Virtual Reality based

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Nov 14, 2013 (3 years and 6 months ago)

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Paris, 10 April 2003

Virtual Reality based
multidimensional therapy

for the treatment

of body image



Paris, 10 April 2003

PRESENTERS

G. Castelnuovo (1
-
2
-
3), M. Bacchetta (2),
G. Cesa (2), S. Conti (2),

E. Molinari (1
-
2
-
3), G. Riva (1
-
3)


1
ATN
-
P LAB, Applied Technology for Neuro
-
Psychology Lab, Istituto Auxologico Italiano, Milano,
Italia,
gianluca.castelnuovo@auxologico.it

2
ATN
-
P LAB, Applied Technology for Neuro
-
Psychology Lab, Istituto Auxologico Italiano, Verbania,
Italia

3
Facoltà di Psicologia, Università Cattolica, Milano,
Italia


Virtual Reality

It can be described as a fully
three
-
dimensional computer
-
generated 'world'

in which a
person can move around and
interact as if he actually was in an
imaginary place.

Virtual reality (VR) is a technology
that
alters the conventional way in
which individuals interact

with
computers.














In VR
users are no longer simply external observers

of images on a
computer screen, but are active participants within a computer
-
generated
three
-
dimensional virtual world.

Paris, 10 April 2003

Previous work from EU Projects (VREPAR and VREPAR 2
-

HC 1053/1055)
has shown that even relatively simple (PC based)
Virtual Reality tools can be
used in psycho
-
neurological assessment and rehabilitation
.

Most of the VR applications in health
care are based on high cost hardware
not affordable for the single therapist
:


-
Graphic workstation => 50KEuros

-
Cave systems => 400KEuros


PC Based Virtual Reality

Due, in large part, to the significant
advances in PC hardware that have
been made over the last three years,
PC based VR is approaching reality
:

Paris, 10 April 2003

Why using Virtual Reality in clinical
psychology?

Advantages of VR therapy (VRT):



Is an
innovative

alternative/support treatment for patients.



Gives the therapist
greater control

over multiple stimulus
parameters.



Provides the ability to
isolate the specific parameters

that
determine the “dysfunctional response”.



Like in vivo therapy, VRT can
provide stimuli

for patients who
have problem with guided imagery.



Can be used as an
intermediate step

in preparing patients for
maintenance therapy involving self
-
directed in vivo exposure.



Patient acceptance
.

Paris, 10 April 2003

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH

VEPSY
-
UPDATED PROJECT

The Project “VEPSY UPDATED” (Telemedicine and Portable Virtual
Environments in Clinical Psychology) involves
12 different research
groups

from three European countries: Italy, Spain and France

Start
: 1/1/2001
-

Duration
: 30 Months
-

Funds
: 1.9 M


/ 1.7M$

Main goal
:

to
prove the
technical and clinical viability

of
using portable and
shared Virtual Reality systems (shared care) in clinical
psychology
. The selected disorders are:

-

anxiety;

-

male sexual disorders;

-

obesity and eating disorders;

Paris, 10 April 2003

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH

New field of application


Only a
small number of real
-
world applications have been
developed for use of VR in clinical psychology
: the largest sample
ever reported in any published study is
72 students

In a positioning paper, the US National Advisory Mental Health
Council suggested that "
Research is needed

to understand both
the positive and the negative effects [of VEs]... on children's' and
adult's perceptual and cognitive skills... and
to exploit the
enormous clinical potential of this technology
" (1995, p.51).



Project goal
: test the efficacy of the developed tools with no less
than
270 patients

in a real clinical setting

Project innovations (1)

Paris, 10 April 2003

Creation of a critical mass


To

reach

this

goal

in

1999

and

2000

different

US

government

institutions

(i
.
e
.

Office

of

Naval

Research,

National

Science

Foundation,

and

Defence

Advanced

Research

Projects

Agency)

funded

the

research

in

this

area

to

the

amount

of

29

million

US
$

(Source
:

DARPA

bullettin,

Jan
.

2001
)
.


In

the

same

year

the

European

institutions

funded

research

in

this

field

with

less

that

5

million

Euros

(estimated

from

CORDIS

database,

2001
)
:

less

than

1
/
5

of

the

US

effort
.

Project

goal
:

joining

the

researchers

who

authored

the

52
%

of

all

the

scientific

publications

in

this

area

(Source
:

Medline,

PsycInfo,

2001
)

Project innovations (2)

Paris, 10 April 2003

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH

Development and on
-
field trial of a low cost
VR/Telemedicine modular platform


A

typical

low

cost

VR

based

solution

for

clinical

psychology

is

now

priced

by

the

market

leading

US

company

about

15000
$
.

For

a

telemedicine

solution

the

price

raises

to

no

less

than

32000
$

(Source
:

Virtually

Better

Inc
.
,

Sept
.

2001
)
;

The

use

of

telemedicine

application

is

limited

to

high
-
bandwidth

connections

(
2

ISDN

lines

or

better)
.


Project

goal
:

develop

an

immersive

modular

VR/telemedicine

clinical

platform,

priced

no

more

than

6
K

Euros

and

working

on

low

bandwith

connection

(
56
Kb)

Project innovations (3)

Paris, 10 April 2003

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH


VEPSY Technology

Therapist office

Home (telemedicine)

Software

High realism VE

(Use of Virtools)


Optimized VE

XML based apps.

Interactive video

Images, text

CPU

Intel based

Desktop/Notebook

Intel based

Desktop/Notebook

Vision

Cy
-
Visor, SVGA

Screen, Stereoscopy

Tracker

Intertrax II, inertial

Navigation

Mouse

Mouse

Paris, 10 April 2003

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH

VEPSY clinical innovations E
-
therapy



Educational component that reduces 2 or 3 sessions at
therapist office




Inter
-
sessions feedback and follow
-
up assessment
using “intelligent” applications at home.




Self
-
application at home for over learning and
supporting exposure tasks coming from VE used in
immersive sesions at therapist office




Communication with therapist (videoconference, E
-
mail)

Paris, 10 April 2003

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH

VEPSY E
-
health system structure

Pathology

Therapist office

Home (telemedicine)

Eating
disorders

Immersive VR


Non
-
immersive VR

Panic
disorders

Immersive VR

XML guided apps.

Sexual
disorders

Immersive VR

No telemedicine

Social
Phobia

Non
-
immersive VR

No telemedicine

Paris, 10 April 2003

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH

The advantages of the VR approach



VR environments less threatening



More control of feared situation



No time/space restraints



Higher levels of safety for the patient



VR allows more privacy



Cost
-
effectiveness

Paris, 10 April 2003

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH

The advantages of telepsychology



Assessment and treatment materials on line




Filling out post
-
treatment and follow
-
up
assessements on line





More support for the patient, self
-
help group
chat meeting, e
-
mail contact with therapist


Increase treatment efficiency

Paris, 10 April 2003

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH

Eating disorders and obesity


ANOREXIA NERVOSA

is characterized by:


-

a refusal to maintain a minimally normal body weight;


-

intense fear
of gaining weight or becoming fat, even



though underweight;


-

a disturbance in perception of body shape and weight;


-

amenorrhea.


BULIMIA NERVOSA

is characterized by:


-

repeated episodes of binge eating;


-

recurrent inappropriate compensatory behavior



(self
-
induced vomiting; misure of laxatives, etc.);


-

Self
-
evaluation is unduly influenced by body shape



and weight.



Paris, 10 April 2003

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH


BINGE EATING DISORDER

is characterized by:


-

recurrent episodes of binge eating;


-

feeling disgusted with oneself, depressed, or very



guilty after overeating;


-

marked distress regarding binge eating is present.


EATING DISORDERS NOT OTHERWISE SPECIFIED


OBESITY
is characterized by:


-

an excessive food consumption;


-

feeling disgusted with oneself, depressed, or very



guilty after overeating;


-

low self
-
esteem.



Eating disorders and obesity

Paris, 10 April 2003

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH

ECT is a short
-
term integrated patient
-
oriented treatment
that integrates virtual reality and telemedicine with
different cognitive, behavioral and visuo
-
motor
techniques:

-
Socratic method;

-
Miracle question;

-
Countering;

-
Alternative interpretation;

-
Label shifting;

-
Exposure with response prevention;

-
Awareness of the distortion;


EXPERIENTIAL COGNITIVE TREATMENT
for EATING DISORDERS (1)

Paris, 10 April 2003

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH

VR has different advantages for clinical psychologist:


it can be used in a medical situation thus avoiding
the need to venture in public situation


it can be more than a tool to provide exposure and
desensitization


it can challenge individual maladaptive
assumptions more easily


it can assure the researcher full control of all the
parameters implied


EXPERIENTIAL COGNITIVE TREATMENT
for EATING DISORDERS (2)

Paris, 10 April 2003

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH

Therapy: In
-
patient and Out
-
patient
phases


In
-
patient phase
(4 weeks)


-

Psychological course



(Assessment,
VR therapy 10 sessions
, groups)


-

Nutritional course



(Assessment, balanced dieting, groups)


-

Physical course



(Assessment, physical activities, Physiotherapy)


Out
-
patient phase
(6 months)


-

E
-
mail


-

Individual and group chat line


-

Tools online


-

Self
-
help group


Paris, 10 April 2003

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH

VR THERAPY


1 Assessment session
(Balance, Sitting room)


8
T
herapeutic sessions


-

Body Image

(Balance, BIVRS,
9
Doors



Room, Gymnasium, Clothes’s Shop,



Swi
mm
ing
-
Pool and

Beach)


-

Eating Control

(Kitchen
, Bathroom,



Bedroom, Supermarket, Pub, Restaurant)



1 C
onclusive session



(Kitchen, BIVRS,
9
Doors Room)


Paris, 10 April 2003

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH

CLINICAL TRIALS

SAMPLES:


Experimental group



Control groups


-

Waiting list group


-

Cognitive
-
Behavioral Therapy group


-

Traditional iter of the Hospital group


Paris, 10 April 2003

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH

SESSIONS OF VIRTUAL REALITY

S
E
SSI
O
N 1

V
R
B
a
l
an
ce

+

Sitt
in
g
Room
S
E
SSI
O
N 2

V
R
K
i
tc
he
n

+

B
a
t
h
r
oom +
B
e
d
roo
m
S
E
SSI
O
N 3

V
R
BIV
R
S
+
9

D
oor
s
Room
S
E
SSI
O
N 4

V
R
S
up
er
ma
r
k
et
S
E
SSI
O
N 5

V
R
G
y
mna
si
um
S
E
SSI
O
N 6

V
R
Pu
b
S
E
SSI
O
N 7

V
R
C
l
o
t
h
e
s
S
ho
p
S
E
SSI
O
N 8

V
R
R
est
aur
a
n
t
S
E
SSI
O
N 9

V
R
S
w
i
mm
i
n
g

P
oo
l

+

Be
a
c
h
S
E
SSI
O
N 10

V
R
K
i
tc
he
n

+

BIV
R
S
+
9

D
oor
s
R
o
om
Paris, 10 April 2003

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH

Eating disorders and obesity: virtual
scripts


Body Image:

Balance, BIVRS,
9
Doors Room, Gymnasium,
Clothes’s Shop,
Swi
mm
ing
-
Pool, Beach.


Eating Control:

Kitchen
, Bathroom,
Bedroom, Supermarket,
Pub, Restaurant
.


Assertiveness:

Gymnasium, Clothes’s Shop, Pub, Restaurant,
Beach.



Social Skill:

Gymnasium, Clothes’s Shop, Pub, Restaurant,
Swi
mm
ing
-
Pool, Beach.

Paris, 10 April 2003

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH


VR Technology Future Trends

Graphic

Processing

Vision

Navigation



Processing Power



More HW functions



Web 3D 3D streaming



Rendering




Mini Cave



V. Retinal



Per. Display




Haptic functions



Touchless technology

Paris, 10 April 2003

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH

VEPSY

Web

Site

manages

and

delivers

applications

to

multiple

users

(therapists

and

end

users)

from

a

data

centre

across

a

wide

area

network
.


The

Web

Site

allows

to
:



distribute

the

developed

protocols


support

therapists

(in

traditional

therapy)

with

online

tools



support

end

users

in

the

follow
-
up

phase


keep

professional

users

updated

(training

online)



promote

VEPSY

project

among

professionals


VEPSY Web Site: An integrated approach

(Promotion, Place & Service)

Paris, 10 April 2003

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH


VEPSY Web Site Approach

Internet

Web S
ite

Patients

Therapists

Training

Centres

Paris, 10 April 2003

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH

Additional slides

Paris, 10 April 2003

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH

SESSION OF VIRTUAL REALITY

1
st
week

Ind. Chat

2
nd
week

Tool online

3
rd
week

Ind. Chat

4
th
week

Group Chat

5
th
week

Ind. Chat

6
th
week

Tool online

7
th
week

Ind. Chat

8
th
week

Group Chat

9
th
week

Ind. Chat

10
th
week

Tool online

11
th
week

12
th
week

DH Group

13
th
week

Ind. Chat

14
th
week

Tool online

15
th
week

16
th
week

Group Chat

17
th
week

18
th
week

Tool online

19
th
week

20
th
week

Group Chat

21
th
week

22
th
week

Tool online

23
th
week

Group Chat

24
th
week

DH Ind.


Paris, 10 April 2003

THIRD INTERNATIONAL SYMPOSIUM

INTERNET

PSYCHIATRY, MENTAL HEALTH