To date, numerous studies have investigated the beneficial role of virtual reality (VR) in psychological rehabilitation as both a
standalone tool, and through its integration with traditional modes of therapy. This review presents the main results of pertinent
randomized control trial (CRT) studies published in the past 15 years. Those seem to suggest that VR is a viable tool to be considered
by clinicians when treating different types of psychological disorders. It also highlights its short-term and long-term benefits in the
rehabilitation of such disorders. However, this review also highlights the need for guidelines that would clarify how VR can be safely
and efficiently implemented in clinical practice.
Rehabilitation is defined as helping somebody “to have a
normal, useful life again after they have been very ill ...” (Oxford
dictionary). Although most rehabilitation programs still use
traditional approaches to compensate for physical, psychological,
or cognitive impairments, the emergence of computer-based tools
is now opening the door for more advanced and personalized
approaches. One of the most promising and rapidly evolving tools
for improving psychological wellbeing is virtual reality (VR) [1, 2].
A VR system involves subjecting users to an artificial environment
while replacing real-world sensory perceptions with digitally
generated ones, thereby promoting a sense of immersion and
allowing users to interact with objects in that environment. The level
of immersion (high vs low immersion) depends on several factors,
especially the type of equipment used. To date, several studies have
explored the beneficial value of VR in rehabilitation as a standalone
tool or through combining it with traditional therapy. Most results
seem to indicate positive effects on patients’ conditions while also
providing long-term effectiveness for rehabilitation programs [3].
Anxiety disorders are the most prevalent of psychiatric
disorders [4]. They include different conditions such as Specific
Phobias, Social Anxiety Disorder (SAD), and Generalized Anxiety
Disorder (GAD). Although Cognitive Behavioral Therapy (CBT) and
Exposure Therapy (ET) are still considered the “gold standard”
evidence-based techniques for the treatment of phobias, findings
revealed that the integration of VR in CBT improves the longevity
of its effects [5]. Moreover, the integration of VR in ET for the
treatment of phobias seems like a viable substitute for traditional
ET [6-20] with enhanced benefits [7] and a higher acceptance and
comfort for patients by giving them more control over the different
scenarios experienced during therapy [8]. On the other hand,
studies revealed that VR can be advantageous over traditional CBT
as an efficient, cost-effective, and practical medium of exposure for
treating social anxiety [21-24]. Finally, VR has also been shown to
be a viable option for the treatment of generalized anxiety disorder
(GAD) [25-29].
Posttraumatic Stress Disorder (PTSD) is a consequence of
exposure to a severe psychological trauma [30] like experiencing
or witnessing a terrifying event. Many studies have explored the
implementation of VR in therapy for PTSD [31-37] based on the
assumption that all experimental protocols using VR provide a riskfree,
authentic, and realistic experience. Results showed clinically
meaningful reductions in PTSD, anxiety, and depressive symptoms,
as well as improved self-reported health on different scales (PTSD
Checklist-Military Version (PCL-M), Beck Anxiety Inventory (BAI),
and Patient Health Questionnaire (PHQ-9)) [37] and higher levels
of relaxation and improvements in sociability [34].
The American Psychiatric Association (2013) [38] defines
psychotic disorders as abnormalities in one or more of the
following: delusions, hallucinations, disorganized thinking, grossly
disorganized or abnormal motor behavior, and negative symptoms
(diminished emotional expression and avolition in schizophrenia).
Studies were also conducted in an attempt to explore the impact
of virtual-reality-based cognitive behavioral therapy (VR-CBT) on
psychotic symptoms (paranoid thoughts and social involvement).
For example, Pot Kolder [39] showed that a VR-CBT group displayed
significantly less momentary paranoid ideation and momentary
anxiety when compared to a control group who received CBT
without VR. Moreover, virtual reality therapy (VRT) elicited
significant decrease in the severity of symptoms of schizophrenia,
including auditory verbal hallucinations and delusions [39-46].
Additionally, studies have also focused on using VR for improving
social skills in schizophrenic patients [43, 47, 48] and a pilot study
using a VR social skills intervention for patients with schizophrenia
has also revealed significant improvements in negative symptoms,
psychopathology, social anxiety and discomfort and avoidance 48.
Most of these improvements were maintained after a four-month
followup.
Finally, studies have also explored the effect of VR in treating
eating disorders [49-52]. For example, Ferrer García [53] used
a VR Cue Exposure Therapy (VR-CET) to put patients in contact
with food regardless of the various levels of anxiety that may arise
from exposure. After treatment, patients receiving VR-CET showed
abstinence from binge eating episodes. Moreover, in a non-clinical
sample, exposure to VR environments incorporating both specific
stimuli and contextual cues significantly reduced food craving and
food related anxiety, [54-56] and the implementation of VR seemed
to increase benefits in weight loss programs for people with
obesity [5, 55, 57-59]. Additionally, adding or combining VR with
traditional forms of treatment, such as CBT, improved body image
dissatisfaction [5, 55, 57, 58, 60].
As we move forward with technology-based therapies, VR
seems to be a viable tool to consider by clinicians in their daily
practice. Current literature emphasizes the added value of VR in
the rehabilitation of psychological disorders. However, and despite
promoting more substantial patient commitment as well as higher
motivation and acceptance [1, 3, 8] while creating a positive and
motivating learning environment for patients [61-64], VR also
has some functional limitations (e.g. dry eyes effect, symptoms of
motion sickness, [65-68], possible delusional thinking in patients
with schizophrenia [65]) as well as some practical limitations (e.g.
availability and accessibility which is mainly caused by the high
prices of VR software and hardware). Moreover, clearer guidelines
for VR protocols are undoubtedly needed to help clarify how VR can
be safely and efficiently implemented in clinical practice. Finally,
the need for more studies covering larger sample sizes remains a
must, and long-term follow-ups are needed before VR becomes part
of what is referred to as “traditional therapy”.
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