Journal of CyberTherapy and Rehabilitation, 2008, 1 (2), 127-146
A GAME A DAY KEEPS THE DOCTOR AWAY: A SHORT REVIEW OF COMPUTER GAMES IN MENTAL HEALTHCARE
L. Gamberini, G. Barresi, A. Majer, F. Scarpetta
Computer games are currently a focal topic in different research areas. One of the emerging contexts for their
use is represented by healthcare. Thanks to their potentialities, they have been successfully exploited in this
domain to foster motivation and to enhance cognitive processes. This paper proposes a review of existing
research on computer games, exploited for prevention, support, training, rehabilitation, and particularly
stressing the relationship between cognitive processes and gaming.
Journal of CyberTherapy and Rehabilitation, 2008, 1 (2), 147-158
A VIRTUAL REALITY BEHAVIOR AVOIDANCE TEST (VR-BAT) FOR THE ASSESSMENT OF SPIDER PHOBIA
A. Mühlberger, M. Sperber, M. J. Wieser, P. Pauli
Lang and colleagues postulated that fear responses must be described on three levels: subjective-cognitive,
physiological, and behavioral. However, in-vivo assessments of fear in phobic situations are complex, difficult
to control, and frequently associated with methodological problems. The present studies used a virtual
reality spider scenario for a behavior avoidance test (VR-BAT). Subjective anxiety, symptoms, heart rate (HR),
skin conductance (SCL), and approach behavior were measured in 34 female spider-phobic participants
during two VR-BATs and during eight exposure trials in-between. The distance and fear ratings decreased
from the first to the second VR-BAT and during the exposure trials. Interestingly, HR and SCL increased
during the exposure trials and HR even between the first to the second VR-BAT. Physiological measures,
fear ratings and approach were only partially associated, but approach and fear measures correlated with
psychometric measures of spider phobia. The virtual reality scenario seems feasible for the behavioral and
physiological assessment of fear.
Journal of CyberTherapy and Rehabilitation, 2008, 1 (2), 159-173
THE ROLE OF MEDIA IN SUPPORTING A STRESS MANAGEMENT PROTOCOL: AN EXPERIMENTAL STUDY
D. Villani, G. Riva
Stress management (SM) is a term widely used with a seemingly obvious meaning but it is not clear how
many different forms of SM exist and how efficacious they are according to the target problem. Stress is a
multidimensional condition and we believe that it requires a wide-spectrum approach. We consider that a
combination of stress management techniques can produce more significant outcomes than did single-strategy
programs. For this reason we propose an integration of three approaches to cope with stress and improve
emotional management from different points of view: the Emotion Focused Therapy; the Behavioral Therapy,
and in particular Relaxation; the Rational Emotive Therapy.
In particular, we decided to use two mediated experiences – audio and immersive 3D video - to support the
Relaxation phase. The critical role in mediated experiences is played by the sense of presence that allows the
experience to evoke the same perceptual reactions and emotions as a real one.
To verify the efficacy of the SM protocol we carried out a controlled trial, comparing an experimental Video
group, an Audio group (that only listened to the relaxing narrative), and a control group without treatment.
Results showed the efficacy of integrating different approaches to cope with stress and suggested the importance of the sense of presence as a mediating variable between the experience and the efficacy of the relaxation process.
Journal of CyberTherapy and Rehabilitation, 2008, 1 (2), 174-181
LOW-COST VIRTUAL MOTOR REHABILITATION FOR NEUROPHYSICAL DISABILITY IMPROVEMENTS IN IMPAIRED PATIENTS
M. Alcaniz, Gil, J.A., Chirivella, J., Noé, E., Colomer, C., Ferri, J.
Motor rehabilitation needs, in most cases, specialists that indicate exercises to do, and, generally, the specialist
must follow the patient most of the time. Moreover, there are not objective measures to evaluate in detail
the correction of exercises and the exercises patient’s evolution. To improve the motor rehabilitation process,
we present a new low-cost system that allows in the first stage, the use of last generation tools for the development of customizable standing exercises. This new system is being validated in an important rehabilitation center with very promising results. The first validations that are taking place indicate that it contributes with important improvements, permitting a smallest dependence of the patient in relation to the specialist, providing objective measures of evolution of the patients in the realization of exercises, and increasing the motivation of the patients in the rehabilitation process.
Journal of CyberTherapy and Rehabilitation, 2008, 1 (2), 182-192
NEW TECHNOLOGIES AND RELAXATION: AN EXPLORATIVE STUDY ON OBESE PATIENTS WITH EMOTIONAL EATING
G. M. Manzoni, A. Gorini, A. Preziosa, F. Pagnini, G. Castelnuovo, E. Molinari, G. Riva
Since stress and negative emotions are critical factors in inducing overeating in obese patients, psychological
and behavioural interventions for obesity should include stress management techniques. A three weeks relaxation protocol supported by the use of new technologies, including virtual reality (VR) and portable mp3 players, was developed in order to reduce stress and related emotional eating episodes in obese patients. Sixty
female obese inpatients reporting emotional eating were included in the study and divided in three experimental groups (virtual reality-VR, imaginative-IM and waiting list). Psychometric and physiological variables were collected. Results show that relaxation training was effective in improving perceived self efficacy in eating control, as well as in decreasing depressive symptoms, anxiety and physiological arousal both in the VR and IM conditions.
This study suggests that relaxation training for obese patients with emotional eating is effective, even if the
lack of differences between the two conditions suggests some important critical considerations.
Journal of CyberTherapy and Rehabilitation, 2008, 1 (2), 193-199
PAIN CONTROL DURING WOUND CARE FOR COMBAT-RELATED BURN INJURIES USING CUSTOM ARTICULATED ARM MOUNTED VIRTUAL
C. Maani, H. Hoffman, P. A. DeSocio, M. Morrow, C. Galin, J. Magula, A. Maiers, K. Gaylord
We describe the first two cases where virtual reality was added to usual pain medications to reduce excessive
pain during wound care of combat-related burn injuries. Patient 1 was a 22 year old male who suffered 3rd
degree burns on 32% of his body, including his right hand, during a roadside bomb terrorist attack in Iraq.
The nurse administered wound care to half of the right hand during VR and the other half of the same hand
during no VR (treatment order randomized). This patient was the first to use a unique custom articulated
robotic-like arm mounted VR goggle system. Three 0-10 graphic rating scale pain scores for each of the two
treatment conditions served as the primary dependent variables. The patient reported less pain when distracted
with VR. "Time spent thinking about pain" dropped from 100% during no VR to 15% during VR, “pain
unpleasantness” ratings dropped from “moderate” (6/10) to “mild” (4/10). Wound care was "no fun at all"
(0/10) during no VR but was "pretty fun" (8/10) during VR. However, Patient 1 reported no reduction in
worst pain during VR. Patient 2 suffered 2nd and 3rd degree burns when his humvee was hit by a terrorist's
rocket propelled grenade in Iraq. During his wound care debridement, "time spent thinking about pain" was
100% (all of the time) with no VR and 0 (none of the time) during VR, "pain unpleasantness" ratings dropped
from "severe" (7/10) to "none". Worst pain dropped from "severe" (8/10) to mild pain (2/10). And fun
increased from zero with no VR to 10 (extremely fun) during VR. Although preliminary, using a within-subjects
experimental design, the present study provided evidence that immersive VR can be an effective adjunctive
nonpharmacologic analgesic for reducing cognitive pain, emotional pain and the sensory component of
pain of soldiers experiencing severe procedural pain during wound care of a combat-related burn injury.
Journal of CyberTherapy and Rehabilitation, 2008, 1 (2), 200-207
APPLYING THE TECHNOLOGY ACCEPTANCE MODEL TO VR WITH PEOPLE WHO ARE FAVORABLE TO ITS USE
M. Bertrand, S. Bouchard
This study aims to test how the Technology Acceptance Model (TAM; Davis, 1989, 1993; Venkatesh, 2000)
applies to the use of virtual reality in clinical settings. The sample is composed of 141 adults interested in using
this technology. We adapted the standard items used to test the TAM and added a perceived cost factor as
it was expected to play a role on Intention of Use. Structural equation modeling was used and, after removing
several parameters, an adequate fit to the data was found. The final model revealed that Intention to Use
VR is predicted only by Perceived Usefulness. These results pinpoint what should be better documented in
order to foster the dissemination of virtual reality among clinicians.