Long COVID and Self-Management Strategies

New Editorial Alert: “The Path Forward: Self-Management Strategies for Long COVID” is now featured in the Cyberpsychology, Behavior, and Social Networking Journal, published by Mary Ann Liebert, Inc. Publishers.

In the midst of the ongoing pandemic, the need to understand and manage Long COVID is more important than ever. This editorial explores the complexities of Long COVID, a condition affecting millions worldwide with a wide range of life-altering symptoms.

#LongCOVID #HealthcareInnovation #Telehealth #DigitalHealth #Cyberpsychology #PublicHealth #VR #DTx

https://www.liebertpub.com/doi/10.1089/cyber.2023.29305.editorial

 

Virtual Reality Exposure Therapy

http://www.theatlantic.com/health/archive/2016/08/exposure-therapy/496547/

Exposure therapy, a form of cognitive behavioral therapy, involves subjecting patients to increasing amounts of things they fear, or otherwise hope to avoid. It is one of the great success stories of mental health, and it’s not just for phobias…

Recently, a more palatable route has been introduced with virtual reality. The Virtual Reality Medical Center in La Jolla, for example, offers VR therapy for all manner of fears. Heights, driving, needles and blood, spiders, enclosed spaces—you name it, they treat it. First steps in traditional phobia treatment sometimes involve imagining fearful scenarios, but a patient’s mind is naturally resistant to those thoughts and will go to some lengths to avoid fleshing out terrifying visions. Virtual reality scenarios have proved useful in social phobias, wherein patients have a debilitating fear of interacting with other people.

www.vrphobia.eu

www.vrphobia.com

www.fearofflyingexpert.com

frontoffice@vrphobia.com

9834 Genesee Avenue, Suite 427, La Jolla, CA 92037

Virtual Reality-Based Therapy Can Help Overcome PTSD and Other Disorders

By Shiva Reddy

Research shows that Virtual Reality-based Graded Exposure Therapy (GET) techniques can improve PTSD symptoms and associated disorders, indicating wider potential applications of Virtual Reality in psychotherapy.

In the recent past, virtual reality has attracted much attention as a potential method for psychotherapy to treat patients with phobiasaddictionsanxiety disorders and posttraumatic stress disorder. Various techniques based on virtual reality—such as virtual reality immersion therapy (VRIT), and virtual reality graded exposure therapy (VR-GET)—have been experimented with and proven to be very effective.

Posttraumatic Stress Disorder and Exposure Therapy

Posttraumatic stress disorder (PTSD) may develop when a person goes through one or more traumatic events such as sexual assault, serious injury, narrowly escaping death, domestic violence or watching a fellow soldier die on the battlefield.

People with PTSD typically suffer from disturbing recurring flashbacks, hyperarousal, bad dreams, frightening thoughts, emotional numbness and strong feelings of depression, guilt and worry.

Exposure therapy, a Cognitive Behavior Therapy (CBT) technique, is the most widely employed tool to help victims manage PTSD symptoms. By helping patients to confront—rather than avoid—the memory of the traumatic event, exposure therapy techniques support the ability to overcome anxieties and fears.

Using other relaxation techniques, victims slowly gain control over responses to traumatic events and learn to cope in a much better way. Exposure therapy has been found to be very effective in treating PTSD, and has a high success rate in treating patients with specific phobias.

Virtual Reality Exposure Therapy

Virtual reality, with its advanced visual immersion devices, specially programmed computers, and three-dimensional artificially created virtual environments, takes exposure therapy to a whole new level—allowing the patient to confront a traumatic experience in a safe and controlled manner.

The most extensive research regarding the applications for VR-based therapy for treating posttraumatic stress disorder was funded by the Office of Naval Research, starting in 2005. This initiative was part of a program to develop new technologies to assist combat veterans of Iraq/Afghanistan in managing PTSD symptoms.

Using new software, hardware, simulations, physiologic monitoring, skills training and therapeutic methods based on Virtual Reality, scientists have experimented with exposing combat veterans to their traumatic experiences in a graded manner.

The advantage of this VR-based Graded Exposure Therapy (VR-GET) is that it helps patients who find it difficult to identify or talk about a traumatic event—which impacts the ability to learn the required skills to cope with a number of anxiety-inducing situations.

In this setting, the combat veteran relives the traumatic episode in a simulation that captures the essential elements of the event—all in a safe and controlled manner—while trying to recognize and manage any excessive autonomic arousal and cognitive reactivity.

 

For the full article, click here.

Virtual Reality Exposure Therapy

http://www.theatlantic.com/health/archive/2016/08/exposure-therapy/496547/

Exposure therapy, a form of cognitive behavioral therapy, involves subjecting patients to increasing amounts of things they fear, or otherwise hope to avoid. It is one of the great success stories of mental health, and it’s not just for phobias…

Recently, a more palatable route has been introduced with virtual reality. The Virtual Reality Medical Center in San Diego, for example, offers VR therapy for all manner of fears. Heights, driving, needles and blood, spiders, enclosed spaces—you name it, they treat it. First steps in traditional phobia treatment sometimes involve imagining fearful scenarios, but a patient’s mind is naturally resistant to those thoughts and will go to some lengths to avoid fleshing out terrifying visions. Virtual reality scenarios have proved useful in social phobias, wherein patients have a debilitating fear of interacting with other people.

www.vrphobia.eu

www.vrphobia.com

www.fearofflyingexpert.com

+1 858 642 0267

frontoffice@vrphobia.com

When Pain Is the Best Therapy

By Jessa Gamble

 In the vast arboretum near my home, ducks clamor on pond shores as shrieking children throw bread. The bike path bustles with university students, and, in winter, the adjacent canal teems with skaters. But for me, any health benefits that accrue from a brisk walk in the park are—I’m convinced—counteracted by the stress of encountering an off-leash dog.

My profound discomfort with canines may not rise to the level of phobia, but it is usually enough to turn a pleasant experience into a trial. When I see a dog, I may abruptly take a wide detour, or turn around altogether. Nevertheless, while easy, this approach probably isn’t helping me overcome my fear. According to science, the best solution to my dog problem is more dogs.

Exposure therapy, a form of cognitive behavioral therapy, involves subjecting patients to increasing amounts of things they fear, or otherwise hope to avoid. It is one of the great success stories of mental health, and it’s not just for phobias. Research on cases of intense fear and even traumatic brain injury shows that for a number of problems, the only way out is through.

After a concussion, for instance, many people find themselves unable to work. Reading for any length of time kicks off bouts of dizziness and a bright light could bring on crashing headaches. Even thinking for any length of time is exhausting. Anything but sitting still and sheltering the mind feels like a dangerous activity. That aversion to pain is perfectly natural, but it can lead to a stalled-out recovery.

Though the vast majority of concussion sufferers are fully recovered within three months or so, a “miserable minority”—5 percent or so—have persistent, debilitating symptoms. Long-term follow up shows no improvement, and even deterioration years down the road. Until recently there was no proven treatment for this seemingly permanent damage to quality of life.

The best treatment for overcoming concussions is a type of cognitive-behavioral therapy that includes going back to work for a longer workday each week, and exercising with progressively greater intensity, even if one’s symptoms come roaring back with a vengeance. Only by pushing through the misery, it seems, can the brain get back to its normal activities.

Exposure therapy is also a highly effective tool for overcoming post-traumatic stress. Reliving the battlefield from the safety of a peacetime environment has been shown to gradually remove the expectation of harm from the memory.

Ethically, for both concussions and PTSD, however, a treatment that consists of suffering is a tough sell for doctors, who have taken an oath not to do harm. The approach is one of the most underutilized treatments for PTSD, because psychologists are deeply uncomfortable with re-traumatizing their patients. And exposure therapy also holds little appeal in the short run for patients. For a concussion-sufferer, seeking out more pain feels like exactly the wrong thing to do.

Of course, many other medical treatments are also painful, and the long-term benefits are considered worth the trade-off. But in the case of exposure therapy, there is no palliative option—no anesthetic or painkiller—because the discomfort is not a side effect, it’s the main event.

Recently, a more palatable route has been introduced with virtual reality. The Virtual Reality Medical Center in San Diego, for example, offers VR therapy for all manner of fears. Heights, driving, needles and blood, spiders, enclosed spaces—you name it, they treat it. First steps in traditional phobia treatment sometimes involve imagining fearful scenarios, but a patient’s mind is naturally resistant to those thoughts and will go to some lengths to avoid fleshing out terrifying visions. Virtual reality scenarios have proved useful in social phobias, wherein patients have a debilitating fear of interacting with other people.

For social phobias, exposure therapy in the real world is hard to control, because social interactions are so complex and unpredictable. A course of virtual-reality therapy will lead the patient through a number of exercises. First they might have to approach someone on the street or walk into a party where people turn to look at them. Finally, they might have to greet guests and—one of the most common of all fears—give a speech.

The practical drawback of virtual-reality therapy is that immersive environments are expensive to create and phobias come in many varieties. If someone has a paralyzing fear of paperclips, they are unlikely to find an off-the-shelf exposure program to treat them. That’s why others are turning to augmented reality, where the real, physical world is supplemented by input—either visual or audio—from a computer.

A head-up display screen that a patient looks through, for instance, can simply overlay a real-world environment with progressively closer-moving images of that patient’s feared object. Children who fear cockroaches can build up their courage until those insects appear to be walking all over their hands. Augmented reality treatment seems to be as effective long term for small animal phobias as actual exposure to those animals.

Only 8 percent of phobia sufferers seek professional help for it, and fear of the treatment itself may be part of that. I am unlikely to subject myself to any more dogs than I already encounter in a given day, though a computerized dog sounds just about manageable. If some newer treatments are more humane, others still turn to that old maxim: No pain, no gain.

 

For original article, click here.

INTERSTRESS project

stress

 

 

Through various techniques, such as relaxation, visualization, biofeedback and cognitive behavioral therapy (CBT),  stress management therapy can help to overcome the negative effects of stress. The INTERSTRESS project had a looked more closely on CBT protocols for treatment and prevention of psychological stress and burnout. This 3-year research study funded under the FP7 program by DG-CONNECT, European Commission, was completed in February 2014, and deliver us here its findings.

 

 

In the standard CBT protocol for stress management, imagination and/or exposure evoke emotions, and the meaning of the associated feelings can be changed through reflection and relaxation. The INTERSTRESS project went a step beyond:  allowing participants (school teachers and nurses) to control experiences that evoke emotions, resulting in meaningful new feelings, which can then be considered and ultimately changed through reflection and relaxation.  Allowing the participants to be actively involved, with a measure of control, helped to improve self-confidence and self-efficacy.

Although traditional CBT focuses directly on modifying dysfunctional thoughts through a rational and deliberate process, INTERSTRESS focused on modification through a more contextualized, experiential process. In the INTERSTRESS training, individuals were actively involved in the learning process, experiencing stressful situations reproduced in virtual environments and reflecting on the stress level in their daily life with the help of advanced technology, Virtual Reality, Smartphones and biofeedback sensors.

 

 

From a clinical point of view, the INTERSTRESS solution offers the following advantages to existing traditional CBT protocols for stress management:

  1. integrated and quantitative assessment of the user’s stress level using biosensors and behavioral analysis: the level of stress is continuously assessed in the virtual world by recording the participant’s behavioral and emotional status;
  2. provision of motivating feedback to improve self-awareness, compliance and long-term outcomes. (Participants receive feedback of their emotional and physical state to improve their appraisal and coping skills in an engaging and motivating fashion.)

 

 

Virtual Reality Medical Institute, VRMI, was the Dissemination Exploitation Workpackage Leader for the INTERSTRESS Project as well as a Clinical Partner and leader of the Marketing Trials.  We are now proud to announce that we are the first provider of the INTERSTRESS solution in a private practice setting, proving that positive research achieved can be successfully translated into real world settings, helping individuals achieve relief long after the project is complete.

We offer these services in Belgium, California and China.  For more information on locations please visit our contact page at:  http://vrphobia.eu/contact or email us at research @ vrphobia.eu.

 

For more information on the research and the treatment, a Pdf is available here.

Posttraumatic stress disorder

PTSD2

 

Posttraumatic stress disorder (PTSD) may develop when a person goes through one or more traumatic events such as sexual assault, serious injury, narrowly escaping death, domestic violence or watching a fellow soldier die on the battlefield. People with PTSD typically suffer from disturbing recurring flashbacks, hyperarousal, bad dreams, frightening thoughts, emotional numbness and strong feelings of depression, guilt and worry.

 

 

Exposure therapy, a Cognitive Behavior Therapy (CBT) technique, is the most widely employed tool to help victims manage PTSD symptoms. By helping patients to confront—rather than avoid—the memory of the traumatic event, exposure therapy techniques support the ability to overcome anxieties and fears. Using other relaxation techniques, victims slowly gain control over responses to traumatic events and learn to cope in a much better way. Exposure therapy has been found to be very effective in treating PTSD, and has a high success rate in treating patients with specific phobias.

Virtual reality, with its advanced visual immersion devices, specially programmed computers, and three-dimensional artificially created virtual environments, takes exposure therapy to a whole new level—allowing the patient to confront a traumatic experience in a safe and controlled manner.

 

 

The most extensive research regarding the applications for VR-based therapy for treating posttraumatic stress disorder was funded by the Office of Naval Research, starting in 2005. This initiative was part of a program to develop new technologies to assist combat veterans of Iraq/Afghanistan in managing PTSD symptoms.

Using new software, hardware, simulations, physiologic monitoring (biofeedback), skills training and therapeutic methods based on Virtual Reality, VRMC (Virtual Reality Medical Institute’s California-based affiliate), designed,  developed, tested and clinically validated VR and biofeedback in a randomized clinical trial carried out at Balboa Naval Hospital and Camp Pendleton Marine Base in Southern California.  The development began after holding focus groups with returning military men and women, to bring in the content and cues that were most important to them as the end users.

The advantage of this VR-based Graded Exposure Therapy (VR-GET) is that it helps patients who find it difficult to identify or talk about a traumatic event—which impacts the ability to learn the required skills to cope with a number of anxiety-inducing situations.

In this setting, the combat veteran relives the traumatic episode in a simulation that captures the essential elements of the event—all in a safe and controlled manner—while trying to recognize and manage any excessive autonomic arousal and cognitive reactivity.

 

 

 

VRMC’s  VR system and protocols are now in use in active duty and veteran’s facilities throughout the U.S. as well as in Poland and Croatia, to serve coalition troops.  It is now with great pride that we announce that Virtual Reality Medical Institute, VRMI, will be the first to offer this treatment in Western Europe.  For more information, or to schedule a consultation session, please email us at research @  vrphobia.eu.

 

 

 

Press release

Virtual Reality-Based Therapy Can Help Overcome PTSD and Other Disorders

In the recent past, virtual reality has attracted much attention as a potential method for psychotherapy to treat patients with phobias, addictions, anxiety disorders andposttraumatic stress disorder. Various techniques based on virtual reality—such as virtual reality immersion therapy (VRIT), and virtual reality graded exposure therapy (VR-GET)—have been experimented with and proven to be very effective.

Posttraumatic Stress Disorder and Exposure Therapy

Posttraumatic stress disorder (PTSD) may develop when a person goes through one or more traumatic events such as sexual assault, serious injury, narrowly escaping death, domestic violence or watching a fellow soldier die on the battlefield.

People with PTSD typically suffer from disturbing recurring flashbacks, hyperarousal, bad dreams, frightening thoughts, emotional numbness and strong feelings of depression, guilt and worry.

Exposure therapy, a Cognitive Behavior Therapy (CBT) technique, is the most widely employed tool to help victims manage PTSD symptoms. By helping patients to confront—rather than avoid—the memory of the traumatic event, exposure therapy techniques support the ability to overcome anxieties and fears.

Using other relaxation techniques, victims slowly gain control over responses to traumatic events and learn to cope in a much better way. Exposure therapy has been found to be very effective in treating PTSD, and has a high success rate in treating patients with specific phobias.

Virtual Reality Exposure Therapy

Virtual reality, with its advanced visual immersion devices, specially programmed computers, and three-dimensional artificially created virtual environments, takes exposure therapy to a whole new level—allowing the patient to confront a traumatic experience in a safe and controlled manner.

The most extensive research regarding the applications for VR-based therapy for treating posttraumatic stress disorder was funded by the Office of Naval Research, starting in 2005. This initiative was part of a program to develop new technologies to assist combat veterans of Iraq/Afghanistan in managing PTSD symptoms.

Using new software, hardware, simulations, physiologic monitoring, skills training and therapeutic methods based on Virtual Reality, scientists have experimented with exposing combat veterans to their traumatic experiences in a graded manner.

The advantage of this VR-based Graded Exposure Therapy (VR-GET) is that it helps patients who find it difficult to identify or talk about a traumatic event—which impacts the ability to learn the required skills to cope with a number of anxiety-inducing situations.

In this setting, the combat veteran relives the traumatic episode in a simulation that captures the essential elements of the event—all in a safe and controlled manner—while trying to recognize and manage any excessive autonomic arousal and cognitive reactivity.

Read a full article here.

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