Cyberpsychology: Virtual Reality (VR) Interventions for Mental Health PDF

Cyberpsychology: Virtual Reality (VR) Interventions for Mental Health Dr Ntaniella R. Pylarinou Today’s session Explore the ways in which Virtual Reality (VR) is being used to change lives and improve patient outcomes in mental health Develop an understanding of the connection s betw...

Cyberpsychology: Virtual Reality (VR) Interventions for Mental Health Dr Ntaniella R. Pylarinou Today’s session Explore the ways in which Virtual Reality (VR) is being used to change lives and improve patient outcomes in mental health Develop an understanding of the connection s between different psychological perspecti ves within this area of research Consider the ethical issues within this rapidly developing field Today’s Session In class tasks Go through your task and get feedback What is the objective for today’s lesson “Discuss the psychological contribution to understanding Virtual Reality within the field of mental health in contemporary society” What is virtual reality? Virtual reality, or VR, is a simulated three-dimensional (3D) environment that lets users explore and interact with a virtual surrounding in a way that approximates reality, as it's perceived through the users' senses. The environment is created with computer hardware and software, although users might also need to wear devices such as goggles, headsets or bodysuits to interact with the environment. How it’s used In recent years Virtual Reality (VR) has emerged as a pioneering tool in therapeutic interventions. VR is reshaping traditional approaches to mental health care, offering novel avenues for assessment, treatment, and support. VR once confined to the realms of gaming and entertainment, has now transcended its recreational origins to become a potent force in psychological well-being. How it’s used The evolution of VR in mental health is marked by its versatility, catering to a spectrum of therapeutic needs. From anxiety and phobia management to post- traumatic stress disorder (PTSD) treatment, VR's immersive experiences provide a controlled environment for individuals to confront and navigate their mental health challenges. Simulated scenarios, meticulously designed to replicate real- world situations, offer a safe space for exposure therapy, allowing patients to confront and overcome their fears in a controlled and supportive setting. How it’s used VR has proven invaluable in stress reduction and mindfulness practices. Guided meditation sessions and relaxation exercises transport users to serene, virtual landscapes, fostering relaxation and emotional regulation. In the realm of cognitive rehabilitation, VR applications have shown promise in enhancing cognitive functions for individuals with conditions such as dementia or traumatic brain injuries.  How it’s used In addition to these therapeutic dimensions, the transformative potential of Social VR stands out as a notable facet of VR in mental health. Social VR addresses the profound challenges of loneliness and social anxiety, providing individuals with immersive environments to practice social interactions, build confidence, and foster a sense of connection in a controlled space. This innovative approach expands the scope of VR's impact, not only as a tool for individual healing but also as a catalyst for social inclusion and community-building in the digital age. As we explore the myriad dimensions of VR in mental health, from individualized therapy to collective well- being, the evolving landscape of technology- assisted interventions promises new hope for those navigating the complexities of mental well-being. Ways in which VR is used in Mental Health Virtual Reality has proven to be a versatile and effective tool in various aspects of mental health care, offering innovative solutions to a range of psychological challenges. Can you think of any? Ways in which VR is used in Mental Health Exposure Therapy Stress Reduction and Relaxation Cognitive Rehabilitation Social VR for Loneliness & Social Anxiety Pain Distraction and Management VR Exposure therapy (VRET) VR provides a controlled and immersive environment for exposure therapy, allowing individuals to confront and overcome fears and phobias. This is particularly beneficial for conditions such as anxiety disorders, post-traumatic stress disorder (PTSD), and specific phobias. VR Exposure therapy (VRET) VRET is where gradual exposure to a negative stimulus is used to reduce anxiety. Virtual exposure is desirable in many situations, as it can be less intimidating and less expensive than traditional in vivo treatment with much the same success. VR Exposure therapy (VRET) Acrophobia The Fear of Heights Acrophobia- Research Emmelkamp et al. (2002) constructed a study to test the relative effectiveness of treating fear of heights with VRET and in vivo exposure as faithfully as possible. To this end, the virtual scenes are reproductions of the actual environments used in the in vivo treatment. Treatment time was short, consisting of 4 weekly sessions of about 1 h. In the in vivo exposure, patients were placed in the areas designed to invoke fear response and were guided and encouraged by the therapists. They were repeatedly challenged to look down, and they were polled for their perceived fear level throughout the experience. Acrophobia- Research The virtual exposure therapy was conducted in much the same way. The patient was exposed to an environment that invoked fear, and as the patient gained confidence in the environment, the therapist evaluated the self- assessed fear level to best determine the time to switch environments. Thirty-three patients participated (16 VR, 17 in vivo) and were evaluated before and after the regiment of treatment, and 6 months after treatment concluded there was a follow-up. The results showed very similar results after treatment and at the follow-up. Both treatments were effective in treating the phobia and had lasting results. Panic disorder Agoraphobia stems from anxiety over having panic attacks in public places. Obviously this phobia would be and particularly hard to treat using in vivo exposure, due to the high risk of embarrassment for the patient. VRET agoraphobia must therefore recreate these public places and allow the patient to gradually adapt to the situation.  Botella et al. (2004) present an excellent implementation of a virtual scenario for treatment of agoraphobia. Their implementation is a series of virtual Panic disorder scenes woven into a task scenario. The patient begins in virtual living area and checks a message left by a friend and on the answering machine. The friend asks the patient to do something, such as buying milk. From there, the agoraphobia patient progresses from the room to the elevator to public transportation to the mall where the task can be completed. Each of these stages can induce anxiety, and the therapist can vary the crowdedness of the scenes to increase anxietal response.  Fear of flying can take many forms, as many different parts of the flight experience can induce anxiety. Hodges, Rothbaum, Watson, Kessler, and Opdyke (1996) present a virtual airplane that would take off, fly, and land in normal or stormy conditions. The virtual scene was comprised of a painstakingly constructed replica of the interior of an aircraft, with storminess and Fear of flying motion depicted through the windows of the airplane and enhanced by appropriate sound effects. Work by Baños et al. (2002) takes a more encompassing view, including in the study the anxiety in trip preparation and arrival at the airport. Both were successful in treating the patients.  Stress Vulnerability to stress is linked to poor mental health. Stress management interventions for people with Reduction and mental health conditions are numerous but they are difficult to implement and have limited effectiveness. Relaxation Virtual reality (VR) relaxation is an innovative intervention that aims to reduce stress. Stress Reduction and Relaxation  Virtual reality (N = 848) studies were included in the review. relaxation Studies were published between 2008 and 2021. for people with 11 studies were conducted in Europe, 13 studies were controlled trials. mental health Participants were mostly working-age adult outpatients conditions: experiencing anxiety or stress-related conditions. Other conditions included eating disorders, depression, a systematic bipolar disorder, and psychosis. review (2023) All studies used a range of nature-based virtual environments, such as forests, islands, mountains, lakes, waterfalls, and most commonly, beaches to promote relaxation. Studies provided evidence of the feasibility, acceptability, and short-term effectiveness of VR relaxation to increase relaxation and reduce stress. Cognitive Rehabilitation Cognitive rehabilitation is a therapeutic approach designed to improve or restore cognitive functioning that has been compromised due to injury or illness. Cognitive rehabilitation is often employed in the context of neurological conditions such as traumatic brain injury (TBI), stroke, dementia, and other conditions affecting the brain's structure and function. Cognitive rehabilitation programs are tailored to the specific needs of each individual. Assessments are conducted to identify cognitive strengths and weaknesses, and interventions are then designed to target areas of impairment. Evidence of feasibility, acceptability, and effectiveness Studies used self-report scales to measure relaxation, mood, anxiety, worry, and perceived stress. Other measures, such as observational teacher reports, were used to measure behavioral problems. Some studies used physiological measurements, such as heart rate and galvanic stress response, as indicators of stress. All studies had findings that indicated that VR relaxation is feasible, including in non-lab-based settings, such as psychiatric wards and in specialist schools for various mental health conditions. Studies reported that VR relaxation is accessible and can reduce pressure on clinicians. Evidence of feasibility, acceptability, and effectiveness Studies indicated that nature-based VR environments are feasible as a low-intensity treatment for people with mental health conditions, including for people who experience severe and acute conditions, and especially where participants lack access or exposure to real-world nature. All studies indicated overall acceptability of VR relaxation. Participants mostly reported that VR relaxation was calming, helpful, enjoyable, relaxing, useful, and an experience that they would recommend to others. Studies indicated that VR relaxation led to short-term improvements in levels of relaxation, and most reported reduced anxiety or stress. In most studies that included another, non-virtual form of relaxation exercise as a control condition, this exercise was also found to improve levels of relaxation and stress. However, VR relaxation was always more effective or equally effective when compared to the non- virtual relaxation exercises. Cognitive rehabilitation post traumatic brain injury: A systematic review for emerging use of virtual reality technology (Anas, et al., 2019) Maggio et al. (2019) found that VR treatment intervention encourages cognitive improvement. VR allows intervention on different cognitive function aspects such as; attention, memory, and executive function that reduce long-term disabilities of individuals with TBI, improving quality of life. Grealy et al. (1999) showed that training in a VR environment provides significant gains in cognitive function in patients with TBI. Jacoby et al. (2013) showed improvement in executive function in individuals with TBI after VR treatment intervention. Training in a VR environment increases feedback, which allows the individual to develop awareness of results and quality of the movements with positive impact on the cognitive and motor level. Multi-sensory feedback and performed repetitions of cognitive and physical tasks combined with sensory stimulation recovers cognitive functions, enhancing neural plasticity processes through complex mechanisms. VR training improves and develops the brain plasticity in early point of the TBI and succeeding recovery in daily life. VR training allows to activate mirror type of neurons with incorporation between cognition and action, whilst reinforcing the individuals’ self-efficacy. Advantages over conventional therapies Has the potential to stimulate numerous real-life or imaginary circumstances. Provides a safe and harmonious environment with potential for unlimited repetitions of the same training task, unlike several traditional training methods, providing delicate performance. Has flexibility to adapt sensory appearance and can be developed for home-based training, whereas traditional rehabilitation treatment can take a long time to complete. With VR the patient can perform the program at home, with minimum input from therapists Social VR for Loneliness & Social Anxiety Virtual environments facilitate social interactions for individuals dealing with social anxiety. Social VR allows users to practice and improve their social skills in a safe and controlled space, ultimately helping them build confidence for real-world interactions. Social VR for Loneliness The widespread adoption of diverse technological tools has transformed human communication, shifting interactions from in-person to virtual platforms. This transition, while expanding global social networks and overcoming physical distance limitations, has significant implications for human connection. The use of digital technology has provided increasingly sophisticated means to connect people across the globe. However, this shift has also reduced non-verbal social cues and opportunities for direct physical contact, impacting individuals' understanding of thoughts, feelings, and perceived closeness. Can you think of any examples? Social virtual reality helps to reduce feelings of loneliness and social anxiety during the Covid-19 pandemic, (Kenyon, Kinakh & Harrison, 2023) People use social VR for many different reasons: to socialise with new and existing friends; to join social interest groups; to learn new skills and generally to be part of a larger community of people (including other professionals) than those that they are part of in the real world. Social VR attracts a wide range of people because of the ease in which people can meet people with similar interests to their own, although it could be argued that up until the recent Covid-19 pandemic social VR tended to attract a greater amount of people who found real-life social interaction difficult. Kenyon, Kinakh & Harrison, (2023) The results of this study show a reduction in social anxiety in individuals with moderate, severe and very severe social anxiety in the online condition, i.e. when using social VR. The increase in availability of VR headsets in recent years has led to an expansion in usage of social VR and the recent Covid-19 pandemic and subsequent social distancing rules led to more people and organisations making a greater use of VR to communicate and carry out their daily business and routines during the prolonged period of social isolation. Social VR also enables people to collaborate in ways not possible within the real world, reducing geographic restrictions and breaking through communication barriers by using visually stimulating content creation tools to enhance the process of human interaction through world-building and event hosting. Pain Distraction and Management VR is a powerful and innovative tool in the realm of pain distraction and management, offering valuable alternatives during medical procedures and chronic pain situations. In the context of medical procedures, where discomfort and anxiety can be prevalent, VR provides a non-pharmacological approach to pain relief. The immersive nature of VR experiences enables individuals to escape the immediate physical environment and redirect their attention away from the sensations associated with medical interventions.  Pain and VR VR for adult pain management is currently in an early phase of research. Studies have explored the use of VR in diverse applications ranging from: wound dressing changes (post-surgical and burns trauma) intra-operative pain management labour analgesia multiple types of chronic pain Using this relatively novel technology for analgesia has produced encouraging results, such as a reduction in pain scores. However, enthusiasm to integrate virtual reality as a clinical tool should be cautioned by methodological biases in the existing literature. These biases include heterogeneity of virtual reality hardware equipment; multiple types of virtual reality software resulting in patients experiencing different levels of immersion, presence and interactivity; lack of blinding; differences in duration of virtual reality therapy sessions; and heterogeneity of recruited patient populations. Pain and VR Available evidence suggests that VR therapy can be applied to facilitate analgesia for acute pain in a variety of inpatient settings. Its effects, however, are likely to vary by patient population and indication. This highlights the need for individualized pilot testing of virtual reality therapy’s effects for each specific clinical use case rather than generalizing its use for the broad indication of facilitating analgesia. In addition, VR therapy has the added potential of concurrently providing procedural anxiolysis, thereby improving patient experience and cooperation, while being associated with a low incidence of side effects (nausea, vomiting, eye strain, and dizziness). There appears to be insufficient evidence to substantiate the effect of virtual reality on autonomic arousal, and this should be considered at best to be for investigational uses, at present. Use of Virtual Reality for the Management of Anxiety and Pain in Dental Treatments: Systematic Review and Meta-Analysis López-Valverde, et al (2020) Fear of dental treatment affects 15%–20% of the population, being recognized by the World Health Organization (WHO) as a real pathology that leads those who are affected by it to reject even the most basic dental treatments, such as simple dental check-ups or cleanings; thus, its management is essential to improve the patient’s quality of life. A Cochrane review of psychological interventions using different types of distraction to relieve pain in children and adolescents, published in 2006 and updated in 2013 and 2018, reported different distraction techniques such as musical therapy, reading, watching films, hypnosis, breathing techniques and combined cognitive-behavioral strategies, as effective tools to reduce pain and anxiety during needle procedures. However, the reviewers considered the level of certainty of the review to be low, since in most of these studies there was no blinding of participants and assessors. VR and Pain The heterogeneity of VR software and hardware is also relevant to the immersive approach, which is influenced by the interaction with the virtual environment, either through translation or change of position, rotation or change of direction, viewpoint or perspective and visual field. This aspect is difficult to analyze when referred to patients who are undergoing dental treatment (especially in children), since adequate patient immersion is hindered by the fact that they are expected to remain with their heads as still as possible to facilitate the professional’s work. Large devices (hardware), also hinder the dentist’s work, limiting vision of and access to the dental operation area. Psychological perspectives Cognitive Perspective Social Perspective Biopsychological Perspective Ethics The use of Virtual Reality (VR) in mental health comes with various ethical considerations that need careful attention. Here are some key ethical considerations  Ethics Informed Consent Users must fully understand the nature of VR interventions, potential risks, and benefits. Obtaining informed consent can be challenging due to the immersive nature of VR experiences. Clear and comprehensive informed consent processes should be established, ensuring participants are aware of the nature of VR treatments, potential emotional responses, and their right to withdraw at any time. Privacy and Confidentiality VR experiences often involve personal and sensitive information. Ensuring the privacy and confidentiality of user data is crucial. Robust data protection measures, encryption, and secure storage should be in place. Clear guidelines on data usage and sharing should be communicated to users. Ethics Equity and Access VR interventions may not be equally accessible to all individuals, potentially exacerbating existing health disparities. Efforts should be made to ensure that VR interventions are accessible to diverse populations. Considerations for cultural sensitivity and inclusivity must be integrated into VR design and implementation. Therapist Competence and Training Therapists using VR should have the necessary competence and training to effectively and ethically utilize the technology. Ongoing training programs for mental health professionals incorporating ethical guidelines for VR use should be established. Certification and accreditation processes can help ensure therapist competency. Ethics Addiction and Dependency Excessive use of VR could potentially lead to addiction or dependency, especially if the technology is used as a primary form of treatment. Clear guidelines on the recommended duration and frequency of VR use should be established. Monitoring for signs of dependency and providing alternative forms of therapy are essential. Long-term Effects and Unknown Risks The long-term effects of sustained VR use for mental health interventions are not fully understood, and there may be unforeseen risks. Continued research and monitoring are necessary to understand the long-term impacts of VR interventions. Users should be informed about the evolving nature of knowledge in this area. Task  Go to e- learning and pick one of the following  Time to see your task from the last lesson Task- Next week Study Chapter 2 Research Methods