Paris, 10 April 2003 Virtual Reality based multidimensional therapy for the treatment of body image

Paris, 10 April 2003

Virtual Reality based multidimensional therapy

for the treatmentof body image

Paris, 10 April 2003Paris, 10 April 2003

PRESENTERS

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

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

1 1 ATN-P LAB, Applied Technology for Neuro-ATN-P LAB, Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milano, Psychology Lab, Istituto Auxologico Italiano, Milano,

Italia, Italia, [email protected] 2 ATN-P LAB, Applied Technology for Neuro-ATN-P LAB, Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Psychology Lab, Istituto Auxologico Italiano,

Verbania, ItaliaVerbania, Italia3 3 Facoltà di Psicologia, Università Cattolica, Milano, Facoltà di Psicologia, Università Cattolica, Milano,

ItaliaItalia

mailto:[email protected]

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.


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:


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.

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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;



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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)


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)




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 6K Euros and working on low bandwith connection (56Kb)




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



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)



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



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



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



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.



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



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)



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)



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



VR THERAPY

1 Assessment session (Balance, Sitting room)

8 Therapeutic sessions

- Body Image (Balance, BIVRS, 9 Doors

Room, Gymnasium, Clothes’s Shop,

Swimming-Pool and Beach)

- Eating Control (Kitchen, Bathroom,

Bedroom, Supermarket, Pub, Restaurant)

1 Conclusive session

(Kitchen, BIVRS, 9 Doors Room)



CLINICAL TRIALS

SAMPLES: Experimental group

Control groups

- Waiting list group

- Cognitive-Behavioral Therapy group

- Traditional iter of the Hospital group



SESSIONS OF VIRTUAL REALITY

SESSI ON 1 VR Balance + Sitting Room

SESSI ON 2 VR Kitchen + Bathroom + Bedroom

SESSI ON 3 VR BIVRS + 9 Doors Room

SESSI ON 4 VR Supermarket

SESSI ON 5 VR Gymnasium

SESSI ON 6 VR Pub

SESSI ON 7 VR Clothes Shop

SESSI ON 8 VR Restaurant

SESSI ON 9 VR Swimming Pool + Beach

SESSI ON 10 VR Kitchen + BIVRS + 9 DoorsRoom



Eating disorders and obesity: virtual scripts

Body Image: Balance, BIVRS, 9 Doors Room, Gymnasium,

Clothes’s Shop, Swimming-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,

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VR Technology Future Trends

GraphicProcessing

Vision

Navigation

• Processing Power• More HW functions• Web 3D 3D streaming

Rendering

• Mini Cave• V. Retinal• Per. Display

• Haptic functions• Touchless technology



VEPSY VEPSY Web Site manages and delivers applications Web Site manages and delivers applications to multiple users (therapists and end users) from to multiple users (therapists and end users) from a data centre across a wide area network.a data centre across a wide area network.

The Web Site allows to:The Web Site allows to:

• distribute the developed protocolsdistribute the developed protocols

• support therapists (in traditional therapy) with online support therapists (in traditional therapy) with online

tools tools

• support end users in the follow-up phasesupport end users in the follow-up phase

• keep professional users updated (training online) keep professional users updated (training online)

• promote VEPSY project among professionals promote VEPSY project among professionals

VEPSY Web Site: An integrated approach(Promotion, Place & Service)



VEPSY Web Site Approach

Internet

Web SWeb Siteite

PatientsPatientsTherapistsTherapistsTraining Training CentresCentres



Additional slides



SESSION OF VIRTUAL REALITY

1st week Ind. Chat

2nd week Tool online

3rd week Ind. Chat

4th week Group Chat

5th week Ind. Chat

6th week Tool online

7th week Ind. Chat

8th week Group Chat

9th week Ind. Chat


11th week 12th week DH Group

13th week Ind. Chat


15th week 16th week Group Chat

17th week 18th week Tool online

19th week 20th week Group Chat

21th week 22th week Tool online

23th week Group Chat

24th week DH Ind.

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Documents

Paris, 10 April 2003 Virtual Reality based multidimensional therapy for the treatment of body image