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 Researchers say the hybrid therapy known as “interreality” was more
effective than traditional cognitive behavioral 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 organizations. 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
behavioral 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
percent decrease in general anxiety levels and a 14 percent increase
in emotional coping skills. Cognitive therapy group members showed
only a 0.5 percent drop in general anxiety and a 0.3 percent
increase in coping skills.
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“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 program to reduce stress. Plus, meditation
and mindfulness approaches don’t emphasize coping skills, the
authors write.
They acknowledge that the results are preliminary, but speculate
that traditional cognitive behavioral 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.
SOURCE: http://bit.ly/1pH5XwE
Journal of Medical Internet Research, online July 8, 2014.
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