Overview. Introduction of the workshop leaders. Essentials in the treatment of anxiety disorders. General issues about VR and anxiety. Interactive technology for therapeutic interventions All anxiety disorders except OCD and GAD. Summary of some of the studies detailed in the handout.
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Kathrine Gapinski, Ph.D.
Shani Robins, Ph.D.
Kathy Vandenburgh, Ph.D.
Elizabeth Durso, M.S.
Lingjun Kong, M.S.
Michael Yun, M.S.
Lei (Laycee) Fan
ThienDi (Kari) Lam
Esteban (Steve) Leon
Scott Tanner Mitten
Thuy VuThe VRMC Team
Brenda K. Wiederhold, Ph.D., MBA, BCIA
Mark D. Wiederhold, M.D., Ph.D., FACP
Pain Distraction, PTSD
Region’s Hospital, Minnesota
University of Washington
ADHD, PTSD, Pain Distraction, Rehabilitation
Walter Reed Army Hospital, D.C.
Hanyang University, Korea
Smoking Cessation/Prevention, Schizophrenia, ADHD, Rehabilitation, Pain Distraction
Inje University Paik Hospital, Korea
Istituto Auxologico, Italy
Eating Disorders, Obesity, Anxiety, Pain Distraction
University of Basel
Anxiety, Physiology, Addictions, Pain Distraction
University of Quebec
Anxiety Disorders, Pain DistractionVRMC Research Collaborations
Generalized Social Phobia
PTSD due to motor vehicle accidentsVirtual Reality Clinical Services(San Diego, West LA, Palo Alto)
International Advisory Board
Scientific and public education
Continuing Education Courses
To further the application of advanced technologies for behavioral healthcare
To serve as a unifying organization for basic and clinical research
To create a set of standards and guidelines for simulationsInteractive Media Institute (IMI)a 501 c3 non-profit organization
Judith Lapierre, Ph.D.
Geneviève Forest, Ph.D.
Bruno Émond, Ph.D.
Genevieve Robillard, M.Sc.
Christian villemaire, B.A.
Serge Larouche.The Cyberpsychology Lab
Stéphane Bouchard, Ph.D. CRC Clinical CyberPsychology
Patrice Renaud, Ph.D.
„Afraid!“Three Systems of Emotion
correlations between domains are only in the order of 0.3.
Lang, P. J. (1978). Anxiety: toward a psychophysiological definition. In H. S. Akiskal & W. L. Webb (Eds.), Psychiatric diagnosis: exploration of biological criteria (pp. 265-389). New York: Spectrum.
From F. Wilhelm
Subjective Units of Distress
Self-Report Scales (P & P)
Overt Behavioral Observation
3 Systems Theory:
Experience, behavior, and physiology are loosely coupled,
rather independent data sources that should be assessed concurrently
in anxiety disorders to provide a comprehensive picture of change in anxiety.
- P. Lang
Consequences X probabilities X imminence
Functional Neuroanatomy of correlated Fear and Anxiety
Fear and Anxiety
( Charney & Deutsch 1996)
Primary sensory and Association Cortices
cells of exteroceptive
nucleus of the
nucleus of the
Dorsolateral prefrontal cortex correlated
Dorsomedial prefrontal cortex
Dorsal anterior cingulate gyrus
Ventrolateral prefrontal cortex
Ventral anterior cingulate gyrus
Regulation - effortful
(of affective states)
Regulation autonomic resp.
(of affective states)
Phillips et al., 2003.
The aim of exposure is to help the patient to confront the feared stimulus in order to correct the dysfunctional associations that have been established between the stimulus and perceived threat (e.g, it is dangerous, I can’t cope).
Lymbic systemOne hypothesis…
Automatic processing of threat-related cues
Mühlberger et al., 2003.
N = 47
Assignement to WL not random
VR > CT = WL at post.
Less clear at f-up on several variables
For 13 motion was simulated / 13 without motion
No significant interaction for mot. / no-mot.
Effect sizes f :
.17 for FSS, .1 for FFratings, .29 for avoidance
10 non-phobics (5 high / 5 low on LSAS):
All time effects p < .01 (repeated measures ANOVA)
Text / lightening high
Text -/ light +
Text +/ light -
Text -/ light -
ANOVA N = 42 :
Condition 3 vs others :
Grid vs the others:
Text - / Light +
45 non-phobics, 5 min. baseline
+ 2 counterbalance tasks
Paired t-tests (in the paper):
Startle: baseline < count < speech
HR*: baseline = count < speech
Skin c: baseline = count < speech
Anxiety: count < speech
*Note. HR data from the paper not shown.
HR data presented here are for all the data
points collected (Cornwell, personnal communication, 2006)
A typical exposure-based scenario using VR (between 5 and 8 sessions).
General overview :
patient’s needs (if not
in an outcome study).