ANXIETY DISORDERS

The anxiety disorders that C2Care helps treating are grouped into different clinical subgroups :

Specific phobias, social phobia, agoraphobia and post traumatic stress disorder.

Virtual Reality Exposure Treatment (VRET) is based on the principles of Cognitive Behavioral Therapy. According to Dr Malbos (2013), people with anxieties actively avoids situations where anxiety provoking stimuli is found. By exposing these patients to the same fear-provoking stimuli in VR, the therapist can create a sense of habituation for the patient. Gradually, the patient will get better used to the anxiety stimuli and will be able – thanks to learning – to function normally in front of real situations and objects that previous created a higher degree of fear or anxiety. This learning process of overcoming a fear, is made possible by immersion and creates the maximal potential of deconditioning.

Social Phobia

The treatment of social phobia in VR is made possible thanks to the virtual environments that are present in the C2Phobia Software. This application offers visual and verbal interactions with avatars, modifications of the facial expressions of the virtual characters, exposure to an audience and more. A module dedicated to school phobia offers the possibility of exposing a young audience to their most resistant anxieties. The software allows a gradual increase of exposure that allows the patient to be confronted with the feared situations with gentleness and efficiency. In addition, the therapist will have the opportunity to interact with the patient via a microphone that facilitates a dialogue between the latter and an avatar in order to work on verbal interactions and social skills.

Specific Phobias

Specific phobias are treated by the Virtual introduction of “ecological” environments to the patient. These can be insects, animals, heights, airplanes, enclosed spaces, driving, etc. The software has been developed to meet the therapeutic needs of the most common phobias. The available environments have been designed from a perspective to enhance phobogenic situations. For each target phobia, the therapist will have the possibility of graduating his exposure to the patient. Virtual reality optimisez the accessibility of environments, situations, objects or animals by overcoming the limits of exposure in vivo.

Agoraphobia

Agoraphobia is a type of anxiety disorder in which the patient fear and avoid places or situations that might cause him to panic and make him feel trapped, helpless or embarrassed. With the C2Phobia application, the patient can progressively be exposed to places such as public transpors, cities, grocery stores, with the goal to regain normal function in those places. In the application, the therapist has optimal control over the exposure situations and their gradations: increase and decrease in crowd flow, management of affordances, immediate feedback on what the patient perceives and does. Treating agoraphobia by exposure becomes practical from the therapist’s perspective is all imaginable exposure environment connected to the disorder easily can be accessed.

Post Traumatic Stress Disorders

The treatment of Post-Traumatic Stress Disorder is based on the need to visualize the context of the birth of the trauma. Virtual reality is one of the most relevant answer to this. C2Care has developed environments that recreates the most widespread trauma contexts. In order to meet the individual needs of each patient, there are functions to add photos and videos for customized experience. Treatment by bilateral visual stimulation is also a technique that can be transposed into virtual reality, which therapists can benefit from with the C2Care solution

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C2Care is also a scientific committee and a network of partners. With a scientific reasearch and development department, we validate our software with a constant concern about the therapeutic effectiveness. Today, we collaborate with Universities and health establishments in the realization of experimental work on the treatment of anxiety disorders by virtual reality.

The University of Nîmes is currently working on anxiety issues.

The CHU de Nice carried out a virtual reality protocol on the treatment of post-traumatic stress disorder for the victims of the Nice terror attack in 2016.
The Saint-Onge hospital center carries out work on social phobia with adolescent patients.

HOW TO START A SESSION?

When treating phobias in Virtual Reality, the patient will be exposed to different virtual contexts. The definite advantage of virtual reality is that it offers the possibility of multiplying situations that allow the gradual increase of exposure. In fact, VRET offers a gentle approach where after prioritizing anxiety-provoking situations, exposure will begin with the least anxiety-provoking context for the patient. Then after the advent of the first therapeutic success, the severity of phobogenic situations will gradually be increased.

Take the example of someone with an uncontrollable fear of flying (aviophobia). The activation of the anxiety will be triggered, in a more or less intense way, when the patient will be confronted with stimuli related to the theme of its phobia. Thus, the first level of exposure could be the entry into the airport, then takeoff which will cause more intense anxiety, passing through areas of turbulence that will amplify the fear. Int the above example, the first step will be to expose the least anxiety-provoking situation when entering the airport, but which nonetheless provokes invasive emotional activation. After this, the patient is put in front of a gradual increase of anxiety provoking stimuli.

HOW LONG IS THE DURATION OF A TREATMENT?

The average duration of exposures for the treatment of anxiety disorders ranges from 30 to 60 minutes. The number of sessions required is also subject to an inter-individual reality and varies from 6 to 12 exhibition sessions.

WHO CAN BE TREATED?

Children, adolescents, adults and the elderly can benefit from Virtual Reality Exposure Therapy.

Restrictions exist however concerning:

– Children under 4 years old because the eye lens is not yet fully formed

– People with epilepsy

– Pregnant women (precautionary measure taken in the absence of concrete medical data)

– Psychotics in the decompensation phase

WHAT ANXIETY DISORDERS THAT CAN BE TREATED BY VIRTUAL REALITY?

Today, some anxiety disorders have been the subject of more research than others. Specific phobias, agoraphobia, social phobia and post-traumatic stress disorder are the most treated anxiety disorders in VR. However, other studies have shed light on the relevance of using virtual reality for the management of OCD, school phobia and generalized anxiety in particular. Furthermore, the huge advantage of virtual reality is that it knows no bounds and the coming years will create great opportunities for VR-Treatment when combining therapeutic and technological skills.

ARE VRET AS EFFECTIVE AS OTHER THERAPIES FOR TREATING ANXIETY DISORDERS?

Regarding the management of phobias and post-traumatic stress, Virtual Reality treatment has the same scientific validity as Cognitive behavioral therapies (CBT).

STUDIES SHOWING THE EFFECTIVENESS OF VIRTUAL REALITY

Mental health researchers began to take an interest in the impact of virtual reality in the 1980s. Today, more and more publications show, through quantitative and qualitative analyzes, the effectiveness of this therapeutic practice. As described by Levy (2017), according to numerous publications including meta-analyzes, virtual reality therapy is at least as effective as exposure in reality in the treatment of specific phobias, panic disorder with agoraphobia, post-traumatic stress disorder and social phobia.

The anxiety disorder family represents the type of pathology that has been the subject of most publications to date. The research has been carried out with adults but also with children and adolescents.

Da Costa (2018) demonstrated the effectiveness of in VR Treatment of patients with amaxophobia (fear of driving). The latter carried out 8 exhibition sessions in virtual environments representing various road contexts (traffic, weather, landscape). Analysis of the data revealed a significant decrease in anxiety, dysfunctional thoughts about driving but also an increase in quality of life.

Bouchard (2016) conducted a study with patients diagnosed with social phobia. 3 experimental groups were formed: one receiving therapy by exposure to virtual reality, a second benefiting from therapy by exposure in real life and a last consisting of patients on the waiting list. The objectives of this study were twofold: to assess the effectiveness of VR-treatment compared to exposure in reality, but also to determine whether virtual reality offered functionalities making therapy easier for the therapist.

Meyenbroeker (2013) studied the impact of VR therapy on agoraphobic patients. The results were compared with groups of patients with the same diagnosis who either received real life exposure or were on the waiting list. The results demonstrate a significant efficacy of exposure in VR and a comparable efficacy between exposure in real life and in VR.