Script for presentation

Vr presentation

S1- Intro

Hello my name is Katie Whelan and I am going to be talking about virtual reality used in cognitive behavioral therapy and exposure therapy for the treatment of phobias. 

S2- what is Virtual Reality?

Virtual Reality is use of computer technology to create a simulation of a 3D image or environment that can be interacted with. The user is immersed and able to interact with 3D worlds. VR stimulates senses such as vision, hearing, touch and possible smell.

 S3- What does VR technology look like?

The most common form would be the Head-mounted display or HMD. Many companies have produced versions like this such as the Oculus Rift, Microsoft hololens, Samsung GearVR, Google Cardboard, Magic leap and so on.

Head-mounted display (HDM)
Oculus Rift VR
Microsoft HoloLens
Sony's Project Morpheus
The Vive by Valve
Samsung GearVr
Google Cardboard
Magic Leap

S4- Is it new technology 

Virtual reality has been around since the 1950s. In 1957 filmmaker, Morton Heilig created the Sensorama, which was a large booth like machine that gave users the illusion of being in a 3D world. Computer scientist, Ivan Sutherland’s created the first Head-mounted display in 1968.  Since then the vr headset has evolved and in 2010 Palmer Luckey created the first prototype of the Oculus Rift. 

S5- How our brain process images

Our brain is designed to pay attention to what’s new in the environment. When light hits the retina, the process of sight begins. The information from the retina is sent via the optic nerve to other parts of the brain which processes the image and allows us to see. 

S6- How VR works on the brain

Vr headsets have two LCD displays, one per eye. There is a lens placed between your eyes and the pixels. The lens focuses and reshapes the picture. This creates a stereoscopic 3D image by angling the two 2D images to mimic how our eyes see the world. Our brain is tricked into thinking that we in that environment. 

S7- What is a phobia?

A phobia is an irrational and excessive fear of an object or situation. It involves a sense of endangerment or a fear of harm. When we are afraid the amygdala in our brain is more active. The amygdala’s main role is to process emotions. Conditions such as phobias, PTSD and anxiety have been suspected of being linked to abnormal functioning of the amygdala. Last year the national institute of mental health estimates that 12.5% of U.S adults experiences a specific phobia once in their lives.

S8- Examples of Phobias

Social phobia involves a fear of social situations. Agoraphobia involves a fear of being trapped in an inescapable place or situation. Lastly specific phobia involves a fear of animals, something medical, the natural environment or situational.  

Statistics on phobias 

In 2017 the national institute of mental health carried out a survey and estimated that 12.5% of U.S adults experiences a specific phobia once in their lives. The most common specific phobia is Arachnophobia, which is a fear of spiders. Then Acrophobia which is heights and finally  aerophobia which is a fear of flying. 

S9- What is cognitive behavioral therapy and in-vivo exposure therapy?

Cognitive behavioral therapy aim is to help you manage your problems by changing the way you think and act. It encourages you to talk about how you think about yourself, the world and other people. Also how what you do affects your thoughts and feelings. With exposure therapy patients experience what they fear in a controlled way and In small doses. 

S10- How Vr is used therapy?

Virtual reality exposure therapy combines cognitive behavior therapy and in-vivo exposure. It allows the patient to face their fears in a safe, controlled environment. They are immersed into a simulation that is aimed at their particular fear. They attend multiple sessions until they feel indifferent to what they feared. 

S11- Examples of a patient using vr in therapy.

There was a case study in 1992, where a 32-year-old woman with aerophobia tested VR exposure therapy to overcome her fear of flying. The virtual scene was a simulated city running on a silicon graphics computer. The results showed that throughout the experience she showed signs of a high level of anxiety at the beginning of each session and as the session progress, her anxiety levels gradually dropped. 

Slide 12- Further investigate of Vr therapy 

To further investigate the transfer effect of VR therapy, she was flown in a helicopter at a low altitude over a beach on the Gulf of Mexico. It was reported that she became more comfortable with flying and experienced less anxiety. 

One conclusion is that when subjected to virtual phobic-invoking situations, the subjects exhibited the same responses that would be exhibited in a real world situation. Over time the patient slowly overcame their phobia. 

S13- How the patient over comes fear with the use of vr therapy?

Virtual reality therapy is beneficial for the patient because they get to face their fears in a safe environment. Many patients have difficulty imagining their fears and express strong aversion to experiencing real situations. VR therapy offers a halfway point. The aim of exposure therapy is for the patient to be exposed to what troubles them until they become indifferent to it. 

S15- benefits of using VR in therapy

Allows the patient to try the therapy without as much anxiety. They can experience the phobia without having to travel to the location. There is Confidentiality for the patient. Therapist can control the situation. The therapy is more realist and effective. Sessions can be repeated in order for the patient to conquer a small portion of their fear. 

S16- Risks of using VRT

Howver to prevent risk certain cautions needs to be taken. According to Stanney, those at risk for psychological harm are primarily those who suffer from panic attacks, those who have serious medical problems such as heart disease or epilepsy, and those who are (or have recently been) taking drugs with major physiological or psychological effects. Therefore patients are asked questions regarding these situations before the procedure.

S17- Company that creates VR therapy

Limbix is a company that’s partnered with multiple colleges that carry out research on phobias and VR. Limbix offer a pack that contains a tablet, VR headset, Charger, docking station, immerse environments, real-world 360 footage and interactive scenes. They offer an at home exposure therapy experience where the user can face their fears in a safe environment and in their own homes. 

S18- Why it’s slow now – cost, new technology

One of the main reasons why VR is not commonly used in cognitive behavior therapy and exposure therapy is because of the cost factor. Secondly there is a lack of research on how effective virtual reality exposure therapy is. Thirdly is a new technology to many people so training would be required. 

S19- Future Of VR in therapy

According to Variety.com virtual reality revenues are estimate to reach $7.17 billion at the end of the year. According to a report by Greenlight insights these figures will grow to $75 billion by 2021. According to Statista.com the figure is estimated grow to 21.5 billion dollars by 2020.Mobile based VR HMD are forecast to account for 75% of global VR display sales. 

S20- Future

While certain statistics offer different insight on the future of the virtual reality industry is certain that it will continue to grow. Vr has grown immensely in the entertainment industry but there are studies carried out that shows its growth in other industries such as medicine, therapy, sport, fashion and so on. 

Thank you for listening. 

Future of VR

https://variety.com/2017/digital/news/virtual-reality-industry-revenue-2017-1202027920/

"According to Variety.com virtual reality revenues are estimate to reach $7.17 billion at the end of the year. According to a report by Greenlight insights these figures will grow to $75 billion by 2021."

"Samsungs Gear VR sold more than 5 million units so far which outperformed Google's daydream VR headset during the first 3 months. 

According to forbes.com VR will transform  the way we watch motion pictures. VR is growing in the entertainment industry and making its way into sport, medicine , therapy, training and more. The viewer would be immersed full in a 360 degree content.  


https://www.statista.com/topics/2532/virtual-reality-vr/

The VR industry is growing at a fast pace, with the market size of virtual reality hardware and software projected to increase from 2.2 billion U.S. dollars in 2017 to more than 19 billion U.S. dollars by 2020. Another forecast projects revenues from the global virtual reality market to reach 21.5 billion U.S. dollars in 2020. Mobile based virtual reality head-mounted displays are forecast to account for about 75 percent of global VR display sales by that time, as the number of mobile virtual reality users worldwide is forecast to grow to more than 130 million.

Benefits of Virtual Reality Therapy

https://pdfs.semanticscholar.org/5a51/8c21ad9efb79318c7eb0530d8baa7f64dd44.pdf

"Many patients appear to have difficulty imagining the prescribed anxiety evoking scene. They also express strong aversion to experiencing real situations".
"VRT can provide stimuli for patients who have difficulty imagine scenes. "
"VRT can generate stimuli of much greater magnitude than standard in vivo techniques"


Case Study- Fear of flying

"first pilot study which was conducted in the late november 1992. The subject was a 32 year old married woman, a human computer interaction group researcher, who was diagnosed and treated for fear of flying utilizing an existing virtual scene. The virtual scene was a simulated city running on a Silicon Graphics computer. This scene originally was created to conduct research on an innovative navigational techniques for virtual environments. The subject participated in eight sessions, each lasting about 30 minutes. The subject reported a high level of anxiety at the beginning of each session, gradually reported lower anxiety levels after remaining in the situation for a few minutes and eventually reported an anxiety level of zero." To investigate the transfer effect of VRT to the real world, she was flown with the therapist accompanying her on a helicopter for approximately 10 minutes at low altitude over a beach on the Gulf of Mexico. As with the VRT sessions, she reported some anxiety at the beginning, but anxiety rapidly reduced to a reasonably comfortable level. Now the subject much more comfortably flies for long distances and experiences much less anxiety


Case study- Aerophobia

In September of 1995, a 42-year-old married man who conducts research at Clark Atlanta University sought treatment for the fear of flying. The subject, accompanied by a virtual therapist, was placed in the cockpit of a virtual environment helicopter and flown over a simulated city for five sessions.

The subject experienced a number of physical and emotional anxiety-related symptoms during the VRT sessions. These symptoms included sweaty palms, loss of balance, weakness in the knees, etc. The VRT resulted in both a significant reduction of anxiety symptoms and the ability to face the phobic situation in the real world. The subject at this time is able to fly to the different geographical locations in reasonable comfort.


Results

"When subjected to virtual phobic-invoking situations, our subjects exhibited the same types of responses as would be exhibited in a real-world situation."

Exposure Therapy
The aim of Expose therapy is for the patient to be exposed to what troubles them and over time become indifferent to it.


Safety/Risks
"While there are some potential risks associated with virtual reality technology, as pointed out by Stanney [17], definite steps must be taken in treatment to minimize these risks. According to Stanney, subjects at risk for psychological harm are primarily those who suffer from panic attacks, those with serious medical problems such as heart disease or epilepsy, and those who are (or have recently been) taking drugs with major physiological or psychological effects. As is clearly stated above, questions regarding these situations must be asked as a part of the screening process, and persons with these characteristics must be excluded from VRT experiences"

Examples of places using VR in therapy

https://www.limbix.com/research

Limbix are partnered with multiple colleges that carry out research on phobias and VR.
 Limbix offer a pack that contains a tablet, VR headset, charger, docking station, immersive environments, real- world 360 footage, interactive scenes. Patients can use voice or gaze controls ti respond toe stimuli or assessments. Eg. How are you feeling right now? speak or look at your answer. Limbix VR kits will become available later this year.

They have been featured in the New York times, Monitor on Psychology, Financial Times, Forbes.

They are offering an at home therapy experience.

Research on VR Therapy
https://pdfs.semanticscholar.org/bfb1/012c4a26ace569a4a43fb17aa2d656ce4a16.pdf

In this article they stated that there was not a lot " quantitative meta- analysis that enhances understanding of the variability and clinical significance of anxiety reduction outcomes after VRET. Searches of electronic databases yielded 52 studies, and of these, 21 studies (300 subjects) met inclusion criteria."

They stated that "exposure therapy is effective for reducing negative affective symptoms. Empirical data from research assessing the efficacy of VRET on affective outcomes have been increasingly emerging over the last 10 years as VR systems have become less costly, more available and generally more usable."
The results was that VRET "appears effective from a clinical psychology standpoint but the results are limited because there isn't enough research and testing done.

With the cost of VR headsets going down there is a potential increase in use of VR for in-vio exposure therapy. It offers a more realistic approach than imagining your fear. 

What is cognitive behavioural therapy?

https://www.hse.ie/eng/health/az/c/cbt/

"Cognitive behavioural therapy aims to helps you manage your problems by changing how you think and act.
CBT encourages you to talk about:

How you think about yourself, the world and other people.
How what you do affects your thoughts and feelings.


Cognitive- change how you think
Behaviour- change what you do

What it's used for?

Obsessive compulsive disorder
Phobias and panic disorder
PTSD
Depression
Eating disorders

CBT can also help with:
Anger problems
Habits
Drug and alcohol abuse
Relationship problems
Sleep Problems"

Phobias on the brain

http://www.neurologytimes.com/blog/phobias-and-brain-activity
By Heidi Moawad, MD
Oct 26, 2016

"Individuals who suffer from phobias have shown to display increased activity of the amygdala when exposed to phobia-inducing stimuli, noted on functional MRI. The amygdala is known to be associated with emotional reactions. The right amygdala is more highly reactive in response to negative emotions, such as those associated with phobias. Whereas the left amygdala is more strongly associated with pleasant emotional reactions. The height the activation of the right amygdala, the greater sense of distress induced by the phobia trigger.

The stria terminals, the anterior cingulate cortex and the insula were found to be hyper-activated in individuals who experienced sustained exposure to phobia inducing pictures in an experimental setting. "

https://www.sciencedaily.com/terms/amygdala.htm

"The amygdala is an almond-shaped set of neutrons located deep in the brains media temporal lobe. Key role is the processing of emotions. Conditionals such as anxiety, PTSD and phobias are suspected of being linked to abnormal functioning of the amygdala. "

What is a phobia?

https://www.verywellmind.com/what-is-a-phobia-2795454
 By Kendra Cherry
Updated Aug 31st, 2018

"According to the American Psychiatric Association:"
" A phobia is an irrational and excessive fear of an object or situation. The phobia invlinvolvesoves a sense of endangerment or a fear of harm.

Symptoms of Phobias

• Dizziness, trembling and increased heart rate
• Breathlessness
• Nausea
• A sense of unreality
• Fear of dying
• Preoccupation with the feared object

In some cases an anxiety attack.

Types of Phobias

Social phobias- involves fear of a social situation

Agoraphobia- involves fear of being trapped in an inescapable place or situation 

Specific phobias- involves fear of a particular object. Eg. Butterflies, moths, snakes.

Specific phobia falls under one of four categories:

Situational: Fear of leaving home, driving, bridges

Animal: Cats, birds, rats, spiders

Medical: Going to the dentist, doctor or seeing blood

The natural environment: Lightning, water, storms, mudslides, hurricanes or tornadoes.

Treatment of phobias

Exposure treatments- Getting person to face their fears

Counter-conditioning- Person learns relaxing techniques around object which will replace anxiety and fear.

People with social phobias might be given medication with a low dose of benzodiazepine or an antidepressant. Possibly with a cognitive- behavioural therapy.

Statistics on Phobias

https://www.nimh.nih.gov/health/statistics/specific-phobia.shtml

"In 2017 the national institute of mental health carried out a survey on people over 18.
There was an estimated 9.1% of U.S adults had specific phobia. It was higher in females (12.2%) than males (5.8%).
An estimate 12.5% of U.S Adults experiences a specific phobia once in their lives.


https://adaa.org/about-adaa/press-room/facts-statistics

• Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18 and older, or 18.1% of the population every year.

https://www.livescience.com/13434-phobias-fears-acrophobia-heights-agoraphobia-arachnophobia.html

https://www.worldatlas.com/articles/10-most-common-phobias.html

Arachnophobia is one of the most common phobias. (spiders)

Ophidiophobia- snakes

Acrophobia -heights

Aerophobia- flying

Cynophobia- dogs

Astraphobia- lighting and thunder

Tryanophiba- medical procures.