Background/Objectives: Modern therapeutic strategies incorporating virtual reality (VR) have emerged as potential treatments for generalized anxiety disorder (GAD), a prevalent and debilitating condition that is challenging to cure. This study aimed to evaluate the efficacy of VR combined with relaxation techniques in patients with GAD by comparing VR-based relaxation with standard mental imagery (MI) relaxation. Methods: Fifty-eight patients with GAD participated in a randomized comparative trial. Specific virtual environments were created using an inexpensive game engine/level editor (GLE). Psychometric scales and physiological instruments were employed to assess the effects of relaxation therapy on anxiety, depression, quality of life, presence within virtual environments and cybersickness. Results: Both the VR and MI groups demonstrated statistically significant improvements in anxiety, worry and mental quality of life scores. However, no significant differences were observed between the two groups in pre-post comparisons of psychometric scores. The VR group exhibited a noticeably higher protocol completion rate and a significant increase in heart rate variability during the therapy. The level of presence in the VR group was satisfactory and significantly correlated with physiological improvements and anxiety reduction, while cybersickness remained low. Participants' preferences for specific virtual environments for relaxation are also discussed. Conclusions: These findings suggest that teaching and practicing relaxation in VR holds therapeutic potential for the treatment of GAD. Further research leveraging advanced VR sensory equipment and artificial intelligence agents is warranted to enhance therapeutic outcomes and explore additional applications.

Abstract Context According to the World Health Organization, alcohol is a major global public health problem, leading to a significant increase in illness and death. To treat alcohol use disorders, new therapeutic tools are being promoted, among which virtual reality (VR) shows promise. Previous research has demonstrated the efficacy of VR in reducing alcohol cravings in patients, but there is a lack of data on its effectiveness in maintaining abstinence or reducing consumption in recently abstinent individuals. The E-Reva study aims to compare the efficacy of a treatment strategy combining virtual reality cue exposure therapy (VR-CET) and cognitive behavioral therapy (CBT) with conventional CBT in reducing alcohol consumption and craving in patients with alcohol use disorder (AUD). In addition to this primary objective, the study will compare the effects of VR-CET combined with CBT on anxiety, depression, rumination, and feelings of self-efficacy versus conventional CBT. Methods This prospective randomized controlled trial will be conducted over 8 months in four addiction departments in France. It includes two parallel groups: i) the VR-CET + CBT group, and ii) the CBT-only group, which serves as a control group. Participants will be recruited by the investigating doctor in the addiction centers. The sample will consist of 156 patients diagnosed with AUD and abstinent for at least 15 days. Both treatment groups will participate in four group CBT sessions followed by four individual sessions: i) the VR-CET group will be exposed to virtual environments associated with alcohol-related stimuli, ii) the CBT-only group will receive traditional CBT sessions. After completion of the 8 sessions, patients will be followed up for 6 months. The primary outcome is the cumulative number of standard drinks consumed at 8 months, assessed using the TLFB method. Discussion Despite the promise of VR-CET to reduce the desire to drink, the effect on alcohol consumption remains uncertain in the existing literature. Our protocol aims to address the limitations of previous research by increasing sample size, targeting consumption reduction, and incorporating neutral environments. E-Reva aims to enrich the literature on the use of VR in the treatment of AUD and open new perspectives for future interventions. Trial registration ClinicalTrials.gov ID NCT06104176, Registered 2023/11/13 ( https://clinicaltrials.gov/study/NCT06104176?id=NCT06104176&rank=1 ). N° IDRCB: 2022-A02797-36. Protocol version 1.0, 12/05/2023.

BackgroundScience is beginning to establish the benefits of the use of virtual reality (VR) in health care. This therapeutic approach may be an appropriate complementary treatment for some mental illnesses. It could prevent high levels of morbidity and improve the physical health of patients. For many years, the literature has shown the health benefits of physical exercise. Physical exercise in a VR environment may improve the management of mild to moderate mental health conditions. In this context, we developed a virtual environment combined with an ergocycle (the augmented physical training for isolated and confined environments [APTICE] system). ObjectiveThis study aims to investigate the impact of physical exercise in a VR environment. MethodsA total of 14 healthy participants (11 men and 3 women; mean age 43.28, SD 10.60 years) undertook 15 minutes of immersive physical exercise using the system. Measures included mindfulness and immersion disposition, subjective perceptions of sensory information, user experience, and VR experience (ie, psychological state, flow, and presence). ResultsFirst, the APTICE system appears to be a useful tool because the user experience is positive (subscales in the AttrakDiff questionnaire: pragmatic quality=0.99; hedonic quality–stimulation=1.90; hedonic quality–identification=0.67; attractiveness=1.58). Second, the system can induce a positive psychological state (negative emotion, P=.06) and an experience of flow and presence (P values ranging from <.001 to .04). Third, individual immersive and mindful disposition plays a role in the VR experience (P values ranging from <.02 to .04). Finally, our findings suggest that there is a link between the subjective perception of sensory information and the VR experience (P values ranging from <.02 to .04). ConclusionsThese results indicate that the device is well accepted with positive psychological and exteroceptive outcomes. Overall, the APTICE system could be a proof of concept to explore the benefits of virtual physical exercise in clinical medicine.

AbstractBackgroundSuccessful interventions have been developed for smoking cessation although the success of smoking relapse prevention protocols has been limited. Cognitive behavioural therapy (CBT) in particular has been hampered by a high relapse rate. Because relapse can be due to conditions associated with tobacco consumption (such as drinking in bars with friends), virtual reality cue exposure therapy (VRCE) can be a potential tool to generate 3D interactive environments that simulate risk situations for relapse prevention procedures.MethodsTo assess the effectiveness of VRCE with CBT, a comparative trial involving 100 smoking abstinent participants was designed with all required virtual environments (VE) created with an inexpensive graphic engine/game level editor.ResultsOutcome measures confirmed the immersive and craving eliciting effect of these VEs. Results demonstrated that more participants in the VRCE group did not experience smoking relapse and that VRCE is at least as efficacious as traditional CBT in terms of craving reduction and decrease in nicotine dependence. Dropout and relapse rate in the VRCE group was noticeably lower than the CBT group. Aside from mood scores, no significant differences were found regarding the other scales.ConclusionThe present clinical trial provides evidence that VRCE was effective in preventing smoking relapse. Improvement in technology and methodology for future research and applications is delineated.

Virtual Reality Exposure Therapy (VRET) a form of exposure treatment that leverages the technology and immersive properties of virtual reality has been used in mental health for several decades with clinical efficacy. Nowadays, several companies propose ready to use virtual environments (VE) for clinicians. However, in practice, therapists or researchers may face rare demands such as patients exhibiting unusual phobias or OCD that require specific therapeutic VEs not available on the market. Therefore, empowering therapist with the tools of a "maker" to create therapeutic VEs themselves for rare cases may be a potential solution. Consequently, this trial involving 8 rare single cases was designed to test this assumption and has three objectives: to assess if a therapist with no coding skills can construct multiple specific therapeutic VEs with a free game engine, to measure the potential therapeutic efficacy of VRET and the VEs for rare cases of phobias and OCD, and to ensure these VEs yielded presence. Psychometric scales were used to assess the effects of the treatment. There was a discernible reduction of the distinct phobia and OCD for each case and a statistically significant improvement on anxiety, mood and mental quality of life scores. The presence level was satisfactory. Despite these promising results, these were single cases and further research on the game engine accessibility for clinicians and trials with a large sample of rare phobias or OCD are encouraged.

Modern therapeutic strategies involving virtual reality (VR) have now become available in mental health for professionals and patients alike. Concerning the treatment of generalized anxiety disorder (GAD), a frequent and debilitating condition, VR had been considered as a possible remedy. Therefore, the efficacy of VR combined with relaxation for patients with GAD was assessed in the context of this analysis comparing VR versus standard mental imagery during relaxation. Specific virtual environments were built for this trial with an inexpensive game level editor. Twenty-seven participants with GAD were included in this intermediate study. Psychometric scales and physiological instruments were used to assess the effects of the treatment. Statistically significant improvement on anxiety, worry and mental quality of life scores was noted for the participants in both groups. Comparison between treatment methods indicated no significant differences, although dropout rate was noticeably higher in the standard group. In the VR group, presence level was satisfactory and cybersickness was low. These results will enable further research in virtual reality relaxation therapy for GAD.

Research treatment protocols are rare regarding an unusual anxiety disorder, namely the fear of sharks (squalophobia). As a possible solution, the effectiveness of virtual reality (VR) exposure therapy for this phobia was tested. The advantage of using VR becomes clearer when a real life set up is impractical, such as exposing a phobic patient to a feared large marine organism, the shark. The effects were evaluated in a single case study involving multiple context-graded aquatic virtual environments with a virtual shark and using affordable VR apparatus and software. Assessment was based on self-report questionnaires. Scores the psychometric instruments exhibited a discernable reduction in fear toward sharks. Such gains were maintained at a 12-month follow-up. Presence rates indicated immersion when confronted to a three-dimensional (3D) virtual shark. This initial study revealed the potential of VR for the treatment of marine biota phobia and its potential to recreate diverse situations for exposure therapy.

Background We recently reported an improvement of precuneus PET metabolism after EMDR therapy in military participants suffering from PTSD. Objective The aim of the present study was to investigate the metabolic changes of precuneus connectivity in these participants after such treatment. Method Fifteen participants with PTSD performed a brain 18F-FDG-PET sensitized by virtual reality exposure to war scenes, before and after EMDR treatment. Inter-regional correlation analysis was performed to study metabolic changes of precuneus connectivity through SPMT maps at whole-brain level (p < 0.005 for the voxel, p < 0.05 for the cluster). Results A decrease of connectivity was observed after EMDR between the precuneus and two significant bilateral clusters of the cerebellum (bilateral Crus I and VI cerebellar lobules, Tmax voxel of 5.8 and 5.3, and cluster size of 343 and 314 voxels, respectively). Moreover, higher cerebellar metabolism before treatment was associated with reduced clinical PTSD scores after EMDR (p = 0.03). Conclusions The posterior cerebellum and its metabolic connectivity with the precuneus are involved in the clinical efficiency of EMDR in PTSD.

The prevalence of posttraumatic stress disorder (PTSD) is higher among veterans, and can lead to disastrous consequences such as suicide. Eye movement desensitization and reprocessing (EMDR) is recommended in first-line psychotherapies for PTSD. Virtual reality exposure (VRE) coupled with 18F-FDG PET imaging can highlight the activated brain regions during stress exposure. The objective of this study is to identify, after EMDR therapy, the regions of brain metabolism that evolve during the stress exposure of a war scene with symptomatic remission in a group of military veterans suffering from PTSD, and to secondarily search for predictive metabolic features. We recruited 15 military veterans suffering from PTSD who performed an 18F-FDG PET sensitized by the exposure to a virtual war scene, before (T0) and after (T1) EMDR therapy. Statistical parametric mapping was used to compare brain metabolism before and after treatment and to study correlations between metabolism and evolution scores on PTSD clinical scales (PTSD Checklist Scale, PCLS; Clinician-Administered PTSD Scale, CAPS). The metabolic activity of the precuneus was increased after EMDR therapy (p < 0.005 uncorrected, k > 180) and correlated with clinical improvement with the CAPS scale (r = −0.73 and p < 0.001). Moreover, the precuneus metabolic value before therapy predicted the clinical improvement on the PCLS scale (T1-T0) after EMDR (r = −0.667 and p < 0.006). The clinical improvement in military patients with PTSD after EMDR is related to increased precuneus metabolism upon VR stress exposure.

The aim of this pilot study is to investigate the impact of virtual reality exposure therapy (VRET) on brain metabolism and connectivity.

As a significant number of abstinent smokers tend to relapse over time, new challenges lie in preventing relapse with immersive technologies such as virtual reality. The effectiveness of virtual reality cue exposure (VRCE) with cognitive behavioural therapy is analysed through a comparative trial involving the first 61 participants. All the required Virtual Environments (VE) were created with an inexpensive Game Level Editor. Outcome measures supported the immersive and craving eliciting effect of the VEs. Results demonstrated that VRCE is at least as efficacious as traditional cognitive behavioural therapy in terms of maintenance of tobacco abstinence, craving reduction and decrease in nicotine dependence. Improvement in technologies and methodology for future research and applications are delineated.

S408of 2.5 mm diameter (sentinella portable gamma camera).The BD scintigraphy criteria are established as: absence of tracer uptake in cerebral cortex and posterior fossa.Any uptakes in said regions or images of doubtful interpretation are considered not compatible with BD.The results of the CPS are compared with the TD.The EEG is not taken into account because it has very few cases.Result: The CPS was positive for BD in 41 of the 46 patients studied, 41 scintigraphy's were positive with other positive auxiliary tests (EEG or Doppler).Of the 5 negative scintigraphy's 4 were clearly negative and 1 was doubtful that it was considered negative or non-diagnostic.No patient presented two different negative ancillary tests for brain death.Conclusion: Cerebral perfusion scintigraphy with a portable gamma camera is emerging as a reliable, useful and easy to perform test, avoiding patient displacement.

De par sa forte prévalence, sa chronicité et son impact social, la peur des hauteurs ou acrophobie représente un domaine de recherche important. La thérapie comportementale par exposition à la réalité virtuelle (TERV) a démontré son efficacité clinique dans le traitement de cette pathologie. Le but de cette étude TEP était de caractériser le métabolisme cérébral des patients atteints d’acrophobie et d’étudier l’impact de la TERV sur ce métabolisme cérébral et les modifications associées de connectivité.

Background Successful interventions have been developed for smoking cessation, but the success of smoking relapse prevention interventions has been limited. In particular, cognitive behavioural therapy (CBT) has been hampered by a high relapse rate. Because relapses can be due to the presence of conditions associated with tobacco consumption (such as drinking in bars with friends), virtual reality exposure therapy (VRET) can generate synthetic environments that represent risk situations for the patient in the context of relapse prevention. The primary objective of this study is to evaluate the effectiveness of CBT coupled with VRET, in comparison to CBT alone, in the prevention of smoking relapse. The secondary objectives are to assess the impact of CBT coupled with VRET on anxiety, depression, quality of life, self-esteem and addictive comorbidities (such as alcohol, cannabis, and gambling). A third objective examines the feasibility and acceptability of VR use considering elements such as presence, cybersickness and number of patients who complete the VRET program. Method/design The present study is a 14-month (2 months of therapy followed by 12 months of follow-up), prospective, comparative, randomized and open clinical trial, involving two parallel groups (CBT coupled with VRET versus CBT alone). The primary outcome is the proportion of individuals with tobacco abstinence at 6 months after the end of the therapy. Abstinence is defined by the total absence of tobacco consumption assessed during a post-test interview and with an apparatus that measures the carbon monoxide levels expired. A total of 60 individuals per group will be included. Discussion This study is the first to examine the efficacy of CBT coupled with VRET in the prevention of smoking relapse. Because VRET is simple to use and has a low cost, this interactive therapeutic method might be easily implemented in clinical practice if the study confirms its efficacy. Trial registration ClinicalTrials.gov Identifier: NCT02205060 (registered 25 July 2014).

This chapter reviews the emerging field of virtual reality exposure therapy (VRET). It introduces new tools available to the 21st-century therapist—head-mounted displays, motion trackers, and data gloves, which are all designed to allow patients to interact efficiently and realistically with three-dimensional representations of disorder-specific stimuli. The processes of habituation and extinction, which are thought to account for the effectiveness of traditional exposure therapy, work in virtual environments as well. Studies have shown some promise across a range of psychiatric disorders, including various phobias, other anxiety disorders, eating disorders, substance use disorders, and even schizophrenia. With the necessary technology becoming more affordable and widely available, the assumption that the equipment needed to use VRET is too expensive will no longer hold. Instead, VRET may eventually contribute to savings in cost and time and to improved access to treatment.