Clinical Virtual Reality tools to advance the prevention, assessment, and treatment of PTSD

Albert 'Skip' Rizzo, Russell Shilling, Albert 'Skip' Rizzo, Russell Shilling

Abstract

Numerous reports indicate that the incidence of posttraumatic stress disorder (PTSD) in Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) military personnel has created a significant behavioural healthcare challenge. These findings have served to motivate research on how to better develop and disseminate evidence-based treatments for PTSD. The current article presents the use of Virtual Reality (VR) as a clinical tool to address the assessment, prevention, and treatment of PTSD, based on the VR projects that were evolved at the University of Southern California Institute for Creative Technologies since 2004. A brief discussion of the definition and rationale for the clinical use of VR is followed by a description of a VR application designed for the delivery of prolonged exposure (PE) for treating Service Members (SMs) and Veterans with combat- and sexual assault-related PTSD. The expansion of the virtual treatment simulations of Iraq and Afghanistan for PTSD assessment and prevention is then presented. This is followed by a forward-looking discussion that details early efforts to develop virtual human agent systems that serve the role of virtual patients for training the next generation of clinical providers, as healthcare guides that can be used to support anonymous access to trauma-relevant behavioural healthcare information, and as clinical interviewers capable of automated behaviour analysis of users to infer psychological state. The paper will conclude with a discussion of VR as a tool for breaking down barriers to care in addition to its direct application in assessment and intervention.

Keywords: BRAVEMIND; PTSD; SimCoach; Veterans; Virtual Reality; exposure therapy; resilience; service members; virtual humans; virtual patients; • The article presents the use of Virtual Reality (VR) as a clinical tool to address the assessment, prevention, and treatment of posttraumatic stress disorder (PTSD).• A brief discussion of the definition and rationale for the clinical use of VR is followed by a description of a VR application designed for the delivery of prolonged exposure (PE) for treating Service Members and Veterans with combat- and sexual assault-related PTSD.• Virtual human applications relevant to PTSD are also discussed.• The clinical use of VR is discussed in a larger context, particularly regarding its capability to break down barriers to care..

Conflict of interest statement

No potential conflict of interest was reported by the authors.

References

    1. Albright G., Adam C., Serri D., Bleeker S., & Goldman R. (2016). Harnessing the power of conversations with virtual humans to change health behaviors. mHealth, 2, 11.
    1. American Psychological Association (2007). Presidential task force on military deployment services for youth, families and service members. The psychological needs of US Military Service Members and their families: A preliminary report. Retrieved April18, 2007, from
    1. Anderson P. L., Zimand E., Hodges L. F., & Rothbaum B. O. (2005). Cognitive behavioral therapy for public-speaking anxiety using virtual reality for exposure. Depression and Anxiety, 22(3), 156–20. doi:10.1002/da.20090
    1. Andrade L. H., Alonso J., Mneimneh Z., Wells J. E., Al-Hamzawi A., Borges G., … Kessler R. C. (2014). Barriers to mental health treatment: Results from the WHO World Mental Health surveys. Psychological Medicine, 44(6), 1303–1317. doi:10.1017/S0033291713001943
    1. Aukstakalnis, & Blatner D. (1992). Silicon mirage: The art and science of virtual reality. Berkeley, CA: Peachpit Press.
    1. Bailenson J. N., & Beall A. C. (2006). Transformed social interaction: Exploring the digital plasticity of avatars In Schroeder R. & Axelsson A. (Eds.), Avatars at work and play: Collaboration and interaction in shared virtual environments (pp. 1–16). Berlin, Germany: Springer Science & Business Media.
    1. Baños R. M., Botella C., Guillen V., García-Palacios A., Quero S., Bretón-López J., & Alcañiz M. (2009). An adaptive display to treat stress-related disorders: EMMA’s world. British Journal of Guidance & Counselling, 37(3), 347–356. doi:10.1080/03069880902957064
    1. Baños R. M., Guillen V., Quero S., García-Palacios A., Alcaniz M., & Botella C. (2011). A virtual reality system for the treatment of stress-related disorders: A preliminary analysis of efficacy compared to a standard cognitive behavioral program. International Journal of Human Computer Studies, 69(9), 602–613. doi:10.1016/j.ijhcs.2011.06.002
    1. Beck A. T., Epstein N., Brown G., & Steer R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897.
    1. Beck J. G., Palyo S. A., Winer E. H., Schwagler B. E., & Ang E. J. (2007). Virtual reality exposure therapy for PTSD symptoms after a road accident: An uncontrolled case series. Behavior Therapy, 38(1), 39–48. doi:10.1016/j.beth.2006.04.001
    1. Beidel D. C., Frueh B. C., Neer S. M., & Lejuez C. W. (2017). The efficacy of Trauma Management Therapy: A controlled pilot investigation of a three-week intensive outpatient program for combat-related PTSD. Journal of Anxiety Disorders, 50, 23–32. doi:10.1016/j.janxdis.2017.05.001
    1. Bickmore T. W., Utami D., Matsuyama R., & Paasche-Orlow M. K. (2016). Improving access to online health information with conversational agents: A randomized controlled experiment. Journal of Medical Internet Research, 18, 1. doi:10.2196/jmir.5239
    1. Blake D. D., Weathers F. W., Nagy L. M., Kaloupek D. G., Gusman F. D., Charney D. S., & Keane T. M. (1995). The development of a Clinician-Administered PTSD Scale. Journal of Traumatic Stress, 8(1), 75–90.
    1. Blanchard E. B., Jones-Alexander J., Buckley T. C., & Forneris C. A. (1996). Psychometric properties of the PTSD Checklist (PCL). Behaviour Research and Therapy, 34(8), 669–673.
    1. Blascovich J., Loomis J., Beall A., Swinth K., Hoyt C., & Bailenson J. (2002). Target article: Immersive virtual environment technology as a methodological tool for social psychology. Psychological Inquiry, 13, 103–124. doi:10.1207/S15327965PLI1302_01
    1. Bogdanova Y., Yee M. K., Ho V. T., & Cicerone K. D. (2016). Computerized cognitive rehabilitation of attention and executive function in acquired brain injury: A systematic review. Journal of Head Trauma Rehabilitation, 31(6), 419–433. doi:10.1097/HTR.0000000000000203
    1. Bohil C. J., Alicea B., & Biocca F. A. (2011). Virtual reality in neuroscience research and therapy. Nature Reviews Neuroscience, 12(12), 752–762. doi:10.1038/nrn3122
    1. Botella C., Serrano B., Baños R. M., & García-Palacios A. (2015). Virtual reality exposure-based therapy for the treatment of post-traumatic stress disorder: A review of its efficacy, the adequacy of the treatment protocol, and its acceptability. Neuropsychiatric Disease and Treatment, 11, 2533–2545. doi:10.2147/NDT
    1. Bresnahan T., Rizzo A. A., Burke S. L., Partin M., Ahlness R. M., & Trimmer M. (2016). Using Virtual Interactive Training Agents (VITA) with adults with autism and other developmental disabilities. In The 2016 Proceedings of the International Conference on Disability, Virtual Reality and Associated Technologies (ICDVRAT) Retrived from
    1. Bryant R. A. (2005). Psychosocial approaches of acute stress reactions. CNS Spectrums, 10(2), 116–122.
    1. Bryanton C., Bossé J., Brien M., Mclean J., McCormick A., & Sveistrup H. (2006). Feasibility, motivation, and selective motor control: Virtual reality compared to conventional home exercise in children with cerebral palsy. CyberPsychology & Behavior, 9(2), 123–128. doi:10.1089/cpb.2006.9.123
    1. Casey G. W. (2011). Comprehensive soldier fitness: A vision for psychological resilience in the US Army. American Psychologist., 66(1), 1–3. doi:10.1037/a0021930
    1. Clement S., Schauman O., Graham T., Maggioni F., Evans-Lacko S., Bezborodovs, N.,..., Thornicroft, G (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine, 45(1), 11–27. doi:10.1017/S0033291715001269
    1. Cornum R., Matthews M. D., & Seligman M. E. P. (2011). Comprehensive Soldier Fitness: Building resilience in a challenging institutional context. American Psychologist., 66(1), 4–9. doi:10.1037/a0021420
    1. Ćosić K., Popović S., Kukolja D., Horvat M., & Dropuljić B. (2010). Physiology-driven adaptive virtual reality stimulation for prevention and treatment of stress related disorders. CyberPsychology, Behavior, and Social Networking, 13(1), 73–78. doi:10.1089/cyber.2009.0260
    1. Costanzo M. E., Leaman S., Jovanovic T., Norrholm S. D., Rizzo A. A., Taylor P., & Roy M. J. (2014). Psychophysiological response to virtual reality and subthreshold posttraumatic stress disorder symptoms in recently deployed military. Psychosomatic Medicine, 76(9), 670–677. doi:10.1097/PSY.0000000000000109
    1. Dascal J., Reid M., IsHak W. W., Spiegel B., Recacho J., Rosen B., & Danovitch I. (2017). Virtual reality and medical inpatients: A systematic review of randomized, controlled trials. Innovations in Clinical Neuroscience, 14(1–2), 14.
    1. de Kleine R. A., Hendriks G.-J., Kusters W. J., Broekman T. G., & van Minnen A. (2012). A randomized placebo-controlled trial of D-cycloserine to enhance exposure therapy for posttraumatic stress disorder. Biological Psychiatry, 71, 962–968. doi:10.1016/j.biopsych.2012.02.033
    1. Deutsch J. E., & McCoy S. W. (2017). Virtual reality and serious games in neurorehabilitation of children and adults: Prevention, plasticity, and participation. Pediatric Physical Therapy, 29, S23–S36. doi:10.1097/PEP.0000000000000387
    1. Difede J., Cukor J., Jayasinghe N., Patt I., Jedel S., Spielman L., … Hoffman H. G. (2007). Virtual Reality exposure therapy for the treatment of posttraumatic stress disorder following September 11, 2001. The Journal of Clinical Psychiatry, 68, 1639–1647.
    1. Difede J., Cukor J., Wyka K., Olden M., Hoffman H., Lee F. S., & Altemus M. (2014). D-cycloserine augmentation of exposure therapy for posttraumatic stress disorder: A pilot randomized clinical trial. Neuropsychopharmacology, 39(5), 1052–1058. doi:10.1038/npp.2013.317
    1. Difede J., & Hoffman H. G. (2002). Virtual reality exposure therapy for World Trade Center Post-traumatic Stress Disorder: A case report. Cyberpsychology & Behavior : the Impact of the Internet, Multimedia and Virtual Reality on Behavior and Society, 5, 529–535. doi:10.1089/109493102321018169
    1. Difede J., Rothbaum B. O., & Rizzo A. (2010). Enhancing exposure therapy for PTSD: Virtual reality and imaginal exposure with a cognitive enhancer. Randomized Controlled Trial. Retrieved from
    1. Erbes C. R., Curry K. T., & Leskela J. (2009). Treatment presentation and adherence of Iraq/Afghanistan era veterans in outpatient care for posttraumatic stress disorder. Psychological Services, 6(3), 175–183. doi:10.1037/a0016662
    1. Falconer C. J., Rovira A., King J. A., Gilbert P., Antley A., Fearon P., … Brewin C. R. (2016). Embodying self-compassion within virtual reality and its effects on patients with depression. British Journal of Psychiatry Open, 2, 74–80. doi:10.1192/bjpo.bp.116.003814
    1. Feldner M. T., Monson C. M., & Friedman M. J. (2007). A critical analysis of approaches to targeted PTSD prevention: Current status and theoretically derived future directions. Behavior Modification, 31, 80–116. doi:10.1177/0145445506295057
    1. Fischer H. (2015, August 7). A guide to US Military casualty statistics: Operation freedom’s sentinel, operation inherent resolve, operation new dawn, operation Iraqi freedom, and operation enduring freedom. Congressional Research Service 7-5700: RS22452. Retrieved January 1, 2016 from
    1. Foa E. B., & Hearst-Ikeda D. (1996). Emotional dissociation in response to trauma: An information-processing approach In Michelson L. K. & Ray W. J. (Eds.), Handbook of dissociation: Theoretical and clinical perspectives (pp. 207–222). New York: Plenum Press.
    1. Foa E. B., Hembree E., & Rothbaum B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences, therapist guide. NY: Oxford University Press.
    1. Foa E. B., & Kozak M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20–35.
    1. Freeman D., Bradley J., Antley A., Bourke E., DeWeevers N., Evans N., … Clark D. M. (2016). Virtual reality in the treatment of persecutory delusions: Randomised controlled experimental study testing how to reduce delusional conviction. The British Journal of Psychiatry, 209(1), 62–67. doi:10.1192/bjp.bp.115.176438
    1. Freeman D., Reeve S., Robinson A., Ehlers A., Clark D., Spanlang B., & Slater M. (2017). Virtual reality in the assessment, understanding, and treatment of mental health disorders. Psychiatry Medicine, 47(14), 2393–2400.
    1. García-Palacios A., Botella C., Hoffman H., & Fabregat S. (2007). Comparing acceptance and refusal rates of virtual reality exposure vs. in vivo exposure by patients with specific phobias. CyberPsychology and Behavior, 10(5), 722–724. doi:10.1089/cpb.2007.9999
    1. Garcia-Palacios A., Hoffman H. G., Kwong See S., Tsai A. M. Y., & Botella C. (2001). Redefining therapeutic success with virtual reality exposure therapy. CyberPsychology & Behavior, 4(3), 341–348. doi:10.1089/109493101300210231
    1. Gates M. A., Holowka D. W., Vasterling J. J., Keane T. M., Marx B. P., & Rosen R. C. (2012). Posttraumatic stress disorder in veterans and military personnel: Epidemiology, screening, and case recognition. Psychological Services, 9, 361–382. doi:10.1037/a0026143
    1. Gerardi M., Rothbaum B. O., Ressler K., Heekin M., & Rizzo A. A. (2008). Virtual reality exposure therapy using a virtual Iraq: Case report. Journal of Traumatic Stress, 21(2), 209–213. doi:10.1002/(ISSN)1573-6598
    1. Godden D. R., & Baddeley A. D. (1980). When does context influence recognition memory? British Journal of Psychology, 71, 99–104. doi:10.1111/bjop.1980.71.issue-1
    1. Gold J. I, Kim S. H, Kant A. J, Joseph M. H, & Rizzo A. (2006). Effectiveness of virtual reality for pediatric pain distraction during iv placement. Cyberpsychology & Behavior, 9(2), 207–213. doi:10.1089/cpb.2006.9.207
    1. Gratch J., & Marsella S. (2004). A domain independent framework for modeling emotion. Journal of Cognitive Systems Research., 5(4), 269–306. doi:10.1016/j.cogsys.2004.02.002
    1. Highland K. B., Costanzo M., Jovanovic T., Norrholm S. D., Ndiongue R. B., Reinhardt B. J., … Roy M. J. (2015). Catecholamine responses to virtual combat: implications for post-traumatic stress and dimensions of functioning. Frontiers in Psychology: Quantitative Psychology and Measurement, 6, article 256, 1–7. doi:10.3389/fpsyg.2015.00256
    1. Hoffman H. G., Chambers G. T., Meyer W. J., Arceneaux L. L., Russell W. J., Seibel E. J., … Sharar S. R. (2011). Virtual reality as an adjunctive non-pharmacologic analgesic for acute burn pain during medical procedures. Annals of Behavioral Medicine: A Publication of the Society of Behavioral Medicine, 41(2), 183–191. doi:10.1007/s12160-010-9248-7
    1. Hone-Blanchet A., Wensing T., & Fecteau S. (2014). The use of virtual reality in craving assessment and cue-exposure therapy in substance use disorders. Frontiers in Human Neuroscience, 8, 884.
    1. Hovar C. (2010, December 10). The military operational medicine research program for the US Army. Retrieved from
    1. Howard M. C. (2017). A meta-analysis and systematic literature review of virtual reality rehabilitation programs. Computers in Human Behavior, 70, 317–327. doi:10.1016/j.chb.2017.01.013
    1. Innes M., & Morrison B. (2017). Projecting the future impact of advanced technologies: Will a robot take my job? InPsych, 39(2). Retrieved June6, 2017, from,
    1. Institute of Medicine (IOM) (2008). Treatment of posttraumatic stress disorder: An assessment of the evidence. Washington, DC: The National Academies Press.
    1. Institute of Medicine (IOM) (2012). Treatment for posttraumatic stress disorder in military and veteran populations: Initial assessment. Washington, D.C.: The National Academies Press.
    1. John N. W., Pop S. R., Day T. W., Ritsos P. D., & Headleand C. J. (2017). The implementation and validation of a virtual environment for training powered wheelchair manoeuvres. IEEE Transactions on Visualization and Computer Graphics, 1. doi:10.1109/TVCG.2017.2700273
    1. Kenny P., Rizzo A. A., Parsons T., Gratch J., & Swartout W. (2007). A virtual human agent for training clinical interviewing skills to novice therapists. Annual Review of Cybertherapy and Telemedicine 2007, (5), 81–89.
    1. Klamroth-Marganska V., Blanco J., Campen K., Curt A., Dietz V., Ettlin T., … Riener R. (2014). Three-dimensional, task-specific robot therapy of the arm after stroke: A multicentre, parallel-group randomised trial. The Lancet Neurology, 13(2), 159–166. doi:10.1016/S1474-4422(13)70305-3
    1. Klinger E., Bouchard S., Légeron P., Roy S., Lauer F., Chemin I., & Nugues P. (2005). Virtual reality therapy versus cognitive behavior therapy for social phobia: A preliminary controlled study. CyberPsychology & Behavior, 8(1), 76–88. doi:10.1089/cpb.2005.8.76
    1. Kok B. C., Herrell R. K., Thomas J. L., & Hoge C. W. (2012). Posttraumatic stress disorder associated with combat service in Iraq or Afghanistan: Reconciling prevalence difference between studies. The Journal of Nervous and Mental Disease, 200(5), 444–450. doi:10.1097/NMD.0b013e3182532312
    1. Kroenke K., & Spitzer R. L. (2002). The PHQ-9: A new depression and diagnostic severity measure. Psychiatric Annals, 32, 509–515. doi:10.3928/0048-5713-20020901-06
    1. Lange B., Koenig S., Chang C.-Y., McConnell E., Suma E., Bolas M., & Rizzo A. A. (2012). Designing informed game-based rehabilitation tasks leveraging advances in virtual reality. Disability and Rehabilitation, 34(22), 1863–1870. doi:10.3109/09638288.2012.670029
    1. Litz B. T., Salters-Pedneault K., Steenkamp M. M., Hermos J. A., Bryant R. A., Otto M. W., & Hofmann S. G. (2012). A randomized placebo-controlled trial of D-cycloserine and exposure therapy for posttraumatic stress disorder. Journal of Psychiatric Research, 46, 1184–1190. doi:10.1016/j.jpsychires.2012.05.006
    1. Lubow R. E., & Moore A. U. (1959). Latent inhibition: The effect of nonreinforced pre-exposure to the conditional stimulus. Journal of Comparative and Physiological Psychology, 52, 415–419. doi:10.1037/h0046700
    1. Lucas G. M., Gratch J., King A., & Morency L-P (2014). It’s only a computer: virtual humans increase willingness to disclose. Computers in Human Behavior, 37, 94–100. doi:10.1016/j.chb.2014.04.043
    1. Luthar S. S., Cicchetti D., & Becker B. (2000). The construct of resilience: A critical evaluation and guidelines for future work. Child Development, 71, 543–562.
    1. Maples-Keller J. L., Yasinski C., Manjin N., & Rothbaum B. O. (2017). Virtual reality-enhanced extinction of phobias and post-traumatic stress. Neurotherapeutics, 14, 554–563. doi:10.1007/s13311-017-0534-y
    1. Matheis R., Schultheis M. T., Tiersky L. A., DeLuca J., Millis S. R., & Rizzo A. A. (2007). Is learning and memory different in a virtual environment? The Clinical Neuropsychologist, 21, 146–161. doi:10.1080/13854040601100668
    1. McCall C., Blascovich J., Young A., & Persky S. (2009). Proxemic behaviors as predictors of aggression towards Black (but not White) males in an immersive virtual environment. Social Influence, 4(2), 1–17.
    1. McLay R. N., Wood D. P., Webb-Murphy J. A., Spira J. L., Wiederhold M. D., Pyne J. M., & Wiederhold B. K. (2011). A randomized, controlled trial of virtual reality-graded exposure therapy for post-traumatic stress disorder in active duty service members with combat-related post-traumatic stress disorder. Cyberpsychology, Behavior, and Social Networking, 14, 223–229. doi:10.1089/cyber.2011.0003
    1. Merians A. S., Fluet G. G., Qiu Q., Saleh S., Lafond I., & Adamovich S. V. (2010). Integrated arm and hand training using adaptive robotics and virtual reality simulations. In: Sharkey, P. and Sanchez, J. (eds.). Proceedings of the 2010 ICDVRAT (pp. 213–222). Reading, UK: University of Reading.
    1. Miyahira S. D., Folen R. A., Hoffman H. G., Garcia-Palacios A., Spira J. L., & Kawasaki M. (2012). The effectiveness of VR exposure therapy for PTSD in returning warfighters. Annual Review of Cybertherapy and Telemedicine, 181, 128–132.
    1. Morbini F., DeVault D., Sagae K., Gerten J., Nazarian A., & Traum D (2014). FLoReS: a forward looking, reward seeking, dialogue manager. In: Natural interaction with robots, knowbots and smartphones (pp. 313–325). New York, NY: Springer;
    1. Morency L.-P., de Kok I., & Gratch J. (2008). Context-based recognition during human interactions: Automatic feature selection and encoding dictionary. In: Digalakis, V., Potamianos, A., Turk, M. (eds.). Proceedings of the 10th International Conference on Multimodal Interfaces (pp. 181–188). Chania, Greece: ACM.
    1. Morina N., Ijntema H., Meyerbröker K., & Emmelkamp P. M. G. (2015). Can virtual reality exposure therapy gains be generalized to real-life? A meta-analysis of studies applying behavioral assessments. Behaviour Research and Therapy, 74, 18–24. doi:10.1016/j.brat.2015.08.010
    1. Mosadeghi S., Reid M. W., Martinez B., Rosen B. T., & Spiegel B. M. R. (2016). Feasibility of an immersive virtual reality intervention for hospitalized patients: An observational cohort study. JMIR Mental Health, 3(2), e28. doi:10.2196/mental.5801
    1. Norcross J. C., Pfund R. A., & Prochaska J. O. (2013). Psychotherapy in 2022: A Delphi poll on its future. Professional Psychology: Research & Practice, 44(5), 363–370. doi:10.1037/a0034633
    1. Norrholm S. D., Jovanovic T., Gerardi M., Breazeale K. G., Duncan M., Duncan M., … Rothbaum B. O. (2016). Baseline psychophysiological and cortisol reactivity as a predictor of PTSD treatment outcome in virtual reality exposure therapy. Behaviour Research and Therapy, 82, 28–37. doi:10.1016/j.brat.2016.05.002
    1. North M. M., North S. M., & Coble J. R. (1998). Virtual reality therapy: An effective treatment for the fear of public speaking. International Journal of Virtual Reality, 3(2), 2–6.
    1. Olthuis J. V., Wozney L., Asmundson G. J., Cramm H., Lingley-Pottie P., & McGrath P. J. (2016). Distance-delivered interventions for PTSD: A systematic review and meta-analysis. Journal of Anxiety Disorders, 44, 9–26. doi:10.1016/j.janxdis.2016.09.010
    1. Opriş D., Pintea S., García-Palacios A., Botella C., Szamosközi Ş., & David D. (2012). Virtual reality exposure therapy in anxiety disorders: A quantitative meta-analysis. Depression and Anxiety, 29(2), 85–93. doi:10.1002/da.20910
    1. Padgett L., Strickland D., & Coles C. (2006). Case study: Using a virtual reality computer game to teach fire safety skills to children diagnosed with Fetal Alcohol Syndrome (FAS). Journal of Pediatric Psychology, 31(1), 65–70. doi:10.1093/jpepsy/jsj030
    1. Park S., Scherer S., Gratch J., Carnevale P., & Morency L.-P. (2013). Affective Computing and Intelligent Interaction (ACII). IEEE, 423–428. doi:10.1109/ACII.2013.76
    1. Parsons T. D., Kenny P., Ntuen C. A., Pataki C. S., Pato M. T., Rizzo A. A., … Sugar J. (2008). Objective structured clinical interview training using a virtual human patient. Studies in Health Technical and Informatics, 132, 357–362.
    1. Parsons T. D., & Rizzo A. A. (2008). Affective outcomes of virtual reality exposure therapy for anxiety and specific phobias: A meta-analysis. Journal of Behavior Therapy and Experimental Psychiatry, 39, 250–261. doi:10.1016/j.jbtep.2007.07.007
    1. Parsons T. D., Rizzo A. A., Rogers S., & York P. (2009). Virtual reality in paediatric rehabilitation: A review. Developmental Neurorehabilitation, 12(4), 224–238.
    1. Powers M., & Emmelkamp P. M. G. (2008). Virtual reality exposure therapy for anxiety disorders: A meta-analysis. Journal of Anxiety Disorders., 22, 561–569. doi:10.1016/j.janxdis.2007.04.006
    1. PTSD Statistics (2017). Retrieved November12, 2017, from
    1. Pugnetti L., Mendozzi L., Motta A., Cattaneo A., Barbieri E., & Brancotti S. (1995). Evaluation and retraining of adults‘ cognitive impairment: Which role for virtual reality technology? Computers in Biology and Medicine, 25, 213–227.
    1. Reger G., & Gahm G. (2008). Virtual reality exposure therapy for active duty soldiers. Journal of Clinical Psychology, 64, 940–946. doi:10.1002/jclp.20512
    1. Reger G. M., Gahm G. A., Rizzo A. A., Swanson R. A., & Duma S. (2009). Soldier evaluation of the virtual reality Iraq. Telemedicine and e-Health Journal., 15, 101–104. doi:10.1089/tmj.2008.0050
    1. Reger G. M., Holloway K. M., Rothbaum B. O., Difede J., Rizzo A. A., & Gahm G. A. (2011). Effectiveness of virtual reality exposure therapy for active duty soldiers in a military mental health clinic. Journal of Traumatic Stress, 24(1), 93–96. doi:10.1002/jts.20574
    1. Reger G. M., Koenen-Woods P., Zetocha K., Smolenski D. J., Holloway K. M., Rothbaum B. O., … Mishkind M. (2016). Randomized controlled trial of prolonged exposure using imaginal exposure vs. virtual reality exposure in active duty soldiers with deployment-related posttraumatic stress disorder (PTSD). Journal of Consulting and Clinical Psychology, 84(11), 946–959. doi:10.1037/ccp0000134
    1. Ressler K. J., Rothbaum B. O., Tannenbaum L., Anderson P., Graap K., Zimand E., … Davis M. (2004). Cognitive enhancers as adjuncts to psychotherapy: Use of D-cycloserine in phobic individuals to facilitate extinction of fear. Archives of General Psychiatry, 61, 1136–1144. doi:10.1001/archpsyc.61.11.1136
    1. Riva G. (2011). The key to unlocking the virtual body: Virtual reality in the treatment of obesity and eating disorders. Journal of Diabetes Science and Technology, 5(2), 283–292. doi:10.1177/193229681100500213
    1. Rizzo A., Difede J., Rothbaum B. O., Reger G., Spitalnick J., Cukor J., & Mclay R. (2010). Development and early evaluation of the Virtual Iraq/Afghanistan exposure therapy system for combat-related PTSD. Annals of the New York Academy of Sciences (NYAS), 1208, 114–125. doi:10.1111/j.1749-6632.2010.05755.x
    1. Rizzo A. A., Bowerly T., Buckwalter J. G., Klimchuk D., Mitura R., & Parsons T. D. (2006). A virtual reality scenario for all seasons: The virtual classroom. CNS Spectrums, 11(1), 35–44. doi:10.1017/S1092852900024196
    1. Rizzo A. A., Buckwalter J. G., Forbell E., Reist C., Difede J., Rothbaum B. O., … Talbot B. (2013). Virtual reality applications to address the wounds of war. Psychiatric Annals, 43(3), 123–138. doi:10.3928/00485713-20130306-08
    1. Rizzo A. A., Buckwalter J. G., & Neumann U. (1997). Virtual reality and cognitive Rehabilitation: A brief review of the future. Journal of Head Trauma Rehabilitation, 12(6), 1–15. doi:10.1097/00001199-199712000-00002
    1. Rizzo A. A., Buckwalter J. G., & van der Zaag C. (2002). Virtual environment applications for neuropsychological assessment and rehabilitation In Stanney K. (Ed.), Handbook of virtual environments (pp. 1027–1064). New York: L.A. Earlbaum.
    1. Rizzo A. A., Cukor J., Gerardi M., Alley S., Reist C., Roy M., … Difede J. (2015a). Virtual reality exposure for PTSD due to military combat and terrorist attacks. Journal of Contemporary Psychotherapy, 45(4), 255–264. doi:10.1007/s10879-015-9306-3
    1. Rizzo A. A., Graap K., Mclay R. N., Perlman K., Rothbaum B., Reger G., et al (2007). Virtual Iraq: Initial case reports from a VR exposure therapy application for combat-related post traumatic stress disorder. IEEE XPlore Virtual Rehabilitation International Conference, 124–130.
    1. Rizzo A. A. (1994). Virtual Reality applications for the cognitive rehabilitation of persons with traumatic head injuries. In Murphy H. J. (Ed.), Proceedings of the 2nd International Conference on Virtual Reality and Persons With Disabilities CSUN: Northridge. doi:10.3168/jds.S0022-0302(94)77044-2
    1. Rizzo A. A., & Koenig S. (in press). Is clinical virtual reality ready for primetime? Neuropsychology.
    1. Rizzo A. A., Lucas G., Gratch J., Stratou G., Morency L.-P., Shilling R., & Scherer S. (2016b). Clinical interviewing by a virtual human agent with automatic behavior analysis. In The 2016 Proceedings of the ICDVRAT
    1. Rizzo A. A., Roy M., Hartholt A., Costanzo M., Highland K. B., Jovanovic T., … Difede J. (2017). Virtual reality applications for the assessment and treatment of PTSD In Bowles S. & Bartone P. T. (Eds.), Military psychology: Clinical and organizational practice. Newyork, NY: Springer.
    1. Rizzo A. A., Schultheis M. T., Kerns K., & Mateer C. (2004). Analysis of assets for virtual reality applications in neuropsychology. Neuropsychological Rehabilitation, 14(1–2), 207–239. doi:10.1080/09602010343000183
    1. Rizzo A. A., Shilling R., Forbell E. D., Scherer S., Gratch J., & Morency L.-P. (2015b). Autonomous virtual human agents for healthcare information support and clinical interviewing In Luxton D. D. (Ed.), Artificial intelligence in mental healthcare practice (pp. 53–80). Oxford: Academic Press.
    1. Rizzo A. A., & Talbot T. (2016a). Virtual reality standardized patients for clinical training In Combs C. D., Sokolowski J. A., & Banks C. M. (Eds.), The digital patient: Advancing medical research, education, and practice (pp. 257–272). New York: Wiley.
    1. Rizzo A. A., & Talbot T (2016a). Virtual reality standardized patients for clinical training In Combs C. D., Sokolowski J. A., & Banks C. M. (Eds), The digital patient: advancing medical research, education, and practice (pp. 257–272). New York: Wiley.
    1. Rothbaum B., Difede J., & Rizzo A. (2008). Therapist treatment manual for virtual reality exposure therapy: Posttraumatic stress disorder in Iraq combat veterans. Atlanta: Virtually Better Inc.
    1. Rothbaum B. O., Hodges L., Alarcon R., Ready D., Shahar F., Graap K., … Baltzell D. (1999). Virtual reality exposure therapy for PTSD Vietnam veterans: A case study. Journal of Traumatic Stress, 12(2), 263–271. doi:10.1023/A:1024772308758
    1. Rothbaum B. O., Hodges L., Ready D., Graap K., & Alarcon R. (2001). Virtual reality exposure therapy for Vietnam veterans with posttraumatic stress disorder. The Journal of Clinical Psychiatry, 62, 617–622.
    1. Rothbaum B. O., Hodges L. F., Ready D., Graap K., & Alarcon R. D (2001). Virtual reality exposure therapy for vietnam veterans with posttraumatic stress disorder. The Journal Of Clinical Psychiatry, 62(8), 617–622. doi:10.4088/JCP.v62n0808
    1. Rothbaum B. O., Price M., Jovanovic T., Norrholm S., Gerardi M., Dunlop B., … Ressler K. (2014). A randomized, double-blind evaluation of d-cycloserine or alprazolam combined with virtual reality exposure therapy for posttraumatic stress disorder (PTSD) in OEF/OIF war veterans. The American Journal of Psychiatry, 171, 640–648. doi:10.1176/appi.ajp.2014.13121625
    1. Rothbaum B. O., & Schwartz A. (2002). Exposure therapy for posttraumatic stress disorder. American Journal of Psychotherapy, 56, 59–75.
    1. Roy M. J., Costanzo M. E., Blair J. R., & Rizzo A. A. (2014). compelling evidence that exposure therapy for PTSD normalizes brain function. Studies in Health Technology and Informatics, 199, 61–65.
    1. Rutten A., Cobb S., Neale H., Kerr S., Leonard A., Parsons S., & Mitchell P. (2003). The AS interactive project: Single-user and collaborative virtual environments for people with high-functioning autistic spectrum disorders. The Journal of Visualization and Computer Animation, 14(5), 233–241. doi:10.1002/(ISSN)1099-1778
    1. Scherer S., Stratou G., Lucas G., Mahmoud M., Boberg J., Gratch J., … Morency L.-P. (2014). Automatic audiovisual behavior descriptors for psychological disorder analysis. Image and Vision Computing, 32, 648–658. doi:10.1016/j.imavis.2014.06.001
    1. Schneider S. M., Kisby C. K., & Flint E. P. (2010, December 10). Effect of virtual reality on time perception in patients receiving chemotherapy. Supportive Care in Cancer. Retrieved from: )
    1. Schnipper M., Robertson A., Zelenko M., Drummond K., Newton C., & Smith M. (2015). The rise and fall and rise of virtual reality. The Verge. Retrieved from
    1. Slater M., & Sanchez-Vives M. V. (2016). Enhancing our lives with immersive virtual reality. Frontiers in Robotics and AI, 3, 74. doi:10.3389/frobt.2016.00074
    1. Sones H. M., Thorp S. R., & Raskind M. (2011). Prevention of posttraumatic stress disorder. Psychiatric Clinics of North America, 34, 79–94. doi:10.1016/j.psc.2010.11.001
    1. Squad Overmatch. (2015). Tactical Combat Casualty Care (TC3) Study-Optimizing Warriors. Achieving Squad Overmatch. Saving Lives. 2015 Quick Look Summary Report, 18 December 2015. Retrieved from:
    1. Steenkamp M. M. (2016). True evidence-based care for posttraumatic stress disorder in military personnel and veterans. JAMA Psychiatry, 73, 431–432. doi:10.1001/jamapsychiatry.2015.2123
    1. Strange A. (2017). ‘House of Cards’ discovers VR, shows us its silly and deadly serious sides Mashable, Downloaded, Retrieved June1, 2017 )
    1. Talbot T. B., Sagae K., John B., & Rizzo A. A. (2012). Sorting out the Virtual Patient: How to exploit artificial intelligence, game technology and sound educational practices to create engaging role-playing simulations. International Journal of Gaming and Computer-Mediated Simulations, 4(3), 1–19. doi:10.4018/IJGCMS
    1. Tarr M. J., & Warren W. H. (2002). Virtual reality in behavioral neuroscience and beyond. Nature Neuroscience, 5, 1089–1092. doi:10.1038/nn948
    1. Tegos S., Demetriadis S., Papadopoulos P. M., & Weinberger A. (2016). Conversational agents for academically productive talk: A comparison of directed and undirected agent interventions. International Journal of Computer-Supported Collaborative Learning, 11(4), 417–440. doi:10.1007/s11412-016-9246-2
    1. Tuerk P. W., Yoder M., Ruggiero K. J., Gros D. F., & Acierno R. (2010). A pilot study of prolonged exposure therapy for posttraumatic stress disorder delivered via telehealth technology. Journal of Traumatic Stress, 23(1), 116–123. doi:10.1002/jts.20494
    1. Turner S. M., Beidel D. C., & Frueh B. C. (2005). Multicomponent behavioral treatment for chronic combat-related Posttraumatic Stress Disorder: Trauma Management Therapy. Behavior Modification, 29, 39–69. doi:10.1177/0145445504270872
    1. Valladares-Rodríguez S., Pérez-Rodríguez R., Anido-Rifón L., & Fernández-Iglesias M. (2016). Trends on the application of serious games to neuropsychological evaluation: A scoping review. Journal of Biomedical Informatics, 64, 296–319. doi:10.1016/j.jbi.2016.10.019
    1. Van Etten M. L., & Taylor S. (1998). Comparative efficacy of treatments of posttraumatic stress disorder: An empirical review. Journal of the American Medical Association, 268, 633–638.
    1. Webb A. K., Vincent A. L., Jin A. B., & Pollack M. H. (2015). Physiological reactivity to nonideographic virtual reality stimuli in veterans with and without PTSD. Brain and Behavior, 5(2), 1–9. doi:10.1002/brb3.308
    1. Wellman J. N., Buckwalter J. G., Courtney C., Marion S., John B., & Rizzo A. A. (submitted). Change in heart rate variability during stress resilience training in a virtual environment. ProQuest Dissertations & Theses Global downloaded, December 19, 2017. Retrieved from:
    1. Wilson J., Onorati K., Mishkind M., Reger M., & Gahm G. A. (2008). Soldier attitudes about technology-based approaches to mental healthcare. CyberPsychology & Behavior, 11, 767–769. doi:10.1089/cpb.2008.0071
    1. Wood D. P., Murphy J. A., Center K. B., Russ C., McLay R. N., Reeves D., … Weiderhold B. K. (2008). Combat related post traumatic stress disorder: A multiple case report using virtual reality graded exposure therapy with physiological monitoring. Studies in Health Technology and Informatics, 132, 556.
    1. Yoon J. H., Ii R. D. L. G., Bordnick P. S., Hawkins R. H., Shapiro B. A., Croft D. E., & Levin H. E. (2014). A pilot study examining the efficacy of virtual-reality based relapse prevention among alcohol-dependent veterans with traumatic brain injury. Drug & Alcohol Dependence, 140, e247. doi:10.1016/j.drugalcdep.2014.02.683
    1. Zhang Z., Bickmore T. W., & Paasche-Orlow M. K. (2017). Perceived organizational affiliation and its effects on patient trust: Role modeling with embodied conversational agents. Patient Education and Counseling, 11, 417.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever