虚拟现实暴露技术在恐惧、焦虑障碍中的应用

虚拟现实(Virtual Reality,VR)技术以计算机技术为基础,能够给来访者提供近似真实的、可以沉浸和交互作用的虚拟环境。近年来,VR技术已被用于精神心理问题治疗的新技术研发和临床应用。其中,VR技术与暴露技术结合,用于多种精神疾病、尤其是恐惧和焦虑障碍的治疗最为多见。本文旨在对虚拟现实暴露技术在特定恐惧症和社交焦虑症的研究和应用进行综述。     

虚拟现实暴露治疗焦虑障碍

本文综述了虚拟现实技术治疗焦虑障碍的研究进展。     

虚拟现实技术在生物医学领域中的应用

背景：虚拟现实也称灵境技术或人工环境,是一种由计算机技术辅助生成的高技术模拟系统,综合集成了计算机图形技术、计算机仿真技术、人工智能、传感技术、显示技术、网络并行处理等技术。 目的：简要介绍虚拟人体、虚拟手术、虚拟实验室以及虚拟现实技术在神经心理学与核医学方面的应用。 方法：由第一作者检索2003/2010 CBM和CNKI数据库中有关文献,以及利用Google搜索引擎检索相关网络信息资源。中文检索词为“虚拟现实、虚拟人、数字人、虚拟手术。”英文检索词为“Virtual Reality,Virtual Human,digital human,virtual surgery。” 结果与结论：虚拟现实技术的应用十分广泛,如：城市规划、能源勘测、工业仿真、古迹复原、建筑虚拟、交通桥梁、港口物流、旅游仿真、虚拟课堂、园林应用、军事仿真等。在生物医学领域,虚拟人、虚拟手术等方面的研究也十分活跃,表现出了很好的效果,并且,虚拟现实技术在生物医学领域的应用也展现出了极好的前景,在核医学与辐射防护领域,虚拟现实系统可用来进行核电站换料任务完成过程中的剂量计算,以及培训在核电站工作的人员,并且虚拟现实暴露疗法对特定恐怖症和其他焦虑障碍有较好的疗效。随着计算机技术的进一步发展,可以预期,在未来几年虚拟现实技术将会成为数字医学最主要的应用工具之一。 关键词：虚拟现实;生物医学;数字人;虚拟手术;医学植入物     

接纳承诺疗法及其在焦虑障碍中的应用

本文目的是通过阐述接纳承诺疗法(ACT)的治疗模型及其在焦虑障碍中的应用,以期改善焦虑障碍患者的心理健康水平,为焦虑障碍的治疗提供新思路。随着生活节奏的加快,焦虑障碍愈发普遍。ACT作为新兴的认知行为疗法,通过六大核心技术帮助焦虑障碍患者缓解消极情绪,提升心理灵活性,提高生活质量。本文以ACT的治疗模型为依托,详述治疗方案中涉及的要点,为在焦虑障碍中更好地应用ACT提供参考。     

延时暴露疗法治疗创伤后应激障碍临床研究

目的：了解延时暴露疗法对创伤后应激障碍（PTSD）患者症状的疗效。方法：使用创伤后应激障碍自评量表（PTSD-SS）、抑郁自评量表（SDS）、焦虑自评量表（SAS）对高中生进行测评,采用延时暴露疗法对21名PTSD患者进行了治疗。结果：地震后1年高中生PTSD患病率为6.65%,女性高于男性,延时暴露治疗后症状明显改善。结论：延时暴露疗法对地震后高中生PTSD治疗有效,在以后的心理干预中应注意关注PTSD患者的恐惧和回避症状。     

用暴露疗法治疗恐怖症状1例

暴露疗法是行为治疗中的一种重要方法,在恐怖症、强迫症、惊恐障碍等焦虑性障碍的治疗中运用广泛。但操作中尚有一些很重要的问题没有完全解决,如医生陪伴暴露还是自我暴露,是否合用抗焦虑剂,是否合用抗抑郁剂,暴     

重复经颅磁刺激对惊恐障碍及广泛性焦虑障碍治疗机制的研究进展

惊恐障碍和广泛性焦虑障碍（GAD）是焦虑障碍的两种主要类型，两种疾病的发病机制复 杂且常共病。研究表明脑部特定区位异常活化或代谢作用对两者发病有重要影响。目前对于两者的 治疗手段主要为药物治疗和心理干预，以上疗法虽有一定疗效但不够明显。近年来，重复经颅磁刺激 （rTMS）作为新型的神经调控技术，其有效性、安全性等特性显著，被推荐用于焦虑障碍治疗中。rTMS 对 于上述两种疾病的治疗机制复杂且存在差异。现总结并分析关于rTMS 治疗惊恐障碍和GAD 的相关机 制，明确两者之间的异同，为精准地治疗惊恐障碍和GAD 提供相关线索。     

神经肽Y系统在心境障碍发病机制中的作用

自从上世纪80年代发现神经肽Y（NPY）及其后逐渐发现NPY各受体亚型以来，NPY系统的作用机制被大量的研究所阐述。目前已经发现其与精神分裂症、心境障碍、焦虑障碍、睡眠障碍、物质依赖、冲动行为、惊恐障碍、自杀等各类精神科常见疾病的产生机制有关。本文将对近年来NPY及其受体亚型在心境障碍中的作用机制进行回顾。     

测血压恐惧症一例北大核心CSCD

特定恐惧症是恐惧性焦虑障碍的一种亚型,指除场所恐惧和社交恐惧以外,针对特定情境或客体的恐惧并采取相应的回避行为。本文报道患者在征兵体检时被告知血压增高作为一种心理应激,因面临身体不合格而不能入伍的风险表现出焦虑恐惧反应,把测量血压与恐惧反应建立了条件性反应关系,以后多年回避测量血压,给患者带来了苦恼,符合了特定恐惧症的诊断。特定恐惧症的治疗主要是心理治疗,特别是暴露治疗或包括暴露技术的认知行为治疗。     

社交焦虑障碍的认知行为集体治疗效果的影响因素

目的 探讨社交焦虑障碍的认知行为集体治疗疗效的影响因素。方法 上海市精神卫生中心就诊的社交焦虑障碍患者中自愿参加认知行为集体治疗者，每个治疗小组6～8人，治疗8周，每周1次2．5小时，内容包括认知重建、放松训练、社交技巧训练、系统暴露、现场暴露和家庭作业。疗效评定工具为Liebowitz社交焦虑评定量表。结果 58例患者中社交焦虑评定量表总分、恐惧因子分和回避因子分治疗前后差异均有统计学显著性意义。在研究可能影响治疗的20种因素中有19种因素有显著的影响作用。结论 认知行为集体治疗社交焦虑障碍有效，但影响疗效因素较多，应用该治疗方案时应予充分考虑。     

Virtual reality exposure therapy for anxiety and related disorders: A meta-analysis of randomized controlled trials

Trials of virtual reality exposure therapy (VRET) for anxiety-related disorders have proliferated in number and diversity since our previous meta-analysis that examined 13 total trials, most of which were for specific phobias (Powers & Emmelkamp, 2008). Since then, new trials have compared VRET to more diverse anxiety and related disorders including social anxiety disorder (SAD), posttraumatic stress disorder (PTSD), and panic disorder (PD) with and without agoraphobia. With the availability of this data, it is imperative to re-examine the efficacy of VRET for anxiety. A literature search for randomized controlled trials of VRET versus control or in vivo exposure yielded 30 studies with 1057 participants. Fourteen studies tested VRET for specific phobias, 8 for SAD or performance anxiety, 5 for PTSD, and 3 for PD. A random effects analysis estimated a large effect size for VRET versus waitlist (g = 0.90) and a medium to large effect size for VRET versus psychological placebo conditions (g = 0.78). A comparison of VRET and in vivo conditions did not show significantly different effect sizes (g = −0.07). These findings were relatively consistent across disorders. A meta-regression analysis revealed that larger sample sizes were associated with lower effect sizes in VRET versus control comparisons (β = −0.007, p < 0.05). These results indicate that VRET is an effective and equal medium for exposure therapy.     

Effectiveness of virtual reality using Wii gaming technology in children with Down syndrome

This quasi-experimental study compared the effect of standard occupational therapy (SOT) and virtual reality using Wii gaming technology (VRWii) on children with Down syndrome (DS). Children (n = 105) were randomly assigned to intervention with either SOT or VRWii, while another 50 served as controls. All children were assessed with measures of sensorimotor functions. At post-intervention, the treatment groups significantly outperformed the control group on all measures. Participants in the VRWii group had a greater pre-post change on motor proficiency, visual-integrative abilities, and sensory integrative functioning. Virtual reality using Wii gaming technology demonstrated benefit in improving sensorimotor functions among children with DS. It could be used as adjuvant therapy to other proven successful rehabilitative interventions in treating children with DS.     

Effects of Virtual Reality-Based Cognitive Training in the Elderly with and without Mild Cognitive Impairment

ObjectiveThis study aimed to introduce a 4-week long fully immersive virtual reality-based cognitive training (VRCT) program that could be applied for both a cognitively normal elderly population and patients with mild cognitive impairment (MCI). In addition, we attempted to investigate the neuropsychological effects of the VRCT program in each group. MethodsA total of 56 participants, 31 in the MCI group and 25 in the cognitively normal elderly group, underwent eight sessions of VRCT for 4 weeks. In order to evaluate the effects of the VRCT, the Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet was administered before and after the program. The program’ s safety was assessed using a simulator sickness questionnaire (SSQ), and availability was assessed using the presence questionnaire. ResultsAfter the eighth session of the VRCT program, cognitive improvement was observed in the ability to learn new information, visuospatial constructional ability, and frontal lobe function in both groups. At the baseline evaluation, based on the SSQ, the MCI group complained of disorientation and nausea significantly more than the cognitively normal elderly group did. However, both groups showed a reduction in discomfort as the VRCT program progressed. ConclusionWe conclude that our VRCT program helps improve cognition in both the MCI group and cognitively normal elderly group. Therefore, the VRCT is expected to help improve cognitive function in elderly populations with and without MCI.     

Static posture tests for the assessment of postural instability after virtual environment use

The aim of this experiment was to measure the effect of immersion in a virtual environment (VE) on postural stability and examine the relationship between postural stability and self-reported simulator sickness. Forty healthy subjects were exposed to 20 min of immersion in an interactive VE with restricted user movement. The VE was viewed on a head mounted display (HMD) and the subject remained standing throughout the immersion period. Two static postures, normal stance and tandem romberg, were recorded before immersion, immediately after immersion and again at 10 min postimmersion. Performance in each posture was simultaneously measured by recording time that the posture could be maintained and mm path length of body sway over a 30-s period. The results demonstrated differences in the sensitivity of postural stability measurement techniques and variations in inter- and intraindividual responses to measures. Sway magnetometry measured a significant increase in postural instability in normal stance after VE immersion. None of the other measures were sensitive to this change. Postimmersion reports of simulator sickness symptoms indicate that the VE stimulus was provocative and correlation was found between reports of simulator sickness and balance-related symptoms. However, no association between self-reported symptoms and performance measures of postural instability was found.     

Examining the benefits of extended reality in neurosurgery: A systematic review

While well-established in other surgical subspecialties, the benefits of extended reality, consisting of virtual reality (VR), augmented reality (AR), and mixed reality (MR) technologies, remains underexplored in neurosurgery despite its increasing utilization. To address this gap, we conducted a systematic review of the effects of extended reality (XR) in neurosurgery with an emphasis on the perioperative period, to provide a guide for future clinical optimization. Seven primary electronic databases were screened following guidelines outlined by PRISMA and the Institute of Medicine. Reported data related to outcomes in the perioperative period and resident training were all examined, and a focused analysis of studies reporting controlled, clinical outcomes was completed. After removal of duplicates, 2548 studies were screened with 116 studies reporting measurable effects of XR in neurosurgery. The majority (82%) included cranial based applications related to tumor surgery with 34% showing improved resection rates and functional outcomes. A rise in high-quality studies was identified from 2017 to 2020 compared to all previous years (p = 0.004). Primary users of the technology were: 56% neurosurgeon (n = 65), 28% residents (n = 33) and 5% patients (n = 6). A final synthesis was conducted on 10 controlled studies reporting patient outcomes. XR technologies have demonstrated benefits in preoperative planning and multimodal neuronavigation especially for tumor surgery. However, few studies have reported patient outcomes in a controlled design demonstrating a need for higher quality data. XR platforms offer several advantages to improve patient outcomes and specifically, the patient experience for neurosurgery.     

虚拟影像术前计划系统在神经外科的临床应用研究

目的探讨三维立体虚拟影像术前计划系统在神经外科常规手术中的应用价值。方法应用Radio Dexter虚拟影像术前计划系统对颅内肿瘤及椎管内肿瘤等15例神经外科常规手术病例进行术前计划操作。结果15例病例均成功进行了术的计划操作。该系统形成的三维立体虚拟影像清晰、逼真，并可进行多种模拟操作，能更清楚、准确地显示手术区域解剖结构及毗邻关系。本组无严重并发症．无死亡病例。结论三维立体虚拟影像术前计划系统能够提高神经外科手术的精确性．降低手术创伤及手术风险，值得推广应用。     

Virtual rehabilitation via Nintendo Wii® and conventional physical therapy effectively treat post-stroke hemiparetic patients

Abstract

Background:

The Nintendo® Wii is a simple and affordable virtual therapy alternative. It may be used at home, and it is a motivating recreational activity that provides continuous feedback. However, studies comparing the use of the Nintendo® Wii to conventional physical therapy are needed.

Objective:

To compare the effect of a rehabilitation treatment using the Nintendo® Wii (NW) with conventional physical therapy (CPT) to improve the sensorimotor function and quality of life for post-stroke hemiparetic patients.

Methods:

The present study applied a randomized, blind, and controlled clinical trial. In total, 30 patients with post-stroke hemiparesis were evaluated. A total of 15 patients were randomly assigned to each group. The SF-36 quality of life and Fugl–Meyer scales were used to evaluate the patients.

Results:

After treatment, the only variable that differed between the groups was the physical functioning domain of the SF-36 in the group that received conventional physical therapy. A significant difference was observed between both groups before and after treatment in terms of the following Fugl–Meyer scale items: passive movement and pain, motor function of the upper limbs (ULs), and balance. The CPT group also showed a significant difference with regard to their UL and lower limb (LL) coordination. The SF-36 scale analysis revealed a significant difference within both groups with regard to the following domains: physical functioning, role limitation due to physical aspects, vitality, and role limitation due to emotional aspects. The NW group also exhibited a significant difference in the mental health domain. The results indicate that both approaches improved the patients' performance in a similar manner.

Conclusion:

Virtual rehabilitation using the Nintendo Wii® and CPT both effectively treat post-stroke hemiparetic patients by improving passive movement and pain scores, motor function of the upper limb, balance, physical functioning, vitality, and the physical and emotional aspects of role functioning.     

Efficacy of virtual reality exposure therapy to treat driving phobia: a case report

An AB case design was used to examine the efficacy of virtual reality exposure therapy (VRET) in treating driving phobia. After a one week baseline, the patient received three treatment sessions over a ten day period. Treatment included practice of four VR driving scenarios. Peak anxiety decreased within and across sessions. Ratings of anxiety and avoidance declined from pre-treatment and post-treatment, with gains maintained at seven month followup. Phobia-related interference in daily functioning similarly decreased. The results suggest that it would be useful to further evaluate the efficacy of VRET for driving phobia in controlled clinical trials.     

Utilizing virtual and augmented reality for educational and clinical enhancements in neurosurgery

Neurosurgery has undergone a technological revolution over the past several decades, from trephination to image-guided navigation. Advancements in virtual reality (VR) and augmented reality (AR) represent some of the newest modalities being integrated into neurosurgical practice and resident education. In this review, we present a historical perspective of the development of VR and AR technologies, analyze its current uses, and discuss its emerging applications in the field of neurosurgery.