addition, the participants perceived the usability of VR therapy. Conclusion: This study suggested that VRET was effective in managing claustrophobia, particularly in minimising anxiety symptoms. Therefore, VRET can be integrated into the therapeutic methods for individuals with claustrophobia. Also, healthcare professionals, including mental health counsellors, can adopt such therapy in their management and treatment plan. [ABSTRACT FROM AUTHOR]

Background: high-intensity exercise is a feasible and effective modality in the early stages of Parkinson's disease (PD). However, there are only a few studies that have carried out this type of intervention in customizable immersive virtual reality (IVR) environments. We explore the feasibility and effects of IVR-based high-intensity training through rowing and cycling exercises on the functional capacity, quality of life, and progression of PD. Methods: a total of 12 participants (61.50 ± 10.49 years old; 41.7% female, 58.3% male; stages I–III) were part of the study, which consisted of interventions of rowing and cycling in an IVR commercial exergame (25 min; twice per week for 14 weeks). The main variables measured were functional capacity, handgrip strength, functional mobility (TUG), functional lower-limb strength (FTSST), aerobic capacity (2-min step test), quality of life (PDQ-39), and Parkinson's disease progression (MDS-UPDRS). Results: the results showed a general improvement in handgrip strength in both hands (p = 0.008; d = 0.28), FTSST (p = 0.029; d = 0.96), and TUG times (p = 0.152; d = 0.22). Aerobic capacity, assessed by a 2-min step test, showed enhanced scores (p = 0.031; d = 0.78). Related to the PDQ-39, all dimensions of the scale were enhanced, highlighting activities of daily living (p = 0.047; d = 0.29) and bodily discomfort (p = 0.041; d = 0.37). Finally, the main symptoms of the disease were reduced, with an improvement in the parameters that show a better incidence of disease progression, such as Part IA and IB (p = 0.013; d = 0.29 and p = 0.021; d = 0.25, respectively), Part II (p = 0.021; d = 0.23), Part III (p = 0.040; d = 0.39), and Part IV (p = 0.013; d = 0.39). Conclusions: the therapeutic exercise (rowing and cycling), when carried out at a high intensity and in a personalized IVR scenario, appear to be a feasible and safe modality for patients with stages I–III of PD, improving their functional capacity, quality of life, and disease progression. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To analyze the effects of an exergame-based training compared to resistance training on the quality of life and symptoms of depression in older adults. METHODS: This was a two-arm, non-blinded, randomized clinical trial. Thirty-five participants (62.09 ± 7.11 years) were randomized either on the Exergame-based Training Group (n = 17) or the Resistance Training Group (n = 18). Sessions lasted 50 to 60 minutes, three times per week, for 13 weeks. For the Exergame-based Training Group, we used games that simulate sports and adventure activities through Xbox360 Kinect™. The Resistance Training Group performed ten exercises per session for upper and lower limbs using free weights and machines, following linear periodization and individualized loads. Quality of life and symptoms of depression were assessed using the World Health Organization Quality of Life assessment - an abbreviated version (WHOQOL-BREF) and the Geriatric Depression Scale, respectively. We performed a two-way analysis of variance (p ≤ 0.05). RESULTS: Only time effects were identified for overall quality of life, general health, and symptoms of depression. After the intervention, overall quality of life score increased (3.82 ± 0.95 versus 4.18 ± 0.53, p = 0.05), whereas symptoms of depression decreased (3.35 ± 1.73 versus 2.59 ± 1.54, p = 0.02) in the Exergame-based Training Group, and the general health improved in the Resistance Training Group (3.78 ± 0.81 versus 4.11 ± 0.68, p = 0.05) compared with the baseline scores. CONCLUSION: Both training groups improved different aspects of quality of life. The Exergaming-based Training Group improved the overall perception, whereas the Resistance Training Group improved the general health-related perception. Participants in the Exergame-based Training Group also decreased the number of symptoms of depression.

Background and objectivesMethodsResultsConclusionsVirtual reality exposure therapy offers a unique opportunity to treat social anxiety disorder. This meta-analysis aims to evaluate the effectiveness of virtual reality exposure therapy compared to waitlist comparators or other interventions for individuals with social anxiety disorder in alleviating anxiety symptoms.A three-step comprehensive search for the randomized controlled trials of virtual reality exposure therapy was conducted from inception to 7 December 2023. The overall effect was measured using Hedges’ g and determined using t-statistics at a significance level of p < 0.05. Sensitivity, subgroup, and meta-regression analyses were carried out.A total of 17 randomized control trials were retrieved from nine electronic databases. Virtual reality exposure therapy has greater efficacy than waitlist comparators in reducing anxiety symptoms at post-intervention and follow-up assessment. Virtual reality exposure therapy demonstrates a similar effect to other interventions at post-intervention and follow-up assessment. We observed a greater effect for participants with symptomatic social anxiety when we combined the intervention with cognitive behavioral therapy compared to its counterpart. Meta-regression analyses found no significant covariate.Overall, virtual reality exposure therapy can provide supplementary therapy for improving anxiety symptoms. Additional high-quality and large-scale trials with long-term follow-up are needed. [ABSTRACT FROM AUTHOR]

• Stimulus response task using virtual reality can improve spatial reactivity. • Background shift emphasizes the intervention effect of neglected space. • The combination of sudden stimulus and background shift is effective for unilateral spatial neglect. • Changes in egocentric center position may not affect reactivity. To investigate the effects of a stimulus response task using virtual reality (VR) for unilateral spatial neglect (USN). Double-blind randomized controlled trial. Acute phase hospital where stroke patients are hospitalized. The participants were 42 patients (N=42) with right-hemisphere cerebral damage who had been experiencing USN in their daily lives. They were randomly assigned to 3 groups: a stimulus response task with a background shift (SR+BS group), a stimulus response task without a background shift (SR group), and an object gazing task (control group). The stimulus response task was to search for balloons that suddenly appeared on the VR screen. A background shift was added to highlight the search in the neglected space. The control task was to maintain a controlled gaze on a balloon that appeared on the VR screen. The intervention period was 5 days. The primary outcome was the participants' scores on a stimulus-driven attention test (SAT) using the reaction time. The stimuli of the SAT were divided into 6 blocks of 3 lines on each side (−3 to +3). The secondary outcomes were their scores on the Behavioral Intention Test conventional, Catherine Bergego Scale, and straight ahead pointing tests. In the SAT, there were significant interaction effects of reaction time between time and group factors in left−2, right+2, and right+3. The SR+BS and SR groups showed significant improvements in the reaction time of left−2 and right+3 compared with the control group. Moreover, the SR+BS group showed a significant improvement in the reaction time of left−2, which was the neglected space, compared with the SR group. However, there were no significant interaction effects of Behavioral Intention Test conventional, Catherine Bergego Scale, and straight ahead pointing. Our results suggest that the use of stimulus response tasks using VR combined with background shifts may improve left-sided USN. [ABSTRACT FROM AUTHOR]

Background: Specific phobias impact over 400 million people worldwide. Digitalizing mental health could alleviate the burden. Still, although the corporate-driven Metaverse is expanding rapidly, there needs to be more momentum in harnessing virtual reality exposure therapy uptake. Objective: This study aims to conceptualize, develop, and deploy a free Virtual Reality Exposure Therapy (VRET) application specifically designed for treating acrophobia and claustrophobia. This pilot study, which holds the promise of a future where mental health is more accessible and effective, explores the feasibility of leveraging transdisciplinary collaboration among specialists to create a safe, accessible, and effective VRET solution. Methods: We conducted a Delphi heuristic approach involving bioethicists, neuroscientists, and tech developers. Second, we reviewed the existing psychological theories and therapeutic strategies for addressing phobias in VR. Third, we conceptualized a thematic analysis-derived framework for a safe, adaptive-gamified free exposure to virtual reality acrophobia and claustrophobia (SAFEvR ACT). Finally, we provide an overview of the iterative improvements made during 12 workshops and 76 weekly briefings on developmental implementations. Results: We developed the SAFEvR ACT into a proof-of-concept application freely deployed on the MentalVerse app platform. Our safety-focused approach can benefit from prevalidation perspectives within future randomized control trials. Conclusions: The resulting application derived from the SAFEvR ACT framework represents a blueprint to counter the current lack of iVR mental health uptake by offering a free VRET alternative. Future research should aim towards developing similar free platforms to lessen mental health burdens and gather quantitative data. We conclude with a call to action to researchers to fine-tune our current approach and take a stand for free digital mental health within MentalVeRse.app. [ABSTRACT FROM AUTHOR]

This paper investigates the application of Virtual Reality Exposure Therapy (VRET) to treat agoraphobia, focusing on two pivotal research questions derived from identified gaps in current therapeutic approaches. The first question (RQ1) addresses the development of complex VR environments to enhance therapy's effectiveness by simulating real‐world anxiety triggers. The second question (RQ2) examines the differential impact of these VR environments on agoraphobic and nonagoraphobic participants through rigorous comparative analyses using t‐tests. Methodologies include advanced data processing techniques for electrodermal activity (EDA) and eye‐tracking metrics to assess the anxiety levels induced by these environments. Additionally, qualitative methods such as structured interviews and questionnaires complement these measurements, providing deeper insights into the subjective experiences of participants. Video recordings of sessions using Unity software offer a layer of data, enabling the study to replay and analyze interactions within the VR environment meticulously. The experimental results confirm the efficacy of VR settings in eliciting significant physiological and psychological responses from participants, substantiating the VR scenarios' potential as a therapeutic tool. This study contributes to the broader discourse on the viability and optimization of VR technologies in clinical settings, offering a methodologically sound approach to the practicality and accessibility of exposure therapies for anxiety disorders. [ABSTRACT FROM AUTHOR]

Public speaking is considered the most anxiety-provoking speaking activity for English as a foreign language (EFL) learner. While traditional lecture-based classrooms hinder EFL learners' constant practice and frequent interaction due to large class sizes and limited time, recent developments in technology, including Artificial Intelligence (AI), Automatic Speech Analysis, and Virtual Reality (VR), may enhance language learning by offering accessible and personalized learning experiences. This study aimed to investigate the effects of technology-enhanced learning on reducing EFL learners' PSA. Thirty-three university students were divided into three groups and received either lecture-based, mobile-assisted, or VR-facilitated instruction for four weeks. The students' perceived PSA levels were reduced in all three groups after their respective instruction, but only the VR-facilitated group reached statistical significance, and there were no differences in the three groups' final oral performances. However, the two technology-enhanced language learning (TELL) groups achieved more convergent performances on the Personal Report of Public Speaking Anxiety scale compared with the non-TELL group, which indicated that the impact of individual differences may have been compensated by technology assistance. The findings suggested that the instructional feedback generated by AI decreased the participants' PSA, although the irreplaceable role of teachers as facilitators was also emphasized, while the potential of using VR in teaching public speaking was evident. [ABSTRACT FROM AUTHOR]

Intense exercise can be neuromodulatory and neuroprotective against Parkinson's disease (PD). Indoor cycling is a good and safe option for this population, but some barriers (monotonous and repetitive environment, lack of monitoring, and an inability to compete with others) could limit its use. Immersive virtual reality (IVR) could be a possible solution to some of these drawbacks, increasing patient motivation and thus adherence to forced exercise programs using cycloergometers. A double-blind, randomized, controlled clinical trial was conducted to explore the feasibility and effects of the ReViPark program (high-intensity pedaling + IVR for 3 months with two sessions per week) on PD progression. In all, 52 people with PD were allocated to the ReViPark group (n = 30; 70.87 ± 6.67 years) and smart cycloergometer group (n = 22; 70.59 ± 6.67 years). This program was feasible, with no adverse effects (no significant Simulator Sickness Questionnaire symptoms and a low negative experience rating for the Game Experience Questionnaire (0.04/4)), no dropouts, high adherence, and good usability (System Usability Scale score of 82.90%). The ReViPark group showed significant improvements in functionality, quality of life, and disease progression as measured by their balance, gait and risk of falling (Timed Up and Go p = 0.028; Tinetti test p = 0.046), PDQ-39 scores (p = 0.035), and MDS-UPDRS scores (p = 0.001). This program is feasible and could lead to improvements in the functional parameters, quality of life, and symptomatology of the participants. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of immersive movement observation in adult patients with haemophilic ankle arthropathy. Design: Multicentre, single-blind, randomized clinical trial. Subjects: 48 patients with haemophilia. Methods: Patients were randomly allocated to 2 groups (180º immersive video-based visualization of movement and a control group with no intervention). Twenty-eight consecutive 15-min home sessions, 1 per day, of immersive visualization of ankle flexion–extension movement were carried out. Three evaluations were performed: pretreatment (T0), post-intervention (T1), and at 16 weeks’ follow-up (T2). The primary variable was joint-pain intensity (visual analogue scale). The secondary variables were conditioned pain modulation (Conditioned Pain Modulation Index), pressure pain threshold (pressure algometer), range of motion (goniometry) and kinesiophobia (Tampa Scale of Kinesiophophia). Results: There were intergroup differences in pain intensity (F = 37.14; p

Acrophobia has traditionally been treated using exposure therapy; however, virtual reality technology has emerged as an alternative that minimizing security risks by presenting three-dimensional stimuli. This study aimed to investigate virtual reality exposure therapy-cognitive restructuring (VRET-CR) effectiveness in reducing acrophobia symptoms. In a pretest-posttest control group design, 27 participants were randomly assigned to the experimental group (n=13) and the control group (n=14). An independent sample t-test revealed a significant differences in the gain scores of the acrophobia questionnaire (AQ) 1 [t (17.08) = -6.173; p

In Cardiovascular Rehabilitation (CR), patient adherence to the maintenance phase is a major challenge. Virtual reality-based therapy (VRBT) promotes acute hemodynamic and autonomic repercussions similar to traditional rehabilitation and can increase patient adherence to the program. However, it is unknown whether the combination of VRBT to a traditional CR manages to maintain or even improve clinical and autonomic variables in long term. To analyze whether VRBT combination in a traditional CR can maintain or improve clinical and autonomic variables in cardiac patients in the maintenance phase of these programs. Twenty-six volunteers (62.04 ± 12.22 years) were evaluated, who underwent an initial assessment and two other assessments (in the sixth and 12th week) of the following outcomes: systolic and diastolic blood pressure, respiratory rate, pulse saturation of oxygen, heart rate, perceived exertion, and cardiac autonomic modulation, using linear and non-linear heart rate variability methods. Except for the apparent lack of clinical significance observed in Shannon Entropy, LF (nu), and HF (nu), the combination of VRBT as routine in a traditional program did not cause significant changes in the analyzed variables. combination of VRBT was able to maintain the chronic hemodynamic and autonomic repercussions caused by traditional CR. [ABSTRACT FROM AUTHOR]

Virtual reality (VR) is an immersive technology that can be used to generate scenes of emotional responses. For people with psychological problems, negative emotions can be treated with the help of virtual reality exposure therapy (VRET). EEG signals can more accurately reflect the types of emotions, make up for the lack of emotion recognition, make the treatment more targeted, and the intervention treatment using virtual environment combined with the accurate recognition of emotions by EEG signals can more effectively achieve the therapeutic effect. Therefore, this paper comprehensively explores the research progress of EEG emotion recognition and exposure therapy, studies new psychotherapy regimens carried out in cooperation with therapists, and identifies some key technologies to create a more commercially effective VRET treatment. [ABSTRACT FROM AUTHOR]

In the context of China's rapid development and accelerated pace of life, people generally face increased pressure, leading to a sharp increase in psychological problems. More than half of the population is sub‐healthy, and patients with mental illness are also increasing year by year. Mental stress is a common cause of psychological and physiological disorders, triggering emergency stress states. Psychotherapy has been developing as an important intervention method, and psychological relief based on relaxation and stress reduction has gradually become a research hotspot. Behavioral therapy and cognitive therapy are common psychological treatments, while relaxation induction methods include breathing training, meditation, music, etc. Virtual reality technology is used in psychological research to improve therapeutic effects. Among them, virtual reality exposure therapy (VRET), which treats anxiety by creating virtual scenes, has attracted attention. And in virtual reality exposure therapy treatment, the patient's psychological state can be grasped by monitoring these physiological reactions. This article will discuss the key technologies for psychological decompression based on VRET, aiming to gain an in‐depth understanding of its principles, applications, etc. [ABSTRACT FROM AUTHOR]

Phobias are characterized as the excessive or irrational fear of an object or situation, and specific phobias affect about 10% of the world population. Blood-injection-injury phobia is a specific phobia that has a unique physical response to phobic stimuli, that is, a vasovagal syncope that causes the person to faint. Phobos is a serious game intended for blood phobia treatment that was created to be played in virtual reality with an HTC Vive that has photorealistic graphics to provide a greater immersion. We also developed a console application in C# for electrocardiography sensor connectivity and data acquisition, which gathers a 1 min baseline reading and then has continuous data acquisition during gameplay. Usability tests were conducted with self-reported questionnaires and with a case study population of 10 testers, which gave insight into the previous game experience of the tester for both digital games and virtual reality games, evaluating the discomfort for hardware on both the sensor and the virtual reality headset, as well as the game regarding usability, user experience, level of immersion, and the existence of motion sickness and its source. The results corroborate that the immersion of the game is good, which suggests that it will help with triggering the phobia. [ABSTRACT FROM AUTHOR]

Public Speaking Anxiety (PSA) interventions targeting adolescents exist; however, not all gain improvement. This exploratory study investigated whether PSA interventions resulted in a decrease in perfectionism and whether pre-treatment level and changes in perfectionism moderated the effects on PSA and social anxiety. The sample consisted of 100 adolescents from junior high schools randomized to four groups: 1) VR only (n = 20), 2) VR + online exposure program (n = 20), 3) online psychoeducation and online exposure program (n = 40), 4) waitlist and online psychoeducation program (n = 20). Self-reported symptoms of PSA, social anxiety, and perfectionism were measured at pre, week 3, post, and 3-months follow-up. Level and change in outcome variables were analyzed using latent growth curve modeling. Results revealed that the interventions did not lead to a reduction in perfectionism. Reduction in perfectionism was associated with a larger reduction in all outcome measures from post to follow-up. No interaction was found between pre-treatment perfectionism and PSA symptoms. High pre-treatment levels of perfectionism were associated with poorer outcomes on social anxiety symptoms from post to follow-up for online exposure groups. The results indicate that one should assess and address high pre-treatment levels of perfectionism during PSA interventions. [ABSTRACT FROM AUTHOR]

This review is structured to systematically study the currently known evidence about Virtual Reality Exposure Therapy (VRET) pertaining to phobias and to analyze important combinations and comparisons of VRET with other psychological interventions. Randomized Control Trial testing studies published in English and peer-reviewed journals with clinically diagnosed patients of phobia were included. PubMed, Scopus, and ResearchGate along with other databases from January 2000 to October 2022 were utilized. Bias like randomization, blinding, allocation sequence concealment, discriminatory result reporting, and others were evaluated. Forty-four research using VRET were included in this review, 11 research were on social phobia, 8 were on agoraphobia, 20 were on different specific phobias and 5 other research had combinations of phobias. VRET proved to be effective as a standalone treatment for phobias and its efficacy increased when combined with pharmacological, cognitive, or augmented reality interventions. This review also discussed the high efficacy of inexpensive gears and the difference in efficacy created by session specifications. The cumulative evidence is now conclusive that the addition of medications or cognitive behavioral therapy to VRET for multiple sessions reduces phobic symptoms among patients with phobias. The potential of person-focused interventions in clinics with VRET depends on its long-term outcome and the knowledge of the technician, further research and modules should be created for the same. [ABSTRACT FROM AUTHOR]

Il s'agit de réinterroger le concept de clivage au moi proposé par R. Roussillon dans les champs psychopathologiques et psychanalytiques à partir d'une situation clinique d'adolescent hikikomori. Adoptant une approche conceptuelle, notre propos se centre sur une forme particulière du clivage qui, au-delà d'une visée purement déficitaire et défensive, peut également se comprendre comme une première forme d'appropriation de soi. Il s'inscrit alors dans un processus de construction identitaire. À partir d'une analyse qualitative d'entretiens cliniques auprès d'un adolescent, il s'agit de montrer en quoi le dispositif de la rencontre thérapeutique dans un centre de soins, et en appui sur une médiation virtuelle, permet la réappropriation de parts de soi initialement clivées. Également, une exploration conceptuelle du clivage, notamment par la notion de verwerfung ainsi que la lecture d'un clivage profond proposée par S. Ferenczi, permet de mieux comprendre ses manifestations, entre besoin développemental et troubles psychopathologiques. Les enjeux développementaux liés à un clivage au moi chez l'adolescent sont multiples. Parfois proche, voire synonyme de la dissociation péritraumatique , le clivage au moi illustre les défenses du sujet contre un événement inélaborable et l'ampute de tout un pan de sa subjectivité. Il concerne aussi l'expérience du corps pubère et son rejet par l'adolescent, ce que le developmental breakdown a fortement mis en évidence. Enfin, il peut favoriser une forme de repli ou de retrait social tel que l' hikikomori et certainement d'autres destins liés à l'évolution du sujet. Dans tous les cas, cette évolution reste incertaine. Si différentes formes de psychopathologies peuvent se manifester, en revanche, le clivage au moi peut signifier une forme de mise en abîme de soi pour tenter de se réapproprier certains éléments douloureux ou non symbolisés de son histoire. Il existe une forme de clivage qui n'est pas seulement une défense pouvant aboutir dans les situations les plus graves à des vécus de morcellement et de déréalisation. Il peut aussi s'inscrire dans un processus « limite » de construction identitaire, une forme de dissociation momentanée du sujet ou schize permettant un retour des parts de soi dans une boucle rétroactive, informant en quelque sorte l'état actuel du Moi. À l'adolescence, ce processus est particulièrement sollicité de par l'intégration du nouveau corps pubère. Soit le sujet, en fonction de sa maturation psychoaffective, s'auto-informe des processus en cours de son monde interne : sa vie fantasmatique, l'intégration du corps sexué, etc. Soit la réduction du clivage opère par le recours à une fonction réceptive et transformationnelle de l'objet, inscrivant ce processus dans une intersubjectivité « croisée ». Penser le sujet, notamment adolescent, dans des formes de dissociation qui ne sont pas uniquement l'expression d'une vulnérabilité, permet de maintenir un regard clinique qui soutient un potentiel de croissance, une capacité résiliente du Moi. L'attention portée aux différents destins du clivage soutient une approche dynamique du fonctionnement psychique et inscrit le sujet dans un continuum entre normal et pathologique. Le clivage au moi, en tant que processus limite, offre une lecture originale des enjeux sous-jacents à l'expression contemporaine des souffrances narcissiques et identitaires, et dynamise une approche purement nosographique. The aim of this article is to re-examine the concept of ego splitting proposed by R. Roussillon in the psychopathological and psychoanalytical fields, based on a clinical case of a teenage hikikomori. In a conceptual approach, our article addresses a specific form of splitting which, beyond a vision, only focuses on its defensive and deficient aspects, can also be understood as a first form of self-appropriation. It then becomes a part of a process of identity construction. Based on a qualitative analysis of several clinical interviews with an adolescent, this article aims to demonstrate the extent to which the therapeutic encounter setting in a Care Center, with the support of virtual mediation, can allow for the reappropriation of some parts of the self that were initially split off. Additionally, a conceptual exploration of ego splitting, notably through the notion of verwerfung as well as the reading of a profound splitting proposed by S. Ferenczi, allows us to better understand its manifestations, depending on whether it is seen as a developmental need or a psychopathological disorder. The developmental stakes associated with ego splitting in adolescents are multiple. Sometimes very similar to a peritraumatic dissociation , ego splitting illustrates the subject's defenses when faced with an event which the psyche cannot deal with, and thus severs an entire part of his subjectivity. It is also about the experience of the newly pubescent body and the adolescent's rejection of it, which was emphasized in the concept of developmental breakdown. Finally, it can lead to a form of withdrawal or social isolation such as with the hikikomori disorder, and certainly other outcomes depending on the subject's evolution. In all cases, this evolution remains uncertain. If different forms of psychopathology can manifest themselves, ego splitting however can signify a form of self-immersion, in an attempt to reappropriate certain painful or unsymbolized elements from his past history. There is a type of splitting, which is not only a defense that can lead to feelings of fragmentation and derealization in the worst-case scenarios. It can also be inscribed in the borderline process of identity construction, a form of temporary dissociation of the patient, or schize , allowing parts of the self to return in a sort of retroactive loop, as an informer of the current state of the ego. In adolescence, this process is particularly active, due to the integration of the newly pubescent body. Either the subject, depending on his psychoaffective maturation, will enquire about the ongoing processes in progress in his inner world (his phantasmatic life, integration of the sexual body, etc.); or the splitting reduction takes place through a receptive and transformational function of the object, aligning this process with a form of "crossed" intersubjectivity. Thinking about the subject, especially during in his teenage years, as he encounters forms of dissociations which are not only the expression of a vulnerability, allows us to maintain a clinical vision which supports a potential for growth, a resilient capacity of the ego. The way we consider different outcomes of ego splitting in this article supports a dynamic approach of the psychological functioning, which places the subject in a continuum between what is normal and what is pathological. Splitting of the ego, as a borderline process, allows for a different reading of the underlying stakes of the contemporary expression of narcissistic and identity-related suffering. It also gives a dynamic perspective to what is usually a nosographic approach. [ABSTRACT FROM AUTHOR]

Background: Needle phobia, also known as blood--injection--injury (BII) phobia, is a severe form of needle fear that affects from 20 to 50 per cent of adolescents, 20 to 30 per cent of young adults and less than 5 per cent of the older adult population. When faced with venepuncture, approximately 75 per cent of patients with needle phobia will undergo an extreme physiological response which can lead to a vasovagal or fainting episode. An emerging therapy for medical phobias is the use of virtual reality, a three-dimensional environment generated by a computer that creates a sense of immersion. Aim: To evaluate the effect of virtual reality on the severity of patient fear or anxiety induced by needle phobia during medical procedures. Methods: We employed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies that used virtual reality to treat or manage needle phobia in adult patients. Two reviewers assessed each article with a third reviewer to resolve disagreements. We searched Medline, Embase, PsycINFO, PubMed and Web of Science from inception to search date. Articles were included if they contained original research and used virtual reality to treat or manage needle phobia in adult patients. Results: Five articles were included -- two randomised controlled trials (RCTs) that used virtual reality exposure therapy for the treatment of needle phobia in adults, one cross-sectional study examining reduction of dental anxiety using virtual reality, and two case studies that used virtual reality as a distraction therapy in adults, one for an adult with needle phobia and another for an adult with needle induced dental phobia. Conclusion: We found a paucity of research into virtual reality as either a treatment for needle phobia or as a distraction modality in adult patients. Further research is required to contribute to the evidence on the effectiveness of virtual reality as management or treatment for needle phobia. [ABSTRACT FROM AUTHOR]

Background: Social anxiety disorder is one of the most common anxiety disorders. Fear of negative evaluation by others is one of the most important features of social anxiety disorder. In various studies, the effectiveness of cognitive-behavioral treatments and virtual reality exposure therapy on the symptoms of anxiety disorders such as social anxiety disorder has been investigated and confirmed, But so far, no study has been conducted on the comparison of the effectiveness of these two types of treatment methods on the fear of negative evaluation of students with social anxiety disorder. Aims: The present study was conducted with the aim of comparing the effectiveness of cognitive-behavioral therapy and virtual reality exposure therapy on the fear of negative evaluation of students with social anxiety disorder. Methods: The current research method was a semi-experimental pre-test-post-test type with a control group and a one-month follow-up. The statistical population of the research included all second-year high school students studying in the schools of Qaem Shahr city in the academic year of 2022-2023. 51 students were included in the study with available sampling method and were randomly placed in two experimental groups and one control group (17 people in each group). The first and second experimental groups were subjected to cognitive-behavioral intervention and virtual reality exposure therapy during 12 and 8 60-minute sessions, respectively. The data collection tools in this research included the Social Phobia Inventory (Connor et al., 2000) and the short form of the Brief Fear of Negative Evaluation Scale (Leary, 1983). Data analysis was done by variance analysis method with repeated measurement and using SPSS-24 software. Results: The findings of this research showed that both cognitive-behavioral therapy interventions and virtual reality exposure therapy significantly reduced the fear of negative evaluation compared to the control group (P

Physical–cognitive stimulation has emerged as a promising strategy for improving the quality of life of patients with amyotrophic lateral sclerosis (ALS). This case study reports on the use of immersive virtual reality (IVR) as a tool for multisensory stimulation in a woman with ALS (76 years old; 11 years since diagnosis; stage 2). The program consisted of IVR stimulation sessions (three sessions per week for 12 weeks). The results showed that the implementation of the program was feasible and safe (no adverse symptoms on the Simulator Sickness Questionnaire), as well as easy to execute (>80% on the System Usability Scale). Additionally, the participant reported improvements in aspects related to her mental health (44% depression and 20% anxiety) and improvements in her quality of life, and she also maintained her values in her functional capacity. This study presents novel and important findings by demonstrating the feasibility of implementing physical–cognitive stimulation programs with IVR in a person with ALS, allowing for multisensory stimulation with commercially available hardware and software and the generation of benefits in their health-related quality of life and mental health.

Multiple sclerosis (MS) is an autoimmune demyelinating disease of the central nervous system with unknown etiology, resulting in various impairments that necessitate continuous rehabilitation to enhance functionality, quality of life, and motor function, including through Virtual Reality (VR) therapy. Comparing tasks in virtual environments and their potential skill transfer to real-world settings could aid in optimizing treatment programs to improve motor performance in individuals with MS. This study aimed to determine whether practicing acquisition and retention phases using two distinct interfaces (concrete—Touch Screen or abstract—Kinect system) affects performance in a subsequent task using a different interface (transfer phase). A randomized clinical trial was conducted with 56 volunteers with MS and 41 controls. Participants engaged in a computer game where they burst as many bubbles as possible within 10 s per attempt. After the acquisition and retention phases, all participants switched interfaces (e.g., those using Kinect switched to Touchscreen and vice versa). Significant performance improvements were observed in both groups during the acquisition phase, which were maintained in the retention phase. Although the abstract interface was more challenging for both groups, only the MS group that practiced with the abstract interface successfully transferred their improvements to the concrete interface. Thus, despite the increased difficulty of the abstract task during practice, it led to better performance transfer when required to complete a subsequent concrete task, suggesting that abstract devices may be beneficial in clinical practice for improving motor function in people with MS.

Background: high-intensity exercise is a feasible and effective modality in the early stages of Parkinson’s disease (PD). However, there are only a few studies that have carried out this type of intervention in customizable immersive virtual reality (IVR) environments. We explore the feasibility and effects of IVR-based high-intensity training through rowing and cycling exercises on the functional capacity, quality of life, and progression of PD. Methods: a total of 12 participants (61.50 ± 10.49 years old; 41.7% female, 58.3% male; stages I–III) were part of the study, which consisted of interventions of rowing and cycling in an IVR commercial exergame (25 min; twice per week for 14 weeks). The main variables measured were functional capacity, handgrip strength, functional mobility (TUG), functional lower-limb strength (FTSST), aerobic capacity (2-min step test), quality of life (PDQ-39), and Parkinson’s disease progression (MDS-UPDRS). Results: the results showed a general improvement in handgrip strength in both hands (p = 0.008; d = 0.28), FTSST (p = 0.029; d = 0.96), and TUG times (p = 0.152; d = 0.22). Aerobic capacity, assessed by a 2-min step test, showed enhanced scores (p = 0.031; d = 0.78). Related to the PDQ-39, all dimensions of the scale were enhanced, highlighting activities of daily living (p = 0.047; d = 0.29) and bodily discomfort (p = 0.041; d = 0.37). Finally, the main symptoms of the disease were reduced, with an improvement in the parameters that show a better incidence of disease progression, such as Part IA and IB (p = 0.013; d = 0.29 and p = 0.021; d = 0.25, respectively), Part II (p = 0.021; d = 0.23), Part III (p = 0.040; d = 0.39), and Part IV (p = 0.013; d = 0.39). Conclusions: the therapeutic exercise (rowing and cycling), when carried out at a high intensity and in a personalized IVR scenario, appear to be a feasible and safe modality for patients with stages I–III of PD, improving their functional capacity, quality of life, and disease progression.

This exploratory case study examined the effect of virtual reality exposure therapy (VRET) for a survivor of sexual violence (SV) as a preparation for a court hearing. Five sessions of VRET were completed before the court hearing, and one follow-up session was completed after the trial. In-depth interviews were conducted after each session for detailed assessment about the effects of therapy and first-hand experience of preparing for court. The participant said that the VRET sessions helped her prepare for court, gave an increased sense of control, and allowed her to manage emotions and bodily reactions. The trial itself and preparing for it was seen as an important part of the recovery process, where social support played an important role. VRET appears to be a promising preparation method for SV survivors taking their cases to court. More research is needed to standardize and improve the quality of VRET and examine how it can be combined with other sources of support. [ABSTRACT FROM AUTHOR]

Virtual Reality technology is being utilized to administer psychotherapy treatments. Virtual Reality Exposure Therapy (VRET) provides a safer and less expensive platform for the exposure therapy treatment of numerous anxiety disorders such as phobias. Though, research studies have demonstrated the effectiveness of VRET, its large scale adoption is yet to be realized. Many VRET solutions have been designed, however, few are widely used or commercially available. Moreover, these solutions lack standardization as there are no significant guidelines available for developing them. Consequently, it prevents the existing VRET systems from being adopted for clinical treatment. Thus, there is a need for determining the critical design requirements to create practically effective, safe and commercially viable VRET solutions. To this end, we put forward key design considerations in designing VRETs. Keeping in view these considerations, we present Defear, a therapist-led VRET solution to facilitate the treatment of phobias. Defear not only provides VRET solutions but also includes wide-ranging features including patient management, meditation, and progress tracking to support therapists in their exposure therapy treatments. Usability assessment showed that Defear was positively and highly rated by the users. Moreover, we also present the challenges in the planning, development, evaluation, and dissemination of VRET applications. [ABSTRACT FROM AUTHOR]

Acrophobia has traditionally been treated using exposure therapy; however, virtual reality technology has emerged as an alternative that minimizing security risks by presenting three-dimensional stimuli. This study aimed to investigate virtual reality exposure therapy-cognitive restructuring (VRET-CR) effectiveness in reducing acrophobia symptoms. In a pretest-posttest control group design, 27 participants were randomly assigned to the experimental group (n=13) and the control group (n=14). An independent sample t-test revealed a significant differences in the gain scores of the acrophobia questionnaire (AQ) 1 [t (17.08) = -6.173; p <0.05] and AQ 2 [t (25) = -4.250; p <0.05] between these groups. Scores on the State-Trait Anxiety Inventory (STAI) and Autonomic Perception Questionnaire (APQ) decreased after six exposure sessions, supporting these findings. Skin conductance and respiratory rate changes during therapy were less significant than heart rate changes. Overall, the results demonstrated the effectiveness of VRET-CR in reducing acrophobia symptoms. [ABSTRACT FROM AUTHOR]

Background: Social anxiety disorder is one of the most common anxiety disorders. Fear of negative evaluation by others is one of the most important features of social anxiety disorder. In various studies, the effectiveness of cognitive-behavioral treatments and virtual reality exposure therapy on the symptoms of anxiety disorders such as social anxiety disorder has been investigated and confirmed, But so far, no study has been conducted on the comparison of the effectiveness of these two types of treatment methods on the fear of negative evaluation of students with social anxiety disorder. Aims: The present study was conducted with the aim of comparing the effectiveness of cognitivebehavioral therapy and virtual reality exposure therapy on the fear of negative evaluation of students with social anxiety disorder. Methods: The current research method was a semi-experimental pre-test-post-test type with a control group and a one-month follow-up. The statistical population of the research included all second-year high school students studying in the schools of Qaem Shahr city in the academic year of 2022-2023. 51 students were included in the study with available sampling method and were randomly placed in two experimental groups and one control group (17 people in each group). The first and second experimental groups were subjected to cognitive-behavioral intervention and virtual reality exposure therapy during 12 and 8 60-minute sessions, respectively. The data collection tools in this research included the Social Phobia Inventory (Connor et al., 2000) and the short form of the Brief Fear of Negative Evaluation Scale (Leary, 1983). Data analysis was done by variance analysis method with repeated measurement and using SPSS-24 software. Results: The findings of this research showed that both cognitive-behavioral therapy interventions and virtual reality exposure therapy significantly reduced the fear of negative evaluation compared to the control group (P<0.01). And the effect of both intervention methods was maintained until the one-month follow-up phase. Also, the findings indicated that cognitive-behavioral therapy was more effective compared to virtual reality exposure therapy (P<0.01). Conclusion: According to the obtained results, it is suggested that child and adolescent counselors and therapists as well as school counselors of the two interventional methods, cognitive-behavioral therapy and virtual reality exposure therapy, with the priority of cognitive-behavioral therapy in particular use to reduce the fear of negative evaluation and in general to reduce the symptoms of social anxiety of students. [ABSTRACT FROM AUTHOR]

Exposure-response prevention is an effective approach to treat anxiety disorders. Virtual reality exposure therapy (VRET) is a promising treatment for patients with posttraumatic stress disorder (PTSD). New research has helped refine and update VRET. In this study, we introduce a form of VRET developed for patients suffering from PTSD after a traffic accident, and present two cases treated using this protocol. After 6 weeks of VRET treatment, the two participants not only improved their PTSD symptoms, but also improved their depressed mood, anxiety, and insomnia symptoms. Future studies of VRET for car accident-related PTSD should utilize a controlled design with randomization in order to account for numerous possible confounds. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the efficacy of an iVR surgical training system for orthognathic surgery training in medical students. Methods: This study comprised 20 fifth year medical students who were randomly assigned to the VR or traditional group for orthognathic surgical education. All participants were initially provided a lecture on orthognathic surgery. The VR group then received 10 educational sessions using the self‐developed iVR training system, whereas the traditional group received 10 sessions using technical manuals and annotated operation videos. These sessions were 40‐min long in both the groups. Before the evaluation, the traditional group completed one session using the training and assessment modes to become familiar with the iVR training system. The score in the assessment mode, time to complete the procedure, number of instrument selection errors, number of prompts given by the system, number of positional and angular errors, and number of timeouts during each step were recorded to evaluate the learning effect. Results: The VR group achieved higher scores than the traditional group (94.67 vs. 87.65). Compared with the control group, the VR group completed the procedure more quickly, with fewer instrument selection and angular errors. No difference in the number of prompts given by the system was observed between the two groups. Conclusions: The iVR surgical training system showed a better learning effect than the traditional learning method for orthognathic surgery. The iVR surgical training system may have utility as a supplement and potential substitute for the traditional surgical training method. [ABSTRACT FROM AUTHOR]

Copyright of Arab Journal for Scientific Publishing is the property of Research & Development of Human Recourses Center (REMAH) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Objective: This research aimed to determine the efficacy of VR therapy in mitigating symptoms of depression, anxiety, and stress among older adults following arthroplasty surgery and to comprehend the influence of psychological improvement on changes in functional outcomes. Methods: Utilizing a parallel-group randomized controlled trial design, the study involved 68 osteoarthritis patients who had recently undergone either total hip or knee arthroplasty. Subjects were split into two groups. The experimental group underwent eight VR therapy sessions during their rehabilitation, while the control group was given standard care. Assessments encompassed both psychological and functional outcomes, with tools like the Hospital Anxiety and Depression Scale, Perceived Stress Scale, and the Barthel Index, among others. The experimental group showcased notable enhancements in both psychological and functional areas compared to the control group. Results: A significant (p value of < 0.001) relationship was found between psychological progress and functional recovery, indicating that psychological factors can serve as predictors for functional outcomes. Conclusions: The findings emphasize the promising role of VR therapy as a beneficial addition to the rehabilitation process for older adults' post-hip and knee arthroplasty. The integration of psychological interventions in standard rehabilitation practices appears valuable, but further studies are needed to ascertain the long-term advantages of such an approach. [ABSTRACT FROM AUTHOR]

Introduction: job stress is defined as the accumulation of stressful factors in job-related situations, which most people agree is stressful, and it can be the direct factor in the intention to leave the job. The present study investigates the effectiveness of virtual reality exposure therapy and compares its effectiveness with mindfulness-based stress reduction based on mindfulness on the components of job stress employees with job stress. Materials and Methods: The research design was a semi-experimental pre and post-test with a control group and a follow-up phase. The statistical population included all employees with job stress in a private company in Isfahan City in 2022, and the research sample included 45 employees who were randomly divided into three groups of 15: virtual reality therapy, mindfulness-based stress reduction therapy, and Controls were replaced. The people of the two intervention groups participated in the intervention sessions; The first experimental group underwent eight 20-minute weekly sessions of virtual reality therapy, and the second experimental group underwent eight weekly 45-minute sessions based on the Kabat-Zin training package (1990 and 2013), but for the control group no interventions were performed. The participants responded to the occupational stress questionnaire of the Health and Safety Institute of England Steinmetz (HSE) (1990) in three stages. The research data were analyzed with analysis of covariance and Bonferroni's post hoc test and using SPSS23 statistical software at two descriptive and inferential levels. Results: The results of covariance analysis and Bonferroni's post hoc test indicated that both intervention methods equally and effectively reduced occupational stress in the fields of role, communication, support of colleagues, changes in employees, and the effect of both interventions remained stable over time (P0.05). Conclusion: The results showed that virtual reality courses and stress reduction based on mindfulness can reduce the tensions and job stress of personnel and employees of organizations.

Background: Specific phobias impact over 400 million people worldwide. Digitalizing mental health could alleviate the burden. Still, although the corporate-driven Metaverse is expanding rapidly, there needs to be more momentum in harnessing virtual reality exposure therapy uptake. Objective: This study aims to conceptualize, develop, and deploy a free Virtual Reality Exposure Therapy (VRET) application specifically designed for treating acrophobia and claustrophobia. This pilot study, which holds the promise of a future where mental health is more accessible and effective, explores the feasibility of leveraging transdisciplinary collaboration among specialists to create a safe, accessible, and effective VRET solution. Methods: We conducted a Delphi heuristic approach involving bioethicists, neuroscientists, and tech developers. Second, we reviewed the existing psychological theories and therapeutic strategies for addressing phobias in VR. Third, we conceptualized a thematic analysis-derived framework for a safe, adaptive-gamified free exposure to virtual reality acrophobia and claustrophobia (SAFEvR ACT). Finally, we provide an overview of the iterative improvements made during 12 workshops and 76 weekly briefings on developmental implementations. Results: We developed the SAFEvR ACT into a proof-of-concept application freely deployed on the MentalVerse app platform. Our safety-focused approach can benefit from prevalidation perspectives within future randomized control trials. Conclusions: The resulting application derived from the SAFEvR ACT framework represents a blueprint to counter the current lack of iVR mental health uptake by offering a free VRET alternative. Future research should aim towards developing similar free platforms to lessen mental health burdens and gather quantitative data. We conclude with a call to action to researchers to fine-tune our current approach and take a stand for free digital mental health within MentalVeRse.app.

Abstract Background Performance anxiety is the most frequently reported anxiety disorder among professional musicians. Typical symptoms are - on a physical level - the consequences of an increase in sympathetic tone with cardiac stress, such as acceleration of heartbeat, increase in blood pressure, increased respiratory rate and tremor up to nausea or flush reactions. These symptoms can cause emotional distress, a reduced musical and artistical performance up to an impaired functioning. While anxiety disorders are preferably treated using cognitive-behavioral therapy with exposure, this approach is rather difficult for treating music performance anxiety since the presence of a public or professional jury is required and not easily available. The use of virtual reality (VR) could therefore display an alternative. So far, no therapy studies on music performance anxiety applying virtual reality exposure therapy have investigated the therapy outcome including cardiovascular changes as outcome parameters. Methods This mono-center, prospective, randomized and controlled clinical trial has a pre-post design with a follow-up period of 6 months. 46 professional and semi-professional musicians will be recruited and allocated randomly to an VR exposure group or a control group receiving progressive muscle relaxation training. Both groups will be treated over 4 single sessions. Music performance anxiety will be diagnosed based on a clinical interview using ICD-10 and DSM-5 criteria for specific phobia or social anxiety. A behavioral assessment test is conducted three times (pre, post, follow-up) in VR through an audition in a concert hall. Primary outcomes are the changes in music performance anxiety measured by the German Bühnenangstfragebogen and the cardiovascular reactivity reflected by heart rate variability (HRV). Secondary outcomes are changes in blood pressure, stress parameters such as cortisol in the blood and saliva, neuropeptides, and DNA-methylation. Discussion The trial investigates the effect of VR exposure in musicians with performance anxiety compared to a relaxation technique on anxiety symptoms and corresponding cardiovascular parameters. We expect a reduction of anxiety but also a consecutive improvement of HRV with cardiovascular protective effects. Trial registration : This study was registered on clinicaltrials.gov. (ClinicalTrials.gov Number: NCT05735860)

Background: Public speaking anxiety (PSA) is a prevalent social anxiety affecting up to 30% of the population. Individuals with PSA often express fear of being evaluated by others and avoid eye contact. Despite this behavioral characteristic, the potential of gaze avoidance reduction as a therapeutic intervention to alleviate PSA-related anxiety remains unexplored. Methods: We designed a standalone virtual reality (VR) gaze exposure treatment focused on enhancing eye contact in public speaking contexts and evaluated its effectiveness in reducing state anxiety during public speaking. In a single-blind, randomized controlled trial, 89 participants with subclinical PSA were assigned to either a gaze exposure treatment or a control group. Assessments occurred at baseline, following a one-hour intervention, and after nine additional 20-minute home interventions. The primary outcome was state anxiety, assessed using the Subjective Units of Distress Scale during a real-life public speaking test. Results: Repeated, but not acute VR gaze exposure reduced state anxiety during public speaking compared to the control group (treatment: baseline 48.95 [SD 19.52], post-intervention 2: 26.60 [SD 19.23]; control: baseline 48.92 [SD 18.43], post-intervention 2: 56.34 [SD 28.15]; adjusted mean group difference: -29.82, 95% CI: -41.77 to -17.87; Cohen's d = -1.07, p < 0.0001). Limitations: Our study design does not allow conclusions regarding the effective component (i.e., gaze exposure vs. social context) of the intervention. Conclusions: Our findings indicate that repeated VR gaze exposure treatment in public speaking contexts can effectively reduce state anxiety during public speaking among individuals with subclinical PSA. These promising results call for further investigations in clinical populations.

Background: This multicenter, three-armed, parallel, single-blind randomized controlled trial (RCT) primarily aims to compare the efficacy of virtual reality exposure therapy (VRET) with that of acceptance and commitment therapy (ACT) and treatment as usual (TAU) to depreciate the degree of alcohol craving among alcohol use disorder patients who have undergone in-patient detoxification across four timelines (t0 = baseline prior to intervention, t1 = 4 weeks after baseline, t2 = 12 weeks after baseline, and t3 = 24 weeks after baseline). The secondary aims of this RCT are to compare the efficacy of VRET with that of ACT and TAU to alleviate the severity of alcohol use disorder, dissipate comorbid depressive and anxiety symptoms, and normalize event-related potential (ERP) in electroencephalogram (EEG) monitoring across the four timelines. Methods: Initially, after 2 weeks of in-patient detoxification, 120 patients with alcohol use disorder will be randomized into three groups (VRET, ACT, and TAU control groups) via stratified permuted block randomization in a 1:1:1 ratio. Baseline assessment (t0) commences, whereby all the participants will be administered with sociodemographic, clinical, and alcohol use characteristics questionnaire, such as Alcohol Use Disorder Identification Test (AUDIT), Penn Alcohol Craving Scale (PACS), Hamilton Anxiety Rating Scale (HAM-A), and Hamilton Depression Rating Scale (HAM-D), while event-related potential (ERP) detection in electroencephalogram (EEG) will also be carried out. Then, 4 weeks of VRET, ACT, and non-therapeutic supportive activities will be conducted in the three respective groups. For the subsequent three assessment timelines (t1, t2, and t3), the alcohol use characteristic questionnaire, such as AUDIT, PACS, HAM-D, HAM-A, and ERP monitoring, will be re-administered to all participants. Discussion: As data on the effects of non-pharmacological interventions, such as VRET and ACT, on the treatment of alcohol craving and preventing relapse in alcohol use disorder are lacking, this RCT fills the research gap by providing these important data to treating clinicians. If proven efficacious, the efficacy of VRET and ACT for the treatment of other substance use disorders should also be investigated in future. [ABSTRACT FROM AUTHOR]

Aims and Objectives: Evidence suggests that preparing patients for surgery using nonpharmacological strategies reduces their anxiety. However, there is no consensus on what the best practices are. This study aims to answer the question: Are interventions using nonpharmacological therapies effective in reducing preoperative anxiety? Background: Preoperative anxiety causes physiological and psychological adverse effects, with a negative effect on postoperative recovery. Introduction: According to the World Health Organization, between 266 and 360 million surgical procedures are performed annually worldwide, and it is estimated that more than 50% of patients will experience some degree of preoperative anxiety. Design: Systematic review of systematic reviews with results of interventions aimed at mitigating preoperative anxiety. Methods: A search was conducted for systematic reviews with meta‐analyses published between 2012 and 2021 in Medline, Scopus, Web of Science and Cochrane Library. Quality was assessed using the AMSTAR‐2 scale. The protocol was registered in PROSPERO. Results: A total of 1016 studies were examined, of which 17 systematic reviews were selected, yielding 188 controlled trials with 16,884 participants. In adults, the most common intervention included music, followed by massage, in children virtual reality and clowns. Almost all controlled trials reported a reduction in preoperative anxiety after the intervention, of which almost half had statistically significant results. Conclusion: Interventions that include music, massage and virtual reality reduce preoperative anxiety and have shown that they are cost‐effective, minimally invasive and with a low risk of adverse effects. Preoperative anxiety can be reduced through a short‐term intervention involving nursing professionals as an alternative or complement to drugs. Relevance to clinical practice: This review suggests that nursing professionals, in collaboration with other health professionals, should continue to conduct research on the reduction in preoperative anxiety. Further research in this area is needed, to reduce heterogeneity and consolidate the results. No Patient or Public Contribution: Not applied to our study, as it is a systematic review of systematic reviews. [ABSTRACT FROM AUTHOR]

Introduction: Obsessive–compulsive disorder (OCD) is characterised by recurrent, repetitive, and unwanted thoughts or impulses triggering significant anxiety. Exposure and response prevention is currently the first-line therapy for OCD. The goal of this validation study was to confirm the potential of the VR house environment that incorporates OCD-specific items that cluster around major symptom dimensions: 'contamination', 'symmetry', 'checking' and 'hoarding' to induce anxiety and compulsive behaviour in patients with OCD. Method: We assessed a sample of OCD patients (n = 44) that was compared to a group of healthy controls (n = 31). The severity of OCD symptoms was assessed in all subjects. During a single session, participants were asked to approach a set of 10 stimuli (covering four OCD dimensions) and rate their current intensity of distress/anxiety and compulsive tendencies (scales 0–5) provoked by observing each stimulus. Before and after the VR exposure, participants completed questionnaires assessing subjective levels of anxiety (before/after VR exposure), their sense of presence in VR and experienced simulator sickness. Results: The results show that the OCD group reports elevated levels of distress and compulsive behaviour when confronted with VR exposure stimuli compared to the control group, but no increase in anxiety levels has been observed after the VR exposure. The subjective ratings of provoked distress and compulsive behaviour are not associated with severity of OCD symptoms, perceived sense of presence, association with cybersickness symptoms is weak. Conclusion: Our data suggest that the VR house environment is a suitable tool for VR exposure therapy in OCD patients as it demonstrates OCD symptom provocation relevant for individual patients. [ABSTRACT FROM AUTHOR]

Intense exercise can be neuromodulatory and neuroprotective against Parkinson’s disease (PD). Indoor cycling is a good and safe option for this population, but some barriers (monotonous and repetitive environment, lack of monitoring, and an inability to compete with others) could limit its use. Immersive virtual reality (IVR) could be a possible solution to some of these drawbacks, increasing patient motivation and thus adherence to forced exercise programs using cycloergometers. A double-blind, randomized, controlled clinical trial was conducted to explore the feasibility and effects of the ReViPark program (high-intensity pedaling + IVR for 3 months with two sessions per week) on PD progression. In all, 52 people with PD were allocated to the ReViPark group (n = 30; 70.87 ± 6.67 years) and smart cycloergometer group (n = 22; 70.59 ± 6.67 years). This program was feasible, with no adverse effects (no significant Simulator Sickness Questionnaire symptoms and a low negative experience rating for the Game Experience Questionnaire (0.04/4)), no dropouts, high adherence, and good usability (System Usability Scale score of 82.90%). The ReViPark group showed significant improvements in functionality, quality of life, and disease progression as measured by their balance, gait and risk of falling (Timed Up and Go p = 0.028; Tinetti test p = 0.046), PDQ-39 scores (p = 0.035), and MDS-UPDRS scores (p = 0.001). This program is feasible and could lead to improvements in the functional parameters, quality of life, and symptomatology of the participants.

Background: Performance anxiety is the most frequently reported anxiety disorder among professional musicians. Typical symptoms are - on a physical level - the consequences of an increase in sympathetic tone with cardiac stress, such as acceleration of heartbeat, increase in blood pressure, increased respiratory rate and tremor up to nausea or flush reactions. These symptoms can cause emotional distress, a reduced musical and artistical performance up to an impaired functioning. While anxiety disorders are preferably treated using cognitive-behavioral therapy with exposure, this approach is rather difficult for treating music performance anxiety since the presence of a public or professional jury is required and not easily available. The use of virtual reality (VR) could therefore display an alternative. So far, no therapy studies on music performance anxiety applying virtual reality exposure therapy have investigated the therapy outcome including cardiovascular changes as outcome parameters. Methods: This mono-center, prospective, randomized and controlled clinical trial has a pre-post design with a follow-up period of 6 months. 46 professional and semi-professional musicians will be recruited and allocated randomly to an VR exposure group or a control group receiving progressive muscle relaxation training. Both groups will be treated over 4 single sessions. Music performance anxiety will be diagnosed based on a clinical interview using ICD-10 and DSM-5 criteria for specific phobia or social anxiety. A behavioral assessment test is conducted three times (pre, post, follow-up) in VR through an audition in a concert hall. Primary outcomes are the changes in music performance anxiety measured by the German Bühnenangstfragebogen and the cardiovascular reactivity reflected by heart rate variability (HRV). Secondary outcomes are changes in blood pressure, stress parameters such as cortisol in the blood and saliva, neuropeptides, and DNA-methylation. Discussion: The trial investigates the effect of VR exposure in musicians with performance anxiety compared to a relaxation technique on anxiety symptoms and corresponding cardiovascular parameters. We expect a reduction of anxiety but also a consecutive improvement of HRV with cardiovascular protective effects. Trial registration: : This study was registered on clinicaltrials.gov. (ClinicalTrials.gov Number: NCT05735860) [ABSTRACT FROM AUTHOR]