Interreality in Practice: Bridging Virtual and Real Worlds in the Treatment of Posttraumatic Stress Disorders

The use of new technologies, particularly virtual reality, is not new in the treatment of posttraumatic stress disorders (PTSD): VR is used to facilitate the activation of the traumatic event during exposure therapy. However, during the therapy, VR is a new and distinct realm, separate from the emotions and behaviors experienced by the patient in the real world: the behavior of the patient in VR has no direct effects on the real-life experience; the emotions and problems experienced by the patient in the real world are not directly addressed in the VR exposure. In this article, we suggest that the use of a new technological paradigm, Interreality, may improve the clinical outcome of PTSD. The main feature of Interreality is a twofold link between the virtual and real worlds: (a) behavior in the physical world influences the experience in the virtual one; (b) behavior in the virtual world influences the experience in the real one. This is achieved through 3D shared virtual worlds; biosensors and activity sensors (from the real to the virtual world); and personal digital assistants and/or mobile phones (from the virtual world to the real one). We describe different technologies that are involved in the Interreality vision and its clinical rationale. To illustrate the concept of Interreality in practice, a clinical scenario is also presented and discussed: Rosa, a 55-year-old nurse, involved in a major car accident.

[1]  G. Riva,et al.  A Second Life for eHealth: Prospects for the Use of 3-D Virtual Worlds in Clinical Psychology , 2008, Journal of medical Internet research.

[2]  Giuseppe Riva,et al.  Virtual reality: an experiential tool for clinical psychology , 2009 .

[3]  Giuseppe Riva,et al.  Virtual Reality in Psychotherapy: Review , 2005, Cyberpsychology Behav. Soc. Netw..

[4]  B. Rothbaum,et al.  Virtual reality exposure therapy. , 2010, The Journal of psychotherapy practice and research.

[5]  Mark B. Powers,et al.  Virtual reality exposure therapy for anxiety disorders: A meta-analysis. , 2008, Journal of anxiety disorders.

[6]  Giuseppe Riva,et al.  From virtual reality to interreality in the treatment of anxiety disorders , 2011 .

[7]  Giuseppe Riva,et al.  Is presence a technology issue? Some insights from cognitive sciences , 2009, Virtual Reality.

[8]  Giuseppe Riva,et al.  Trials BioMed Central Study protocol The potential of Virtual Reality as anxiety management tool: a randomized controlled study in a sample of patients affected by Generalized Anxiety Disorder , 2008 .

[9]  Brenda K. Wiederhold,et al.  Cost Effectiveness of Virtual Reality Graded Exposure Therapy with Physiological Monitoring for the Treatment of Combat Related Post Traumatic Stress Disorder , 2009, Annual Review of Cybertherapy and Telemedicine.

[10]  Giuseppe Riva,et al.  Panic and Agoraphobia in a Virtual World , 2002, Cyberpsychology Behav. Soc. Netw..

[11]  Cristina Botella,et al.  Internet and Virtual Reality as Assessment and Rehabilitation Tools for Clinical Psychology and Neuroscience 3 Virtual Reality and Psychotherapy , 2022 .

[12]  Giuseppe Riva,et al.  Interreality: A New Paradigm for E-health , 2009, Annual Review of Cybertherapy and Telemedicine.

[13]  B. Rothbaum,et al.  Virtual reality exposure therapy for Vietnam veterans with posttraumatic stress disorder. , 2001, The Journal of clinical psychiatry.

[14]  Larry F. Hodges,et al.  Virtual reality exposure therapy abbreviated treatment manual: Fear of flying application , 1999 .

[15]  Giuseppe Riva,et al.  Interaction and presence in the clinical relationship: virtual reality (VR) as communicative medium between patient and therapist , 2002, IEEE Transactions on Information Technology in Biomedicine.

[16]  A. Rizzo,et al.  Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: a meta-analysis. , 2008, Journal of behavior therapy and experimental psychiatry.

[17]  Hunter G. Hoffman,et al.  Virtual Reality Exposure Therapy for World Trade Center Post-traumatic Stress Disorder: A Case Report , 2002, Cyberpsychology Behav. Soc. Netw..

[18]  K. Ressler,et al.  Virtual reality exposure therapy using a virtual Iraq: case report. , 2008, Journal of traumatic stress.

[19]  Cezar Giosan,et al.  The Application of Virtual Reality to the Treatment of PTSD Following the WTC Attack , 2006, Annals of the New York Academy of Sciences.

[20]  Barbara O Rothbaum,et al.  Using virtual reality to help our patients in the real world , 2009, Depression and anxiety.

[21]  Mariano Alcañiz Raya,et al.  Affective Interactions Using Virtual Reality: The Link between Presence and Emotions , 2007, Cyberpsychology Behav. Soc. Netw..

[22]  Albert A. Rizzo,et al.  VR PTSD Exposure Therapy Results with Active Duty OIF/OEF Combatants , 2009, MMVR.

[23]  Rosa María Baños,et al.  Mixing Realities? An Application of Augmented Reality for the Treatment of Cockroach Phobia , 2005, Cyberpsychology Behav. Soc. Netw..

[24]  T. Sensky,et al.  All you need is cognitive behaviour therapy? , 2002, BMJ : British Medical Journal.

[25]  Cali M. Fidopiastis,et al.  Mixed Reality for PTSD/TBI Assessment. , 2009 .

[26]  E Salas,et al.  The effect of stress inoculation training on anxiety and performance. , 1996, Journal of occupational health psychology.

[27]  Hunter G. Hoffman,et al.  The Illusion of Presence in Immersive Virtual Reality during an fMRI Brain Scan , 2003, Cyberpsychology Behav. Soc. Netw..

[28]  B. Rothbaum,et al.  Virtual Reality Exposure Therapy for PTSD Vietnam Veterans: A Case Study , 1999, Journal of traumatic stress.

[29]  Giuseppe Riva,et al.  Ambient Intelligence in Health Care , 2003, Cyberpsychology Behav. Soc. Netw..

[30]  Pedro Gamito,et al.  Virtual Reality Therapy Controlled Study for War Veterans with PTSD. Preliminary Results. , 2009 .

[31]  Corey J. Bohil,et al.  Virtual reality in neuroscience research and therapy , 2011, Nature Reviews Neuroscience.

[32]  Sun I. Kim,et al.  Exploring the Use of Computer Games and Virtual Reality in Exposure Therapy for Fear of Driving Following a Motor Vehicle Accident , 2003, Cyberpsychology Behav. Soc. Netw..

[33]  Pedro Gamito,et al.  Virtual Reality Therapy Controlled Study for War Veterans with PTSD. Preliminary Results , 2009, Annual Review of Cybertherapy and Telemedicine.

[34]  Brenda K. Wiederhold,et al.  Combat-Related Post-Traumatic Stress Disorder: A Case Report Using Virtual Reality Exposure Therapy with Physiological Monitoring , 2007, Cyberpsychology Behav. Soc. Netw..

[35]  M. Hilsenroth,et al.  Distinctive activities of cognitive-behavioral therapy. A review of the comparative psychotherapy process literature. , 2002, Clinical psychology review.

[36]  Andrea Gaggioli,et al.  Therapeutic applications of the mobile phone , 2009 .

[37]  Evan M. Forman,et al.  A Randomized Controlled Effectiveness Trial of Acceptance and Commitment Therapy and Cognitive Therapy for Anxiety and Depression , 2007, Behavior modification.

[38]  Rosa María Baños,et al.  Using augmented reality to treat phobias , 2005, IEEE Computer Graphics and Applications.

[39]  Andrea Gaggioli,et al.  Virtual Worlds, Real Healing , 2007, Science.

[40]  Charles E. Hughes,et al.  Mixed Reality for PTSD/TBI Assessment , 2009, Annual Review of Cybertherapy and Telemedicine.

[41]  Brenda K. Wiederhold,et al.  Internet and Virtual Reality as Assessment and Rehabilitation Tools for Clinical Psychology and Neuroscience 14 the Future of Cybertherapy: Improved Options with Advanced Technologies , 2022 .

[42]  G. Riva,et al.  Virtual reality in anxiety disorders: the past and the future , 2008, Expert review of neurotherapeutics.

[43]  P. McKenna,et al.  Cognitive behavioural therapy for major psychiatric disorder: does it really work? A meta-analytical review of well-controlled trials , 2009, Psychological Medicine.

[44]  Carolyn Black Becker,et al.  Cognitive-Behavioral Therapy for PTSD: A Case Formulation Approach , 2006 .

[45]  JoAnn Difede,et al.  Innovative use of virtual reality technology in the treatment of PTSD in the aftermath of September 11. , 2002, Psychiatric services.

[46]  Giuseppe Riva,et al.  From Technology to Communication: Psycho-social Issues in Developing Virtual Environments , 1999, J. Vis. Lang. Comput..

[47]  Brenda K. Wiederhold,et al.  Combat Related Post Traumatic Stress Disorder: A Multiple Case Report Using Virtual Reality Graded Exposure Therapy with Physiological Monitoring , 2008, MMVR.