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。     

虚拟现实暴露疗法在社交焦虑中的应用:效果、机制及展望

由于传统干预方法的诸多局限,虚拟现实暴露疗法(virtual reality exposure therapy,VRET)逐渐应用于对社交焦虑的干预,VRET是将虚拟现实技术与传统行为暴露治疗相结合而形成的一种新的干预方法。文章总结了VRET的三个发展阶段及其研究范式,述评了在VRET过程中的作用机制。未来研究可致力于设计更加自然的人机交互技术,实现技术与社交焦虑治疗的深度融合以及关注第三人称视角应用的作用及机制。     

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.     

Psychiatric and behavioral problems in aggressive drivers

Motor vehicle accidents (MVAs) are a leading cause of accidental death and injury, and aggressive driving has been identified as a risk factor for MVAs. Assessing psychiatric and behavioral disturbances in aggressive drivers is germane to the development of prevention and intervention programs for this population. The present study compared the prevalence of psychiatric diagnoses and behavioral problems in young adult drivers with self-reported high driving aggression to that of drivers with low driving aggression. Aggressive drivers evidenced a significantly higher current and lifetime prevalence of Oppositional Defiant Disorder, Alcohol and Substance Use Disorders, and Cluster B Personality Disorders, and a significantly greater lifetime prevalence of Conduct Disorder, Attention-Deficit/Hyperactivity Disorder, and Intermittent Explosive Disorder. Aggressive drivers also had a significantly greater prevalence of self-reported problems with anger, as well as a greater family history of anger problems and conflict. The findings suggest that prevention and intervention programs designed to reduce aggressive driving may need to address the presence of psychiatric and behavioral problems that could potentially complicate treatment or impede responses to treatment.     

Do self-statements enhance the effectiveness of virtual reality exposure therapy? A comparative evaluation in acrophobia.

There is a clear need for more detailed analysis of the role of cognitive self-statements in virtual reality exposure therapy (VRET). To date, no research on this topic has been done. The primary aim of this study was to investigate whether coping self-statements would enhance the effectiveness of VRET. In a randomized crossover design, 26 patients with acrophobia (DSM-IV diagnosis of specific phobia) were randomly assigned to two sessions of VRET followed by two sessions of VRET plus coping self-statements, or the other way around: first two sessions of VRET plus coping self-statements followed by two sessions of VRET. Results showed that VRET, regardless of addition of coping self-statements, decreased anxiety of heights, decreased avoidance of height situations, and improved attitudes towards heights. However, at 6-month follow-up, most gains during treatment were not fully retained.     

Treatment of acrophobia in virtual reality: the role of immersion and presence

In this study the effects of virtual reality exposure therapy (VRET) were investigated in patients with acrophobia. Feelings of presence in VRET were systematically varied by using either a head-mounted display (HMD) (low presence) or a computer automatic virtual environment (CAVE) (high presence). VRET in general was found to be more effective than no treatment. No differences were found in effectiveness between VRET using an HMD or CAVE. Results were maintained at 6 months follow-up. Results of VRET were comparable with those of exposure in vivo (Cyberpsychology and Behavior 4 (2001) 335). In treatment completers no relationship was found between presence and anxiety. Early drop-outs experienced less acrophobic complaints and psychopathology in general at pre-test. They also experienced less presence and anxiety in the virtual environment used in session one as compared to patients that completed VRET.     

Cognitive-behavioral treatment and antidepressants combined with virtual reality exposure for patients with chronic agoraphobia

In this study we compared the efficacy of virtual reality exposure combined with cognitive-behavioral therapy (VRET) to that of traditional cognitive-behavioral therapy (CBT) alone in reducing phobic symptoms in a sample of patients with long-term agoraphobia. The study was a between-subject design with three experimental conditions (VRET group, N = 30; CBT group, N = 30; and medication only group, N = 20) and repeated measures (pre-treatment, post-treatment, and six-month follow-up). All patients were receiving antidepressant medication. Results showed that all therapies were statistically effective both at post-treatment and six-month follow-up. The VRET group showed clinical improvement in most variables measured at follow-up. The CBT group showed the highest dropout rates. These results are discussed pointing out that VRET probably serves as an intermediate procedure for an efficient exposure to phobic stimuli. Besides describing the advantages of VRET for the treatment of agoraphobia symptoms in cost-benefit terms, the study also considered issues related to higher treatment adherence and motivation.     

Acceptance and Commitment Therapy for Anger Dysregulation with Military Veterans: A Pilot Study

Anger dysregulation is a commonly reported problem by treatment-seeking military veterans that is associated with a range of negative outcomes. However, there is a paucity of studies examining interventions for anger and aggressive behavior in this population. Theory and empirical evidence suggest Acceptance and Commitment Therapy (ACT) may be a viable and effective treatment for anger dysregulation among veterans. The present study examined the feasibility and preliminary effectiveness of an open trial of an ACT group intervention for veterans reporting difficulties with anger and aggressive behavior. Twenty-three male military veterans (mean age?=?54.83) initiated a 12-week ACT intervention with assessments administered at pre-treatment, post-treatment, and 6-week follow-up. Treatment completers found the intervention favorable, and participation was associated with improvements in trait physical aggression and psychological flexibility, while significant changes in anger reactivity, quality of life, and verbal aggression were not found. Results suggest group-based ACT for anger dysregulation is feasible in a male military veteran sample, and warrants further investigation.     

An integrated approach to delivering exposure-based treatment for symptoms of PTSD and depression in OIF/OEF veterans: preliminary findings

Combat-exposed military personnel from the wars in Iraq and Afghanistan report high rates of PTSD and associated psychiatric problems. A formidable body of research supports exposure therapy as a front-line intervention for PTSD; however, relative to studies of civilians, fewer investigations have evaluated the effectiveness of exposure therapy using military samples. Specifically, barriers to care (e.g., stigma associated with receiving mental health services ) may compromise utilization of evidence-based psychotherapy. As such, researchers have argued that veterans with PTSD may require an integrated and innovative approach to the delivery of exposure techniques. This paper presents the rationale for and preliminary data from an ongoing clinical trial that compares the home-based telehealth (HBT) application of a brief, behavioral treatment (Behavioral Activation and Therapeutic Exposure; BA-TE) for veterans with PTSD to the standard, in-person application of the same treatment. Forty OIF/OEF veterans with PTSD and MDD were consented, enrolled, and randomized to condition (BA-TE in-person, or BA-TE HBT) and symptoms of anxiety and depression were assessed at pre- and posttreatment. Participants in both conditions experienced reductions in depression, anxiety, and PTSD symptoms between pre- and posttreatment, suggesting that HBT application of an integrated PTSD treatment may be feasible and effective.     

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.     

The effect of positive and negative emotions on young drivers: A simulator study

The study examined the influence of affect induction on actual risk-taking behavior in a driving simulator, as well as the links between personal variables (relevance of driving to self-esteem, sensation seeking) and the level of risky driving. Eighty young drivers aged 18–21 (M = 19.24, SD = 0.75) were randomly divided into four induction groups: relaxing positive affect; arousing positive affect; negative affect; and neutral affect. The participants drove on a simulator, with various parameters of risky driving measured before and after emotion priming.As predicted, arousing positive affect and negative affect led to increased risky driving, whereas relaxing positive affect moderated risk-taking. In addition, the results confirm previous findings regarding the personal variables, revealing that higher levels of relevance of driving to self-esteem and sensation seeking are associated with higher levels of risk-taking in the simulated driving.The findings indicate that the driver’s emotional state has a significant effect on risk-taking on the road. Moreover, they show that the conventional use of negative affect in safe driving campaigns is liable to heighten the tendency for risky driving rather than reduce it. In contrast, relaxing positive affect was found to lead to lower risk-taking. The study is unique in revealing a correlation between results previously obtained for the willingness to drive recklessly and actual risky driving behavior observed on a driving simulator. By expanding the understanding of the motivations for youngsters’ risky driving, the study may aid in designing effective, theoretically sound, interventions aimed at reducing the tendency for dangerous driving among young drivers.     

Anger,aggression, risky behavior,and crash-related outcomes in three groups of drivers

High anger drivers who acknowledged problems with driving anger and were interested in treatment were compared to high and low anger drivers who did not acknowledge problems with driving anger or want treatment. Although high anger drivers who acknowledged problems reported greater anger on two measures than high anger drivers who did not acknowledge problems, both high anger groups tended not to differ from one another and were more frequently and intensely angered when driving, reported more aggressive and less adaptive/constructive forms of expressing anger while driving, engaged in more aggressive and risky behavior on the road, and experienced more of some accident-related outcomes than low anger drivers. High anger groups did not differ from each other, but reported more trait anxiety and anger and more outward negative and less controlled general anger expression than the low anger group. The two groups of high anger drivers, however, require different types of interventions given their state of readiness for driving anger reduction. Results were also interpreted as supportive of the state-trait model of anger and construct validity of the Driving Anger Scale.     

Evaluating the effectiveness of a young driver-education intervention: Learn2Live

Road traffic collisions are the leading cause of death among young adults, and behaviour change interventions play a key role in battling this public health concern. Road safety interventions are often educational and have traditionally relied on fear appeals to alter risky driving behaviour - yet there is a paucity of data regarding their effectiveness. Peer-education has been championed as an additional route to promoting safe driving behaviour. To examine these issues, this study evaluated the effectiveness of a fear appeal intervention in improving young drivers’ attitudes towards risky driving behaviour. A total sample of 800 high school and college students (16–20 years old) completed a similar set of questionnaires pre- and post-intervention and at a 3-month follow-up. Two different types of follow-up interventions were also compared: a peer-led and an expert-led road safety educational event. Measures evaluating attitudes towards risky driving behaviour were completed at all 3 time frames, and questions regarding the participants' perception of the follow-up event were asked. Overall, our data showed an improvement in attitudes towards risky driving behaviours both immediately after the intervention and three months later. These changes were especially evident among females. With regard to the follow-ups, both were effective in improving the attitudes towards risky driving. However, the peer-led event was preferred by the participants compared to the expert-led follow-up.     

The Driving Anger Expression Inventory: A Validity Study with Community College Student Drivers

This study explored the relationship of driving anger expression to driving anger, trait anger, general anger expression, and aggressive and risky behavior while driving. Verbal, physical, and vehicular forms of expressing anger while driving correlated positively with each other, driving and trait anger, anger-in, and anger-out and negatively with adaptive/constructive driving anger expression and general anger-control. Adaptive/constructive expression formed small negative correlations with these measures, except for a positive correlation with anger-control. Regression models controlling for demographic variables and driving anger, trait anger, or general anger expression demonstrated forms of driving anger expression added variance to predicting aggressive and risky behavior. Forms of driving anger expression partially mediated the effects for driving anger, trait anger, and general anger expression on aggressive and risky behavior. No moderation effects were found for age, gender, or miles driven. Findings provided evidence for convergent and incremental validity for the Driving Anger Expression Inventory.     

An examination of the relationships between cannabis use,driving under the influence of cannabis and risk-taking on the road

IntroductionSome studies have suggested that regular cannabis users appear to exhibit a general reckless driving style that may contribute to an inflated estimate of collisions related to driving under the influence of cannabis (DUIC) among this group.ObjectiveThis study investigated whether patterns of cannabis use would predict levels of self-reported unsafe driving behaviours and levels of performance observed in a driving simulator.MethodThe study investigated 48 young cannabis users with respect to frequency of cannabis consumption, alcohol use, driving exposure, self-reported dangerous driving habits, impulsivity, sensation seeking and performance in a driving simulator.ResultsCannabis use was positively associated with DUIC, with sensation seeking and with self-reports of risky driving. An ANOVA confirmed a significant effect of levels of consumption of cannabis among participants on self-report risk-taking in driving. Moreover, the observed behaviours during the simulation tasks correlated with risky driving habits, and with the self-reported frequency of driving in the hour following smoking cannabis or immediately after drinking alcohol.ConclusionSince cannabis usage and DUIC appear to be related to an overall reckless style of driving, it is proposed that public safety policies should be more holistic, simultaneously targeting multiple on-road dangerous behaviours for intervention.     

Differences in Unit Cohesion and Combat-Related Mental Health Problems Based on Attachment Styles in US Military Veterans

This study explored the differences in perceived unit cohesion, trauma symptoms, depression symptoms, and anxiety symptoms controlling for childhood trauma, based on attachment style in US military veterans. Previous studies have reported that higher levels of military unit cohesion, bonding through the social relationships between service members and their larger units, and secure attachment, are negatively associated with trauma symptoms, depression symptoms, and anxiety symptoms in veterans. This study examined mental health distress symptoms as well as military unit cohesion across attachment styles. Results suggest mean differences in trauma symptoms, depression symptoms, and anxiety symptoms across attachment styles. However, there was no difference in perceived unit cohesion across the four attachment styles. Those using fearful-avoidant attachment styles reported the highest mean trauma, depression, and anxiety symptoms followed by those using a dismissing-avoidant attachment style. Those using a secure attachment style reported the least mean trauma, depression, and anxiety symptoms. Implications for assessing and treating avoidant type attachment styles are discussed.     

Web-Based Intervention for Returning Veterans with Symptoms of Posttraumatic Stress Disorder and Risky Alcohol Use

A substantial number of military personnel who have served in Iraq (Operation Iraqi Freedom; OIF) and Afghanistan (Operating Enduring Freedom; OEF) develop symptoms of posttraumatic stress disorder (PTSD) in response to their military experiences and many of these same individuals will drink in a risky or problematic manner following deployment. If left untreated, PTSD symptoms and alcohol problems can become chronic and have a significant, negative impact on the lives of veterans, their families and communities. Further, OIF and OEF service members are often reluctant to seek treatment for mental health symptoms or alcohol problems secondary to stigma. In order to reach this population it is essential that new strategies and venues for delivering evidence-based care are explored. Web-based interventions are uniquely suited to this cohort of veterans in that they have the potential to reach a significant number of veterans who commonly use the Web and who might not otherwise receive care. This article will review the prevalence of PTSD and alcohol problems among OIF and OEF veterans, common barriers they experience with accessing care in traditional mental health settings, and what is known about the effectiveness of Web-based approaches for PTSD and alcohol problems. It also describes the components of a new Web-based intervention, developed by the authors, that uses motivational enhancement and cognitive-behavioral strategies to intervene with returning veterans who report PTSD symptoms and problem drinking. Recommendations for future directions in working with returning veterans with PTSD and alcohol problems will be offered.     

The value of self-report measures as indicators of driving behaviors among young drivers

Although much of the knowledge in transportation psychology has been gained by means of self-report measures, there is still a dispute regarding the usefulness and validity of such instruments. This series of two studies employed multivariate statistical models to examine associations between self-report and objective measures in two samples of young drivers. Study 1 (n = 151) compared scores on the Multidimensional Driving Style Inventory (MDSI), a self-report questionnaire tapping four broad driving styles, with the naturalistic driving recorded by an in-vehicle data recorder (IVDR). Study 2 (n = 80) compared responses to the Reckless Driving Habits Scale, assessing the frequency with which drivers commit a set of risky behaviors, with driving measures collected by a simulator. This study also examined the personality trait of sensation seeking, as well as gender and driving experience. In Study 1, the analysis revealed positive associations between high scores on the risky and hostile driving styles measured by the MDSI and risky behaviors measured by the IVDR, as well as inverse correlations between the latter and high MDSI scores on the anxious and careful driving styles. Similarly, in Study 2 associations were found between the self-reported frequency of reckless driving habits and several risky behaviors measured by the driving simulator. In addition, risky behaviors correlated with the sociodemographic variables and sensation seeking. The two studies therefore show that self-report measures are reliable tools for assessing driving behaviors for purposes of research, evaluation, and intervention.     

Driving anger: correlates and a test of state-trait theory

A survey and field study evaluated predictions from state-trait theory applied to driving anger. Trait driving anger, the propensity to become angry when driving, correlated positively with anger in frequently occurring driving situations and in day-to-day driving and with aggressive and risky behaviors while driving. Although not correlated with crash rates or moving violations, trait driving anger correlated with crash-related conditions such as loss concentration, loss of vehicular control, and close calls. Results generally supported predictions from state-trait theory and the construct validity of the Driving Anger Scale, as well as mapping correlates of the disposition to become angry while driving.     

Does morality predict aggressive driving? A conceptual analysis and exploratory empirical investigation

Risky and aggressive driving is an important cause of traffic casualties and as such a major health and cost problem to society. Given the consequences for others, risky and aggressive driving has a clear moral component. Surprisingly, however, there has been little research on the relation between morality and risky and aggressive driving behavior. In this study we aim at addressing this gap. First, we present a conceptual analysis of the relationship between moral values and aggressive driving behavior. For this purpose, we extend Schwartz’s integrated model of ethical decision making and apply it to the context of aggressive driving. This conceptual analysis shows that moral decision-making processes consist of several stages, like moral awareness, moral judgment and moral intent, each of which are influenced by individual and situational factors and all of which need to materialize before someone’s generally endorsed moral value affects concrete behavior. This suggests that the moral value-aggressive driving relationship is rather indeterminate. This conceptual picture is confirmed by our empirical investigation, which tests to what extent respondents’ moral values, measured through the Moral Foundation Questionnaire, are predictive of respondents’ aggressive driving behavior, as measured through an aggressive driving behavior scale. Our results show few and rather weak empirical relationships between moral values and committed aggressive driving behaviors, as was expected in light of our conceptual analysis. We derive several policy implications from these results.