Can Virtual Reality Ever Be Implemented in Routine Clinical Settings? A Systematic Narrative Review of Clinical Procedures Contained Within Case Reports for the Treatment of PTSD

Abstract

The evidence base for the use of immersive technologies, such as Virtual Reality (VR), for the treatment of Post-Traumatic Stress Disorder (PTSD) is compelling. Despite promising results wide spread use and adoption of this technology within routine clinical practice remains limited. A lack of detailed technical guidelines might be one of the reasons that hamper such uptake. To address this gap, the current review focuses on earlier design types, namely Clinical Case Reports in order to uncover additional detail in relation to clinical presentations and unique technical procedures. Systematic searches returned 419 results with 15 studies meeting inclusion criteria. This included 13 single subject case reports studies and 2 case series, totaling 27 participants. Results show the use of VR technology to treat PTSD is mainly exposure based. When using such interventions clinicians should conduct a thorough assessment of their clients' background, trauma memory, and triggers in order to tailor the VR experience. They should also plan some early orientation work to help clients acclimatize to the new virtual environment. Gathering self-reported data every 5 min throughout exposure will help with client monitoring, alongside physiological data. The use of olfactory or tactile stimuli may also be helpful during exposure, but is not a necessity. In conclusion, the costs of VR equipment have dropped significantly in the past years making this more accessible and affordable for healthcare providers. Nonetheless, a significant gap remains regarding the use of VR interventions for PTSD in clinical practice. The dearth of qualitative data available within the case report literature, might however help to bridge this gap.

360° Videos for Immersive Mental Health Interventions: a Systematic Review

“…Computer-generated virtual reality (VR) has been established as a means for successfully delivering exposure therapy in the treatment of anxiety disorders (Carl et al, 2019;Opris et al, 2012) including social anxiety disorder (SAD; Bouchard et al, 2017), fear of flying (Ferrand et al, 2015), panic disorder or agoraphobia (Bottela et al, 2007;Gromer et al, 2018), and posttraumatic stress disorder (PTSD; Best et al, 2020). Relying on IT as an exposure technique consistently seems to yield better results compared to imaginal exposure (Guitard, et al, 2019).…”

Dropping the E: The potential for integrating e-mental health in psychotherapy

“…Subsequently, customizations can be added to tailor this environment to a particular trauma (e.g., noises, relevant colours or visuals, avatars of robbers) and a therapist can also be more directive in their guidance. The overall aim is to learn a patient how to emotionally (re)process information concerning the traumatic event more accurately, which in turn helps to remove negative feelings and fear responses concerning the trauma and related cues [33].…”

Appraising Virtual Technologies’ Impact on Older Citizens’ Mental Health—A Comparative between 360° Video and Virtual Reality

“…These lead to reduced independence for the individuals, resulting in an increased number of older people being admitted to nursing homes and requiring assistance for living [ 16 , 17 ]. This leads to a deterioration in both mental and physical health [ 1 , 8 , 14 , 18 , 19 ], resulting in depression and anxiety [ 1 , 2 , 20 , 21 , 22 , 23 ], loneliness [ 24 , 25 , 26 ], and sedentarism [ 8 , 27 ].…”

“…Immersive technologies, such as virtual reality (VR), augmented reality (AR), and mixed reality (XR), have been demonstrated to be effective tools in the therapeutic treatment of posttraumatic stress disorder [ 20 , 28 ], phobias [ 29 , 30 ], dementia [ 22 , 31 ], loneliness, and stress [ 12 , 32 , 33 , 34 ], and such systems have a positive influence on older people’s mental and physical wellbeing.…”

“…VR technology has improved dramatically over the last decade, offering better quality and accessible pricing [ 20 , 35 , 36 ] and providing affordable tools for entertainment and clinical healthcare [ 32 , 37 , 38 , 39 ]. With this emerging technology, it is possible to create highly immersive and realistic environments for individuals with reduced mobility [ 32 , 37 , 40 ].…”