'Interreality' may enhance stress therapies

An attendee tries on the Oculus VR Inc. Rift Development Kit 2 headset at the 2014 Electronic Entertainment Expo (E3) in Los Angeles, California June 11, 2014.
PHOTO: 'Interreality' may enhance stress therapies

Using virtual reality to add "real world" challenges to psychotherapy sessions may enhance the treatment's effect for people learning to cope with workplace stress, according to a small study from Italy.

Researchers say the hybrid therapy known as "interreality" was more effective than traditional cognitive behavioural therapy, which is currently considered the gold standard for more serious anxiety or post traumatic stress disorders.

"Psychological stress has reached pandemic proportions in industrialized countries. Exposure to prolonged stress is known to increase the risk of physical and mental health problems, including depression and disabling anxiety conditions," said Dr. Andrea Gaggioli from the Istituto Auxologico Italiano in Milan, who led the study.

"In particular, work-related stress is responsible for around one fifth of staff turnover, with negative implications for the productivity of organisations. Identifying more effective strategies to help people dealing with stress is an important research challenge," he told Reuters Health in an email.

"The trouble with stress is that it is so very personal," Gaggioli said. "Stress-related disorders depend a great deal on how the person experiencing a stressor is put together - psychologically and physically."

Using biosensors, smart phones and virtual reality technology, Gaggioli and his team designed a system to give therapists a window into how a specific patient experiences stress to better understand their stress triggers and pinpoint what the person should do differently to cope in a stressful situation.

To see if this technology-enhanced therapy approach works, the researchers recruited 121 nurses and teachers.

All the men and women filled out pre- and post-test questionnaires to measure their stress levels. The participants were then randomly assigned to either the interreality treatment group, a cognitive behavioural therapy (CBT) group or a waiting list group that received no treatment.

For five weeks, participants in both treatment groups attended two hour-long sessions a week to learn ways to manage their stress.

Examples of a stressful virtual scenario used during therapy with a teacher was "class management" or "coping with parent's criticism." For nurses the scenarios included "managing patient's relatives" and "managing a medical emergency situation."

The interreality participants also received counseling and training to cope with their stress based on how they performed in the virtual-reality sessions.

When members of the standard CBT group met, they were instructed to close their eyes and imagine the same sorts of stressful situations that interreality group members had experienced in simulation. They didn't have mobile phones to keep track of their "stress history," but were told to keep a diary.

People in both the cognitive therapy and interreality groups reported less stress at the end of the experiment than those on the waiting list, but the interreality group showed bigger improvements.

According to the results published in the Journal of Medical Internet Research, participants in the interreality group had a 12 per cent decrease in general anxiety levels and a 14 per cent increase in emotional coping skills. Cognitive therapy group members showed only a 0.5 per cent drop in general anxiety and a 0.3 per cent increase in coping skills.

"A real strength here is the mix of technology, practitioners and real-life use - which seems like a potentially powerful therapeutic mix," said Chris Williams, a professor and psychiatrist at the University of Glasgow in Scotland, who was not involved in the study.

"The results show early encouraging results, however a key issue is that the people involved in this early stage study were stressed rather than facing the level of clinical anxiety normally seen by mental health workers," Williams told Reuters Health in an email.

"In fact," he added, "people with definite diagnoses such as generalized anxiety disorders or phobias were ruled out of the study. That means that it's still too early to quite know whether that group of people can benefit. That's important because at the moment CBT is almost entirely focused on people with mental health disorders. I'm afraid as with lots of early stage research I'd have to say it shows promise, but for use clinically there need to be more studies."

The researchers point out that the anxiety reduction seen among participants who used interreality is greater than some research has found using a meditation programme to reduce stress. Plus, meditation and mindfulness approaches don't emphasise coping skills, the authors write.

They acknowledge that the results are preliminary, but speculate that traditional cognitive behavioural therapy appeared to be less effective because it doesn't take place in real time while the patient is experiencing the stress.

Williams noted that virtual reality could be useful when therapists are working with a patient on a problem that can't easily be tested or controlled in the real world, like coping with a wasp phobia in winter, or facing anxiety in a crowded shop.

"These virtual reality approaches can potentially be very helpful therefore by allowing the patient and the practitioner to plan a step by step way of facing fears - and doing so in a way without surprises. The package cleverly mixes everyday examples - plus encourages use in real life with support from a worker."

"We believe that this approach can provide mental health researchers and practitioners with powerful new tools for assessment, treatment and progress monitoring," study coauthor Guiseppe Riva, also with the Instituto Auxologico Italiano, told Reuters Health.

Interreality is a way of using technology to bridge together real and virtual experiences to help a person learn new psychological skills, he said.