Francesco Vincelli

From Imagination to Virtual Reality: The Future of Clinical Psychology

The possible role of virtual reality (VR) in clinical psychology derives prevalently from the central role occupied by the imagination and by memory in psychotherapy. These two elements, which are fundamental in the life of everyone, present absolute and relative limits to individual potential. Thanks to virtual experiences, it is possible to transcend these limits. The re-created world may be more vivid and real at times than the one that most subjects are able to describe through their own imagination and through their own memory. This article focuses on imaginative techniques to find new ways of applications in therapy. In particular, the way VR can be used to improve the efficacy of current techniques is explored. VR produces a change with respect to the traditional relationship between client and therapist. The new configuration of this relationship is based on the awareness of being more skilled in the difficult operations of recovery of past experiences through the memory and of foreseeing future experiences through the imagination. At the same time, subjects undergoing treatment perceive the advantage of being able to recreate and use a real experiential world within the confines of their therapistss clinical offices.

Virtual reality-based experiential cognitive treatment of obesity and binge-eating disorders

This paper describes the characteristics and preliminary evaluation of Experimential Cognitive Therapy (Experimential CT), a VR-based treatment to be used in the treatment and assessment of obesity and binge-eating disorders. Experimential CT is a relatively short-term, integrated, patient-oriented approach that focuses on individual discovery. The main characteristic of this approach is the use of Virtual Reality, a new technology that allows the user to be immersed in a computer-generated virtual world. Two preliminary clinical trials were carried out on female patients: 25 patients suffering from binge-eating disorders were included in the first study and 18 obese in the second. At the end of the inpatient treatments, the patients of both samples modified significantly their bodily awareness. This modification was associated to a reduction in problematic eating and social behaviours. No subjects experienced simulation sickness. Copyright

Interaction and presence in the clinical relationship: virtual reality (VR) as communicative medium between patient and therapist

The great potential offered by virtual reality (VR) to clinical psychologists derives prevalently from the central role, in psychotherapy, occupied by the imagination and by memory. These two elements, which are fundamental in our life, present absolute and relative limits to the individual potential. Using VR as an advanced imaginal system, an experience that is able to reduce the gap existing between imagination and reality, it is possible to transcend these limits. In this sense, VR can improve the efficacy of a psychological therapy for its capability of reducing the distinction between the computers reality and the conventional reality. Two are the core characteristics of this synthetic imaginal experience: the perceptual illusion of nonmediation and the possibility of building and sharing a common ground. In this sense, experiencing presence in a clinical virtual environment (VE), such as a shared virtual hospital, requires more than reproduction of the physical features of external reality. It requires the creation and sharing of the cultural web that makes meaningful, and therefore visible, both people and objects populating the environment. The paper outlines a framework for supporting the development and tuning of clinically oriented VR systems.

Experiential Cognitive Therapy for the Treatment of Panic Disorder With Agoraphobia: Definition of a Clinical Protocol

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Effects of group experiential cognitive therapy for the treatment of panic disorder with agoraphobia.

A treatment protocol, called experiential cognitive therapy (ExCT), was developed. It integrated traditional cognitive behavior therapy (CBT) with virtual reality exposure for the treatment of panic disorder with agoraphobia (PDA). The objective of this study was to test the efficacy of short-term (four sessions) ExCT compared with a traditional 12-session panic control program (PCP) for the treatment of PDA. Forty patients diagnosed as having PDA by the diagnostic criteria of DSM-IV were randomly assigned to ExCT and PCP groups of 20 patients each. The treatment effects were measured with self-report questionnaires, including the BDI, STAI, ASI, PBQ, ACQ, and BSQ. The authors also assessed high end-state functioning (HES), including the success rate of stopping or reducing medication at post-treatment and 6-month follow-up. In all ratings, both ExCT and PCP groups showed significant improvement post-treatment compared with pre-treatment scores. There were no significant differences between the two treatment groups in HES and medication discontinuation at post-treatment, but there was a significant difference in medication discontinuation at 6-month follow-up. These results suggested that although short-term effectiveness of ExCT might be comparable to the effectiveness of PCP, long-term effectiveness of ExCT might be relatively inferior to the effectiveness of PCP.

A VR-based multicomponent treatment for panic disorders with agoraphobia.

Agoraphobia consists of a group of fears of public places such as going outside, using public transportation and being in public places, which cause serious interference in daily life. Many studies demonstrated the effectiveness of a multicomponent cognitive-behavioral treatment strategy for panic disorder with agoraphobia. The traditional protocol involves a mixture of cognitive and behavioral techniques which are intended to help patients identify and modify their dysfunctional anxiety-related thoughts, beliefs and behavior. Emphasis is placed on reversing the maintaining factors identified in the cognitive and behavioral patterns. We use Virtual Reality (VR) to support Panic Disorder treatment. The preliminary treatment protocol for Panic Disorder and Agoraphobia, named Experiential-Cognitive Therapy (ECT), was developed at the Applied Technology for Neuro-Psychology Lab of Istituto Auxologico Italiano, Verbania, Italy, in cooperation with the Psychology Department of the Catholic University of Milan, Italy. The actual version included the efforts of researchers from the Center for Advanced Multimedia Psychotherapy, California School of Professional Psychology, San Diego (CA), USA, and from the Seoul Paik Hospital, Inje University, Seoul, Korea. The goal of ECT is to decondition fear reactions, to modify misinterpretational cognition related to panic symptoms and to reduce anxiety symptoms. The characteristics of the approach will be presented through the description of the clinical protocol.

Virtual reality and imaginative techniques in clinical psychology.

The great potential offered by Virtual Reality (VR) derives prevalently from the central role, in psychotherapy, occupied by the imagination and by memory. These two elements, which are fundamental in the life of every one of us, present absolute and relative limits to individual potential. Thanks to virtual experiences, it is possible to transcend these limits. The re-created world may at times be more vivid and real than the one that most subjects are able to describe through their own imagination and through their own memory. This chapter focuses on imaginative techniques to find new ways of applications in therapy. In particular the chapter analyses in which way VR can be used to improve the efficacy of current techniques. VR produces a change with respect to the traditional relationship between client and therapist. The new configuration of this relationship is based on the awareness of being more skilled in the difficult operations of recovery of past experiences, through the memory, and of foreseeing of future experiences, through the imagination. At the same time, the subject undergoing treatment perceives the advantage of being able to re-create and use a real experiential world within the walls of the clinical office of his own therapist.

Virtual reality: a new tool for panic disorder therapy

The use of a multicomponent cognitive–behavioral treatment strategy for panic disorder with agoraphobia is actually one of the preferred therapeutical approach for this disturbance. This method involves a mixture of cognitive and behavioral techniques which are intended to help patients identify and modify their dysfunctional anxiety-related thoughts, beliefs and behavior. Emphasis is placed on reversing the maintaining factors identified in the cognitive and behavioral patterns. The treatment protocol includes exposure to the feared situation, interoceptive exposure and cognitive restructuring. The paper presents a treatment protocol for panic disorder and agoraphobia, named experiential–cognitive therapy, that integrates the use of virtual reality in a multicomponent cognitive–behavioral treatment strategy. The goal of experiential–cognitive therapy is to decondition fear reactions, to modify misinterpretational cognition related to panic symptoms and to reduce anxiety symptoms.

VREPAR Projects: The Use of Virtual Environments in Psycho-Neuro-Physiological Assessment and Rehabilitation

Due, in large part, to the significant advances in PC hardware that have been made over the last 3 years, PC-based virtual environments are approaching reality. Virtual Reality Environments for Psychoneurophysiological Assessment and Rehabilitation (VREPAR) are two European Community funded projects (Telematics for health-HC 1053/HC 1055, http:// www.psicologia.net) that are trying to develop a PC-based virtual reality system (PC-VRS) for the medical market that can be marketed at a price that is accessible to its possible endusers (hospitals, universities, and research centres) and that would have the modular, connectability, and interoperability characteristics that the existing systems lack. In particular, the projects are developing three hardware/software modules for the application of the PCVRS in psycho-neuro-physiological assessment and rehabilitation. The chosen development areas are eating disorders (bulimia, anorexia, and obesity), movement disorders (Parkinsons disease and torsion dystonia) and stroke disorders (unilateral neglect and hemiparesis). This article describes the rationale of the modules and the preliminary results obtained.

Virtual reality assisted cognitive behavioral therapy for the treatment of Panic Disorders with Agoraphobia.

The chapter describes the characteristics of the Experiential-Cognitive Therapy (ECT) protocol for Panic Disorder and Agoraphobia. The goal of ECT is to decondition fear reactions, to modify misinterpretational cognition related to panic symptoms and to reduce anxiety symptoms. This is possible in an average of eight sessions of treatment plus an assessment phase and booster sessions, through the integration of Virtual Experience and traditional cognitive-behavioral techniques. We decided to employ the techniques included in the cognitive-behavioral approach because they showed high levels of efficacy. Through virtual environments we can gradually expose the patient to feared situation: virtual reality consent to re-create in our clinical office a real experiential world. The patient faces the feared stimuli in a context that is nearer to reality than imagination. For ECT we developed the Virtual Environments for Panic Disorders--VEPD--virtual reality system. VEPD is a 4-zone virtual environment developed using the Superscape VRT 5.6 toolkit. The four zones reproduce different potentially fearful situations--an elevator, a supermarket, a subway ride, and large square. In each zone the characteristics of the anxiety-related experience are defined by the therapist through a setup menu.