PTSD Threatens Global Economies

Recent news reports reveal the tip of an iceberg that is threatening to sink the ship of state in countries worldwide— the iceberg known as posttraumatic stress disorder (PTSD). PTSD increasingly threatens to swamp health systems and social support systems, even as some of these budgets are cut for lack of funds as a result of the global economic crisis. The human toll is even more devastating.

  • On May 12, 2009, the Associated Press (AP) reported that a 44-year-old U.S. sergeant, nearing the end of his third tour in Iraq, was so angry at the Army he opened fire in the combat-stress clinic in Baghdad, killing five people.
  • On May 22, 2009, AP related the story of a 24-year-old ex-soldier on trial in Kentucky for raping a 14-year-old Iraqi girl and murdering her parents and sister while on duty in Iraq. The jury cannot agree whether or not to sentence him to death.

It is probable we will see more headlines like these in the next 6 months because the U.S. Army will not be able to give soldiers adequate time at home between tours of duty until the end of 2010. Since 2001, the U.S. has deployed nearly 1 million soldiers to Iraq and Afghanistan, and more than 300,000 of them have served multiple tours. About 20% of these soldiers return with psychological damage, most commonly PTSD and depression. At least half of PTSD sufferers smoke, and others become dependent on alcohol or prescription drugs. PTSD increases risk of cardiovascular disease, and multiple traumas have a deleterious effect on many aspects of physical health. Overall, the U.S. Army’s suicide rate reached an all-time high in 2008. For those who survive, lifetime benefits for a U.S. service member permanently disabled because of PTSD may top $1 million. Finally, the most recent estimate of the annual cost of anxiety disorders in the United States, with PTSD ranking highest in terms of per-person health care expenditures, was $42.3 billion in mental and physical health services alone.

In Europe, about 41 million people have anxiety disorders, and PTSD may occur in up to 37% of those exposed to trauma such as combat, sexual and physical assault, being held hostage or imprisoned, terrorism, torture, natural and manmade disasters, accidents, and receiving a diagnosis of a life-threatening illness.

Because PTSD has such varied symptoms, a combination of treatments is often necessary. Anxiety-reducing medications, antidepressants, support from friends and family, and cognitive-behavioral therapy (CBT) involving exposure can help with recovery. However, these types of traditional therapies do not have acceptable recovery rates. Front-line antidepressant medications for the disorder—such as selective serotonin reuptake inhibitors—rarely yield better than a 40% reduction in symptoms. Traditional psychotherapy fares only slightly better, with only 44% of all those entering treatment classified as improved at the end of the treatment period.

Fortunately, we live in a time when advances in medical technology abound. A recent Google search of ‘‘PTSD technology issues 2009’’ revealed that two of the five top links addressed the value of virtual reality (VR) therapy for PTSD.

A panel of experts has published a consensus opinion that exposure therapy is the most appropriate therapy for PTSD. Prior to the availability of VR therapy applications, the existing standard of care for PTSD was imaginal exposure therapy in which patients ‘‘relive’’ the traumatic event in a graded and repeated process. Exposure therapy is based on emotional processing theory (EPT). Applying EPT to PTSD, fear memories are stored as a ‘‘fear structure’’ and include psychological and physiological information about stimuli, meaning, and responses. Once accessed and emotionally engaged, the structure is open to modification through CBT, and over time, treatment will result in extinction of the fear response.

Although exposure therapy has been shown to be effective, one hallmark of PTSD is avoiding reminders of the trauma. Because of this, many patients are unable or unwilling to visualize the traumatic event during imaginal therapy. In studies that address treatment nonresponders, failure to engage emotionally or visualize well enough to elicit an emotional response are cited as most predictive of nonresponse to treatment, since the fear structure is not accessed during therapy and is therefore not open to change.

This is where VR can step in to enhance treatment. In recent years, VR has been shown to improve treatment efficacy for PTSD in survivors of many types of trauma, including motor vehicle accidents, war, earthquake, and terrorism such as the 9=11 World Trade Center attacks. By being placed in an environment where a trauma has occurred (in war veterans, it could be a virtual combat setting; in armed conflict survivors, a virtual countryside under attack), and then slowly experiencing that situation in a controlled way, patients may begin to habituate to the PTSD symptoms and come to reappraise the instigating situation. This allows emotional processing to occur and may free PTSD sufferers from their intrusive memories and disturbing symptoms. Unlike in vivo therapy, which takes the patient into real-world scenarios (which is not practical or even possible with war veterans), VR permits the patient to interact with anxiety-inducing scenarios in the safety and confidentiality of the therapy room. Early results indicate response rates as high as 80% with VR exposure therapy.

In Europe and America, decision makers are beginning to focus attention on technology solutions to this problem. A NATO-supported advanced research workshop, Wounds of War: Addressing Posttraumatic Stress Disorder (PTSD) in Peacekeeping and Combat Troops, organized by the Interactive Media Institute and also supported by the U.S. Army’s Military Operational Medicine Research Program, brought together experts from 14 countries in October 2009 in St. Kanzian, Klopeiner See, Su¨dka¨rnten, Austria.

The American Recovery and Reinvestment Act (ARRA) of 2009 provides the U.S. Department of Veterans Affairs (VA) with $1.4 billion, most of which is to be spent on facilities upgrades, health information technology, and other programs designed to create jobs. The U.S. Department of Defense will receive $7.4 billion under ARRA, most of which will be used in a similar fashion. ARRA requires an unprecedented level of accountability and transparency, so world citizens can track the projects completed with these funds. At this, just one third of ARRA funds have been released.

If one of the aims of ARRA funding is, as DoD states, to ‘‘care for U.S. Service members and their families,’’ surely some of these funds can be directed to large-scale research studies designed to prove the efficacy and cost effectiveness of VR therapy for current and former service members with PTSD. While a growing number of Veterans Administration facilities are using VR therapy in controlled studies that allow veterans to receive this most effective treatment, only when governments consider it a priority to mainstream such therapy can we avoid our ships of state becoming the next Titanic.

Editor-in-Chief Brenda K. Wiederhold
2009 Winter Editorial

Journal of CyberTherapy & Rehabilitation

Winter 2009, Volume 2, Issue 4



Welcome to the Winter 2009 issue of the Journal of Cy- berTherapy & Rehabilitation (JCR). We are pleased to bring this special issue of our publication to readers, critics and researchers around the world. Our peer-re- viewed academic journal explores the uses of advanced technologies for therapy, training, education, prevention and rehabilitation. JCR is a quarterly published aca- demic journal, unique in the fact that it focuses on the rapidly expanding worldwide trend of applying ground- breaking technology towards the field of healthcare. Psychiatry, psychology, physical medicine and rehabil- itation, neurorehabilitation, oncology, obesity, eating disorders and autism continue to be main areas of inter- est studied by JCR.

Since our inaugural issue, JCR has received interna- tional attention from peers, international institutions and international conferences. A common thirst for new knowledge and application of cutting-edge technolo- gies to better the lives of others brings this diverse group of people towards a similar goal. Advanced tech- nologies, such as robotics, adaptive displays, E-health, virtual reality (VR) and non-invasive physiological monitoring are now applied to many diverse fields of healthcare. As this body of research is added to, pa- tients, doctors and therapists can look towards a hopeful future and new ways to treat mental and physical dis- orders. Within this issue of JCR, we present compre- hensive review articles submitted by preeminent scholars in the field. The content is diverse, featuring such topics as VR immersions, the effects of video game playing and even online forums to treat sufferers of disease.

This special issue of JCR includes three full papers, as well as all presented abstracts, written by presenters from the “Beyond Brain Machine Interface: Motor, Cognitive and Virtual” pre-conference workshop, held September 2, 2009 in Minneapolis, Minnesota. The conference, co-organized by the Army Research Office, IEEE EMBS and the Interactive Media Institute, edu- cated attendees on more efficient and intuitive ways of achieving system control than manual manipulation and allowed for discourse among academics, members of the scientific community, biomedical device engineers and the clinician user community. Scientists from five different countries and ten diverse institutions gathered to discuss these technologies and developments in their fields of research, and gave formal presentations on their papers.

In this issue’s first article Cai, Milcent and Franco ex- plore the human-machine visual digest system by fo- cusing on the relationship between gaze and object. They describe ways to better utilize network bandwidth and in turn, minimize the resulting media footprint by combining human vision and machine vision.

Next, Scherer et al. discuss brain-computer interface re- search using EEG and ECoG-based paradigms that are presented to the reader, along with ways to improve in- formation transfer rates. Different BCI projects are dis- cussed, such as an anatomically correct testbed for a human hand model.

In the following article, Raspelli et al. conduct further research on the Multiple Errands Test, applying virtual reality to assess executive functions in patients suffer- ing from Parkinson’s disease and stroke.

In the fourth manuscript, Pallavicini et al. report find- ings on a study to treat sufferers of Generalized Anxiety Disorder using biofeedback, virtual reality and mobile phones. The use of mobile phones allowed patients to continue treatment in an outpatient setting and ad- dresses the classic problem associated with VR ther- apy–the lack of mobility for the treatment system.

Gras, Hummer and Hine, in the fifth manuscript, com- pare the reliability and validity of the Nintendo Wii Fit to the widely used NeuroCom EquiTest, to measure bal- ance and help rehabilitate patients.

Lastly, Cantelmi and Talli explain the psychological and psychopathological risks associated with overuse of the Internet, including the problems associated with defining a relevant syndrome, possible diagnostic cri- teria and possible therapies for treatment.

This issue of JCR will continue to explore the ways in which healthcare, in Europe and worldwide, can benefit from the applications of technology. I would like to sin- cerely thank the contributing authors for their inspiring work and dedication to this field of research. I also want to thank JCR’s Associate Editors – Professor Botella, Professor Bouchard, Professor Gamberini and Professor Riva for their leadership and hard work, as well as our internationally renowned Editorial Board for their contributions. We encourage readers and subscribers to con- tact us with ideas and manuscripts. Your input continues to enrich our publication. Looking to 2010, we are op- timistic as this diverse field continues to grow and at- tract those wishing to learn more and those already supporting and implementing new technologies. With only more room to grow, we will continue to bring you news of further developments in the upcoming year.


Brenda K. Wiederhold, Ph.D., MBA, BCIA

Editor-in-Chief, Journal of CyberTherapy & Rehabilitation

Virtual Reality Medical Institute

2009 Fall Guest Editorial

Journal of CyberTherapy & Rehabilitation

Fall 2009, Volume 2, Issue 3



In this special issue of the Journal of CyberTherapy and Reha- bilitation, you will find several papers that were  selected from the more than one hundred submissions received by the Scien- tific Committee for the International Symposium on Neurore- habilitation.

Seeing the need to strengthen the collaboration between tech- nical and health related disciplines, the International Sympo- sium on Neurorehabilitation: from Basics to Future was held in Valencia, Spain on October 15-16, 2009. The main purpose of the Symposium was to bring together engineers, researchers and health care professionals to share ideas and experiences with the aim of creating a “common language” that will help to increase the efficacy of the neurorehabilitation process and to improve the quality of life of patients. World-renowned re- searchers in cognitive and motor rehabilitation, virtual reality, telerehabilitation, brain-machine interfaces, patient assessment, behavioral science, neuroplasticity, neuroimaging, neurophar- macology and rehabilitation robotics updated participants on the current state of their respective research areas during the Symposium. Similarly, more than 350 delegates from around the world participated in this event and provided examples of their current work.

In the coming years, the incidence of diseases and afflictions with a neurological origin will increase to–what some have ven- tured to call–epidemic proportions. Among the main reasons be- hind this “coming epidemic” is the shift that the world’s population will experience, according to several forecasts, to- wards an increasingly older population as a result of improve- ments in medicine and standards of living. According to the United Nations, more than 20 percent of the world’s population will be over 60 years old by the year 2050, more than doubling the current size of this population segment. This shift towards an older population will not be limited to the developed world; most of the developing world will experience a similar popula- tion shift in the coming decades. Unfortunately, an aging popu- lation increases exponentially the risk of suffering from afflictions affecting the central nervous system, which could lead to a lower quality of life for these individuals, or even death. Among these afflictions one can find multiple sclerosis, Parkin- son’s disease, Alzheimer’s disease, stroke, among many others. Recent advances in neurorehabilitation, the specialized and interdisciplinary treatment of individuals suffering from neu- rological afflictions, can prove to be extremely important to ameliorate the suffering experienced by these individuals and to help them to return to a normal life. At the same time, we are seeing the increasing importance of technology in our everyday lives. As a result, technology is also playing an im- portant role in the improvement of neurorehabilitation, and we feel that its importance will only increase over time. Ap- plying technology to the neurorehabilitation process can not only assist us in obtaining more precise diagnostics and in improving the flow of information between health care pro- fessionals but it can also help us to develop more effective and efficient rehabilitation-specific clinical pathways. Simi- larly, the increasing bandwidth capacity of our telecommuni- cation networks could bring hope to individuals that do not have access to rehabilitation facilities by making possible the implementation of telerehabilitation-based treatments. Fur- thermore, the increasing importance of assistive technology and orthetics also shows how technology can have a great im- pact on the quality of life of our patients long after the reha- bilitation process has finalized.

In this symposium, several sessions have been centered in virtual rehabilitation and related fields. Virtual Rehabilita- tion is a recent scientific and technological area that inves- tigates the use of interactive graphics technologies and telecommunications to provide rehabilitation and clinical services in a more effective and efficient way. It is a multi- disciplinary field that combines technologies such as virtual reality, augmented reality, bioelectronics, medical imaging, ambient intelligence, natural man-machine interfaces, all aimed at achieving better therapies for patients and more sustainable services health.

At this moment, we are experiencing the emergence of an infor- mation society increasingly based on the production and ex- change of information. New information and computer technologies (ICT’s) are having an impact in the field of rehabil- itation of motor and cognitive functions. Over the past twenty years this progress in technology has provided clinicians with new opportunities for evaluation and treatment of cognitive dis- orders, which were not available with traditional methods. Sev- eral tools have been created in order to evaluate and train the cognitive impairment that is associated with acquired or devel- opmental cerebral damage including memory, spatial knowledge representation and planning abilities and executive function.

With virtual rehabilitation we are developing engaging virtual worlds in which patients interact while rehabilitating, envi- ronments that are capable of recognizing the patient and pro- vide the necessary services even at home, miniaturized and low-cost tracking and monitoring systems used to enable pa- tients to continue rehabilitation at home thus saving costs to health services and improving both the quality of care, intel- ligent TV screens that recognize the patient’s movements and through virtual agents are leading him in the exercises, or robotic systems that assist the patient in their exercises in both the clinic and at home. In coming years, we will attend to a revolution in this field through the combined efforts of clini- cians and technology, which we intend to make closer ties in scientific events like the International Symposium on Neu- rorehabilitation. We hope that you enjoy these papers and that you will join us in the next edition of the International Sym- posium on Neurorehabilitation to be held in 2011.



Mariano Alcañiz, Ph.D.,
Director Institute LabHuman
and Javier Chirivella, Ph.D.,
Director Servicio Daño Cerebral/NISA

“Medical Marker” Inaugural Class Introduced

Another highlight of the EDC’s Schwartz Awards Luncheon was unveiling of bioOrlando’s new “Medical Marker” program, which is designed to build awareness of the growing presence of biotech and life science companies in our region.

Ray Gilley, EDC President & CEO, described the program as a way to recognize the growing number of leaders in scientific research and medical technology, as well as companies who have contributed substantially to the evolution of such technologies in Central Florida. “On an ongoing basis, Medical Markers will be presented to life science and biotech organizations throughout the four county region,” explained Gilley.

A design for the marker, the work of talented local artist Dralene “Red” Hughes, was unveiled. Hughes submitted her concept as part of a design competition promoted by United Arts. The artist explains her design concept (above) as follows: “An abstract figure formed from checks and balances reaches for a goal, represented by the bright star. The figure is stepping forward and up, with the upper extension pointing to the Orlando area on a Florida map.”

Florida Senator Lee Constantine, a tireless community advocate who introduced the bill that put the UCF College of Medicine into Statute, then introduced the inaugural class of Medical Marker recipients. As Constantine explained, this founding group represents the pioneers of our region’s medical and life science industry. “These are the organizations and industries that blazed the trail and ensured that Metro Orlando would be well-positioned as a true contender for the life science industry,” he said.

bioOrlando’s inaugural class of Medical Marker recipients includes:

  • Florida Hospital, est. 1908
  • Orlando Health, est. 1918
  • Florida’s Blood Centers, est. 1942
  • South Lake Hospital, est. 1947; home to National Training Center
  • Health Central, est. 1952
  • Tavistock Group / Lake Nona
  • VaxDesign
  • CuraScript
  • .decimal
  • Emergency Medicine Learning & Resource Center
  • Virtual Reality Medical Center


2009 Summer Editorial

Journal of CyberTherapy & Rehabilitation

Summer 2009, Volume 2, Issue 2



Welcome to the Summer 2009 issue of the Journal of CyberTher- apy & Rehabilitation (JCR). We are pleased to bring the fifth issue of our publication to readers, critics and researchers around the world. Our peer-reviewed academic journal explores the uses of advanced technologies for therapy, training, education, pre- vention and rehabilitation. JCR is a quarterly-published aca- demic journal, unique in the fact that it focuses on the rapidly expanding worldwide trend of applying ground-breaking tech- nology towards the field of healthcare. Psychiatry, psychology, physical medicine and rehabilitation, neurorehabilitation, oncol- ogy, obesity, eating disorders and autism continue to be main areas of interest studied by JCR.

Since our inaugural issue, JCR has received attention from peers, international institutions and international conferences. A common thirst for new knowledge and application of cutting-edge technolo- gies to better the lives of others drives this diverse group of people towards a similar goal. Advanced technologies, such as robotics, adaptive displays, E-health, virtual reality (VR) and non-invasive physiological monitoring are now applied to many diverse fields of healthcare. As this body of research is added to, patients, doctors and therapists can look towards a hopeful future and new ways to treat mental and physical disorders. The content of this issue of JCR reflects our diversity, featuring such topics as VR immersions, the effects of video game playing and online forums to treat suf- ferers of disease.

In the first article Wang and Reid explore the application of a virtual reality-cognitive rehabilitation (VR-CR) approach in treating autism in children. In this study, virtual reality (VR) was used as an interactive, cognitive-focused treatment which allowed for greater flexibility than traditional methods for treating autism.

Next, Murray presents research based on the treatment of phan- tom limb pain in amputees using VR. Studies using research stemming from traditional “mirror-box” methods were con- ducted and Murray looks closely at three VR systems that were implemented in the treatment of phantom limb pain.

In the third article, Aime, Cotton and Bouchard take a close look at women suffering from eating disorders and implement VR as an experimental new form of treatment for these patients. VR im- mersions were conducted to assess whether or not treatment was successful in helping women suffering from eating disorders as well as overall concern over their weight and shape.

Bouchard, St-Jacques, Renaud and Wiederhold, in the fourth manuscript, address the side effects of immersions in VR for people suffering from anxiety disorders. In this study, researchers used a sample group of patients suffering from anxieties of various types and measured reports of side effects before and after VR immer- sions to determine whether or not patients and therapists should be concerned about the lasting complications of side effects.
In the fifth paper, King and Delfabbro present findings on re- search detailing motivational differences in video game play. Factors that were considered include motivation to play video games, intrinsic and extrinsic motivations, and total time spent playing. These findings can be used to help video game players determine if their playing behavior points to a problematic level of involvement.

In another article addressing video game playing, Wang and Yang explore the relationships between thrill seeking, perceived risk and aggressive tendencies and how these factors relate to the acceptance of playing violent video games. Behavioral in- tention was also closely studied as well as differences in male and female gaming styles.

Lastly, Fullwood and Wootton examine the possibilities of com- puter-mediated communication (CMC) to help patients deal with emotionally-sensitive issues. To do so, an online support forum produced by the National Society of Epilepsy was used. Key fac- tors, such as anonymity and willingness for disclosure, were studied and used to determine whether CMC meets criteria for offering support to sufferers.

Future issues of JCR will continue to explore the ways in which healthcare, in Europe and worldwide, can benefit from innova- tive applications of technology. I would like to sincerely thank the contributing authors for their inspiring work and dedication to this field of research. I also want to thank JCR’s Associate Ed- itors – Professor Botella, Professor Bouchard, Professor Gam- berini and Professor Riva for their leadership and hard work, as well as our internationally renowned Editorial Board for their contributions. We encourage readers and subscribers to contact us with ideas and manuscripts. Thank you again for your support of JCR. We look forward to providing you with more ways in which technology is contributing to increased quality of life in citizens of the world.



Brenda K. Wiederhold, Ph.D., MBA, BCIA

Editor-in-Chief, Journal of CyberTherapy & Rehabilitation

Virtual Reality Medical Institute

2009 Spring Editorial

Journal of CyberTherapy & Rehabilitation

Spring 2009, Volume 2, Issue 1



As we begin 2009, I want to say “vielen herzlichen Dank” to all those who believed in our new Journal of CyberTherapy    &    Rehabilitation    ( JCR)    and    encouraged its formation. JCR was founded after many requests from the community and exists to support the communi- ty. Our inaugural year, 2008, is now behind us, and I am pleased at the reception given by those already in the community, as well as those just discovering the benefits of adding technology to existing healthcare methods and protocols. JCR has thus far published articles by researchers and scientists from around the globe, and is disseminating its newest findings and research through advanced technologies to multiple continents and over thirty-nine countries. Led by an internationally renowned Editorial Board, JCR’s authors and board members currently hail from Australia, Belgium, Canada, Croatia, Denmark, Germany, Greece, Israel, Italy, Mexico, the Netherlands, Portugal, South Korea, Spain, Switzerland, the United Kingdom and the United States. JCR is truly international and our aim is to disseminate premier research findings to all corners of the globe.

I am also proud to say that our companion publication, CyberTherapy & Rehabilitation (C&R) Magazine, was launched in December 2008. While JCR is a peer- reviewed, scientific journal, C&R serves as the voice of our association and covers clinically focused and prac- tice-driven articles, congress reports, news and other relevant topics appealing to a wider readership includ- ing industry professionals, policy makers, clinicians, and individual citizens.

In 2008, I had the sincere pleasure of participating in many international conferences, in addition to organizing the 13th annual CyberTherapy Conference in San Diego. Each conference was for me an enjoyable learn- ing experience, and I left each full of amazement at how far we have come. It is inspiring to hear both newcom- ers and veterans of cyber-psychology, therapy, training, and rehabilitation reporting on new discoveries; expand- ing this seemingly infinite field.

As Editor-in-Chief of the official journal of the 14th annual CyberTherapy & CyberPsychology conference (CT14), I am especially looking forward to the upcom- ing international conference which is being held in beau- tiful Lago Maggiore (Verbania), Italy 21-23 June 2009. CT14 has already gained much attention from interna- tional organizations and, as in years past, promises to host an international crowd of pre-eminent scientists and industry leaders.

This issue of JCR encompasses research from some of the finest scholars in the field. With submissions detailing some of the most promising applications for technology in therapy, rehabilitation, gaming, and online studies, we are proud to publish studies that have laid the ground- work for this ever-changing field up to this point. This year we are focusing on more in-depth studies, while in 2008, many of our articles served as a review of specialty areas in cybertherapy and rehabilitation. I am grateful for all the authors’ hard work, groundbreaking ideas, and sci- entific rigor in disseminating findings to help progress our community. I am both pleased and honored to pub- lish the articles in this issue knowing full well the time, energy, and countless hours these papers required.
In our first paper, Tarnanas et al. describes the basic sys- tem architecture used for virtual reality (VR) emotional human agents and develops a new method of a relative scored personality measure. The article discusses the use of VR as a potential tool for personnel screening and selection in organizations.

The second article by King and Delfabbro evaluates the status of heavy game players in comparison with Australian normative data. The physical and mental health of over 400 users, described as “heavy” video game players, was assessed.

Next, Hoffman et al. studies how interactivity influences the magnitude of VR analgesia. Hoffman explores immer- sive VR as an alternative to traditional pain medications for burn victims during their treatment. The use of a high-tech helmet has broken ground on this interactive vs. non-inter- active VR study.

The fourth article by Kott et al. uses a VR system combined with treadmill training for children with cerebral palsy. This pilot study combines treatment with the element of playful gaming to incorporate rehabilitation and technolo- gy with a level of fun.

Dr. Griffiths, in our fifth article, examines Internet addic- tion behavior and the use of Internet help and therapy for those suffering from it. It also investigates various types of online help and therapy available for online problem gam- blers and evaluates their overall effectiveness.

Next, Russoniello et al. investigates the effectiveness of casual video games in improving mood and decreasing stress. Russoniello et al. discusses the possible use of games to help treat stress-related medical disorders, including diabetes and depression. This study points to the potential of video games to both prevent and treat stress-related medical orders.

Our final paper, by Zurlo and Riva, discusses electronic brainstorming for creative idea generation. The study examined how the personality traits of group members and the characteristics of the communication process may impact both group creativity and productivity.

Once more, I would like to thank the authors for their incredible work and dedication to this growing discipline. I also want to thank JCR’s Associate Editors: Professor Botella, Professor Bouchard, Professor Gamberini, and Professor Riva for their leadership and hard work; as well as our internationally renowned Editorial Board for their many contributions.    Our next issue will continue to explore the ways in which technology influences and enhances the healthcare of citizens throughout the world. JCR is interested in original research and ideas for future thematic issues from you, our readers. This is your journal, so please contact us with your interesting manuscripts and ideas. Thank you for your continuing support of JCR. The possibilities and potential for advanced technology in healthcare are unlimited, and I am proud to be a part of such a thriving and groundbreaking community. To employ a famous quote: “Together, we can make a difference!” We can change healthcare as we know it!



Brenda K. Wiederhold, Ph.D., MBA, BCIA

Editor-in-Chief, Journal of CyberTherapy & Rehabilitation

Virtual Reality Medical Institute

2008 Summer Editorial

Journal of Cybertherapy & Rehabilitation

Summer 2008, Volume 1, Issue 2



Welcome to the second issue of the Journal of CyberTherapy & Rehabilitation (JCR). This peer-reviewed academic journal continues to explore the uses of advanced technologies for therapy, training, education, prevention, and rehabilitation. JCR is a quarterly published academic journal, which focuses on the rapidly expanding worldwide trend of moving toward technological applications in healthcare. Our main interests include, but are not limited to, psychiatry, psychology, physical medicine and rehabilitation, neurology, occupational therapy, physical therapy, cognitive rehabilitation, neurorehabilitation, oncology, obesity, eating disorders, and autism, among many others.

Advanced technologies such as virtual reality (VR), robotics, non-invasive physiological monitoring, E-health, and adaptive displays are being applied to several areas of healthcare. New areas of research regarding the use of advanced technologies in healthcare are transforming this ever-changing field revealing new discoveries, aiding patients with both mental and physical disorders.

Since the debut of our inaugural issue, JCR has received international attention from peers, international institutions, and international conferences. The JCR is the official journal of the International Association of CyberTherapy & Rehabilitation (IACR) and the official journal of the CyberTherapy Conference series, the fourteenth annual confer- ence will be held in Verbania next June, which has gained interest from European high-level conferences on health- care to Ministers of Health all over the European continent. The IACR has recently collaborated with Med-e-Tel 2009, an international annual telehealth conference that draws an enormous and diverse attendance, after Med-e-Tel’s 2008 addition of telepsychiatry, to bring cybertherapy to another innovative field of healthcare. Both the Association and the Journal have been invited to European conferences on health and wellbeing, which has opened many doors for opportunities through our gained publicity. “Healthcare in Europe needs to change,” remarked Zofija Mazej- Kukovic, Slovenian Minister of Health and currently holding the European Union Presidency, while interviewing for the JCR. “I look forward to working with as many possible partners and organizations in the future.”

This issue of JCR features comprehensive articles by preeminent scholars in the field. This issue’s reviews and studies include some of the most promising applications for technology in therapy and rehabilitation, surveying the concepts and studies that laid the groundwork for the field up to this point. In the previous issue, the focus of the articles were an introduction for those new to the field as well as an expansion of knowledge of those well-estab- lished in their careers with newer applications for technology in healthcare. This issue has many new and innovative expansions on cybertherapy and healthcare in more focused fields. It is exciting to see the JCR evolve into new aspects of the field, moving technology and scientific findings, as well as our journal, into the transforming field of cybertherapy.

In the first paper, Gamberini writes an article on the continual usage of computer games in healthcare. Gamberini et al. focuses their article on proposing a review of existing research on computer games, exploited for prevention, support, training, rehabilitation, and specifically reviewing the relationship between cognitive processes and gaming. The article shows the success and ability to foster motivatation and to enhance cognitive processes.

The second article, by Mülberger et al. focuses virtual reality therapy on treatment for phobias, specifically on patients who suffer from spider phobia. “A Virtual Reality Behavior Avoidance Test (VR-BAT) for the Assessment of Spider Phobia” use virtual environments and spider scenarios for a behavior avoidance test, monitoring subjective anxiety, symptoms, heart rate, skin conductance, and approach behavior in 34 female patients. Their research found a very effective result for physiological assessment of fear.

The next article by Villani and Riva which is entitled, “The Role of Media in Supporting a Stress Management Protocol: An Experimental Study,” focuses on stress management and the sense of presence carried out through virtual environments. This article suggests the importance of the sense of presence as a mediating variable between the experience and the efficacy of the relaxation process, creating new advances in therapeutic approaches.

After that, Alcaniz et al. authored “Low-cost Virtual Motor Rehabilitation for Neurophysical Disability Improvements in Impaired Patients,” which attempts to find a new way of using technology to improve motor rehabilitation to customize exercises for patients. The end result brings promising outcomes, citing increased motivation for patients in the rehabilitation process.

Later is an article using technology and therapy to treat obese patients with emotional eating. “New Technologies and Relaxation: An Explorative Study on Obese Patients with Emotional Eating,” written by Manzoni et al. analyze stress and negative emotions as critical factors in inducing overeating in obese patients using virtual reality. The authors present several examples of the effectiveness of relaxation training using VR for emotional eating.

Hoffman et al., wrote the sixth article, “Pain Control During Wound Care for Combat-Related Burn Injuries Using Custom Articulated Arm Mounted Virtual Reality Goggles,” for the use of pain control for soldiers suffering from various combat-related wounds. The VR goggle system proved to distract and even entertain many patients during wound care, dropping pain from “severe” to “mild.” This article focuses mainly on burn victims using VR as an effec- tive adjunctive nonpharmacologic analgesic for reducing cognitive pain, emotion pain, and sensory components.

Finally, the article “Applying the Technology Acceptance Model to VR with People who are Favorable to its Use,” by Bertrand and Bouchard tests the Technology Acceptance Model as applied to the use of virtual reality in clinical settings. The results reveal that Intention to Use VR is predicted only by Perceived Usefulness, which then indicates how to better document the dissemination of virtual reality among clinicians.

The third issue of JCR will continue to explore the ways in which technology influences and enhances the healthcare of citizens in Europe and throughout the world. We are interested in receiving original research and ideas for future theme issues from our readership. Current topics being considered include non-manual displays, neurophysiology, VR and e-health for special populations including the elderly, pediatrics, and those with disabilities, among others. Please contact us with your interesting manuscripts and ideas for additional topics for the Journal, and thank you for your support of this promising new publication.



Brenda K. Wiederhold, Ph.D., MBA, BCIA

Editor-in-Chief, Journal of CyberTherapy & Rehabilitation

Virtual Reality Medical Institute