1. The Use of Virtual Reality in Clinical Psychology Jo Hunt Cara Heneghan Jemma Hogwood Kelly Harris

2. Virtual reality used in… Phobias PTSD Male sexual dysfunction Schizophrenia Addictions Autistic Spectrum Disorder Eating disorders Obesity

3. Why is it used? Active participation with 3D world Learn to manipulate problems High level of control Safer, less embarrassing Administered in traditional setting Potential for visualisation Active learning – encourages motivation Objectively measure behaviour Individualise treatment Riva 2005; Mantovani et al 2003; Weiss & Katz 2004

4. The Controversy Can therapeutic experiences in the virtual environment be successfully transferred to real life situations?

5. Treatments for obesity Exercise and dieting Pharmacological drugs Surgery Cognitive Behavioural Therapy Self help groups Telephone therapy Internet & e-mail Virtual Reality Riva 2005; Sutton 2005

6. The Case Study Riva et al 2001 Experimental: 7 sessions of VR Treatment including low-calorie diet & exercise Control: No VR sessions Same diet & exercise programme & psycho-nutritional group. VREDIM (VR for Eating Disorders modification) VEBIM (Virtual Environment for Body image modification)

7. Methodology Psychometric Tests & Assessments FRS (Figure Rating Scale) Thompson & Altabe (1991) CDRS (Contour Drawing Rating Scale) Thompson & Gray (1995) Also combines therapeutic methods: Socratic, Miracle Question, Cognitive and Behavioural approaches. Head Mounted Display system Joystick

8. The Zones Zone 1: Stimuli that elicits abnormal eating behaviours Miracle Question: Imagine life without the complaint. Other Zones: To assess & modify symptoms of anxiety related to food exposure: Intergrating CBT methods (including Countering and Label Shifting). Throughout all sessions the therapist uses the Socratic Style.

9. Results Experimental: Reduced body dissatisfaction Reduced level of anxiety Increased self-efficacy Reduced over-eating Weight loss (mean 11.33kg) Control: Increased exercise Improved ability and anxiety scores Weight loss (mean 7.58kg)

10. Advantages Integration of different methods. VR enhanced traditional methods due to increased presence. Impacted aspects of body image disturbance not usually addressed by CBT: - self-efficacy - body experience disturbances

11. Body Image Self-efficacy: - Increased control and motivation to change. Body Experience Disturbances: - New experience and awareness of body. - Modified attitude to body due to differentiation between assumption and perception.

12. Criticisms of Study The study only provides preliminary results The social aspect of obesity? (The Psychologist, April 2005) High cost, low access

13. The Controversy Can the experiences of the virtual environment be transferred to the real world? Results suggest in this case… Yes! BUT… some issues to consider Lack of qualitative evaluations from the client perspective Role of motivation Role of the therapist Clear clinical guidelines needed

14. Conclusion - Not suggesting isolated use of VR - Integration of traditional psychological therapies into the VE * Cognitive * Behavioural * Psychodynamic * Experiential (Riva 2003) - Different aspects of problem are made accessible

15. References Mantovani, F., and Castelnuovo, G., (2003). Sense of presence in virtual training: enhancing skills acquisition and transfer of knowledge through learning experience in virtual environments. In: Riva, G., Davide, F., and Ijsselsteijn, W.A., eds., Being there: concepts, effects and measurement of user presence in synthetic environments. Amsterdam: IOS Press. Riva, G., (2005). Virtual reality in the treatment of eating disorders and obesity. IT and Communications. www.cybertherapy.infowww.cybertherapy.info Riva, G., (2003). Virtual Environments in Clinical Psychology. Psychotherapy: theory/research/practice/training, Vol 40(1/2), pp.1-9. Riva, G., Bacchetta, M., Baruffi, M. and Molinari, E., (2001). Virtual Reality- based multidimensional therapy for the treatment of body image disturbances in obesity: a controlled study. CyberPsychology and Behaviour, Vol 4(4), pp.511-526. Sutton, J., ed., (2005). A Big Issue (Special Feature). Psychologist, 18(4), pp.215-226. Weiss, P.L. and Katz, N. (2004). The potential of virtual reality for rehabilitation. Journal of rehabilitation research and development, 41(5).