Virtual reality, electrophysiology & motion tracking technologies in mental illnesses

Introduction

Exposure therapy is a well-established psychological treatment used to manage anxiety disorders, phobias, and posttraumatic stress disorder (PTSD) [1,2]. Traditionally, it involves exposing patients to anxiety-provoking stimuli in real-world settings or through guided imagination, helping them gradually face and diminish their fears. However, recent technological advancements have introduced innovative approaches that enhance how well treatment works and the engagement of exposure therapy. One such technology is Virtual Reality (VR) [3-6], which creates immersive, three-dimensional environments that simulate real-life scenarios. This allows patients to confront their fears in a controlled and safe setting, offering significant advantages over traditional methods by providing a highly customizable and repeatable therapeutic experience [3-6].

Additionally, integrating motion tracking technology [4] enables precise monitoring of a patient’s physical responses during therapy sessions. This real-time feedback allows therapists to adjust treatments to better suit the patient’s needs and track their progress more accurately. Electrophysiological sensors, such as electroencephalography (EEG) [7] and Heart Rate Variability (HRV) monitors [8], further enhance this approach by measuring neural and cardiovascular activity. These sensors provide objective data on the patient’s arousal and emotional state, enabling a total assessment and facilitating more effective, personalized interventions. The combination of VR, motion tracking, and electrophysiological sensors offers a multidisciplinary approach that promises to improve exposure therapy goals and expand its applicability to various mental health disorders.

Background

VR creates immersive, controllable environments that can simulate real-life scenarios without exposing patients to actual danger. This capability is particularly beneficial in exposure therapy, where gradual exposure to feared stimuli is essential [9,10]. Studies have shown that VR-based Exposure Therapy (VRET) can effectively reduce symptoms of PTSD, specific phobias, and social anxiety disorders by providing a safe and controlled setting for patients to confront their fears. One significant advantage of VR is the ability to tailor the virtual environment to the personal needs of the patient. Therapists can adjust the intensity and nature of the stimuli in real time [11,12], allowing for personalized treatment plans. This customization enhances the therapy’s relevance and effectiveness, ensuring that patients are exposed to appropriate levels of challenge and support.

In that customization, additional technologies such as motion tracking cameras enhance the immerses of the virtual environment as well and the incorporation of electrophysiological sensors may dynamically change the Exposure Therapy treatment based on the patient’s needs; in more detail.

Enhancing engagement and feedback

Motion tracking technology captures and analyzes the patient’s movements in real-time. In exposure therapy, motion tracking can monitor physical responses to anxiety-provoking stimuli, providing valuable feedback to both patients and therapists [13,14]. This data can help in understanding the patient’s progress and adjusting the therapy accordingly. Motion tracking can also facilitate teletherapy by allowing therapists to monitor patients’ physical responses remotely [15]. This capability is particularly valuable in contexts where in-person therapy sessions are impractical, such as during the COVID-19 pandemic or for patients in remote locations. By providing accurate data on physical responses [16,17], motion tracking ensures that therapists can still deliver high-quality care from a distance.

Monitoring physiological responses

Electrophysiological sensors, such as EEG [7] and Heart Rate Variability (HRV) monitors, measure the body’s physiological responses to stress and anxiety. Integrating these sensors with VR and motion tracking systems allows for a total assessment of a patient’s physiological and psychological states during therapy sessions. These sensors provide real-time data on neural and cardiovascular activity, which can be used to assess the patient’s level of arousal and emotional state [18]. This information is invaluable for therapists as it provides objective metrics to gauge the effectiveness of the therapy and make necessary adjustments. For example, if a patient exhibits elevated heart rates or heightened brain activity in response to certain stimuli, the therapist can modulate the intensity of the exposure to better manage the patient’s anxiety levels [3,19].

The combination of VR, motion tracking, and electrophysiological sensors offers a synergistic approach to exposure therapy [20,21]. VR provides an immersive environment, motion tracking ensures accurate monitoring of physical responses, and electrophysiological sensors deliver real-time data on physiological states. Together, these technologies enable a holistic understanding of the patient’s experience and facilitate more precise and effective interventions.

Research into these technologies enhances the therapeutic process by providing immersive, customizable environments and real-time physiological monitoring, leading to more effective and personalized care. While challenges such as usability, standardization, and ethical considerations remain, addressing these issues through focused research and interdisciplinary collaboration will unlock the full potential of these tools. Ultimately, the continued development and refinement of these technologies promise to transform mental health care, offering innovative solutions for improved patient results indicates that integrating these technologies can lead to improved patient results [22]. Patients often report higher levels of engagement and a greater sense of presence in VR environments compared to traditional therapy settings. The ability to monitor and respond to both physical and physiological responses in real time allows for a more adaptive and responsive therapeutic approach, potentially leading to faster and more sustained improvements in mental health conditions [23].

Discussion

The integration of Virtual Reality (VR), motion tracking, and electrophysiological sensors into exposure therapy has shown promising results in enhancing treatment goals for various mental health conditions. These technologies offer immersive, controllable environments and real-time monitoring of physiological responses, enabling more tailored and effective therapeutic interventions. However, several challenges need to be addressed to fully realize their potential. Future research should focus on improving the usability and accessibility of these systems by developing user-friendly interfaces, reducing equipment costs, and creating portable solutions. Establishing standardized protocols and guidelines for clinical use is essential to ensure consistent and effective application. Longitudinal studies are also necessary to assess the long-term efficacy and safety of these interventions, providing a total understanding of their impact over time.

In addition to these practical considerations, ethical issues about data privacy and patient consent must be prioritized. Developing robust data protection protocols and ensuring regulatory compliance will be crucial in maintaining patient trust. Furthermore, interdisciplinary collaboration across fields such as psychology, engineering, and computer science is essential for advancing these technologies and translating research into clinical practice. Exploring novel applications beyond traditional exposure therapy, such as enhancing mindfulness training or improving cognitive-behavioral therapy for depression, can expand the therapeutic potential of these tools. By addressing these challenges and focusing on innovation, the integration of VR, motion tracking, and electrophysiological sensors can significantly improve mental health care and provide more effective, personalized treatment options for patients.

Finally, it is important to consider the known negative effects of VR therapy on anxiety disorders, phobias, and PTSD. Some patients may experience cybersickness [24,25], a form of motion sickness induced by VR environments, which can cause symptoms like dizziness, nausea, and disorientation. Additionally, VR therapy may sometimes lead to increased anxiety if the virtual environments are too intense or not adequately tailored to the patient’s tolerance levels. These adverse effects are relatively rare and often manageable, but they highlight the need for careful calibration of VR scenarios. When compared to real exposure therapy, VR offers the advantage of a controlled and safe environment, reducing the risk of encountering unpredictable variables present in real-world settings. However, real exposure therapy can sometimes provide a confrontation with fears, which might be necessary for some patients to achieve significant breakthroughs. Both methods have their unique benefits and drawbacks, and the choice between them should be guided by personal patient needs and preferences.

Conclusion

These technologies enhance the therapeutic process by providing immersive, customizable environments and real-time physiological monitoring, leading to more effective and personalized care. While challenges such as usability, standardization, and ethical considerations remain, addressing these issues through focused research and interdisciplinary collaboration will unlock the full potential of these tools. Ultimately, the continued development and refinement of these technologies promise to transform mental health care, offering innovative solutions for improved patient results.

1. Society of Clinical Psychology. What is Exposure Therapy? American Psychological Association: Division 12.
2. Craske MG, Treanor M, Conway CC, Zbozinek T, Vervliet B. Maximizing exposure therapy: an inhibitory learning approach. Behav Res Ther. 2014 Jul; 58:10-23. doi: 10.1016/j.brat.2014.04.006. Epub 2014 May 9. PMID: 24864005; PMCID: PMC4114726.
3. Abramowitz JS, Deacon BJ, Whiteside SPH. Exposure therapy for anxiety: Principles and practice. 2011. https://www.lib.uwo.ca/cgibin/ezpauthn.cgi?url=http://search.proquest.com/docvi ew/856410898?accountid=15115%5Cnhttp://vr2pk9sx9w.search.serialssolutions.com/?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&rfr_id=info:sid/PsycINFO&rft_val_fmt=info:ofi/fm t
4. Scheggi S, Meli L, Pacchierotti C, Prattichizzo D. Touch the virtual reality: Using the leap motion controller for hand tracking and wearable tactile devices for immersive haptic rendering. In: ACM SIGGRAPH 2015 Posters. SIGGRAPH 2015; 2015. doi: 10.1145/2787626.2792651.
5. Kritikos J, Alevizopoulos G, Koutsouris D. Personalized Virtual Reality Human-Computer Interaction for Psychiatric and Neurological Illnesses: A Dynamically Adaptive Virtual Reality Environment That Changes According to Real-Time Feedback from Electrophysiological Signal Responses. Front Hum Neurosci. 2021 Feb 12; 15:596980. doi: 10.3389/fnhum.2021.596980. PMID: 33643010; PMCID: PMC7906990.
6. Kritikos J, Makrypidis A, Alevizopoulos A, Alevizopoulos G, Koutsouris D. Can Brain–Computer Interfaces Replace Virtual Reality Controllers? A Machine Learning Movement Prediction Model during Virtual Reality Simulation Using EEG Recordings. Virtual Worlds. 2023; 2(2). doi: 10.3390/virtualworlds2020011.
7. Vortmann LM, Kroll F, Putze F. EEG-Based Classification of Internally- and Externally-Directed Attention in an Augmented Reality Paradigm. Front Hum Neurosci. 2019 Oct 9; 13:348. doi: 10.3389/fnhum.2019.00348. PMID: 31649517; PMCID: PMC6794454.
8. Solcà M, Ronchi R, Bello-Ruiz J, Schmidlin T, Herbelin B, Luthi F, Konzelmann M, Beaulieu JY, Delaquaize F, Schnider A, Guggisberg AG, Serino A, Blanke O. Heartbeat-enhanced immersive virtual reality to treat complex regional pain syndrome. Neurology. 2018 Jul 31; 91(5):e479-e489. doi: 10.1212/WNL.0000000000005905. Epub 2018 Jul 6. PMID: 29980635.
9. Kritikos J, Caravas P, Tzannetos G, Douloudi M, Koutsouris D. Emotional stimulation during motor exercise: An integration to the holistic rehabilitation framework. Annu Int Conf IEEE Eng Med Biol Soc. 2019 Jul; 2019:4604-4610. doi: 10.1109/EMBC.2019.8857548. PMID: 31946890.
10. Baus O, Bouchard S. Moving from virtual reality exposure-based therapy to augmented reality exposure-based therapy: a review. Front Hum Neurosci. 2014 Mar 4; 8:112. doi: 10.3389/fnhum.2014.00112. PMID: 24624073; PMCID: PMC3941080.
11. Kritikos J, Mehmeti A, Nikolaou G, Koutsouris D. Fully portable low-cost motion capture system with real-time feedback for rehabilitation treatment. In: International Conference on Virtual Rehabilitation (ICVR); 2019. doi: 10.1109/ICVR46560.2019.8994561.
12. Diemer J, Alpers GW, Peperkorn HM, Shiban Y, Mühlberger A. The impact of perception and presence on emotional reactions: a review of research in virtual reality. Front Psychol. 2015 Jan 30; 6:26. doi: 10.3389/fpsyg.2015.00026. PMID: 25688218; PMCID: PMC4311610.
13. Park SJ, Hussain I, Hong S, Kim D, Park H, Benjamin HCM. Real-time gait monitoring system for consumer stroke prediction service. In: Digest of Technical Papers - IEEE International Conference on Consumer Electronics; 2020. doi: 10.1109/ICCE46568.2020.9043098.
14. Kritikos J, Tzannetos G, Zoitaki C, Poulopoulou S, Koutsouris PD. Anxiety detection from Electrodermal Activity Sensor with movement interaction during Virtual Reality Simulation. In: International IEEE/EMBS Conference on Neural Engineering (NER); 2019. doi: 10.1109/NER.2019.8717170.
15. Kritikos J, Zoitaki C, Tzannetos G, Mehmeti A, Douloudi M, Nikolaou G, Alevizopoulos G, Koutsouris D. Comparison between Full Body Motion Recognition Camera Interaction and Hand Controllers Interaction used in Virtual Reality Exposure Therapy for Acrophobia. Sensors (Basel). 2020 Feb 25; 20(5):1244. doi: 10.3390/s20051244. PMID: 32106452; PMCID: PMC7085665.
16. Alevizopoulos A, Kritikos J, Alevizopoulos G. Intelligent machines and mental health in the era of COVID-19. Psychiatriki. 2021 Jul 10; 32(2):99-102. Greek, Modern, English. doi: 10.22365/jpsych.2021.015. Epub 2021 May 28. PMID: 34052787.
17. Kritikos J, Poulopoulou S, Zoitaki C, Douloudi M, Koutsouris D. Full Body Immersive Virtual Reality System with Motion Recognition Camera Targeting the Treatment of Spider Phobia. In: Lecture Notes of the Institute for Computer Sciences, Social-Informatics and Telecommunications Engineering (LNICST). 2019; 288:216–230. doi: 10.1007/978-3-030-25872-6_18.
18. Bermudez I Badia S, Quintero LV, Cameirao MS, Chirico A, Triberti S, Cipresso P, Gaggioli A. Toward Emotionally Adaptive Virtual Reality for Mental Health Applications. IEEE J Biomed Health Inform. 2019 Sep; 23(5):1877-1887. doi: 10.1109/JBHI.2018.2878846. Epub 2018 Oct 31. PMID: 30387752.
19. Cardoş RAI, David OA, David DO. Virtual reality exposure therapy in flight anxiety: A quantitative meta-analysis. Computers in Human Behavior. 2017. doi: 10.1016/j.chb.2017.03.007.
20. Fischer MJ, Scharloo M, Abbink JJ, Thijs-Van A, Rudolphus A, Snoei L, Weinman JA, Kaptein AA. Participation and drop-out in pulmonary rehabilitation: a qualitative analysis of the patient's perspective. Clin Rehabil. 2007 Mar; 21(3):212-21. doi: 10.1177/0269215506070783. PMID: 17329278.
21. Caravas P, Kritikos J, Alevizopoulos G, Koutsouris D. Participant Modeling: The Use of a Guided Master in the Modern World of Virtual Reality Exposure Therapy Targeting Fear of Heights. In: Lecture Notes of the Institute for Computer Sciences, Social-Informatics and Telecommunications Engineering (LNICST); 2021. doi: 10.1007/978-3-03076066-3_13.
22. Coelho CM, Silva CF, Santos JA, Tichon J, Wallis G. Contrasting the effectiveness and efficiency of virtual reality and real environments in the treatment of acrophobia. PsychNology Journal. 2008.
23. Kritikos J, Poulopoulou S, Zoitaki D, Douloudi M, Koutsouris P. Pervasive Computing Paradigms for Mental Health, vol. 207. Lecture Notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering. Cham: Springer International Publishing; 2018; 207. doi: 10.1007/978-3-319-74935-8.
24. Mittelstaedt J, Wacker J, Stelling D. Effects of display type and motion control on cybersickness in a virtual bike simulator. Displays. 2018. doi: 10.1016/j.displa.2018.01.002.
25. Alevizopoulos, A.; Alevizopoulou, M.; Kritikos, J.; Alevizopoulos, G. Biosensor-Integrated Virtual Reality (VR) System Assisted CBT and the Alteration of Delusional Perceptions in Psychosis. Preprints 2024, 2024041956. https://doi.org/10.20944/preprints202404.1956.v1