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PubMed1995

Reality orientation therapy in Alzheimer disease: useful or not? A controlled study.

The aim of this controlled study was to evaluate the effects of a long-term program of formal didactic group therapy [class reality orientation therapy (ROT)] in Alzheimer disease. The study was conducted in the day hospital of an Alzheimer Dementia Research and Care Unit (Brescia, Italy), a multidisciplinary care center providing diagnostic evaluation and treatment for elderly patients with cognitive impairment. The criteria for the inclusion of patients in the study were mild to moderate cognitive impairment [Mini Mental Status Examination (MMSE) between 11 and 24/30] and absence of major aphasia, blindness, and overt behavioral disturbances such as wandering or agitation. Sixteen patients constituted the experimental group and 12 the control group. The last cognitive, functional, and affective evaluation in the experimental and control group was performed 8.2 and 8.5 months after baseline assessment, respectively. The experimental group had repeated cycles of 1-month ROT classes, and 5-7 weeks was allowed between each cycle. Differential change for MMSE score between the two groups was significant. In the experimental group, there was mild improvement in MMSE score (0.68 point) at the last assessment, whereas the control group declined (-2.58 points). This treatment effect on MMSE score (3.27 points) was controlled for potential confounders in a multiple regression analysis. Adjusted treatment effect, including age, education, baseline MMSE, disease duration, disease severity, number of diseases other than Alzheimer, and time elapsing from baseline to last assessment, was very slightly lower: 3.12. In the experimental group, treatment effect was evaluated by comparing ROT cycle changes and resting period changes. A clearly significant treatment effect was found for MMSE and verbal fluency.

Aged↗
PubMed2004

Virtual reality exposure therapy of anxiety disorders: a review.

Virtual reality exposure therapy (VRET) is an altered form of behavioral therapy and may be a possible alternative to standard in vivo exposure. Virtual reality integrates real-time computer graphics, body tracking devices, visual displays, and other sensory input devices to immerse patients in a computer-generated virtual environment. Research on this type of treatment for anxiety disorders is discussed in this article, and the mediating and moderating variables that influence VR treatment effectiveness as well. Evidence is found that VRET is effective for participants with fear of heights and of flying. For other phobias, research to date is not conclusive. More randomized clinical trials in which VRET is compared with standard exposure are required. Furthermore, studies are needed in which VRET is not just a component of the treatment package evaluated, but in which VRET should be assessed as a stand-alone treatment.

Anxiety Disorders↗
PubMed2005

Current status of virtual reality exposure therapy in anxiety disorders: editorial review.

PURPOSE OF REVIEW: In recent years, a considerable number of publications have appeared on different aspects of virtual reality exposure therapy in the treatment of anxiety disorders. The purpose of the present article is to review the evidence that has emerged to support the potential of this therapy in the treatment of anxiety disorders. RECENT FINDINGS: Case histories and open comparative studies, as well as randomized controlled studies, have been published on the use of virtual reality exposure therapy in the treatment of anxiety disorders. Most studies in the field have been on specific phobias, in particular on fear of flying, acrophobia, fear of driving, claustrophobia and fear of spiders. In addition, several studies have been published on the use of virtual reality exposure therapy for social anxiety disorders, posttraumatic stress disorder and panic disorder with or without agoraphobia. SUMMARY: Recent studies provide evidence that virtual reality exposure therapy is a promising tool for the treatment of several anxiety disorders.

Editorial↗
PubMed2006

Virtual reality exposure therapy: 150-degree screen to desktop PC.

Virtual reality exposure therapy (VRET) developed using immersive or semi-immersive virtual environments present a usability problem for practitioners. To meet practitioner requirements for lower cost and portability VRET programs must often be ported onto desktop environments such as the personal computer (PC). However, success of VRET has been shown to be linked to presence, and the environment's ability to evoke the same reactions and emotions as a real experience. It is generally accepted that high-end virtual environments (VEs) are more immersive than desktop PCs, but level of immersion does not always predict level of presence. This paper reports on the impact on presence of porting a therapeutic VR application for schizophrenia from the initial research environment of a semi-immersive curved screen to PC. Presence in these two environments is measured both introspectively and across a number of causal factors thought to underlie the experience of presence. Results show that the VR exposure program successfully made users feel they were "present" in both platforms. While the desktop PC achieved higher scores on presence across causal factors participants reported they felt more present in the curved screen environment. While comparison of the two groups was statistically significant for the PQ but not for the IPQ, subjective reports of experiences in the environments should be considered in future research as the success of VRET relies heavily on the emotional response of patients to the therapeutic program.

Adolescent↗
PubMed1995

[Skin and gene therapy. Hopes and realities].

Genetic therapy is developing rapidly in dermatology. Because they are highly accessible and can be cultured and grafted, skin cells are an excellent application for this still experimental therapeutic approach. There are several possible applications in skin diseases. In this review we discuss the techniques of gene transfer, experimental results and future perspectives as well as the limitations of this new therapeutic strategy.

Adenoviridae↗
PubMed1999

Virtual reality exposure therapy for PTSD Vietnam Veterans: a case study.

Virtual reality (VR) integrates real-time computer graphics, body tracking devices, visual displays, and other sensory input devices to immerse a participant in a computer-generated virtual environment that changes in a natural way with head and body motion. VR exposure (VRE) is proposed as an alternative to typical imaginal exposure treatment for Vietnam combat veterans with posttraumatic stress disorder (PTSD). This report presents the results of the first Vietnam combat veteran with PTSD to have been treated with VRE. The patient was exposed to two virtual environments, a virtual Huey helicopter flying over a virtual Vietnam and a clearing surrounded by jungle. The patient experienced a 34% decrease on clinician-rated PTSD and a 45% decrease on self-rated PTSD. Treatment gains were maintained at 6-month follow-up.

Humans↗
PubMed2006

The role of presence in virtual reality exposure therapy.

A growing body of literature suggests that virtual reality is a successful tool for exposure therapy in the treatment of anxiety disorders. Virtual reality (VR) researchers posit the construct of presence, defined as the interpretation of an artificial stimulus as if it were real, to be a presumed factor that enables anxiety to be felt during virtual reality exposure therapy (VRE). However, a handful of empirical studies on the relation between presence and anxiety in VRE have yielded mixed findings. The current study tested the following hypotheses about the relation between presence and anxiety in VRE with a clinical sample of fearful flyers: (1) presence is related to in-session anxiety; (2) presence mediates the extent that pre-existing (pre-treatment) anxiety is experienced during exposure with VR; (3) presence is positively related to the amount of phobic elements included within the virtual environment; (4) presence is related to treatment outcome. Results supported presence as a factor that contributes to the experience of anxiety in the virtual environment as well as a relation between presence and the phobic elements, but did not support a relation between presence and treatment outcome. The study suggests that presence may be a necessary but insufficient requirement for successful VRE.

Adaptation, Psychological↗
PubMed2005

Reality orientation therapy combined with cholinesterase inhibitors in Alzheimer's disease: randomised controlled trial.

BACKGROUND: Reality orientation therapy combined with cholinesterase inhibitors has not been evaluated in patients with Alzheimer's disease. AIMS: To perform such an evaluation. METHOD: We randomly assigned 79 of 156 patients treated with donepezil to receive a reality orientation programme. Caregivers of the treatment group were trained to offer the programme at home 3 days a week, 30 min/day, for 25 consecutive weeks, and were invited to stimulate and involve patients in reality-based communication. RESULTS: The treatment group showed a slight improvement in Mini-Mental State Examination (MMSE) scores (mean change +0.2, s.e.=0.4) compared with a decline in the control group (mean change -1.1, s.e.=0.4; P=0.02). Similarly for the Alzheimer's Disease Assessment Scale--Cognition (treatment group mean change +0.4, s.e.=0.8; control group -2.5, s.e.=0.8; P=0.01). The intervention had an equal effect on cognition in those with mild (MMSE score > or = 20) and moderate (score <20) dementia. No significant effect was observed for behavioural and functional outcomes. CONCLUSIONS: Reality orientation enhances the effects of donepezil on cognition in Alzheimer's disease.

Adult↗
PubMed2001

Virtual reality exposure therapy for Vietnam veterans with posttraumatic stress disorder.

BACKGROUND: Virtual reality (VR) integrates real-time computer graphics, body-tracking devices, visual displays, and other sensory input devices to immerse a participant in a computer-generated virtual environment that changes in a natural way with head and body motion. VR exposure (VRE) is proposed as an alternative to typical imaginal exposure treatment for Vietnam combat veterans with posttraumatic stress disorder (PTSD). METHOD: This report presents the results of an open clinical trial using VRE to treat Vietnam combat veterans who have DSM-IV PTSD. In 8 to 16 sessions, 10 male patients were exposed to 2 virtual environments: a virtual Huey helicopter flying over a virtual Vietnam and a clearing surrounded by jungle. RESULTS: Clinician-rated PTSD symptoms as measured by the Clinician Administered PTSD Scale, the primary outcome measure, at 6-month follow-up indicated an overall statistically significant reduction from baseline (p = .0021) in symptoms associated with specific reported traumatic experiences. All 8 participants interviewed at the 6-month follow-up reported reductions in PTSD symptoms ranging from 15% to 67%. Significant decreases were seen in all 3 symptom clusters (p < .02). Patient self-reported intrusion symptoms as measured by the Impact of Event Scale were significantly lower (p < .05) at 3 months than at baseline but not at 6 months, although there was a clear trend toward fewer intrusive thoughts and somewhat less avoidance. CONCLUSION: Virtual reality exposure therapy holds promise for treating PTSD in Vietnam veterans.

Follow-Up Studies↗
PubMed1997

Virtual reality exposure therapy.

It has been proposed that virtual reality (VR) exposure may be an alternative to standard in vivo exposure. Virtual reality integrates real-time computer graphics, body tracking devices, visual displays, and other sensory input devices to immerse a participant in a computer-generated virtual environment. Virtual reality exposure is potentially an efficient and cost-effective treatment of anxiety disorders. VR exposure therapy reduced the fear of heights in the first controlled study of virtual reality in treatment of a psychiatric disorder. A case study supported the efficacy of VR exposure therapy for the fear of flying. The potential for virtual reality exposure treatment for these and other disorders is explored, and therapeutic issues surrounding the delivery of VR exposure are discussed.

Fear↗
PubMed2001

Reality orientation therapy to delay outcomes of progression in patients with dementia. A retrospective study.

OBJECTIVE: To evaluate the impact of continued Reality Orientation Therapy (ROT) in delaying the outcomes of dementia progression. DESIGN: Retrospective study. Data collection was based on review of clinical charts and on telephone interviews performed with patients or primary caregivers. SETTING: Day hospital of the Alzheimer's Disease Unit, Brescia (Italy). SUBJECTS: Seventy-four patients enrolled in at least one cycle of ROT from 1994 to 1998 were studied. INTERVENTIONS: Rehabilitative intervention based on formal ROT. MAIN OUTCOME MEASURES: This study analysed the time to the occurrence of any of the following: cognitive decline on Mini-Mental State Examination scores, urinary incontinence as an index of functional decline, institutionalization, and death. RESULTS: Data on a 30-month period after the first ROT session were analysed. We compared 46 patients (treatment group) who completed from 2 to 10 ROT cycles (corresponding to 8-40 weeks of training; mean = 15.48) with 28 patients (control group) who completed only one ROT cycle (4 weeks). Treatment group showed higher estimated survival rates than control group on cognitive decline (p = 0.022) and institutionalization (p = 0.002). The relative risks for cognitive decline and institutionalization in the control group compared with treatment group were 0.60 (p = 0.014), and 0.42 (p = 0.021), respectively. CONCLUSIONS: Continued ROT classes during the early to middle stages of dementia may delay nursing home placement and slow down the progression of cognitive decline.

Aged↗
PubMed2002

Vascular gene therapy: a reality of the 21st century.

Current therapies for the treatment of atherosclerotic vascular disease are aimed at either disrupting or bypassing flow-limiting lesions. Preventative strategies are necessary to decrease the burden of disease but are limited by genetic predispositions to certain diseases and the body's innate response to injury. Gene therapy, defined as the purposeful therapeutic overexpression or attenuation of a gene product, has enormous potential benefits in vascular disease prevention and treatment strategies. This article reviews the scientific considerations involved in the development of gene therapy strategies and outlines some of the gene products that are currently being used. These interventional genetic approaches will be reviewed in the context of specific vascular disease processes, including atherosclerosis, restenosis, and thrombosis. Gene therapy will serve an enhancing and adjuvant role to evolving surgical therapies.

Animals↗
PubMedDate not supplied

Virtual reality exposure therapy in the treatment of fear of flying: a case report.

The efficacy of virtual reality (VR) exposure therapy was examined for the fear of flying. Virtual reality exposure involved six sessions of graded exposure to flying in a virtual airplane. The specific contribution of anxiety management techniques (AMT) and the VR exposure was examined in a single case design. The subject was a 42-year-old female with a debilitating fear and avoidance of flying. All self-report measures of the fear and avoidance of flying decreased following AMT and decreased still further following VR exposure. A planned post-treatment flight was completed with anxiety measures indicating comfortable flight. The implications of this new medium for exposure therapy are discussed.

Adaptation, Psychological↗
PubMed1983

Reality orientation therapy--a controlled trial.

Sixty long-stay patients who were demented or withdrawn or both were randomly allocated to reality orientation or diversional occupational therapy and were assessed blind on two scales. Owing to a high drop-out rate only 19 organic and 19 functional patients satisfied reasonable criteria for inclusion in the analyses. Those treated by reality orientation therapy fared better than the controls but not significantly so. Initial test scores were no guide to outcome. The results suggested that both organic and functional patients benefited cognitively, but hardly at all behaviourally, from both types of treatment.

Adult↗
PubMedDate not supplied

Efficacy of virtual reality exposure therapy to treat driving phobia: a case report.

An AB case design was used to examine the efficacy of virtual reality exposure therapy (VRET) in treating driving phobia. After a one week baseline, the patient received three treatment sessions over a ten day period. Treatment included practice of four VR driving scenarios. Peak anxiety decreased within and across sessions. Ratings of anxiety and avoidance declined from pre-treatment and post-treatment, with gains maintained at seven month followup. Phobia-related interference in daily functioning similarly decreased. The results suggest that it would be useful to further evaluate the efficacy of VRET for driving phobia in controlled clinical trials.

Adult↗
PubMed2003

Preliminary research on the efficacy of virtual reality exposure therapy to treat driving phobia.

This article presents a review of preliminary research of two studies of the efficacy of virtual reality exposure therapy (VRET) to treat driving phobia. Study 1 describes a case study of a patient who completed a 7-day baseline followed by three sessions of VRET. Her peak anxiety decreased within and across sessions. At the post-treatment assessment, her phobic-related symptoms had diminished and she no longer met diagnostic criteria for driving phobia. Clinical improvement was maintained at 1-, 3-, and 7-month follow-up. In study 2, a multiple baseline across-subjects design was used to treat five patients over eight weekly VRET sessions. Visual and statistical analyses showed clear improvement in driving anxiety and avoidance in three patients between pre- and post-treatment assessments, and they no longer met criteria for driving phobia. There was marginal improvement in one patient, and the remaining individual showed no treatment gains. There was negligible change in actual driving frequency for any of the patients. Some gains were lost at the follow-up, particularly for the two individuals with poorer treatment responses. The results from these preliminary studies suggest that VRET may be a promising intervention for treating driving phobia. Avenues for improving treatment outcome are discussed.

Adult↗
PubMed2006

Virtual reality exposure therapy and standard (in vivo) exposure therapy in the treatment of fear of flying.

This controlled clinical trial tested virtual reality exposure (VRE) therapy for the fear of flying (FOF), a relatively new and innovative way to do exposure therapy, and compared it to standard (in vivo) exposure therapy (SE) and a wait list (WL) control with a 6- and 12-month follow-up. Eighty-three participants with FOF were randomly assigned to VRE, SE, or WL. Seventy-five participants, 25 per group, completed the study. Twenty-three WL participants completed randomly assigned treatment following the waiting period. Treatment consisted of 4 sessions of anxiety management training followed either by exposure to a virtual airplane (VRE) or an actual airplane at the airport (SE) conducted over 6 weeks. Results indicate that VRE was superior to WL on all measures, including willingness to fly on the posttreatment flight (76% for VRE and SE; 20% for WL). VRE and SE were essentially equivalent on standardized questionnaires, willingness to fly, anxiety ratings during the flight, self-ratings of improvement, and patient satisfaction with treatment. Follow-up assessments at 6 and 12 months indicated that treatment gains were maintained, with more than 70% of respondents from both groups reporting continued flying at follow-up. Based on these findings, the use of VRE in the treatment of FOF was supported in this controlled study, suggesting that experiences in the virtual world can change experiences in the real world.

Adult↗