TY - JOUR AU - Nijman, Saskia Anne AU - Veling, Wim AU - Greaves-Lord, Kirstin AU - Vos, Maarten AU - Zandee, Catharina Elizabeth Regina AU - Aan het Rot, Marije AU - Geraets, Chris Neeltje Wil AU - Pijnenborg, Gerdina Hendrika Maria PY - 2020 DA - 2020/8/7 TI - Dynamic Interactive Social Cognition Training in Virtual Reality (DiSCoVR) for People With a Psychotic Disorder: Single-Group Feasibility and Acceptability Study JO - JMIR Ment Health SP - e17808 VL - 7 IS - 8 KW - social cognition KW - virtual reality KW - psychotic disorder KW - cognitive remediation therapy KW - emotion perception KW - theory of mind KW - social cognition training AB - Background: People with a psychotic disorder commonly experience problems in social cognition and functioning. Social cognition training (SCT) improves social cognition, but may inadequately simulate real-life social interactions. Virtual reality (VR) provides a realistic, interactive, customizable, and controllable training environment, which could facilitate the application of skills in daily life. Objective: We developed a 16-session immersive VR SCT (Dynamic Interactive Social Cognition Training in Virtual Reality [DiSCoVR]) and conducted a single-group feasibility pilot study. Methods: A total of 22 people with a psychotic disorder and reported problems in social cognition participated. Feasibility and acceptability were assessed using a survey for participants and therapists, and by examining relevant parameters (eg, dropouts). We analyzed preliminary treatment effects on social cognition, neurocognition, and psychiatric symptoms. Results: A total of 17 participants completed the study. Participants enjoyed DiSCoVR (mean 7.25, SD 2.05; range 3-10), thought it was useful for daily social activities (mean 7.00, SD 2.05; range 3-10), and enjoyed the combination of VR and a therapist (mean 7.85, SD 2.11; range 3-10). The most frequently mentioned strength of DiSCoVR was the opportunity to practice with personalized social situations (14/20, 70%). A significant improvement of emotion perception was observed (Ekman 60 Faces; t16=–4.79, P<.001, d=–0.67), but no significant change was found in other measures of social cognition, neurocognition, psychiatric symptoms, or self-esteem. Conclusions: DiSCoVR was feasible and acceptable to participants and therapists, and may improve emotion perception. UR - https://mental.jmir.org/2020/8/e17808 UR - https://doi.org/10.2196/17808 UR - http://www.ncbi.nlm.nih.gov/pubmed/32763880 DO - 10.2196/17808 ID - info:doi/10.2196/17808 ER - TY - JOUR AU - Cheng, Vivian Ya-Wen AU - Huang, Chiu-Mieh AU - Liao, Jung-Yu AU - Hsu, Hsiao-Pei AU - Wang, Shih-Wen AU - Huang, Su-Fei AU - Guo, Jong-Long PY - 2020 DA - 2020/7/23 TI - Combination of 3-Dimensional Virtual Reality and Hands-On Aromatherapy in Improving Institutionalized Older Adults’ Psychological Health: Quasi-Experimental Study JO - J Med Internet Res SP - e17096 VL - 22 IS - 7 KW - three-dimensional KW - virtual reality KW - aromatherapy KW - older adult KW - happiness KW - stress KW - sleep quality KW - meditation KW - life satisfaction AB - Background: In Taiwan, which has one of the most rapidly aging populations in the world, it is becoming increasingly critical to promote successful aging strategies that are effective, easily usable, and acceptable to institutionalized older adults. Although many practitioners and professionals have explored aromatherapy and identified its psychological benefits, the effectiveness of combining 3-dimensional (3D) virtual reality and hands-on aromatherapy remains unknown. Objective: A quasi-experimental trial was designed to evaluate the effectiveness of this combination in lowering perceived stress and promoting happiness, sleep quality, meditation experience, and life satisfaction among institutionalized older adults in Taiwan. Methods: A total of 60 institutionalized elderly participants either received the combined intervention or were in a control group. Weekly 2-hour sessions were implemented over 9 weeks. The outcome variables were happiness, perceived stress, sleep quality, meditation experience, and life satisfaction, which were assessed at baseline and after the intervention. Results: Generalized estimating equation (GEE) analyses indicated that the experimental group showed significant post-intervention improvements in terms of scores for happiness, perceived stress, sleep quality, meditation experience, and life satisfaction (n=48; all P<.001). Another GEE analysis showed that the significant improvements in the 5 outcome variables persisted in participants aged 80 years and older (n=35; all P<.001). Conclusions: This is the first trial to explore the effectiveness of a combination of 3D virtual reality and hands-on aromatherapy in improving older adults’ psychological health. The results are promising for the promotion of psychological health in institutionalized older adults. Trial Registration: ClinicalTrials.gov NCT04324216; https://clinicaltrials.gov/ct2/show/NCT04324216. UR - http://www.jmir.org/2020/7/e17096/ UR - https://doi.org/10.2196/17096 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706660 DO - 10.2196/17096 ID - info:doi/10.2196/17096 ER - TY - JOUR AU - Cadieux, Lee AU - Keenan, Mickey PY - 2020 DA - 2020/5/12 TI - Can Social Communication Skills for Children Diagnosed With Autism Spectrum Disorder Rehearsed Inside the Video Game Environment of Minecraft Generalize to the Real World? JO - JMIR Serious Games SP - e14369 VL - 8 IS - 2 KW - autism KW - behavior analysis KW - serious games KW - social skills KW - gamification KW - Lego KW - neurodiversity KW - Minecraft KW - virtual worlds KW - virtual reality UR - http://games.jmir.org/2020/2/e14369/ UR - https://doi.org/10.2196/14369 UR - http://www.ncbi.nlm.nih.gov/pubmed/32396129 DO - 10.2196/14369 ID - info:doi/10.2196/14369 ER - TY - JOUR AU - Pot-Kolder, Roos AU - Veling, Wim AU - Geraets, Chris AU - Lokkerbol, Joran AU - Smit, Filip AU - Jongeneel, Alyssa AU - Ising, Helga AU - van der Gaag, Mark PY - 2020 DA - 2020/5/5 TI - Cost-Effectiveness of Virtual Reality Cognitive Behavioral Therapy for Psychosis: Health-Economic Evaluation Within a Randomized Controlled Trial JO - J Med Internet Res SP - e17098 VL - 22 IS - 5 KW - psychosis KW - virtual reality KW - cognitive behavioral therapy KW - cost-effectiveness AB - Background: Evidence was found for the effectiveness of virtual reality-based cognitive behavioral therapy (VR-CBT) for treating paranoia in psychosis, but health-economic evaluations are lacking. Objective: This study aimed to determine the short-term cost-effectiveness of VR-CBT. Methods: The health-economic evaluation was embedded in a randomized controlled trial evaluating VR-CBT in 116 patients with a psychotic disorder suffering from paranoid ideation. The control group (n=58) received treatment as usual (TAU) for psychotic disorders in accordance with the clinical guidelines. The experimental group (n=58) received TAU complemented with add-on VR-CBT to reduce paranoid ideation and social avoidance. Data were collected at baseline and at 3 and 6 months postbaseline. Treatment response was defined as a pre-post improvement of symptoms of at least 20% in social participation measures. Change in quality-adjusted life years (QALYs) was estimated by using Sanderson et al’s conversion factor to map a change in the standardized mean difference of Green’s Paranoid Thoughts Scale score on a corresponding change in utility. The incremental cost-effectiveness ratios were calculated using 5000 bootstraps of seemingly unrelated regression equations of costs and effects. The cost-effectiveness acceptability curves were graphed for the costs per treatment responder gained and per QALY gained. Results: The average mean incremental costs for a treatment responder on social participation ranged between €8079 and €19,525, with 90.74%-99.74% showing improvement. The average incremental cost per QALY was €48,868 over the 6 months of follow-up, with 99.98% showing improved QALYs. Sensitivity analyses show costs to be lower when relevant baseline differences were included in the analysis. Average costs per treatment responder now ranged between €6800 and €16,597, while the average cost per QALY gained was €42,030. Conclusions: This study demonstrates that offering VR-CBT to patients with paranoid delusions is an economically viable approach toward improving patients’ health in a cost-effective manner. Long-term effects need further research. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) 12929657; http://www.isrctn.com/ISRCTN12929657 UR - https://www.jmir.org/2020/5/e17098 UR - https://doi.org/10.2196/17098 UR - http://www.ncbi.nlm.nih.gov/pubmed/32369036 DO - 10.2196/17098 ID - info:doi/10.2196/17098 ER - TY - JOUR AU - Lindner, Philip AU - Rozental, Alexander AU - Jurell, Alice AU - Reuterskiöld, Lena AU - Andersson, Gerhard AU - Hamilton, William AU - Miloff, Alexander AU - Carlbring, Per PY - 2020 DA - 2020/4/29 TI - Experiences of Gamified and Automated Virtual Reality Exposure Therapy for Spider Phobia: Qualitative Study JO - JMIR Serious Games SP - e17807 VL - 8 IS - 2 KW - virtual reality KW - gamification KW - serious game KW - exposure therapy KW - phobia KW - user experience AB - Background: Virtual reality exposure therapy is an efficacious treatment of anxiety disorders, and recent research suggests that such treatments can be automated, relying on gamification elements instead of a real-life therapist directing treatment. Such automated, gamified treatments could be disseminated without restrictions, helping to close the treatment gap for anxiety disorders. Despite initial findings suggesting high efficacy, very is little is known about how users experience this type of intervention. Objective: The aim of this study was to examine user experiences of automated, gamified virtual reality exposure therapy using in-depth qualitative methods. Methods: Seven participants were recruited from a parallel clinical trial comparing automated, gamified virtual reality exposure therapy for spider phobia against an in vivo exposure equivalent. Participants received the same virtual reality treatment as in the trial and completed a semistructured interview afterward. The transcribed material was analyzed using thematic analysis. Results: Many of the uncovered themes pertained directly or indirectly to a sense of presence in the virtual environment, both positive and negative. The automated format was perceived as natural and the gamification elements appear to have been successful in framing the experience not as psychotherapy devoid of a therapist but rather as a serious game with a psychotherapeutic goal. Conclusions: Automated, gamified virtual reality exposure therapy appears to be an appealing treatment modality and to work by the intended mechanisms. Findings from the current study may guide the next generation of interventions and inform dissemination efforts and future qualitative research into user experiences. UR - http://games.jmir.org/2020/2/e17807/ UR - https://doi.org/10.2196/17807 UR - http://www.ncbi.nlm.nih.gov/pubmed/32347803 DO - 10.2196/17807 ID - info:doi/10.2196/17807 ER - TY - JOUR AU - Krohn, Stephan AU - Tromp, Johanne AU - Quinque, Eva M AU - Belger, Julia AU - Klotzsche, Felix AU - Rekers, Sophia AU - Chojecki, Paul AU - de Mooij, Jeroen AU - Akbal, Mert AU - McCall, Cade AU - Villringer, Arno AU - Gaebler, Michael AU - Finke, Carsten AU - Thöne-Otto, Angelika PY - 2020 DA - 2020/4/27 TI - Multidimensional Evaluation of Virtual Reality Paradigms in Clinical Neuropsychology: Application of the VR-Check Framework JO - J Med Internet Res SP - e16724 VL - 22 IS - 4 KW - virtual reality KW - neuropsychology KW - cognition KW - research design UR - https://www.jmir.org/2020/4/e16724 UR - https://doi.org/10.2196/16724 UR - http://www.ncbi.nlm.nih.gov/pubmed/32338614 DO - 10.2196/16724 ID - info:doi/10.2196/16724 ER - TY - JOUR AU - Brown, Theresa AU - Nauman Vogel, Emily AU - Adler, Sarah AU - Bohon, Cara AU - Bullock, Kim AU - Nameth, Katherine AU - Riva, Giuseppe AU - Safer, Debra L AU - Runfola, Cristin D PY - 2020 DA - 2020/4/23 TI - Bringing Virtual Reality From Clinical Trials to Clinical Practice for the Treatment of Eating Disorders: An Example Using Virtual Reality Cue Exposure Therapy JO - J Med Internet Res SP - e16386 VL - 22 IS - 4 KW - virtual reality KW - exposure therapy KW - eating disorders KW - translational research KW - technological innovation UR - http://www.jmir.org/2020/4/e16386/ UR - https://doi.org/10.2196/16386 UR - http://www.ncbi.nlm.nih.gov/pubmed/32324145 DO - 10.2196/16386 ID - info:doi/10.2196/16386 ER - TY - JOUR AU - Noben, Lore AU - Goossens, Simone Maria Theresia Anna AU - Truijens, Sophie Eva Marieke AU - van Berckel, Marijn Marthe Georgine AU - Perquin, Christel Wilhelmina AU - Slooter, Gerrit Dirk AU - van Rooijen, Stefanus Johannes PY - 2019 DA - 2019/12/18 TI - A Virtual Reality Video to Improve Information Provision and Reduce Anxiety Before Cesarean Delivery: Randomized Controlled Trial JO - JMIR Ment Health SP - e15872 VL - 6 IS - 12 KW - virtual reality KW - cesarean section KW - counseling KW - preoperative care KW - surgery KW - anxiety KW - childbirth AB - Background: Anxiety levels before cesarean delivery (CD) can lead to a negative birth experience, which may influence several aspects of the woman’s life in the long term. Improving preoperative information may lower preoperative anxiety and lead to a more positive birth experience. Objective: This study aimed to determine whether a virtual reality (VR) video in addition to standard preoperative information decreases anxiety levels before a planned CD. Methods: Women scheduled to undergo term elective CD were recruited from the outpatient clinic. They were randomized and stratified based on history of emergency CD (yes or no). All participants received standard preoperative information (folder leaflets and counseling by the obstetrician); the VR group additionally watched the VR video showing all aspects of CD such as the ward admission, operating theater, spinal analgesia, and moment of birth. The primary outcome measure was a change in score on the Visual Analogue Scale for Anxiety (ΔVAS-A) measured at admission for CD, compared with the baseline VAS-A score. Results: A total of 97 women were included for analysis. The baseline characteristics were similar in both groups, except for a significantly higher level of education in the control group. There was no significant decrease in the VAS-A score of the women in the VR group (n=49) compared with those in the control group (n=48; ΔVAS-A=1.0; P=.08; 95% CI −0.1 to 2.0). Subgroup analysis for the group of women with a history of emergency CD showed a trend toward decreased preoperative anxiety, despite the small sample size of this subgroup (n=17; P=.06). Of the 26 participants who provided completed questionnaires, 22 (85%) in the VR group reported feeling more prepared after seeing the VR video; of the 24 participants’ partners who completed the questionnaires, 19 (79%) agreed with the participants. No discomfort or motion sickness was reported. Conclusions: A VR video may help patients and their partners feel better prepared when planning a CD. This study showed that VR does not lead to a decrease in preoperative anxiety. However, subgroups such as women with a history of emergency CD may benefit from VR videos. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) 74794447; http://www.isrctn.com/ISRCTN74794447 (retrospectively registered) UR - http://mental.jmir.org/2019/12/e15872/ UR - https://doi.org/10.2196/15872 UR - http://www.ncbi.nlm.nih.gov/pubmed/31850850 DO - 10.2196/15872 ID - info:doi/10.2196/15872 ER - TY - JOUR AU - Kip, Hanneke AU - Kelders, Saskia M AU - Bouman, Yvonne H A AU - van Gemert-Pijnen, Lisette J E W C PY - 2019 DA - 2019/08/19 TI - The Importance of Systematically Reporting and Reflecting on eHealth Development: Participatory Development Process of a Virtual Reality Application for Forensic Mental Health Care JO - J Med Internet Res SP - e12972 VL - 21 IS - 8 KW - eHealth KW - technology development KW - virtual reality KW - forensic psychiatry KW - community-based participatory research KW - human-centered design KW - case study AB - Background: The use of electronic health (eHealth) technologies in practice often is lower than expected, mostly because there is no optimal fit among a technology, the characteristics of prospective users, and their context. To improve this fit, a thorough systematic development process is recommended. However, more knowledge about suitable development methods is necessary to create a tool kit that guides researchers in choosing development methods that are appropriate for their context and users. In addition, there is a need for reflection on the existing frameworks for eHealth development to be able to constantly improve them. Objective: The two main objectives of this case study were to present and reflect on the (1) methods used in the development process of a virtual reality application for forensic mental health care and (2) development model that was used: the CeHRes Roadmap (the Centre for eHealth Research Roadmap). Methods: In the development process, multiple methods were used to operationalize the first 2 phases of the CeHRes Roadmap: the contextual inquiry and value specification. To summarize the most relevant information for the goals of this study, the following information was extracted per method: (1) research goal, (2) explanation of the method used, (3) main results, (4) main conclusions, and (5) lessons learned about the method. Results: Information on 10 methods used is presented in a structured manner. These 10 methods were stakeholder identification, project team composition, focus groups, literature study, semistructured interviews, idea generation with scenarios, Web-based questionnaire, value specification, idea generation with prototyping, and a second round of interviews. The lessons learned showed that although each method added new insights to the development process, not every method appeared to be the most appropriate for each research goal. Conclusions: Reflection on the methods used pointed out that brief methods with concrete examples or scenarios fit the forensic psychiatric patients the best, among other things, because of difficulties with abstract reasoning and low motivation to invest much time in participating in research. Formulating clear research questions based on a model’s underlying principles and composing a multidisciplinary project team with prospective end users appeared to be important in this study. The research questions supported the project team in keeping the complex development processes structured and prevented tunnel vision. With regard to the CeHRes Roadmap, continuous stakeholder involvement and formative evaluations were evaluated as strong points. A suggestion to further improve the Roadmap is to explicitly integrate the use of domain-specific theories and models. To create a tool kit with a broad range of methods for eHealth development and further improve development models, studies that report and reflect on development processes in a consistent and structured manner are needed. UR - http://www.jmir.org/2019/8/e12972/ UR - https://doi.org/10.2196/12972 UR - http://www.ncbi.nlm.nih.gov/pubmed/31429415 DO - 10.2196/12972 ID - info:doi/10.2196/12972 ER - TY - JOUR AU - Ose, Solveig Osborg AU - Færevik, Hilde AU - Kaasbøll, Jannike AU - Lindgren, Martin AU - Thaulow, Kristin AU - Antonsen, Stig AU - Burkeland, Olav PY - 2019 DA - 2019/6/10 TI - Exploring the Potential for Use of Virtual Reality Technology in the Treatment of Severe Mental Illness Among Adults in Mid-Norway: Collaborative Research Between Clinicians and Researchers JO - JMIR Form Res SP - e13633 VL - 3 IS - 2 KW - virtual reality KW - severe mental illness KW - collaborative research KW - technology KW - social work AB - Background: Virtual reality (VR) technology is not currently used in the treatment of severe mental health illness in Norway. Objective: We aimed to explore the potential of VR as a treatment for severe mental health illness in Norway, through collaborative research between clinicians and researchers. Methods: A collaborative research team was established, comprising researchers, the manager at a district psychiatric center, and the manager of the local municipal mental health service. An all-day workshop with eight clinicians—four from specialist mental health services and four from municipal mental health services—was conducted. The clinicians watched three different VR movies and after each one, they answered predefined questions designed to reflect their immediate thoughts about VR’s potential use in clinical practice. At the end of the workshop, two focus group interviews, each with four clinicians from each service level, were conducted. Results: VR technology in specialist services might be a new tool for the treatment of severe mental health illness. In municipal mental health services, VR might particularly be useful in systematic social training that would otherwise take a very long time to complete. Conclusions: We found substantial potential for the use of VR in the treatment of severe mental health illness in specialist and municipal mental health services. One of the uses of VR technology with the greatest potential was helping individuals who had isolated themselves and needed training in social skills and everyday activity to enable them to have more active social lives. VR could also be used to simulate severe mental illness to provide a better understanding of how the person with severe mental illness experiences their situation. UR - http://formative.jmir.org/2019/2/e13633/ UR - https://doi.org/10.2196/13633 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199315 DO - 10.2196/13633 ID - info:doi/10.2196/13633 ER - TY - JOUR AU - Birckhead, Brandon AU - Khalil, Carine AU - Liu, Xiaoyu AU - Conovitz, Samuel AU - Rizzo, Albert AU - Danovitch, Itai AU - Bullock, Kim AU - Spiegel, Brennan PY - 2019 DA - 2019/01/31 TI - Recommendations for Methodology of Virtual Reality Clinical Trials in Health Care by an International Working Group: Iterative Study JO - JMIR Ment Health SP - e11973 VL - 6 IS - 1 KW - clinical trials KW - consensus KW - virtual reality AB - Background: Therapeutic virtual reality (VR) has emerged as an efficacious treatment modality for a wide range of health conditions. However, despite encouraging outcomes from early stage research, a consensus for the best way to develop and evaluate VR treatments within a scientific framework is needed. Objective: We aimed to develop a methodological framework with input from an international working group in order to guide the design, implementation, analysis, interpretation, and communication of trials that develop and test VR treatments. Methods: A group of 21 international experts was recruited based on their contributions to the VR literature. The resulting Virtual Reality Clinical Outcomes Research Experts held iterative meetings to seek consensus on best practices for the development and testing of VR treatments. Results: The interactions were transcribed, and key themes were identified to develop a scientific framework in order to support best practices in methodology of clinical VR trials. Using the Food and Drug Administration Phase I-III pharmacotherapy model as guidance, a framework emerged to support three phases of VR clinical study designs—VR1, VR2, and VR3. VR1 studies focus on content development by working with patients and providers through the principles of human-centered design. VR2 trials conduct early testing with a focus on feasibility, acceptability, tolerability, and initial clinical efficacy. VR3 trials are randomized, controlled studies that evaluate efficacy against a control condition. Best practice recommendations for each trial were provided. Conclusions: Patients, providers, payers, and regulators should consider this best practice framework when assessing the validity of VR treatments. UR - https://mental.jmir.org/2019/1/e11973/ UR - https://doi.org/10.2196/11973 UR - http://www.ncbi.nlm.nih.gov/pubmed/30702436 DO - 10.2196/11973 ID - info:doi/10.2196/11973 ER - TY - JOUR AU - Provoost, Simon AU - Lau, Ho Ming AU - Ruwaard, Jeroen AU - Riper, Heleen PY - 2017 DA - 2017/05/09 TI - Embodied Conversational Agents in Clinical Psychology: A Scoping Review JO - J Med Internet Res SP - e151 VL - 19 IS - 5 KW - eHealth KW - review KW - embodied conversational agent KW - human computer interaction KW - clinical psychology KW - mental disorders KW - intelligent agent KW - health behavior AB - Background: Embodied conversational agents (ECAs) are computer-generated characters that simulate key properties of human face-to-face conversation, such as verbal and nonverbal behavior. In Internet-based eHealth interventions, ECAs may be used for the delivery of automated human support factors. Objective: We aim to provide an overview of the technological and clinical possibilities, as well as the evidence base for ECA applications in clinical psychology, to inform health professionals about the activity in this field of research. Methods: Given the large variety of applied methodologies, types of applications, and scientific disciplines involved in ECA research, we conducted a systematic scoping review. Scoping reviews aim to map key concepts and types of evidence underlying an area of research, and answer less-specific questions than traditional systematic reviews. Systematic searches for ECA applications in the treatment of mood, anxiety, psychotic, autism spectrum, and substance use disorders were conducted in databases in the fields of psychology and computer science, as well as in interdisciplinary databases. Studies were included if they conveyed primary research findings on an ECA application that targeted one of the disorders. We mapped each study’s background information, how the different disorders were addressed, how ECAs and users could interact with one another, methodological aspects, and the study’s aims and outcomes. Results: This study included N=54 publications (N=49 studies). More than half of the studies (n=26) focused on autism treatment, and ECAs were used most often for social skills training (n=23). Applications ranged from simple reinforcement of social behaviors through emotional expressions to sophisticated multimodal conversational systems. Most applications (n=43) were still in the development and piloting phase, that is, not yet ready for routine practice evaluation or application. Few studies conducted controlled research into clinical effects of ECAs, such as a reduction in symptom severity. Conclusions: ECAs for mental disorders are emerging. State-of-the-art techniques, involving, for example, communication through natural language or nonverbal behavior, are increasingly being considered and adopted for psychotherapeutic interventions in ECA research with promising results. However, evidence on their clinical application remains scarce. At present, their value to clinical practice lies mostly in the experimental determination of critical human support factors. In the context of using ECAs as an adjunct to existing interventions with the aim of supporting users, important questions remain with regard to the personalization of ECAs’ interaction with users, and the optimal timing and manner of providing support. To increase the evidence base with regard to Internet interventions, we propose an additional focus on low-tech ECA solutions that can be rapidly developed, tested, and applied in routine practice. UR - http://www.jmir.org/2017/5/e151/ UR - https://doi.org/10.2196/jmir.6553 UR - http://www.ncbi.nlm.nih.gov/pubmed/28487267 DO - 10.2196/jmir.6553 ID - info:doi/10.2196/jmir.6553 ER - TY - JOUR AU - Tashjian, Vartan C AU - Mosadeghi, Sasan AU - Howard, Amber R AU - Lopez, Mayra AU - Dupuy, Taylor AU - Reid, Mark AU - Martinez, Bibiana AU - Ahmed, Shahzad AU - Dailey, Francis AU - Robbins, Karen AU - Rosen, Bradley AU - Fuller, Garth AU - Danovitch, Itai AU - IsHak, Waguih AU - Spiegel, Brennan PY - 2017 DA - 2017/03/29 TI - Virtual Reality for Management of Pain in Hospitalized Patients: Results of a Controlled Trial JO - JMIR Ment Health SP - e9 VL - 4 IS - 1 KW - pain KW - virtual reality KW - inpatients KW - hospitalization AB - Background: Improvements in software and design and reduction in cost have made virtual reality (VR) a practical tool for immersive, three-dimensional (3D), multisensory experiences that distract patients from painful stimuli. Objective: The objective of the study was to measure the impact of a onetime 3D VR intervention versus a two-dimensional (2D) distraction video for pain in hospitalized patients. Methods: We conducted a comparative cohort study in a large, urban teaching hospital in medical inpatients with an average pain score of ≥3/10 from any cause. Patients with nausea, vomiting, dementia, motion sickness, stroke, seizure, and epilepsy and those placed in isolation were excluded. Patients in the intervention cohort viewed a 3D VR experience designed to reduce pain using the Samsung Gear Oculus VR headset; control patients viewed a high-definition, 2D nature video on a 14-inch bedside screen. Pre- and postintervention pain scores were recorded. Difference-in-difference scores and the proportion achieving a half standard deviation pain response were compared between groups. Results: There were 50 subjects per cohort (N=100). The mean pain reduction in the VR cohort was greater than in controls (−1.3 vs −0.6 points, respectively; P=.008). A total of 35 (65%) patients in the VR cohort achieved a pain response versus 40% of controls (P=.01; number needed to treat=4). No adverse events were reported from VR. Conclusions: Use of VR in hospitalized patients significantly reduces pain versus a control distraction condition. These results indicate that VR is an effective and safe adjunctive therapy for pain management in the acute inpatient setting; future randomized trials should confirm benefit with different visualizations and exposure periods. Trial Registration: Clinicaltrials.gov NCT02456987; https://clinicaltrials.gov/ct2/show/NCT02456987 (Archived by WebCite at http://www.webcitation.org/6pJ1P644S) UR - http://mental.jmir.org/2017/1/e9/ UR - https://doi.org/10.2196/mental.7387 UR - http://www.ncbi.nlm.nih.gov/pubmed/28356241 DO - 10.2196/mental.7387 ID - info:doi/10.2196/mental.7387 ER - TY - JOUR AU - Mosadeghi, Sasan AU - Reid, Mark William AU - Martinez, Bibiana AU - Rosen, Bradley Todd AU - Spiegel, Brennan Mason Ross PY - 2016 DA - 2016/06/27 TI - Feasibility of an Immersive Virtual Reality Intervention for Hospitalized Patients: An Observational Cohort Study JO - JMIR Ment Health SP - e28 VL - 3 IS - 2 KW - virtual reality therapy KW - hospitalization KW - feasibility studies AB - Background: Virtual reality (VR) offers immersive, realistic, three-dimensional experiences that “transport” users to novel environments. Because VR is effective for acute pain and anxiety, it may have benefits for hospitalized patients; however, there are few reports using VR in this setting. Objective: The aim was to evaluate the acceptability and feasibility of VR in a diverse cohort of hospitalized patients. Methods: We assessed the acceptability and feasibility of VR in a cohort of patients admitted to an inpatient hospitalist service over a 4-month period. We excluded patients with motion sickness, stroke, seizure, dementia, nausea, and in isolation. Eligible patients viewed VR experiences (eg, ocean exploration; Cirque du Soleil; tour of Iceland) with Samsung Gear VR goggles. We then conducted semistructured patient interview and performed statistical testing to compare patients willing versus unwilling to use VR. Results: We evaluated 510 patients; 423 were excluded and 57 refused to participate, leaving 30 participants. Patients willing versus unwilling to use VR were younger (mean 49.1, SD 17.4 years vs mean 60.2, SD 17.7 years; P=.01); there were no differences by sex, race, or ethnicity. Among users, most reported a positive experience and indicated that VR could improve pain and anxiety, although many felt the goggles were uncomfortable. Conclusions: Most inpatient users of VR described the experience as pleasant and capable of reducing pain and anxiety. However, few hospitalized patients in this “real-world” series were both eligible and willing to use VR. Consistent with the “digital divide” for emerging technologies, younger patients were more willing to participate. Future research should evaluate the impact of VR on clinical and resource outcomes. ClinicalTrial: Clinicaltrials.gov NCT02456987; https://clinicaltrials.gov/ct2/show/NCT02456987 (Archived by WebCite at http://www.webcitation.org/6iFIMRNh3) UR - http://mental.jmir.org/2016/2/e28/ UR - https://doi.org/10.2196/mental.5801 UR - http://www.ncbi.nlm.nih.gov/pubmed/27349654 DO - 10.2196/mental.5801 ID - info:doi/10.2196/mental.5801 ER - TY - JOUR AU - Gaggioli, Andrea AU - Pallavicini, Federica AU - Morganti, Luca AU - Serino, Silvia AU - Scaratti, Chiara AU - Briguglio, Marilena AU - Crifaci, Giulia AU - Vetrano, Noemi AU - Giulintano, Annunziata AU - Bernava, Giuseppe AU - Tartarisco, Gennaro AU - Pioggia, Giovanni AU - Raspelli, Simona AU - Cipresso, Pietro AU - Vigna, Cinzia AU - Grassi, Alessandra AU - Baruffi, Margherita AU - Wiederhold, Brenda AU - Riva, Giuseppe PY - 2014 DA - 2014/07/08 TI - Experiential Virtual Scenarios With Real-Time Monitoring (Interreality) for the Management of Psychological Stress: A Block Randomized Controlled Trial JO - J Med Internet Res SP - e167 VL - 16 IS - 7 KW - psychological stress KW - Interreality KW - virtual reality KW - biosensors KW - heart rate KW - heart rate variability KW - biofeedback training KW - relaxation training KW - physiological monitoring KW - smartphones AB - Background: The recent convergence between technology and medicine is offering innovative methods and tools for behavioral health care. Among these, an emerging approach is the use of virtual reality (VR) within exposure-based protocols for anxiety disorders, and in particular posttraumatic stress disorder. However, no systematically tested VR protocols are available for the management of psychological stress. Objective: Our goal was to evaluate the efficacy of a new technological paradigm, Interreality, for the management and prevention of psychological stress. The main feature of Interreality is a twofold link between the virtual and the real world achieved through experiential virtual scenarios (fully controlled by the therapist, used to learn coping skills and improve self-efficacy) with real-time monitoring and support (identifying critical situations and assessing clinical change) using advanced technologies (virtual worlds, wearable biosensors, and smartphones). Methods: The study was designed as a block randomized controlled trial involving 121 participants recruited from two different worker populations—teachers and nurses—that are highly exposed to psychological stress. Participants were a sample of teachers recruited in Milan (Block 1: n=61) and a sample of nurses recruited in Messina, Italy (Block 2: n=60). Participants within each block were randomly assigned to the (1) Experimental Group (EG): n=40; B1=20, B2=20, which received a 5-week treatment based on the Interreality paradigm; (2) Control Group (CG): n=42; B1=22, B2=20, which received a 5-week traditional stress management training based on cognitive behavioral therapy (CBT); and (3) the Wait-List group (WL): n=39, B1=19, B2=20, which was reassessed and compared with the two other groups 5 weeks after the initial evaluation. Results: Although both treatments were able to significantly reduce perceived stress better than WL, only EG participants reported a significant reduction (EG=12% vs CG=0.5%) in chronic “trait” anxiety. A similar pattern was found for coping skills: both treatments were able to significantly increase most coping skills, but only EG participants reported a significant increase (EG=14% vs CG=0.3%) in the Emotional Support skill. Conclusions: Our findings provide initial evidence that the Interreality protocol yields better outcomes than the traditionally accepted gold standard for psychological stress treatment: CBT. Consequently, these findings constitute a sound foundation and rationale for the importance of continuing future research in technology-enhanced protocols for psychological stress management. Trial Registration: ClinicalTrials.gov: NCT01683617; http://clinicaltrials.gov/show/NCT01683617 (Archived by WebCite at http://www.webcitation.org/6QnziHv3h). UR - http://www.jmir.org/2014/7/e167/ UR - https://doi.org/10.2196/jmir.3235 UR - http://www.ncbi.nlm.nih.gov/pubmed/25004803 DO - 10.2196/jmir.3235 ID - info:doi/10.2196/jmir.3235 ER - TY - JOUR AU - Clemente, Miriam AU - Rey, Beatriz AU - Rodriguez-Pujadas, Aina AU - Breton-Lopez, Juani AU - Barros-Loscertales, Alfonso AU - Baños, Rosa M AU - Botella, Cristina AU - Alcañiz, Mariano AU - Avila, Cesar PY - 2014 DA - 2014/06/27 TI - A Functional Magnetic Resonance Imaging Assessment of Small Animals’ Phobia Using Virtual Reality as a Stimulus JO - JMIR Serious Games SP - e6 VL - 2 IS - 1 KW - neuroimaging KW - patient assessment KW - virtual reality KW - phobia AB - Background: To date, still images or videos of real animals have been used in functional magnetic resonance imaging protocols to evaluate the brain activations associated with small animals’ phobia. Objective: The objective of our study was to evaluate the brain activations associated with small animals’ phobia through the use of virtual environments. This context will have the added benefit of allowing the subject to move and interact with the environment, giving the subject the illusion of being there. Methods: We have analyzed the brain activation in a group of phobic people while they navigated in a virtual environment that included the small animals that were the object of their phobia. Results: We have found brain activation mainly in the left occipital inferior lobe (P<.05 corrected, cluster size=36), related to the enhanced visual attention to the phobic stimuli; and in the superior frontal gyrus (P<.005 uncorrected, cluster size=13), which is an area that has been previously related to the feeling of self-awareness. Conclusions: In our opinion, these results demonstrate that virtual stimulus can enhance brain activations consistent with previous studies with still images, but in an environment closer to the real situation the subject would face in their daily lives. UR - http://games.jmir.org/2014/1/e6/ UR - https://doi.org/10.2196/games.2836 UR - http://www.ncbi.nlm.nih.gov/pubmed/25654753 DO - 10.2196/games.2836 ID - info:doi/10.2196/games.2836 ER -