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Paris, 10 April 2003

Virtual Reality based multidimensional therapy for the treatment of body image. Paris, 10 April 2003. PRESENTERS. G. Castelnuovo (1-2-3), M. Bacchetta (2), G. Cesa (2), S. Conti (2), E. Molinari (1-2-3), G. Riva (1-3)

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Paris, 10 April 2003

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  1. Virtual Reality based multidimensional therapy for the treatment of body image Paris, 10 April 2003

  2. PRESENTERS G. Castelnuovo (1-2-3), M. Bacchetta (2), G. Cesa (2), S. Conti (2), E. Molinari (1-2-3), G. Riva (1-3) 1 ATN-P LAB, Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Milano, Italia, gianluca.castelnuovo@auxologico.it 2 ATN-P LAB, Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Verbania, Italia 3 Facoltà di Psicologia, Università Cattolica, Milano, Italia Paris, 10 April 2003

  3. Virtual Reality Virtual reality (VR) is a technology that alters the conventional way in which individuals interact with computers. It can be described as a fully three-dimensional computer-generated 'world' in which a person can move around and interact as if he actually was in an imaginary place. In VR users are no longer simply external observers of images on a computer screen, but are active participants within a computer-generated three-dimensional virtual world. Paris, 10 April 2003

  4. PC Based Virtual Reality • Most of the VR applications in health care are based on high cost hardware not affordable for the single therapist: • Graphic workstation => 50KEuros • Cave systems => 400KEuros Due, in large part, to the significant advances in PC hardware that have been made over the last three years, PC based VR is approaching reality: Previous work from EU Projects (VREPAR and VREPAR 2 - HC 1053/1055) has shown that even relatively simple (PC based) Virtual Reality tools can be used in psycho-neurological assessment and rehabilitation. Paris, 10 April 2003

  5. Why using Virtual Reality in clinical psychology? • Advantages of VR therapy (VRT): • Is an innovative alternative/support treatment for patients. • Gives the therapist greater control over multiple stimulus parameters. • Provides the ability to isolate the specific parameters that determine the “dysfunctional response”. • Like in vivo therapy, VRT can provide stimuli for patients who have problem with guided imagery. • Can be used as an intermediate step in preparing patients for maintenance therapy involving self-directed in vivo exposure. • Patient acceptance. Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

  6. VEPSY-UPDATED PROJECT The Project “VEPSY UPDATED” (Telemedicine and Portable Virtual Environments in Clinical Psychology) involves 12 different research groups from three European countries: Italy, Spain and France Start: 1/1/2001 - Duration: 30 Months - Funds: 1.9 M€ / 1.7M$ Main goal: to prove the technical and clinical viability of using portable and shared Virtual Reality systems (shared care) in clinical psychology. The selected disorders are: - anxiety; - male sexual disorders; - obesity and eating disorders; Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

  7. Project innovations (1) New field of application Only a small number of real-world applications have been developed for use of VR in clinical psychology: the largest sample ever reported in any published study is 72 students In a positioning paper, the US National Advisory Mental Health Council suggested that "Research is needed to understand both the positive and the negative effects [of VEs]... on children's' and adult's perceptual and cognitive skills... and to exploit the enormous clinical potential of this technology" (1995, p.51). Project goal: test the efficacy of the developed tools with no less than 270 patients in a real clinical setting Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

  8. Project innovations (2) Creation of a critical mass To reach this goal in 1999 and 2000 different US government institutions (i.e. Office of Naval Research, National Science Foundation, and Defence Advanced Research Projects Agency) funded the research in this area to the amount of 29 million US$ (Source: DARPA bullettin, Jan. 2001). In the same year the European institutions funded research in this field with less that 5 million Euros (estimated from CORDIS database, 2001): less than 1/5 of the US effort. Project goal: joining the researchers who authored the 52% of all the scientific publications in this area (Source: Medline, PsycInfo, 2001) Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

  9. Project innovations (3) Development and on-field trial of a low cost VR/Telemedicine modular platform A typical low cost VR based solution for clinical psychology is now priced by the market leading US company about 15000$. For a telemedicine solution the price raises to no less than 32000$ (Source: Virtually Better Inc., Sept. 2001); The use of telemedicine application is limited to high-bandwidth connections (2 ISDN lines or better). Project goal: develop an immersive modular VR/telemedicine clinical platform, priced no more than 6K Euros and working on low bandwith connection (56Kb) Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

  10. VEPSY Technology Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

  11. VEPSY clinical innovations E-therapy • Educational component that reduces 2 or 3 sessions at therapist office • Inter-sessions feedback and follow-up assessment using “intelligent” applications at home. • Self-application at home for over learning and supporting exposure tasks coming from VE used in immersive sesions at therapist office • Communication with therapist (videoconference, E-mail) Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

  12. VEPSY E-health system structure Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

  13. The advantages of the VR approach • VR environments less threatening • More control of feared situation • No time/space restraints • Higher levels of safety for the patient • VR allows more privacy • Cost-effectiveness Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

  14. The advantages of telepsychology • Assessment and treatment materials on line • Filling out post-treatment and follow-up assessements on line • More support for the patient, self-help group chat meeting, e-mail contact with therapist Increase treatment efficiency Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

  15. Eating disorders and obesity • ANOREXIA NERVOSA is characterized by: - a refusal to maintain a minimally normal body weight; - intense fear of gaining weight or becoming fat, even though underweight; - a disturbance in perception of body shape and weight; - amenorrhea. • BULIMIA NERVOSA is characterized by: - repeated episodes of binge eating; - recurrent inappropriate compensatory behavior (self-induced vomiting; misure of laxatives, etc.); - Self-evaluation is unduly influenced by body shape and weight. Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

  16. Eating disorders and obesity • BINGE EATING DISORDER is characterized by: - recurrent episodes of binge eating; - feeling disgusted with oneself, depressed, or very guilty after overeating; - marked distress regarding binge eating is present. • EATING DISORDERS NOT OTHERWISE SPECIFIED • OBESITY is characterized by: - an excessive food consumption; - feeling disgusted with oneself, depressed, or very guilty after overeating; - low self-esteem. Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

  17. EXPERIENTIAL COGNITIVE TREATMENT for EATING DISORDERS (1) • ECT is a short-term integrated patient-oriented treatment that integrates virtual reality and telemedicine with different cognitive, behavioral and visuo-motor techniques: • Socratic method; • Miracle question; • Countering; • Alternative interpretation; • Label shifting; • Exposure with response prevention; • Awareness of the distortion; Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

  18. EXPERIENTIAL COGNITIVE TREATMENT for EATING DISORDERS (2) • VR has different advantages for clinical psychologist: • it can be used in a medical situation thus avoiding the need to venture in public situation • it can be more than a tool to provide exposure and desensitization • it can challenge individual maladaptive assumptions more easily • it can assure the researcher full control of all the parameters implied Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

  19. Therapy: In-patient and Out-patient phases • In-patient phase (4 weeks) - Psychological course (Assessment, VR therapy 10 sessions, groups) - Nutritional course (Assessment, balanced dieting, groups) - Physical course (Assessment, physical activities, Physiotherapy) • Out-patient phase (6 months) - E-mail - Individual and group chat line - Tools online - Self-help group Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

  20. VR THERAPY • 1 Assessment session (Balance, Sitting room) • 8 Therapeutic sessions - Body Image(Balance, BIVRS, 9 Doors Room, Gymnasium, Clothes’s Shop, Swimming-Pool andBeach) - Eating Control(Kitchen, Bathroom, Bedroom, Supermarket, Pub, Restaurant) • 1 Conclusive session (Kitchen, BIVRS, 9 Doors Room) Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

  21. CLINICAL TRIALS SAMPLES: • Experimental group • Control groups - Waiting list group - Cognitive-Behavioral Therapy group - Traditional iter of the Hospital group Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

  22. SESSIONS OF VIRTUAL REALITY Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

  23. Eating disorders and obesity: virtual scripts • Body Image: Balance, BIVRS, 9 Doors Room, Gymnasium, Clothes’s Shop, Swimming-Pool, Beach. • Eating Control: Kitchen, Bathroom, Bedroom, Supermarket, Pub, Restaurant. • Assertiveness:Gymnasium, Clothes’s Shop, Pub, Restaurant, Beach. • Social Skill:Gymnasium, Clothes’s Shop, Pub, Restaurant, Swimming-Pool, Beach. Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

  24. VR Technology Future Trends Graphic Processing • Processing Power • More HW functions • Web 3D 3D streaming • Rendering • Mini Cave • V. Retinal • Per. Display Vision • Haptic functions • Touchless technology Navigation Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

  25. VEPSY Web Site: An integrated approach (Promotion, Place & Service) • VEPSY Web Site manages and delivers applications to multiple users (therapists and end users) from a data centre across a wide area network. • The Web Site allows to: • distribute the developed protocols • support therapists (in traditional therapy) with online tools • support end users in the follow-up phase • keep professional users updated (training online) • promote VEPSY project among professionals Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

  26. Internet VEPSY Web Site Approach Web Site Training Centres Therapists Patients Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

  27. Additional slides Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

  28. SESSION OF VIRTUAL REALITY Paris, 10 April 2003 THIRD INTERNATIONAL SYMPOSIUM INTERNET PSYCHIATRY, MENTAL HEALTH

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