Hur Ji-Won, Shin Hyemin, Jung Dooyoung, Lee Heon-Jeong, Lee Sungkil, Kim Gerard J, Cho Chung-Yean, Choi Seungmoon, Lee Seung-Moo, Cho Chul-Hyun
School of Psychology, Korea University, Seoul, Republic of Korea.
Department of Biomedical Engineering, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea.
JMIR Ment Health. 2021 Apr 14;8(4):e25731. doi: 10.2196/25731.
Although it has been well demonstrated that the efficacy of virtual reality therapy for social anxiety disorder is comparable to that of traditional cognitive behavioral therapy, little is known about the effect of virtual reality on pathological self-referential processes in individuals with social anxiety disorder.
We aimed to determine changes in self-referential processing and their neural mechanisms following virtual reality treatment.
We recruited participants with and without a primary diagnosis of social anxiety disorder to undergo clinical assessments (Social Phobia Scale and Post-Event Rumination Scale) and functional magnetic resonance imaging (fMRI) scans. Participants with social anxiety disorder received virtual reality-based exposure treatment for 6 sessions starting immediately after baseline testing. After the sixth session, participants with social anxiety disorder completed follow-up scans during which they were asked to judge whether a series of words (positive, negative, neutral) was relevant to them.
Of 25 individuals with social anxiety disorder who participated in the study, 21 completed the sessions and follow-up; 22 control individuals also participated. There were no significant differences in age (P=.36), sex (P=.71), or handedness (P=.51) between the groups. Whole-brain analysis revealed that participants in the social anxiety disorder group had increased neural responses during positive self-referential processing in the medial temporal and frontal cortexes compared with those in the control group. Participants in the social anxiety disorder group also showed increased left insular activation and decreased right middle frontal gyrus activation during negative self-referential processing. After undergoing virtual reality-based therapy, overall symptoms of the participants with social anxiety disorder were reduced, and these participants exhibited greater activity in a brain regions responsible for self-referential and autobiographical memory processes while viewing positive words during postintervention fMRI scans. Interestingly, the greater the blood oxygen level dependent changes related to positive self-referential processing, the lower the tendency to ruminate on the negative events and the lower the social anxiety following the virtual reality session. Compared with that at baseline, higher activation was also found within broad somatosensory areas in individuals with social anxiety disorder during negative self-referential processing following virtual reality therapy.
These fMRI findings might reflect the enhanced physiological and cognitive processing in individuals with social anxiety disorder in response to self-referential information. They also provide neural evidence of the effect of virtual reality exposure therapy on social anxiety and self-derogation.
尽管已有充分证据表明虚拟现实疗法治疗社交焦虑症的疗效与传统认知行为疗法相当，但对于虚拟现实对社交焦虑症患者病理性自我参照过程的影响却知之甚少。
我们旨在确定虚拟现实治疗后自我参照加工的变化及其神经机制。
我们招募了有和没有社交焦虑症初步诊断的参与者，进行临床评估（社交恐惧症量表和事后反刍量表）以及功能磁共振成像（fMRI）扫描。患有社交焦虑症的参与者在基线测试后立即接受为期6次的基于虚拟现实的暴露治疗。在第六次治疗后，患有社交焦虑症的参与者完成随访扫描，在此期间他们被要求判断一系列词语（积极的、消极的、中性的）是否与自己相关。
参与研究的25名患有社交焦虑症的个体中，21名完成了治疗和随访；22名对照个体也参与了研究。两组在年龄（P = 0.36）、性别（P = 0.71）或利手（P = 0.51）方面无显著差异。全脑分析显示，与对照组相比，社交焦虑症组的参与者在颞叶内侧和额叶皮质进行积极自我参照加工时神经反应增强。社交焦虑症组的参与者在进行消极自我参照加工时，左侧岛叶激活增加，右侧额中回激活减少。在接受基于虚拟现实的治疗后，患有社交焦虑症的参与者的总体症状有所减轻，并且这些参与者在干预后fMRI扫描期间查看积极词语时，在负责自我参照和自传体记忆过程的脑区表现出更大的活动。有趣的是，与积极自我参照加工相关的血氧水平依赖性变化越大，在虚拟现实治疗后对负面事件进行反刍的倾向越低，社交焦虑程度也越低。与基线时相比，患有社交焦虑症的个体在虚拟现实治疗后的消极自我参照加工过程中，广泛的体感区域内也发现了更高的激活。
这些fMRI研究结果可能反映了社交焦虑症患者对自我参照信息的生理和认知加工增强。它们还为虚拟现实暴露疗法对社交焦虑和自我贬低的影响提供了神经学证据。
