Abstract:Background
Virtual reality (VR) is as effective a technique as traditional cognitive behavioral therapy (CBT) and a promising tool for treating panic disorder symptoms because VR exposure can be safer and has better acceptability than in vivo exposure and is more immersive than exposure through imagination. CBT techniques can be delivered more effectively using VR as well. So far, VR has required high-quality devices, but the development of mobile VR technology has improved user availability. At th… Show more
“…It has to be stated that therapeutic guidelines recommend that a therapist stay by the side of the patient [ 7 ]. On the contrary, there is growing evidence that a self-management app for VRE leads to symptom reduction and is at least not inferior to that with therapist guidance [ 45 , 72 ]. Hence, both kinds of apps are used in practice [ 73 ].…”
Background
The effectiveness of virtual reality exposure (VRE) in the treatment of anxiety disorders is well established. Several psychological mechanisms of VRE have been identified, whereby both emotional processing and the sense of presence play a key role. However, there are only few studies that contribute to our knowledge of examples of implementation in the case of VRE for claustrophobia based on patients' experiences and the perspective of therapists.
Objective
This study asks for key elements of a VRE app that are necessary for effective exposure for people with claustrophobic symptoms.
Methods
A mixed methods design was applied in which patients (n=15) and therapeutic experts (n=15) tested a VRE intervention of an elevator ride at 5 intensity levels. Intensity was varied by elevator size, duration of the elevator ride, and presence of virtual humans. Quantitative measures examined self-reported presence with the Igroup Presence Questionnaire (IPQ) ranging from 0 to 6 and 15 Likert-scaled evaluation items that had been developed for the purpose of this study, ranging from 1 to 5. In both measures, higher scores indicate higher levels of presence or agreement. Think-aloud protocols of the patients and semistructured interviews posttreatment of all participants were conducted to gain in-depth perspectives on emotional processes.
Results
The intervention induced a feeling of presence in patients and experts, posttreatment scores showed a high IPQ presence score (mean 3.84, SD 0.88), with its subscores IPQ spatial presence (mean 4.53, SD 1.06), IPQ involvement (mean 3.83, SD 1.22), and IPQ experienced realism (mean 2.75, SD 1.02). Patients preferred a setting in the presence of a therapist (mean 4.13, SD 0.83) more than the experts did (mean 3.33, SD 1.54). Think-aloud protocols of the patients revealed that presence and anxiety both were achieved. Qualitative interviews of patients and experts uncovered 8 topics: feelings and emotions, personal story, telepresence, potential therapeutic effects, barriers, conditions and requirements, future prospects, and realization. The intensity levels were felt to appropriately increase in challenge, with ambivalent results regarding the final level. Virtual humans contributed to feelings of fear.
Conclusions
Key elements of a VRE app for claustrophobic symptoms should include variation of intensity by adding challenging cues in order to evoke presence and anxiety. Virtual humans are a suitable possibility to make the intervention realistic and to provide a sense of closeness; however, some of the fears might then be related to symptoms of social phobia or agoraphobia. Patients may need the physical presence of a therapist, though not all of them share this view. A higher degree of sophistication in the intensity levels is needed to deliver targeted help for specific symptoms of anxiety.
“…It has to be stated that therapeutic guidelines recommend that a therapist stay by the side of the patient [ 7 ]. On the contrary, there is growing evidence that a self-management app for VRE leads to symptom reduction and is at least not inferior to that with therapist guidance [ 45 , 72 ]. Hence, both kinds of apps are used in practice [ 73 ].…”
Background
The effectiveness of virtual reality exposure (VRE) in the treatment of anxiety disorders is well established. Several psychological mechanisms of VRE have been identified, whereby both emotional processing and the sense of presence play a key role. However, there are only few studies that contribute to our knowledge of examples of implementation in the case of VRE for claustrophobia based on patients' experiences and the perspective of therapists.
Objective
This study asks for key elements of a VRE app that are necessary for effective exposure for people with claustrophobic symptoms.
Methods
A mixed methods design was applied in which patients (n=15) and therapeutic experts (n=15) tested a VRE intervention of an elevator ride at 5 intensity levels. Intensity was varied by elevator size, duration of the elevator ride, and presence of virtual humans. Quantitative measures examined self-reported presence with the Igroup Presence Questionnaire (IPQ) ranging from 0 to 6 and 15 Likert-scaled evaluation items that had been developed for the purpose of this study, ranging from 1 to 5. In both measures, higher scores indicate higher levels of presence or agreement. Think-aloud protocols of the patients and semistructured interviews posttreatment of all participants were conducted to gain in-depth perspectives on emotional processes.
Results
The intervention induced a feeling of presence in patients and experts, posttreatment scores showed a high IPQ presence score (mean 3.84, SD 0.88), with its subscores IPQ spatial presence (mean 4.53, SD 1.06), IPQ involvement (mean 3.83, SD 1.22), and IPQ experienced realism (mean 2.75, SD 1.02). Patients preferred a setting in the presence of a therapist (mean 4.13, SD 0.83) more than the experts did (mean 3.33, SD 1.54). Think-aloud protocols of the patients revealed that presence and anxiety both were achieved. Qualitative interviews of patients and experts uncovered 8 topics: feelings and emotions, personal story, telepresence, potential therapeutic effects, barriers, conditions and requirements, future prospects, and realization. The intensity levels were felt to appropriately increase in challenge, with ambivalent results regarding the final level. Virtual humans contributed to feelings of fear.
Conclusions
Key elements of a VRE app for claustrophobic symptoms should include variation of intensity by adding challenging cues in order to evoke presence and anxiety. Virtual humans are a suitable possibility to make the intervention realistic and to provide a sense of closeness; however, some of the fears might then be related to symptoms of social phobia or agoraphobia. Patients may need the physical presence of a therapist, though not all of them share this view. A higher degree of sophistication in the intensity levels is needed to deliver targeted help for specific symptoms of anxiety.
“…In the first session of treatment, the therapist explains things about panic attacks so that these attacks become unpredictable and uncontrollable in the person's mind, and the person's misconceptions about panic symptoms, including the idea of going crazy, disappear, such as "When our ancestors were in the forests, they were residents, they were exposed to all kinds of natural disasters." Naturally, if they did not sleep at night with the fear of a lion or leopard attack, they would fall into such a deep sleep that they would not notice the presence of a lion or a leopard and become their prey [11]. Therefore, we are the descendants of ancestors who were worried about the dangers around them and were in a state of alertness.…”
Section: Psychological Training In the Treatment Of The Panic Disordermentioning
Panic disorder is one of the most debilitating mental disorders. Therefore, it is necessary to apply treatments for this problem to eliminate the disability of patients. Both psychotherapy and medication have been shown to reduce the frequency and severity of panic attacks and panic disorder. In this chapter, we first mentioned cognitive-behavioral therapy as the cornerstone of psychotherapy for panic disorder and then, medication as one of the most common treatments for this disorder. Cognitive-behavioral therapy has been found by numerous studies to be the most important psychotherapy for panic attacks and panic disorder. Medication is another effective treatment because some medications can be very helpful in managing the symptoms of a panic attack as well as anxiety and depression. Finally, emotion regulation therapies for the treatment of panic disorder will be introduced and explained for the first time.
“…Weiterhin gibt es erste Wirksamkeitsnachweise für ein VR-gestütztes Selbsthilfeprogramm VR-gestütztes Selbsthilfeprogramm bei Panikstörung [ 25 ], bei dem mithilfe einer Smartphone-App selbstständig KVT-Elemente (Psychoedukation, Entspannungsübungen und Exposition) in einer VR-Umgebung durchgeführt werden. Im Vergleich zu einer Wartelistenkontrollgruppe zeigte die VR-App-Gruppe eine signifikant stärkere Symptomreduktion.…”
Section: Evidenzlage Zu Digitalen Interventionen Bei Panikstörung Und...unclassified
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