Anksiyete Bozukluklarında Sanal Gerçeklik

Öz

Sanal gerçeklik, bireyin duyularını yanıltarak fiziksel olarak sanal ortamın içindeymiş gibi hissetmesine olanak sağlayan üç boyutlu bilgisayar grafikleri temelli teknolojilerin kullanıldığı görece yeni bir maruz bırakma aracıdır. Sanal gerçeklik çalışmalarının son yıllarda klinik psikoloji alanında da yaygınlaştığı; sanal gerçekliğe dayalı terapilerin başta anksiyete bozuklukları olmak üzere geniş bir yelpazede uygulama alanına sahip olduğu görülmektedir. Sanal gerçekliğin zihinsel imgelemeye kıyasla daha gerçekçi olduğu ve daha güçlü bir “orada olma” hissi yarattığı; yaşantısal maruz bırakmaya kıyasla ise daha güvenli bir başlangıç noktası olduğu, daha kullanışlı ve kontrollü bir şekilde uygulanabildiği belirtilmektedir. Bu derleme makalesinde anksiyete bozukluklarında (özgül fobi, panik bozukluk ve agorafobi, yaygın anksiyete bozukluğu, sosyal fobi), travma sonrası stres bozukluğunda ve obsesif-kompulsif bozuklukta sanal gerçekliğe dayalı olarak gerçekleştirilen maruz bırakma çalışmalarının incelenmesi amaçlanmıştır.

Anahtar Kelimeler

• Sanal gerçeklik,anksiyete bozuklukları,travma sonrası stres bozukluğu,obsesif-kompulsif bozukluk

Virtual Reality for Anxiety Disorders

Abstract

Virtual reality is a relatively new exposure tool that uses three-dimensional computer-graphics-based technologies which allow the individual to feel as if they are physically inside the virtual environment by misleading their senses. As virtual reality studies have become popular in the field of clinical psychology in recent years, it has been observed that virtual-reality-based therapies have a wide range of application areas, especially on anxiety disorders. Studies indicate that virtual reality can be more realistic than mental imagery and can create a stronger feeling of “presence”; that it is a safer starting point compared to in vivo exposure; and that it can be applied in a more practical and controlled manner. The aim of this review is to investigate exposure studies based on virtual reality in anxiety disorders (specific phobias, panic disorder and agoraphobias, generalized anxiety disorder, social phobia), posttraumatic stress disorder and obsessive compulsive disorder.

Keywords

• irtual reality,anxiety disorders,posttraumatic stress disorder,obsessive compulsive disorder

References

1. Abdüsselam MS, Karal H (2012) Fizik öğretiminde artırılmış gerçeklik ortamlarının öğrenci akademik başarısı üzerine etkisi: 11. sınıf manyetizma konusu örneği. Eğitim ve Öğretim Araştırmaları Dergisi, 1:170-181.
2. Abramowitz JS, Brigidi BD, Roche KR (2001) Cognitive-behavioral therapy for obsessive-compulsive disorder: a review of the treatment literature. Res Soc Work Pract, 11:357-372.
3. APA (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC, American Psychiatric Association.
4. Anderson P, Rothbaum BO, Hodges LF (2003) Virtual reality in the treatment of social anxiety: two case reports. Cogn Behav Prac, 10:240–247.
5. Anderson PL, Zimand E, Hodges LF, Rothbaum BO (2005) Cognitive behavioral therapy for public-speaking anxiety using virtual reality for exposure. Depress Anxiety, 22:156-158.
6. Balcıoğlu İ, Ünsalver BÖ (2006) Yaygın anksiyete bozukluğu: epidemiyoloji, prognoz ve farmakolojik olmayan tedaviler. Cerrahpaşa Tıp Fakültesi Dergisi, 37:115-120.
7. Bolu A, Erdem M, Öznur T (2014). Travma sonrası stres bozukluğu. Anatolian Journal of Clinical Investigation, 8:98-104.
8. Belloch A, Cabedo E, Carrió C, Lozano-Quilis JA, Gil-Gómez JA, Gil-Gómez H (2014) Virtual reality exposure for OCD: is it feasible? Revista de Psicopatología y Psicología Clínica, 19:37-44.

9. Botella C, Baños RM, Perpiñá C, Villa H, Alcañiz M, Rey A (1998) Virtual reality treatment of claustrophobia: a case report. Behav Res Ther, 36:239–246.
10. Botella C, Baños RM, Villa H, Perpiñá C, García-Palacios A (2000) Virtual reality in the treatment of claustrophobic fear: a controlled, multiple-baseline design. Behav Ther, 31:583-595.
11. Botella C, Osma J, Garcia-Palacios A, Quero S, Baños RM (2004) Treatment of flying phobia using virtual reality: data from a 1-year follow-up using a multiple baseline design. Clin Psychol Psychother, 11:311–323.
12. Botella CM, Juan MC, Baños RM, Alcañiz M, Guillén V, Rey B (2005) Mixing realities? an application of augmented reality for the treatment of cockroach phobia. Cyberpsychol Behav, 8:162–171.
13. Botella C, Villa H, García-Palacios A, Baños RM, Quero S, Alcañiz M et al. (2007) Virtual reality exposure in the treatment of panic disorder and agoraphobia: a controlled study. Clin Psychol Psychother, 14:164–175.
14. Botella C, Breton-López J, Quero S, Baños RM, García-Palacios A, Zaragoza, I et al. (2011) Treating cockroach phobia using a serious game on a mobile phone and augmented reality exposure: a single case study. Comput Human Behav, 27:217–217.
15. Bouchard S, St-Jacques J, Côté S, Robillard G, Renaud P (2003) Exemples de l’utilisation de la réalité virtuelle dans le traitement des phobies (using virtual reality in the treatment of phobias). Revue Francophone de Clinique Comportementale et Cognitive, 8(4):5–12.
16. Bouchard S, Côté S, St-Jacques J, Robillard G, Renaud P (2006) Effectiveness of virtual reality exposure in the treatment of arachnophobia using 3D games. Technol Health Care, 14:19-27.
17. Bouchard S, Dumoulin S, Robillard G, Guitard T, Klinger E, Forget H et al. (2011) A randomized control trial for the use of in virtuo exposure in the treatment of social phobia: final results. J Cyber Ther Rehabil, 4:197-200.
18. Bullinger AH (2005) Treating acrophobia in a virtual environment. 10th Annual CyberTherapy Conference, June 6–10 2005, Basel, Switzerland.
19. Carlin AS, Hoffman HG, Weghorst S (1997) Virtual reality and tactile augmentation in the treatment of spider phobia: a case report. Behav Res Ther, 35:153-158.
20. Choi YH, Jang DP, Ku JH, Shin MB, Kim SI (2001) Short-term treatment of acrophobia with virtual reality therapy (VRT): a case report. Cyberpsychol Behav, 4:349–354.
21. Côté S, Bouchard S (2008) Virtual reality exposure for phobias: a critical review. J Cyber Ther Rehabil, 1:75-91.
22. Deacon BJ, Abramowitz JS (2004) Cognitive and behavioral treatments for anxiety disorders: a review of meta-analytic findings. J Clin Psychol, 60:429-441.
23. Difede J, Hoffman HG (2002) Virtual reality exposure therapy for World Trade Center post-traumatic stress disorder: a case report. Cyberpsychol Behav, 5:529–535.
24. Dilbaz N (2000) Sosyal anksiyete bozukluğu: tanı, epidemiyoloji, etiyoloji, klinik ve ayırıcı tanı. Klinik Psikiyatri Dergisi, 2:3-21.
25. Dumoulin S, Bouchard S, Robillard G, Arsenault JE (2008) “Reality tests” increase the efficacy of in virtuo exposure for claustrophobics. CyberTherapy Conference, June 23–25 2008, San Diego, USA.
26. Emmelkamp PMG, Bruynzeel M, Drost L, van der Mast CAPG (2001) Virtual reality treatment in acrophobia: a comparison with exposure in vivo. Cyberpsychol Behav, 4:335–340.
27. Emmelkamp PMG, Krijn M, Hulsbosch AM, De Vries S, Schuemie MJ, Van der Mast CAPG (2002) Virtual reality treatment versus exposure in vivo: a comparative evaluation in acrophobia. Behav Res Ther, 40:509-516.
28. Emmelkamp PM (2005) Technological innovations in clinical assessment and psychotherapy. Psychother Psychosom, 74:336-343.
29. Erdem, HA (2013) Sanal gerçeklik ortamının-etkileşimli görsel eğitim aracı olarak-ilkokul eğitiminde kullanılması (Yüksek lisans tezi). İzmir, Dokuz Eylül Üniversitesi.
30. Ertan T (2008) Psikiyatrik bozukluklarin epidemiyolojisi. In Türkiye'de Sık Karşılaşılan Psikiyatrik Hastaliklar Sempozyumu (Eds M Uğur, İ Balcıoğlu, N Kocabaşoğlu):25-30. İstanbul, İstanbul Üniversitesi Cerrahpaşa Tıp Fakültesi Yayınları.
31. Foa EB, Kozak MJ (1986) Emotional processing of fear: exposure to corrective information. Psychol Bull, 99:20-35.
32. Garcia-Palacios A, Hoffman H, Carlin A, Furness TU, Botella C (2002) Virtual reality in the treatment of spider phobia: a controlled study. Behav Res Ther, 40:983-993.
33. Gebara CM, Barros-Neto TPD, Gertsenchtein L, Lotufo-Neto F (2016) Virtual reality exposure using three-dimensional images for the treatment of social phobia. Rev Bras de Psiquiatr, 38:24-29.
34. Gerardi M, Rothbaum BO, Ressler K, Heekin M, Rizzo A (2008) Virtual reality exposure therapy using a virtual Iraq: case report. J Trauma Stress, 21:209–213.
35. Gorini A, Riva G (2008) Virtual reality in anxiety disorders: the past and the future. Expert Rev Neurother, 8:215-233.
36. Gorini A, Pallavicini F, Algeri D, Repetto C, Gaggioli A, Riva G (2010) Virtual reality in the treatment of generalized anxiety disorders. Stud Health Technol Inform, 154:39-43.
37. Gregg L, Tarrier N (2007) Virtual reality in mental health: a review. Soc Psychiatry Psychiatr Epidemiol, 42:343-354.
38. Gunawan LT, van der Mast C, Neerincx MA, Emmelkamp PMG, Krijn M (2004) Usability of the therapist’s user interface in virtual reality exposure therapy for fear of flying. Euromedia 2004, April 19–21 2004, Hasselt, Belgium.
39. Gültekin BK, Dereboy IF (2011) Üniversite öğrencilerinde sosyal fobinin yaygınlığı ve sosyal fobinin yaşam kalitesi, akademik başarı ve kimlik oluşumu üzerine etkileri. Turk Psikiyatri Derg, 22:150-158.
40. Harris SR, Kemmerling RL, North MM (2002) Brief virtual reality therapy for public speaking anxiety. Cyberpsychol Behav, 5:543-550.
41. Hodges LF, Rothbaum BO, Watson BA, Kessler GD, Opdyke D (1996) Virtual reality exposure for fear of flying therapy. IEEE Comput Graph Appl, 16(6):42-49.
42. Hoffman HG, Garcia-Palacios A, Carlin A, Furness Iii TA, Botella-Arbona, C (2003) Interfaces that heal: Coupling real and virtual objects to treat spider phobia. Int J Hum Comput Interact, 16:283-300.
43. İzgiç F, Akyüz G, Doğan O, Kuğu N (2004) Social phobia among university students and its relation to self-esteem and body image. Can J Psychiatry, 49:630-634.
44. Kırmızıoğlu Y, Doğan O, Kuğu N, Akyüz G (2009) Prevalence of anxiety disorders among elderly people. Int J Geriatr Psychiatry, 24:1026-1033.
45. Kim K, Kim CH, Cha KR, Park J, Han K, Kim YK et al. (2008) Anxiety provocation and measurement using virtual reality in patients with obsessive-compulsive disorder. Cyberpsychol Behav, 11:637-641.
46. Kim K, Kim CH, Kim SY, Roh D, Kim S (2009) Virtual reality for obsessive-compulsive disorder: past and the future. Psychiatry Investig, 6:115-121.
47. Kim K, Kim SI, Cha KR, Park J, Rosenthal MZ, Kim JJ et al. (2010) Development of a computer-based behavioral assessment of checking behavior in obsessive-compulsive disorder. Compr Psychiatry, 51:86-93.
48. Kim K, Roh D, Kim CH, Cha KR, Rosenthal MZ, Kim S I (2012a) Comparison of checking behavior in adults with or without checking symptom of obsessive-compulsive disorder using a novel computer-based measure. Comput Methods Programs Biomed, 108: 434-441.
49. Kim K, Roh D, Kim SI, Kim CH (2012b) Provoked arrangement symptoms in obsessive-compulsive disorder using a virtual environment: a preliminary report. Comp Biol Med, 42:422–427.
50. Klein RA (1998) Virtual reality exposure therapy (fear of flying): from a private practice perspective. Cyberpsychol Behav, 1:311–316.
51. Klein RA (1999) Virtual reality exposure therapy in the treatment of fear of flying. J Contemp Psychother, 30:195–208.
52. Klinger E, Chemin I, Légeron P, Roy S, Lauer F, Nugues P (2002) Issues in the design of virtual environments for the treatment of social phobia. In Proceedings of the 1st International Workshop on Virtual Reality Rehabilitation (VRMHR2002). November 7-8, 2002, Lausanne, Switzerland.
53. Klinger E, Bouchard S, Légeron P, Roy S, Lauer F, Chemin I et al. (2005) Virtual reality therapy versus cognitive behavior therapy for social phobia: a preliminary controlled study. Cyberpsychol Behav, 8:76–88.
54. Köroğlu E (2011) Psikiyatri El Kitabı, 4. Baskı. Ankara, Hekimler Yayın Birliği.
55. Krijn M, Emmelkamp PMG, Biemond R, de Wilde de Ligny C, Schuemie MJ, van der Mast CAPG (2004a) Treatment of acrophobia in virtual reality: The role of immersion and presence. Behav Res Ther, 42:229–239.
56. Krijn M, Emmelkamp PM, Olafsson RP, Biemond R (2004b) Virtual reality exposure therapy of anxiety disorders: a review. Clin Psychol Rev, 24:259-281.
57. Krijn M, Emmelkamp PMG, Olapsson RP, Bouwman M, van Gerven LJ, Spinhoven P et al. (2007) Fear of flying treatment methods: Virtual reality exposure vs cognitive behavioural therapy. Aviat Space Environ Med, 78:121-128.
58. Laforest M, Bouchard S, Cretu A M, Mesly O (2016) Inducing an anxiety response using a contaminated virtual environment: validation of a therapeutic tool for obsessive- compulsive disorder. Frontiers in ICT, 3:18.
59. Malbos E, Mestre DR, Note ID, Gellato C (2008) Virtual reality in claustrophobia: multiple components therapy involving game editor virtual environments exposure. Cyberpsychol Behav, 11:695–697.
60. Malbos E, Boyer L, Lançon C (2013) Virtual reality in the treatment of mental disorders. Presse Med, 42:1442-1452.
61. McLay RN, Wood DP, Webb-Murphy JA, Spira JL, Wiederhold MD, Pyne JM et al. (2011) A randomized, controlled trial of virtual reality-graded exposure therapy for post-traumatic stress disorder in active duty service members with combat-related post-traumatic stress disorder. Cyberpsychol Behav Soc Netw, 14:223–229.
62. Michaliszyn D, Marchand A, Bouchard S, Martel MO, Poirier-Bisson J (2010) A randomized, controlled clinical trial of in virtuo and in vivo exposure for spider phobia. Cyberpsychol Behav Soc Netw, 13:689-695.
63. Mirzayev İ (2015) İnme hastalarında sanal gerçeklik eğitiminin üst ekstremite fonksiyonlarına etkisinin araştırılması (Tıpta uzmanlık tezi). Ankara, Başkent Üniversitesi.
64. Mühlberger A, Hermann MJ, Wiedemann G, Ellgring H, Pauli P (2001) Repeated exposure of flight phobics to flights in virtual reality. Behav Res Ther, 39:1033–1050.
65. Mühlberger A, Wiedemann G, Pauli P (2003) Efficacy of one-session virtual reality exposure treatment for fear of flying. Psychother Res, 13:323–336.
66. Mühlberger A, Bülthoff HH, Wiedemann G, Pauli G (2007) Virtual reality for the psychophysiological assessment of phobic fear: responses during virtual tunnel driving. Psychol Assess, 19:340-346.
67. Nichols S, Patel H (2002) Health and safety implications of virtual reality: a review of empirical evidence. Appl Ergon, 33:251-271.
68. North MM, North SM, Coble JR (1996) Virtual environments psychotherapy: a case study of fear of flying disorder. Presence, 5(4):1–5.
69. North MM, North SM, Coble JR (1997a) Virtual reality therapy for fear of flying. Am J Psychiatry, 154:130.
70. North MM, North SM, Coble JR (1997b) Virtual reality therapy: an effective treatment for psychological disorders. Stud Health Technol Inform, 44:59-70.
71. Opriş D, Pintea S, García-Palacios A, Botella C, Szamosközi S, David D (2012) Virtual reality exposure therapy in anxiety disorders: a quantitative meta-analysis. Depress Anxiety, 29:85-93.
72. Owens ME, Beidel DC (2015) Can virtual reality effectively elicit distress associated with social anxiety disorder? J Psychopathol Behav Assess, 37:296-305.
73. Page S, Coxon M (2016) Virtual reality exposure therapy for anxiety disorders: small samples and no controls? Front Psychol, 7:1-4.
74. Parrott M, Bowman D, Ollendick T (2004) An immersive virtual environment for the treatment of ophidiophobia. Cyberpsychol Behav, 7:301-302.
75. Parsons TD, Rizzo AA (2008) Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: a meta-analysis. J Behav Ther Exp Psychiatry, 39:250-261.
76. Pérez-Ara MA, Quero S, Botella C, Banos R, Andreu-Mateu S, García-Palacios A, et al. (2010) Virtual reality interoceptive exposure for the treatment of panic disorder and agoraphobia. Stud Health Technol Inform, 154:77-81.
77. Pitti CT, Penate W, de la Fuente J, Bethencourt J, Acosta L, Villaverde M et al. (2008) Agoraphobia: combined treatment and virtual reality. preliminary results. Actas Esp Psiquiatra 36:94-101.
78. Powers MB, Emmelkamp PM (2008) Virtual reality exposure therapy for anxiety disorders: a meta-analysis. J Anxiety Disord, 22:561-569.
79. Rachman S, De Silva P (2009) Obsessive Compulsive Disorder. 4th ed. New York, Oxford University Press.
80. Reger GM, Gahm GA (2008) Virtual reality exposure therapy for active duty soldiers. J Clin Psychol, 64:940–946.
81. Reger GM, Holloway KM, Candy C, Rothbaum BO, Difede JA, Rizzo AA et al. (2011) Effectiveness of virtual reality exposure therapy for active duty soldiers in a military mental health clinic. J Trauma Stress, 24:93–96.
82. Reger GM, Koenen-Woods P, Zetocha K, Smolenski DJ, Holloway KM, Rothbaum BO et al. (2016) Randomized controlled trial of prolonged exposure using imaginal exposure vs. virtual reality exposure in active duty soldiers with deployment-related posttraumatic stress disorder (PTSD). J Consult Clin Psychol, 84:946-959.
83. Repetto C, Gaggioli A, Pallavicini F, Cipresso P, Raspelli S, Riva G (2013) Virtual reality and mobile phones in the treatment of generalized anxiety disorders: a phase-2 clinical trial. Pers Ubiquitous Comput, 17:253-260.
84. Riva G (2009) Virtual reality: an experiential tool for clinical psychology. Br J Guid Counc, 37:337-345.
85. Rizzo AA, Reger G, Difede J, et al. (2009) Development and clinical results from the virtual Iraq exposure therapy application for PTSD. Virtual Rehabilitation International Conference, June 29-July 2 2009, Haifa, Israel.
86. Rothbaum BO, Hodges LF, Kooper R, Opdyke D, Williford JS, North M (1995a) Effectiveness of computer-generated (virtual reality) graded exposure in the treatment of acrophobia. Am J Psychiatry, 152:626–628.
87. Rothbaum BO, Hodges LF, Kooper R, Opdyke D, Williford JS, North M (1995b) Virtual reality graded exposure in the treatment of acrophobia: a case report. Behav Ther, 26:547–554.
88. Rothbaum BO, Hodges LF, Watson BA, Kessler GD, Opdyke D (1996) Virtual reality exposure therapy in the treatment of fear of flying: a case report. Behav Res Ther, 34:477–481.
89. Rothbaum BO, Hodges L, Cooper R (1997) Virtual reality exposure therapy. J Psychother Pract Res, 6:291–296.
90. Rothbaum BO, Hodges L, Alarcon R, Ready D, Shahar F, Graap K et al. (1999) Virtual reality exposure therapy for PTSD Vietnam veterans: a case study. J Trauma Stress, 12:263–271.
91. Rothbaum BO, Hodges LF, Smith S, Lee JH, Price L (2000) A controlled study of virtual reality exposure therapy for the fear of flying. J Cons Clin Psychol, 68:1020–1026.
92. Rothbaum BO, Hodges LF, Ready D, Graap K, Alarcon RD (2001) Virtual reality exposure therapy for Vietnam veterans with posttraumatic stress disorder. J Clin Psychiatry, 62:617–622.
93. Srivastava K, Das R, Chaudhury S (2014) Virtual reality applications in mental health: challenges and perspectives. Ind Psychiatry J, 23:83-85.
94. Stanney KM (2002) Handbook of Virtual Environments: Design, Implementation and Applications. Mahwah, NJ, Erlbaum.
95. Şimşek Z, Ak D, Altındağ A, Güneş M (2008) Prevalence and predictors of mental disorders among women in Sanliurfa, Southeastern Turkey. J Public Health (Oxf ), 30:487-93.
96. Srivastava K, Das R, Chaudhury S (2014) Virtual reality applications in mental health: challenges and perspectives. Ind Psychiatry J, 23(2):83-85.
97. Tworus R, Szymanska S, Illnicki S (2010) A soldier suffering from ptsd treated by controlled stress exposition using virtual reality and behavioral training. Cyberpsychol Behav Soc Netw, 13:103-107.
98. Vincelli F, Anolli L, Bouchard S, Wiederhold BK, Zurloni V, Riva G (2003) Experiential cognitive therapy in the treatment of panic disorder with agoraphobia: a controlled study. Cyberpsychol Behav, 6:321–328.
99. Wald J, Taylor S (2003) Preliminary research on the efficacy of virtual reality exposure therapy to treat driving phobia. Cyberpsychol Behav, 6:459-465.
100. Walshe DG, Lewis EJ, Kim SI, O'Sullivan K, Wiederhold BK (2003) Exploring the use of computer games and virtual reality in exposure therapy for fear of driving following a motor vehicle accident. Cyberpsychol Behav, 6:329-334.
101. Wiederhold BK, Gevirtz R, Wiederhold MD (1998) Fear of flying: a case report using virtual reality therapy with physiological monitoring. Cyberpsychol Behav, 1:97–104.
102. Wiederhold BK, Wiederhold MD (2000) Lessons learned from 600 virtual reality sessions. Cyberpsychol Behav, 3:393–400.
103. Wiederhold BK, Wiederhold MD (2003) Three-year follow-up for virtual reality exposure for fear of flying. Cyberpsychol Behav, 6:441-445.
104. Wiederhold BK, Wiederhold MD (2005) Virtual reality therapy for anxiety disorders: advances in evaluation and treatment. Washington DC, American Psychological Association.
105. Wiederhold BK, Wiederhold MD (2008) Virtual reality for posttraumatic stress disorder and stress inoculation training. J Cyber Ther Rehabil, 1:23-35.
106. Wiederhold BK, Bouchard S (2014) Advances in Virtual Reality and Anxiety Disorders. New York, Springer.