Virtual Reality Exposure Therapy for PTSD symptoms after a road accident: an uncontrolled case series

This report examined whether Virtual Reality Exposure Therapy (VRET) could be used in the treatment of posttraumatic stress disorder (PTSD) symptoms in the aftermath of a serious motor vehicle accident. Six individuals reporting either full or severe subsyndromal PTSD completed 10 sessions of VRET, which was conducted using software designed to create real-time driving scenarios. Results indicated significant reductions in posttrauma symptoms involving reexperiencing, avoidance, and emotional numbing, with effect sizes ranging from d=.79 to d=1.49. Indices of clinically significant and reliable change suggested that the magnitude of these changes was meaningful. Additionally, high levels of perceived reality ("presence") within the virtual driving situation were reported, and patients reported satisfaction with treatment. Results are discussed in light of the possibility for VRET to be useful in guiding exposure in the treatment of PTSD following road accidents.     

Irrational Cognitions and the Fear of Flying

In order to test the hypothesis that the fear of flying is associated with irrational evaluative beliefs, as postulated by Rational Emotive Behavior Therapy for anxiety disorders, 15 fearful flyers and 7 non-fearful flyers participated in the Articulated Thoughts during Simulated Situations procedure. Six experimental scenes depicting some basic fears associated with the fear of flying and six supposedly non-anxiety provoking flight-related control scenes were used. The fear of flying group displayed significantly more irrational thoughts and significantly higher subjective ratings of anxiety on all experimental and five control scenes compared to the non-fearful flyers. Their negative cognitions were predominantly characterized by awfulizing and low frustration tolerance. The results are interpreted as offering support for the cognitive view that anxiety, and the fear of flying, are associated with negative cognitions characterized by a preoccupation with danger and with an overestimation of the seriousness of the perceived threat (awfulizing) and an underestimation of coping abilities (low frustration tolerance).     

Repeated exposure of flight phobics to flights in virtual reality

The present study examined the effects of repeated exposure of flight phobics to flights in virtual reality (VR). Flight phobics were randomly assigned either to complete one VR test flight followed by four VR exposure flights (VR group; N=15) in one lengthy session or to complete one VR test flight followed by a lengthy relaxation training session (relaxation group; N=15). All participants completed a second VR test flight at the end of the session. Fear reports and physiological fear reactions (heart rate, skin conductance level) during VR exposures were registered, and fear of flying was assessed psychometrically from 3 weeks before to 3 months after exposure. Exposure to VR flights elicited subjective and physiological fear responses in flight phobics, and these responses attenuated within and across VR flights. Fear reduction associated with repeated VR exposure was greater than fear reduction caused by relaxation training. Fear of flying improved in both treatment groups, but several outcome measures indicated greater effects in the VR treated group than in the relaxation group. These findings indicate that exposure in virtual reality may offer a new and promising approach for the treatment of fear of flying.     

Increased interoceptive awareness in fear of flying: sensitivity to suffocation signals

In flight phobia, particular environmental factors can facilitate a fear response. The current study aimed to explore the relationship between respiratory sensations and fear of flying: individuals with fear of flying may be more sensitive to suffocation signals and could experience more bodily sensations as a consequence of an added resistive respiratory load. The sample included 19 subjects with fear of flying and 19 controls. Each subject wore a mask to which a respiratory load could be added. First, an interference paradigm was used: respiratory loads were presented during a tone detection task. Next, subjects were asked to detect the loads. After each task, subjects reported their somatic sensations. All subjects showed interference of the respiratory loads. However, subjects with fear of flying were more accurate in detecting the loads, thereby indicating higher interoceptive awareness. Moreover, their superior accuracy was related to increased bodily sensations: a higher interoceptive awareness resulted in increased symptom reporting. It follows that treatment interventions for fear of flying should be supplemented with interventions that target internal stimuli.     

焦虑障碍的虚拟现实暴露疗法研究述评

虚拟现实暴露疗法(VRET)是传统的行为疗法的一种转换形式, 也是经典的现实情境暴露疗法的替代性治疗形式。虚拟现实整合了即时计算机图形学、身体感觉传感、视觉成像技术, 给来访者提供近似真实的、可以沉浸(immersion)和交互作用的虚拟环境。研究者采用虚拟现实暴露疗法治疗幽闭恐怖症、恐高症、飞行恐怖症、创伤后应激障碍、惊恐障碍等焦虑障碍, 并且关注虚拟现实暴露疗法的认知机制以及心理生理机制。实验研究表明, 虚拟现实暴露疗法在治疗焦虑障碍时是有效的。被试经过治疗之后, 对情境的控制感和自我效能感提升, 消极自我评价降低, 对创伤事件的容忍力提高, 重新获得对情境的控制感。与心率指标相比, 皮肤电是预测虚拟现实暴露疗法治疗效果更好的指标。虚拟现实暴露疗法还处于实验验证阶段, 并没有应用到实际临床中, 需要更加规范的实验设计验证该疗法的认知机制以及心理生理机制。虚拟现实暴露疗法结合功能磁共振成像(FMRI)用于心理治疗, 会是未来发展的新方向。     

Creating state of the art,next-generation Virtual Reality exposure therapies for anxiety disorders using consumer hardware platforms: design considerations and future directions

Decades of research and more than 20 randomized controlled trials show that Virtual Reality exposure therapy (VRET) is effective in reducing fear and anxiety. Unfortunately, few providers or patients have had access to the costly and technical equipment previously required. Recent technological advances in the form of consumer Virtual Reality (VR) systems (e.g. Oculus Rift and Samsung Gear), however, now make widespread use of VRET in clinical settings and as self-help applications possible. In this literature review, we detail the current state of VR technology and discuss important therapeutic considerations in designing self-help and clinician-led VRETs, such as platform choice, exposure progression design, inhibitory learning strategies, stimuli tailoring, gamification, virtual social learning and more. We illustrate how these therapeutic components can be incorporated and utilized in VRET applications, taking full advantage of the unique capabilities of virtual environments, and showcase some of these features by describing the development of a consumer-ready, gamified self-help VRET application for low-cost commercially available VR hardware. We also raise and discuss challenges in the planning, development, evaluation, and dissemination of VRET applications, including the need for more high-quality research. We conclude by discussing how new technology (e.g. eye-tracking) can be incorporated into future VRETs and how widespread use of VRET self-help applications will enable collection of naturalistic “Big Data” that promises to inform learning theory and behavioral therapy in general.     

Flygrädsla i Sverige. En enkätundersökning av svenskars rädsla för trafikflyg som transportmedel

Abstract

Föreliggande arbete avser en enkätundersökning av svenskars flygrädsla. Tvätusen svenska med-borgare i äldrarna 18–75 är erhöll en enkät med 25 frägor angäende flygrädsla och hur denna päverkar viljan att utnyttja trafikflyget.

Christer L. Nordlund: A questionnaire of Swedes' fear of flying. During the spring and summer of 1982, 1 992 randomly selected individuals received a written questionnaire concerning fear of flying. 1 484 individuals returned the questionnaire and 169 of the remainders were interviewed by telephone and were included in the material. 76% of the individuals in the material had flown one or more times, while 6% reported that because of fear they had never flown. 17% reported that they could not consider flying, owing to fear, or for other reasons. 10% answered that they experienced relatively great or greater fear when flying, while 15% answered that they felt the same when thinking about flying. When asked about different parts of a flight, 25% revealed that they felt relatively great or greater fear during some part of it, and about 30% reported the same level of fear when clear air turbulence was encountered. The prevalence of flight fear depends upon the definition used. If “daring to fly” is used as a criterion, 10% of the Swedish population, i.e. 600 000 Swedes, can be considered to be afraid of flying. Given that flying is quite safe (from a statistical point of view), anyone experiencing discomfort during a flight could be regarded as demonstrating fear of flying. With this criterion, 50% of the interviewed individuals (= 3 000 000 Swedes) could be regarded as apprehensive about flying.     

Fear questionnaires for simple phobias: Psychometric evaluations for a Norwegian sample

The present study presents psychometric data for four different phobic fear questionnaires in a Norwegian sample of 284 subjects. The questionnaires concerned fear of flying, snakes, spiders and a questionnaire of general phobic complaints. The results showed a high estimate of internal consistency, and a very high test-retest reliability for all questionnaires. A low to moderate degree of intercorrelation between the questionnaires appeared. A clear sex difference emerged in responding to all four questionnaires. In addition, a clinical sample of phobics with fear of flying as the main symptom was compared to the larger sample on a fear of flying scale. The results showed a clear difference in responding between the samples. The present study concludes that the four different fear questionnaires yielded a high degree of reliability, and their use in clinical practice is encouraged.     

Interactive Virtual Reality versus Vignette-Based Assessment of Children’s Aggressive Social Information Processing

Research on Child and Adolescent Psychopathology - This study examined whether interactive Virtual Reality (VR) provides a more ecologically valid assessment of children’s aggressive social...     

Satiation Therapy and Exposure Response Prevention in the Treatment of Obsessive Compulsive Disorder

The purpose of present study was to test the comparative effectiveness of Satiation Therapy and Exposure Response Prevention techniques in the treatment of obsessive–compulsive disordered patients. Sixty self-referred male outpatient cases were investigated within a randomized controlled trial. Patients were allocated to Satiation Therapy, Exposure Response Prevention or wait-list control groups. Obsessive–compulsive symptoms were measured by the Yale-Brown Obsessive Compulsive Scale at baseline, post-treatment, and 3 and 6 month follow-ups. The therapeutic groups had more significant improvement than the control group. In addition, there was not a significant difference between therapeutic groups on post-treatment and follow-up assessments which showed that Satiation Therapy and Exposure Response Prevention were similarly effective in reducing obsessive–compulsive symptoms. Analyses revealed that therapeutic groups had improved significantly while the control group had continued unchanged. Finally, the present investigation supported both Satiation Therapy and Exposure Response Prevention in the treatment of obsessive–compulsive disorder.     

Manipulations of exposure-based therapy to reduce return of fear: a replication

Using exposure-based treatment for fear of heights, we tested two different manipulations, namely administering blocks of exposure trials on an expanding spaced schedule and varying the nature of the exposure, both of which have been shown to reduce return of fear [Rowe, M. K., & Craske, M. G. (1998a). Effects of an expanding-spaced versus massed exposure schedule on fear reduction and return of fear. Behaviour Research and Therapy, 36, 701-718; Rowe, M. K., & Craske, M. G. (1998b). Effects of varied-stimulus exposure training on fear reduction and return of fear. Behaviour Research and Therapy, 36, 719-734.]. The samples for these two studies included 23 and 34 undergraduates, respectively. Fear was assessed before, immediately after and one month after treatment using self-report and physiological measures. Study hypotheses were not strongly supported, but the manipulations did lead to different responses during treatment. The data suggest that physiological habituation is not necessary for fear reduction. Expanding spaced treatment may have increased generalization, and those in the constant and varied conditions responded to different aspects of the exposure. Reasons for the failure to replicate previous research and ideas for future research are discussed.     

What is so frightening about spiders? Self‐rated and self‐disclosed impact of different characteristics and associations with phobia symptoms

Spider phobia is a common and impairing mental disorder, yet little is known about what characteristics of spiders that spider phobic individuals find frightening. Using screening data from a clinical trial, we explored which characteristics that spider‐fearful individuals (n = 194) rated as having the greatest impact on fear, used factor analysis to group specific characteristics, and explored linear associations with self‐reported phobia symptoms. Second, a guided text‐mining approach was used to extract the most common words in free‐text responses to the question: “What is it about spiders that you find frightening?” Both analysis types suggested that movement‐related characteristics of spiders were the most important, followed by appearance characteristics. There were, however, no linear associations with degree of phobia symptoms. Our findings reveal the importance of targeting movement‐related fears in in‐vivo exposure therapy for spider phobia and using realistically animated spider stimuli in computer‐based experimental paradigms and clinical interventions such as Virtual Reality exposure therapy.     

条件化恐惧复发的动物模型及相关神经机制

创伤后应激障碍(PTSD)受到国内外普遍关注, 临床上常用的暴露疗法就是基于消退原理, 但经过治疗的患者复发率仍然很高, 这提示抑制复发可能是治疗创伤后应激障碍的关键问题。条件性恐惧复发的动物模型主要包括重建、续新和自发恢复, 但是对续新的研究最多。前人的研究结果表明, 恐惧复发具有异质性, 但海马、前额叶与杏仁核三大脑区或许构成了共同的神经基础。文章从脑区机制及药理干预方面进行了综述, 以期对基础研究和临床诊治提供参考。     

Combat-related post-traumatic stress disorder: a case report using virtual reality exposure therapy with physiological monitoring.

The current report summarizes a case study from an Office of Naval Research (ONR) funded project to compare the effects of virtual reality graded exposure therapy (VRGET) with cognitive behavioral group therapy in active-duty corpsmen. Details of the collaborative program between the Virtual Reality Medical Center (VRMC) and Naval Medical Center San Diego (NMCSD) will be discussed.     

Recalcitrant Fears of Death

According to what I will refer to as judgmentalist approaches to the fear of death (JFD), the fear of death conforms to the structure implied by judgmentalist theories of emotion. JFD holds that fears of death are constituted in part by evaluative judgments or beliefs about one’s own death. Although many philosophers endorse JFD (explicitly or implicitly), there is good reason to believe that it may be problematic. For, there is a troubling (and, for the purposes of this discussion, rather interesting) objection to judgmentalist theories of emotion; if judgmentalism is false, then so too is JFD. In brief, the worry with judgmentalist theories is this: it is sometimes the case that one has an emotion, but holds a belief (or beliefs) that is in tension with the emotion. For example, I sometimes fear flying despite the fact that I believe flying is not dangerous. Emotions of this sort are often referred to as recalcitrant emotions, and they are widely thought to pose a serious challenge to judgmentalist theories. In this paper, I consider an objection to JFD based on the existence of recalcitrant bouts of the fear of death. I include in this discussion an Epicurean-inspired solution to the problem of emotional recalcitrance. Although I argue this solution may be ultimately unsuccessful, I believe it is still worth considering. For, in most discussions of the problem of emotional recalcitrance, philosophers abandon judgmentalism in favour of some other theory of emotion. The Epicurean-inspired solution I discuss in this paper, however, may allow one to retain one’s commitment to judgmentalism.     

Emotion-specific modulation of early visual perception

Exposure to fearful facial expressions enhances vision at low spatial-frequencies and impairs vision at high spatial-frequencies. This perceptual trade-off is thought to be a consequence of a fear-related activation of the magnocellular visual pathway to the amygdala. In this study we examined the generality of the effect of emotion on low-level visual perception by assessing participants' orientation sensitivity to low and high spatial-frequency targets following exposure to disgust, fear, and neutral facial expressions. The results revealed that exposure to fear and disgust expressions have opposing effects on early vision: fearful expressions enhanced low spatial-frequency vision and impaired high spatial-frequency vision, while disgust expressions, like neutral expressions, impaired low spatial-frequency vision and enhanced high spatial-frequency vision. Thus we show the effect of exposure to fear on visual perception is not a general emotional effect, but rather one that may that depend on amygdala activation, or one that may be specific to fear.     

Post-extinction conditional stimulus valence predicts reinstatement fear: Relevance for long-term outcomes of exposure therapy

Exposure therapy for anxiety disorders is translated from fear conditioning and extinction. While exposure therapy is effective in treating anxiety, fear sometimes returns after exposure. One pathway for return of fear is reinstatement: unsignaled unconditional stimuli following completion of extinction. The present study investigated the extent to which valence of the conditional stimulus (CS+) after extinction predicts return of CS+ fear after reinstatement. Participants (N = 84) engaged in a differential fear conditioning paradigm and were randomised to reinstatement or non-reinstatement. We hypothesised that more negative post-extinction CS+ valence would predict higher CS+ fear after reinstatement relative to non-reinstatement and relative to extinction retest. Results supported the hypotheses and suggest that strategies designed to decrease negative valence of the CS+ may reduce the return of fear via reinstatement following exposure therapy.     

Failure to overcome 'innate' fear: a developmental test of the non-associative model of fear acquisition

The non-associative, Darwinian theory of fear acquisition proposes that some individuals fail to overcome biologically-relevant fears (e.g. height) because they (1) do not have sufficient safe exposure to the relevant stimuli early in life or (2) are poor habituators who have difficulty 'learning not to fear'. These two hypotheses were tested in a longitudinal birth cohort study. Study 1 found evidence for reduced exposure to height stimuli in childhood for individuals with a fear of heights compared to study members without fear. Study 2 found evidence for higher levels of stress reactivity (a proxy for habituation) in childhood and adolescence among 18-year-old height phobics compared to study members with dental phobia and those with no fear. The results were discussed in relation to recent findings suggesting that some evolutionary-relevant fears may appear in the absence of traumatic 'learning' experiences. The merits of adding a fourth, non-associative pathway to Rachman's [Rachman, S. (1977)]. The conditioning theory of fear acquisition: a critical examination. Behaviour Research and Therapy, 15, 375-387) three pathways model of fear acquisition were briefly considered.     

The Rational-Reality Based Approach to Treating the Criminal Child Abuser

The Rational-Reality based approach to treating child abusers incorporates the philosophies of Rational Behavior Training and Reality Therapy into a therapeutic strategy that helps clients to learn skills in making rational decisions that can aid them in living harmoniously within the family structure. Those persons involved with the practical implementation of theoretical constructs while working in counseling sessions with persons who are child abusers may find that an eclectic approach such as this one is beneficial in teaching people how to increase their skill in reasoning. It seems that this approach to counseling the parental child abuser is a strategy that allows the parent figure to understand and perceive positively the personal benefits that accrue from not abusing the child.