CyberTherapy 2008

Pre-Conference Workshops
Workshop Chair: Walter Greenleaf, PhD
Sunday, June 22, 2008

WS #1: Basic Issues about Virtual Reality and its Clinical Applications
Stéphane Bouchard, PhD – Université du Québec en Outaouais
Evelyne Klinger, PhD – Arts et Métiers ParisTech Angers-Laval

This introduction workshop presents on the one hand concepts that are essentials to understand if one is interested in using virtual reality in clinical applications, such as: what is virtual reality, what kind of equipment is involved, what is the feeling of presence, what is cybersickness and how to prevent it, how to get or create virtual environments, etc. Practical guidelines will be offered to conduct safer virtual immersions. It is highly recommended for people who are new to the field of virtual reality. These information will not be introduced in the more advanced workshops presented during the afternoon. On the other hand, participants to this introduction workshop will be able to try and test some VR interfaces such as HMD.

WS #2: Bridging Basic Pain Research, Conventional Pain Treatments and VR Pain Treatments
David A. Thomas, PhD – National Institute on Drug Abuse
Jeffrey I. Gold, PhD
Linda Sorkin, Ph.D.

Virtual reality (VR) has gained recognition as a means of attenuating pain during medical procedures. However, there have been only a handful of investigations into the neurobiological mechanisms associated with VR’s efficacy. In this workshop, the neurobiology and psychophysiology of pain will be overviewed, including the mechanisms of action of conventional pain treatments. An overview of our understanding of the efficacy of VR at reducing pain will also be given. Then, participants will integrate these two fields by drawing parallels between the underlying mechanisms of conventional pain treatments and those supposed to underlie VR-based pain treatments.

WS #3: VR and Neurological Assessment/Rehabilitation & Neuroscience
Albert “Skip” Rizzo, PhD – University of Southern California

Neuropsychological assessment often suffers from problems with ecological validity where tests being used rarely predict performance in real-life situations. By reproducing physical reality in a standard and replicable fashion, virtual reality can be used to assess neuropsychological disorders in ways that are potentially more systematic and precise. In addition to measuring behavior, it also is experimentally of interest to measure nervous system function more directly. To that end, we have successfully used VR to measure brain responses during functional magnetic resonance imaging, as well as to measure cardiac (ECG) and arousal measure (i.e.galvanic skin responses) while participants are engaged in VR cognitive tasks. The presenters will provide an overview of the field of neuropsychological assessment and cognitive rehabilitation VR applications, and detail their strengths and limitations. They will also discuss both the hardware and software issues involved in collecting simultaneous central and peripheral nervous system measures during VR neuropsychological assessment.

WS #4: VR and the Treatment of Anxiety Disorders
Brenda K. Wiederhold, PhD, MBA, BCIA – Virtual Reality Medical Center, Interactive Media Institute
Stéphane Bouchard, PhD – Université du Québec en Outaouais

The key therapeutic ingredient in the treatment of anxiety disorders is referred to as exposure. Exposure consists essentially in having the patient face the fear situation. Exposure has been integrated in more sophisticated treatment packages that are now considered among the few really effective treatments available for mental disorders such as specific phobias, social anxiety, posttraumatic stress disorder, and panic disorder with agoraphobia. Empirical studies conducted by researchers around the world are showing more and more convincingly that virtual reality can be used to successfully conduct exposure. In addition to reviewing the literature on this form of therapy, treatment packages will be presented and tips to conduct effective exposure will be provided. A basic knowledge of anxiety disorders treatment is assumed for participants of this advanced workshop.

WS #5: VR and the Treatment of Eating Disorders, Obesity and Addiction
Giuseppe Riva, PhD – Istituto Auxologico Italiano
Azucena Garcia-Palacios, PhD – Universitat Jaume I

Eating Disorders:
VR has a clinical potential in the treatment of eating disorders and body-image problems. The experiential approach of VR allows the therapist to immerse the patient in virtual environments where her body-image can be confronted and more adaptive eating behavior can be practiced. To detail this approach, will be described, followed by the presentation of two different treatment protocols.

In the last 5 years research using virtual reality to study alcohol and drug addiction has begun to emerge with greater frequency. Initial studies have demonstrated the feasibility of VR for assessing craving and reactivity to drug cues/triggers. At present, VR tools and environments have been developed for the treatment of drug dependence, and are now being tested in controlled trials. Experts in VR and addictions will present an overview of addictions covering theories and applications of VR in nicotine, marijuana, alcohol, methamphetamine, and cocaine dependence. Workshop participants will gain an in-depth understanding of cue reactivity assessment and treatment of substance dependence using the latest VR environments. Future research directions and opportunities for funding and collaborations will be addressed.

WS #6: VR and Motor Rehabilitation
Cali M. Fidopiastis, PhD – Institute for Simulation and Training at the University of Central Florida

Physical and occupational therapists aim to enhance the functional ability of individuals with motor impairment as well as their capacity to participate in daily life activities. For many injuries and disabilities, the rehabilitation process is long and arduous, and therapists face the challenge of finding effective and motivating intervention tools that will facilitate this process. Virtual Reality-based rehabilitation appears to provide an answer to this challenge via its well-known assets including the opportunity for interactive learning, the ability to quantify clinical outcome measures and to provide safe and ecologically-valid environments. Virtual reality facilitates the provision of functional tasks that may be graded to meet specific therapeutic objectives and client capabilities. Although the advantages of Virtual Reality are becoming more widely recognized within the clinical community, the rehabilitation team faces a daunting challenge – to find a VR system that enables achievement of the goals stated above, is feasible to implement within a clinical setting and yet is affordable by the typical clinical facility. Moreover, it is desirable that the VR system will not excessively encumber the clients nor expose them to disturbing side effects. The objective of this workshop is to present the principles of VR-based therapy for motor rehabilitation in terms of a comparison to the achievement of therapeutic objectives via conventional intervention. Experimental results from the literature will be used to support the clinical applications of VR.

WS #7: Presence and Cybertherapy
Cheryl Bracken, PhD – Cleveland State University
Anna Spagnolli, PhD – University of Padova, Italy

How is it that people can treat mediated stimuli as if it were real? The concept of presence or the perceptual illusion of non-mediation addresses this question. How active must the patient/participant be in order to experience this sense of presence? Can a patient experience too much presence? Research suggests there is a threshold for presence in virtual environment. This workshop will answer these questions and draw from the literature on presence and therapy.

WS #8: Brain-Computer Interface (BCI)
Christoph Guger, PhD – Guger Technologies OEG

The Brain-Computer Interface research area is a fast expanding field in the world of biomedical engineering. BCIs have been developed during the last years for people with severe disabilities to improve their quality of life. Applications of BCI systems comprise the restoration of movements, communication and environmental control. However, recently BCI applications have been also used in different research areas e.g. in the field of virtual reality. The workshop gives insight into the hardware and software components for BCI research. Biosignal amplifiers, feature extraction algorithms and classification algorithms will be discussed. Furthermore the usage of motor commands for cursor control and the P300 component for spelling text will be shown. Visitors are welcome to test their BCI performance during the workshop. Furthermore the usage of BCIs for prosthetic devices and Virtual Reality will be shown.

Post-Conference Workshop
Thursday, June 26th, 2008

WS #9: Virtual Reality Assisted Exposure Therapy in the Treatment of PTSD
Jim Spira, PhD, MPH, ABPP – Clinical Professor, University of California, San Diego
Virtual Reality Medical Center

This intermediate/advanced workshop trains clinicians to use VR systems and physiological monitoring in order to facilitate exposure based treatment of PTSD, including combat and civilian in origin. Three major approaches to exposure will be discussed, and strengths and weaknesses of each being discussed and demonstrated. These include flooding type approaches (maintaining maximum arousal), gradual exposure with minimal arousal , and graded exposure eliciting high arousal and training in arousal control. Cognitive (attentional) and autonomic control techniques will be taught. Imagery and Self-hypnosis techniques will be taught for inter-session practice by patients, and for clinicians without access to VR equipment.