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. 

Why use Virtual Reality Therapy

http://centerforanxietydisorders.com/virtual-reality-therapy-for-phobias/

Many patients attend therapy session in order to talk about their phobias and possibly get rid of them. With "cognitive behaviour therapy patients recognize the thoughts that are causing negative feelings surrounding their fears". "Once the thoughts have been identified, the patient learns how to replace them with positive ones." With in-vivo exposure therapy patients experience what they fear in a controlled way and in small doses. With small steps they can confront and gradually conquer their phobia. With virtual reality exposure therapy it combines cognitive behaviour therapy and in-vivo exposure. It allows the patient to face their fears in a safe, controlled environment.

When the patient puts on the VR headset they are immersed into a simulation that is aimed at their particular fear. The patient might be aware that it's not real but there is still enough "realism to trigger their emotional responses to their phobia". "According to this article 83% of people who have tried VR therapy have managed to put their fears behind them".

VR therapy benefits

• "Allowing the patient to try the therapy without as much anxiety.
• Experience the phobia without having to travel to the location. Can exposure small triggers for your phobia.

• 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."

Virtual reality used in Psychology

VR used in Psychology treatment

https://files.eric.ed.gov/fulltext/EJ1131318.pdf

"potential use in relation to training and inter- personal skill development, also perhaps in clinical diagnosis and therapy"

In this article they discuss VR being used in psychology as a means of research. The environment can be adapted and they can research behaviour and responses to the environment. More specifically treatment of phobias. "The particular benefits of using virtual environments  in treating anxiety and post-traumatic stress disorder have been documented for several years". "It can be used with patients who have difficulty visualizing scenes and with those patients who are too phobic to experience the real equivalent situation. The VR allows the patient to experience/challenge their fear while remaining in a safe environment. The results showed that the user showed the symptoms of fear. 

https://www.psychologytoday.com/intl/blog/know-your-mind/201605/how-virtual-reality-could-transform-mental-health-treatment

Evolution of Virtual Reality

In 1957 filmmaker Morton Heilig invented a "large booth-like machine called the Sensorama". It was intended to give users the illusion of being in a 3D immersive world, complete with smell, stern sound, vibrations and atmospheric effects like wind. In 1960 he developed his idea to create the first head-mounted display which he patent. Alas he never created this idea but the idea helped lay the groundwork for future VR.


"Sword of Damocles"

In 1968, computer scientist,  Ivan Sutherland created the first VR head-mounted display (HMD). This versions connected to a stereoscopic display from a computer program which depicted simple virtual wireframe shapes. These shapes changed perspective when the user moved their head. These shapes were also displayed on a real background so it could also be considered the birth of augmented reality. However due to the headgear being to heavy, it never developed more than just a lab project.

"The super Cockpit 1970-80s"

Around the same time military engineer, Thomas Furness developed the "Super Cockpit". He created "a training cockpit with computer generated 3D maps, infrared and radar imagery as well as avionics data into real-time 3D space". This device allowed trainee pilots to control an aircraft using "gestures, speech and eye movements."

Sega was one of the first companies to attempt to launch a VR headset. Development started in 1991. "The design has a sleek black plastic design that concealed LCD displays, stereo headphones and internal inertial sensors for tracking head movement."

In 2010, 18 year old Palmer Luckey created the first prototype of the Oculus Rift. It had a 90 degree field view. It raised $2.4 million on Kickstarter and was purchased by Facebook for $2 billion in 2014.

In 2017 many companies are working on their own VR Headsets such as Google Cardboard, Apple, amazon, Sony, etc.


https://www.digitaltrends.com/cool-tech/history-of-virtual-reality/

How our brain processes images and VR

https://www.brainfacts.org/Thinking-Sensing-and-Behaving/Vision/2012/Vision-Processing-Information

"Vision begins with light passing through the cornea and the lens, which combine to produce a clear image of the visual world on a sheet of photoreceptors called the retina"

"The information from the retina — in the form of electrical signals — is sent via the optic nerve to other parts of the brain, which ultimately process the image and allow us to see."



The reason I researched this is because I want to know how our brains process objects in front of us. Then how VR HMD trick our brains into think it's real.

How our VR works on our eyes and brain

https://www.wareable.com/vr/how-does-vr-work-explained

"VR headsets used either two feeds sent to one display or two LCD displays, one per eye. There are also lenses which are placed between your eyes and the pixels. The lenses focus and reshape the picture for each eye and create a stereoscopic 3D image by angling the two 2D images to mimic how each of our two eyes views the world. "

Head tracking

"The picture in front of you shifts as you look up, down, side to side or at an angle. A system called 6DoF (six degrees of freedom) plots your head in terms of your X,Y and Z axis to measure head movements. "

Headphones can be used to increase the sense of immersion.

Our brain and processing images

https://www.psychologytoday.com/us/blog/is-your-brain-culture/200903/your-brain-movies

"Uri Hasson and Rafael Malach conducted a method of hypothesis-prediction-experiement-conclusion. The had five subjects what the first 30 minutes of The Good, The Bad and the Ugly while lying in a MRI scanner. Their hypothesis and prediction was that they were trying to predict how similar brain activity of each viewer would be between each viewer. What they found was that the viewers brains behaved alike (about 45% of the neocortex) in the occipital, temporal, and parietal lobes. These regions are involved in primary sensory perception plus some multimodal complex response functions."





"Specifically viewer's brains behaved alike in the primary visual areas of occipital and temporal cortex, Heschl's gyrus ( auditory region), Wernicke's area ( language processing) , Some limbic areas (emotion), the fusiform gyrus (face recognition) and the association cortices that partially integrate primary sensory data. Their summary was that the viewers data was similar at the level of sensory processing and simple comprehension of the plot of the film. As a contrast the viewers brains behaved differently when it came to advanced areas of info processing. They did not share activity in the supra marginal gyrus, the angular gyrus and prefrontal areas. The first two of these are polymodal areas where our brains put perceptions together to achieve a complex perception of a while environment. The prefrontal areas presumably directed the viewers emotional and intellectual understanding of what they are seeing.

Basically our brain takes in the image(s) in front of it and processes what it is seeing. The brain is designed to pay attention to what's new in the environment so we remain focuses on the movie because it's constantly providing us with new information. The viewers brains behaved alike in some visual and auditory areas and in a region (lateral occipital cortex) active in object recognition. We process the basic sounds and sights the same way."


The reason I read and researched this article is because I am researching VR used in psychological  treatment. It's the mind I am examining and how an artificial world can be used to treat phobias. The first thing I need to understand is how our brain works when processing images.

What is Virtual Reality?

https://www.marxentlabs.com/what-is-virtual-reality/
Author: Sonia Schechter
Published: Jun 3rd, 2015
Website : Marxent


What is VR?
"Virtual Reality (VR) is the use of computer technology to create a simulated environment. VR places the user inside an experience. Users are immersed and able to interact with 3D worlds. Simulating senses such as vision, hearing, touch, even smell. Virtual Reality creates an artificial environment to inhabit. The position of the user’s eyes are located within the simulated environment."


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

Audio
"human beings react more quickly to audio cues than to visual cues"

Change of research and plan

After a few weeks of researching VR used in medicine and psychological treatment I feel like I don't have a clear path for what I am trying to research and also educate myself on. I feel that because I am not a medical student I do not have enough knowledge to be able to discuss VR used in medicine or surgery. Additionally all the papers I read are coming to the same conclusion which is that it provides the doctors with more visual information. I feel as though that's only the surface and I don't know how to dive in deeper. I am started to become curious about VR used in psychological treatment. Here is a rough plan on what I wish to research and I am hoping that this will guide me:

1. What is Virtual Reality?
2. How are brain works and how we immerse ourselves in stories, films, games, etc.
3. How Virtual reality works on the mind/brain.
4. Mental disorders/ Phobias and treatment
5. Cases of VR being used to treat phobias and examine behaviour/reaction.


This is my rough guideline for myself. I believe that there will be more information on this topic and I'm curious to read how VR works on our mind.

VR in medicine in 1999

Benefits of Virtual reality in medicine. 

In this article they made a list of the benefits of Virtual reality in Medicine. Virtual reality is a computer generated simulation of three-dimensional images or environment. One key advantage of using VR instead of a 2D image is that it provides "clinicians with a more naturalistic view of a patient's anatomy." Here are a few other benefits they stated:

• Virtual reality technology plays an important role in telemedicine from remote diagnosis to complex tele interventions. 
• Computerized three dimensional atlases of human anatomy, physiology, and pathology are about to revolutionize the teaching of these subjects.
• Several virtual reality systems have been developed and tested for the physical or mental rehabilitation of patients and for supporting mental health therapy.
• Training for medical students.

The technology

"Appropriate algorithms to calculate the visual appearance of the virtual scene to be visualised (rendering); and physical devices (in most cases graphical displays) to present the resulting images to the user."
"Tactile and haptic (force) sensing is an important source of information when interacting with the virtual environment. Accordingly, these forces have to be transmitted to the user if immersion in a virtual scene with a reasonable level of realism is desired"

Diagnostics 

"Virtual endoscopic procedures could replace real endoscopic investigations in the foreseeable future in some areas of diagnosis."

Preoperative planning
"The use of computer models to plan and optimize surgical interventions preoperatively is part of daily clinical practice."
" The planning of a surgery on a computer screen, trying out different surgical approaches with realistic prediction of the outcome (for example, postoperative appearance of the patient), and planning individualised custom made implants have substantial impact on the success and safety of the intervention."

Education and training systems

"Systems based on virtual reality offer a unique opportunity for the training of professional surgical skills." 
"The rapid adoption of minimally invasive surgical techniques is one of the major driving forces in the development of surgical trainers. The extreme limitations placed on visual and manipulative freedom, including the loss of tactile feedback and the unusual hand-eye coordination, makes extensive specialised training for such interventions necessary."


This article was posted on the 13th Nov, 1999.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1129082/


My thoughts and conclusion
One important fact that appears in every VR  and medicine articles is that VR provides more information for Doctors and Medical students. In this article is talks about using VR to provide a more "natural image" for the Clinicians. We live in a 3D world and Doctors perform surgery on a 3D human. Therefore wouldn't it be easier for doctors to examine 3D images of the areas that are affected?

VR in medicine and psychology

https://www.researchgate.net/profile/Maria_Schultheis/publication/232580487_The_application_of_virtual_reality_technology_in_rehabilitation/links/02e7e517eba3b38088000000.pdf

I found this article on google scholars and it was published in 2001. What's interesting about it is that it talks about VR and how is is still developing but has successfully integrated  in multiple areas of medicine and psychology. VR was used in surgical training, treatment of phobias, PTSD and eating disorders. It is also used to distract patients from the pain of dental work, burn treatment and chemotherapy. They state that one "benefit of VR is that it allows users to forget that they are in a simulation".Additionally it provides a safe learning environment that minimizes risks from error.

One of their first "efforts" was creating a virtual classroom and the simulation was aimed at children with ADHD. They created a realistic setting that featured objects that you would normally find in a classroom. They adjusted the simulation based on the age of the child. They monitored the child's "reaction time" to the instruction that they were given in the simulation. "Behavioural factors" such as being distracted and hyperactivity were assessed.

Conclusion
I thought that this article focused more on what exactly AV technology is and how it was used in a way to study patients with mental disorders. It keeps the patient physically safe for them to analyze their behaviour in the simulation. However in this article it questioned the ethics behind it. It might be safe physically for the patient but what about mentally.

Virtual Reality used in medicine

During this semester I will be researching how Virtual Reality is used in medicine. More specifically how it is used to aid Doctors in surgery. Additionally I will be examining how VR is used as a pedagogical tool to teach surgeons procedures before they apply those techniques to a patient. I am also curious to look at how VR might be used in PTSD and for helping patients after their surgery or treatment.

The first article I found was about a pair of twins who were conjoined at the torso in 2017. https://www.washingtonpost.com/news/innovations/wp/2017/07/21/how-doctors-used-virtual-reality-to-save-the-lives-of-conjoined-twin-sisters/?noredirect=on&utm_term=.b2bc1535b7b5
 The Doctors used "google-like virtual reality to explore a 3D model of the twins heart". They were able to scale the model from the size of a "walnut" to the size of the room. With the use of VR the Doctors are able to examine the tiny intricate details of the two hearts and come up with a solution. A Doctor named Azakie stated that, "the imaging helped us prepare by developing an approach in the event that we came across something we didn't expect".

What I understood from this article is that, with the use of VR, it helped prepare the Doctors and altered their solution. With X-rays you only have a flat 2D image of the organ/area. Whereas with the 3D objects in VR you have more information which is key when it comes to surgery. You are able to explore a full 360 degrees of the object. Additionally when Doctors are performing surgery they are working with a 3D human with 3D organs. Surely 3D imagery is the way forward because Doctors are already so similar with working in 3D?