Utilizing virtual reality as a therapeutic tool psychiatry

Date
2022-04
Journal Title
Journal ISSN
Volume Title
Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH ABSTRACT: The mass production of modern cellphone technology has resulted in a dra matic cost reduction of producing Virtual Reality (VR) head-mounted dis plays. Although VR has been effective in the treatment of phobias, uptake is still far from mainstream. Fear of heights (i.e. acrophobia) is one of the more common forms of phobias in the general population. Up to 28% of people have distress and anxiety when exposed to heights (i.e. visual heights intoler ance (VHI)), with up to 6% of people meeting clinical criteria for the specific phobia. Virtual Reality Exposure Therapy (VRET) for acrophobia has been shown to be effective as early as the 1990s. There are, however, still relatively few randomized controlled studies that have looked at its effectiveness . Even fewer studies look at physiological responses associated with fear cessation. Biofeedback is the process of presenting participants with their physiological responses allowing them to gain a measure of control over them. Biofeedback shows promise as a treatment adjunct for specific phobias. We therefore aim to create a VR height exposure platform, that offers a graduated exposure, is optimized to avoid excessive motion sickness, is cost-effective for widespread use, and is validated by participant reports collected during the exposure. Here we developed and tested a cost effective VR acrophobia environment with biofeedback in a sample of 22 participants, 4 of whom had clinically measurable acrophobia. We constructed an Electrodermal Activity (EDA) biofeedback prototype using two Arduino boards, one being electrically isolated (Nano) to reduce noise and increase safety. The second Arduino (UNO R3) was con nected via USB to a VR workstation running the Unreal Engine 4.24.2. USB connectivity was established via the UE4duino plugin. All participants un derwent clinical screening, excluding for confounding psychopathology except acrophobia. Acrophobia symptoms were evaluated using the Visual Height Intolerance Severity Scale (vHISS) questionnaire. Participants were placed on a VR platform which ascended to 28 meters. Subjective stress responses were recorded during the task as well as VR related motion sickness. Data was en tered into a repeated measures ANOVA to check for within-subject differences in levels of stress, comparing when the platform was on the ground as well as in the air. Afterwards participants experiences were evaluated via a brief questionnaire. Biofeedback based on the mean of the signal consistently informed participants that they were stressed while the platform was elevated. Participants showed a significant increase in mean skin conductance signal while the platform was elevated. Continuous decomposition analysis as well as subjective responses confirmed the accuracy of the biofeedback provided. All participants reported a positive experience using the biofeedback, most perceiving it to be accurate. The present work indicates that biofeedback in VRET is a promising treatment adjunct, which should be explored in further clinical trials.
AFRIKAANSE OPSOMMING: Met die koms van die massaproduksie van die moderne selfoontegnologie, het die koste van die vervaardiging van Virtual Reality (VR) kopgemonteerde skerms gedaal. Alhoewel VR baie belowend is met die behandeling van akrofobie, vrees vir vlieg en ander, is die opname nog ver van die hoofstroom. Hoogtevrees (d.w.s. akrofobie) is een van die meer algemene vorme van fobies in die algemene bevolking. Tot 28% van mense ervaar nood en angs wanneer hulle aan hoogtes blootgestel word (d.i. visuele hoogte-intoleransie (VHI)), met tot 6% van mense wat aan kliniese kriteria vir die spesifieke fobie voldoen. VRET vir akrofobie is reeds in die 1990’s doeltreffend getoon. Daar is egter nog relatief min gekontroleerde studies wat na die doeltreffendheid daar van gekyk het. Nog minder wat kyk na fisiologiese reaksies wat verband hou met vreesbeëindiging. Bioterugvoer is die proses om deelnemers hul fisiologiese reaksies voor te stel wat hulle in staat stel om ’n mate van beheer oor hul fisiologie te verkry. Bioterugvoer blyk belowend as ’n behandelingsaanvulling vir spesifieke fobies. Ons beoog dus om ’n VR-vrees vir hoogte-blootstellingsplatform te skep, wat geleidelike blootstelling bied, geoptimaliseer is om oormatige bewegingsiekte te vermy, koste-effektief is vir wydverspreide gebruik en bekragtig word deur kliëntverslae wat ingesamel word tydens die blootstelling. Hier het ons ’n koste-effektiewe VR-akrofobie-omgewing met bioterugvoer ontwikkel en getoets in ’n gesonde steekproef van 22 deelnemers, van wie 4 klinies meetbare akrofobie gehad het. Ons het ’n Electrodermal Activity (EDA) bioterugvoer toestel gebou deur van twee Arduino-borde gebruik te maak, waarvan een elektries geïsoleer is (Nano) om die sein te verbeter en veiligheid te verhoog. Die tweede Arduino (UNO R3) is via USB gekoppel aan ’n VRmet die Unreal Engine 4.24.2. USB-verbinding is tot stand gebring deur die UE4duino-plugin. Alle deelnemers het kliniese sifting ondergaan, en is uitgesluit vir psigopatologie behalwe akrofobie. Akrofobie simptome is geëvalueer deur gebruik te maak van die Visual Height Intolerance Severity (vHISS) vraelys. Deelnemers is op ’n VR-platform geplaas wat tot 28 meter gehys is. Subjektiewe stresreaksies is aangeteken tydens die taak sowel as VRverwante bewegingsiekte. Data is in ’n repeated measures ANOVA ingevoer om te kyk vir within-group verskille in stresvlakke, met vergelyking wanneer die platform op die grond sowel as in die lug was. Daarna is deelnemers se ervarings deur middel van ’n kort vraelys geëvalueer. Bioterugvoer gebaseer op die gemiddelde van die sein het deelnemers konsekwent ingelig dat hulle gestres is terwyl die platform in die lug was. Deelnemers het ’n beduidende toename in gemiddelde velgeleidingsein getoon terwyl die platform verhewe was. ’n Continuous decomposition analysis, sowel as subjektiewe response het die akkuraatheid van die bioterugvoer bevestig. Alle deelnemers het ’n positiewe ervaring met die gebruik van die bioterugvoer gerapporteer, en die meeste het dit as akkuraat beskou. Die huidige werk dui aan dat bioterugvoer in VRET ’n belowende behandelingshulpmiddel is, wat in verdere kliniese proewe ondersoek moet word.
Description
Thesis (MEng)--Stellenbosch University, 2022.
Keywords
Electrodermal activity, Acrophobia, VRET, UCTD, Therapeutic tool -- Psychiatry
Citation