Mayer Gwendolyn, Gronewold Nadine, Polte Kirsten, Hummel Svenja, Barniske Joshua, Korbel Jakob J, Zarnekow Rüdiger, Schultz Jobst-Hendrik
Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany.
Information and Communication Management, Technische Universität Berlin, Berlin, Germany.
JMIR Ment Health. 2022 Dec 5;9(12):e40056. doi: 10.2196/40056.
The effectiveness of virtual reality exposure (VRE) in the treatment of anxiety disorders is well established. Several psychological mechanisms of VRE have been identified, whereby both emotional processing and the sense of presence play a key role. However, there are only few studies that contribute to our knowledge of examples of implementation in the case of VRE for claustrophobia based on patients' experiences and the perspective of therapists.
This study asks for key elements of a VRE app that are necessary for effective exposure for people with claustrophobic symptoms.
A mixed methods design was applied in which patients (n=15) and therapeutic experts (n=15) tested a VRE intervention of an elevator ride at 5 intensity levels. Intensity was varied by elevator size, duration of the elevator ride, and presence of virtual humans. Quantitative measures examined self-reported presence with the Igroup Presence Questionnaire (IPQ) ranging from 0 to 6 and 15 Likert-scaled evaluation items that had been developed for the purpose of this study, ranging from 1 to 5. In both measures, higher scores indicate higher levels of presence or agreement. Think-aloud protocols of the patients and semistructured interviews posttreatment of all participants were conducted to gain in-depth perspectives on emotional processes.
The intervention induced a feeling of presence in patients and experts, posttreatment scores showed a high IPQ presence score (mean 3.84, SD 0.88), with its subscores IPQ spatial presence (mean 4.53, SD 1.06), IPQ involvement (mean 3.83, SD 1.22), and IPQ experienced realism (mean 2.75, SD 1.02). Patients preferred a setting in the presence of a therapist (mean 4.13, SD 0.83) more than the experts did (mean 3.33, SD 1.54). Think-aloud protocols of the patients revealed that presence and anxiety both were achieved. Qualitative interviews of patients and experts uncovered 8 topics: feelings and emotions, personal story, telepresence, potential therapeutic effects, barriers, conditions and requirements, future prospects, and realization. The intensity levels were felt to appropriately increase in challenge, with ambivalent results regarding the final level. Virtual humans contributed to feelings of fear.
Key elements of a VRE app for claustrophobic symptoms should include variation of intensity by adding challenging cues in order to evoke presence and anxiety. Virtual humans are a suitable possibility to make the intervention realistic and to provide a sense of closeness; however, some of the fears might then be related to symptoms of social phobia or agoraphobia. Patients may need the physical presence of a therapist, though not all of them share this view. A higher degree of sophistication in the intensity levels is needed to deliver targeted help for specific symptoms of anxiety.
虚拟现实暴露疗法（VRE）在治疗焦虑症方面的有效性已得到充分证实。已确定了VRE的几种心理机制，其中情绪处理和临场感都起着关键作用。然而，基于患者体验和治疗师视角，关于VRE在幽闭恐惧症治疗中的实施实例的研究却很少。
本研究旨在探讨VRE应用程序中对于有幽闭恐惧症症状的人进行有效暴露治疗所必需的关键要素。
采用混合方法设计，患者（n = 15）和治疗专家（n = 15）对电梯乘坐的VRE干预进行了5个强度级别的测试。强度通过电梯大小、电梯乘坐时间和虚拟人物的出现来改变。定量测量使用Igroup临场感问卷（IPQ）来检查自我报告的临场感，范围从0到6，以及为本研究开发的15个李克特量表评估项目，范围从1到5。在这两种测量中，分数越高表明临场感或认同感越高。对患者进行出声思维记录，并对所有参与者进行治疗后半结构化访谈，以深入了解情绪过程。
该干预在患者和专家中诱发了临场感，治疗后分数显示IPQ临场感得分较高（平均3.84，标准差0.88），其子分数IPQ空间临场感（平均4.53，标准差1.06）、IPQ投入感（平均3.83，标准差1.22）和IPQ体验真实感（平均2.75，标准差1.02）。患者比专家更倾向于有治疗师在场的环境（平均4.13，标准差0.83）（专家平均3.33，标准差1.54）。患者的出声思维记录显示实现了临场感和焦虑感。对患者和专家的定性访谈揭示了8个主题：感受与情绪、个人故事、远程临场感、潜在治疗效果、障碍、条件与要求、未来前景和实现情况。强度级别被认为在挑战性方面适当增加，对于最后一级别结果存在矛盾。虚拟人物加剧了恐惧感。
用于幽闭恐惧症症状的VRE应用程序的关键要素应包括通过添加具有挑战性的线索来改变强度，以唤起临场感和焦虑感。虚拟人物是使干预更真实并提供亲近感的合适选择；然而，某些恐惧可能与社交恐惧症或广场恐惧症症状相关。患者可能需要治疗师的实际在场，尽管并非所有患者都认同这一点。需要在强度级别上有更高的精细度，以便针对特定焦虑症状提供有针对性的帮助。
