Bringing Exposure Therapy to Real-Life Context With Augmented Reality
| Status: | Not yet recruiting |
|---|---|
| Conditions: | Psychiatric |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - 45 |
| Updated: | 8/30/2018 |
| Start Date: | September 2018 |
| End Date: | September 2020 |
| Contact: | Arash Javanbakht, MD |
| Email: | ajavanba@med.wayne.edu |
| Phone: | 313-577-0766 |
Bringing Exposure Therapy for Small Animal Phobias (Spiders and Snakes) to Real-Life Context With Augmented Reality
In this patent pending project, the investigators will develop an augmented reality exposure
therapy method for arachnophobia and fear of snake to test in the clinic. The platform will
include a software that allows the clinician (psychiatrist/therapist) to position virtual
objects in the real environment of the patient with the above mentioned phobias while the
patient is wearing the augmented reality (AR) device. Then the clinician will lead the
patient through steps of exposure therapy to the fear objects. The investigators will then
measure the impact of treatment and compare to before treatment measures of fear of the
phobic object.
Exposure therapy is the most evidence-based treatment for specific phobias, social phobia,
obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). The core
principle is patient's exposure to the feared objects/situations guided by a clinician. For
example, in arachnophobia, patient is exposed to pictures of spiders printed or on a computer
screen- or if available, view of a real tarantula in the office. Gradually, patient tolerates
viewing/approaching the spider from a closer distance, and fear response extinguishes. The
clinician has a crucial role in signaling safety to the patient, as well as providing support
and coaching. This treatment is limited by multiple factors: 1) limited access to feared
objects/situations in the clinic, 2) even when feared objects are available, they are not
diverse (e.g. different types and colors of spiders), which limits generalization of safety
learning, 3) when available, clinician has very limited control over behaviors of the feared
objects (e.g. spider/snake), 4) safety learning is limited to the clinic office context, and
contextualization of safety learning to real life experiences is left to the patient to do
alone, which often does not happen. This is specifically important in conditions such as
PTSD, where there is cumulative evidence for impaired contextualization as a key
neurobiological underpinning. 5) Lack of geographical access to experts in exposure therapy,
especially for PTSD, in rural areas.
therapy method for arachnophobia and fear of snake to test in the clinic. The platform will
include a software that allows the clinician (psychiatrist/therapist) to position virtual
objects in the real environment of the patient with the above mentioned phobias while the
patient is wearing the augmented reality (AR) device. Then the clinician will lead the
patient through steps of exposure therapy to the fear objects. The investigators will then
measure the impact of treatment and compare to before treatment measures of fear of the
phobic object.
Exposure therapy is the most evidence-based treatment for specific phobias, social phobia,
obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). The core
principle is patient's exposure to the feared objects/situations guided by a clinician. For
example, in arachnophobia, patient is exposed to pictures of spiders printed or on a computer
screen- or if available, view of a real tarantula in the office. Gradually, patient tolerates
viewing/approaching the spider from a closer distance, and fear response extinguishes. The
clinician has a crucial role in signaling safety to the patient, as well as providing support
and coaching. This treatment is limited by multiple factors: 1) limited access to feared
objects/situations in the clinic, 2) even when feared objects are available, they are not
diverse (e.g. different types and colors of spiders), which limits generalization of safety
learning, 3) when available, clinician has very limited control over behaviors of the feared
objects (e.g. spider/snake), 4) safety learning is limited to the clinic office context, and
contextualization of safety learning to real life experiences is left to the patient to do
alone, which often does not happen. This is specifically important in conditions such as
PTSD, where there is cumulative evidence for impaired contextualization as a key
neurobiological underpinning. 5) Lack of geographical access to experts in exposure therapy,
especially for PTSD, in rural areas.
Anxiety and stress-related disorders are very common. One in three people experience some
form of anxiety disorder including phobias, PTSD, and OCD. These disorders chronically limit
one's ability to function and enjoy life. In addition to the common prevalence, wars in Iraq
and Afghanistan have left about 13% of the returning veterans with combat PTSD, and even more
with partial symptoms. Lifetime prevalence of PTSD is as high as 10% in women. Economic
burden of anxiety disorders is between 42 to 52 billion dollars, one third of the country's
total mental health bill. Near 30% of this money is spent in treatment costs. Burden of lost
workdays only for PTSD is $3 billion.
Exposure therapy is the most effective treatment for cue-related anxiety disorders such as
specific phobias, social phobia, OCD, and PTSD. The core principle is exposure to the feared
objects/situations guided by a clinician. For example, in arachnophobia (fear of spiders)
patient is exposed to picture of a spider on a computer, or from distance in the office, and
gradually, with help of the clinician, they tolerate view of the spider from a closer
distance. Clinician has a crucial role as the social safety cue in this process.
Although exposure therapy is very effective in treatment of phobias, OCD, and PTSD, there are
limitations. Access and adherence to, and efficacy of exposure therapy are limited to 50% by
multiple factors: First, there is a national shortage of psychiatrists and psychotherapists;
patients often have to be on waiting list for weeks to months, and in many geographical
locations such services are extremely scarce or do not exist. More than 50% of clinicians are
not trained in exposure therapy, and there is usually geographical barriers for access to
skilled therapists. In general, more than half of the US counties are unable to recruit
mental health providers. Very frequently patients only receive medication or supportive
therapy for several years before they can see a specialist trained in exposure therapy.
Certain conditions like social phobia or PTSD make it increasingly difficult to leave the
house and go to the clinic. Second, the feared objects are not always available in office for
exposure and exposure most of the times is limited to pictures, movie clips, imagination,
narrative, or memories. Imaginary exposure commonly lacks the level of arousal that is
required for development of new safety learning. Third, patients have to practice real-life
exposure on their own. In vivo treatment is commonly limited: often patients do not create
situations that elicit the optimal safety learning, do not know how to create exposure
situations, or simply do not follow through because of high anxiety in the absence of someone
to coach them. This gap between exposure in the office, and real-life exposure remains a
significant roadblock in successful exposure therapy. Fourth, clinicians are usually unable
to provide treatment across multiple physical, temporal and social contexts that can promote
contextualization of safety learning. Exposure mostly happens in the physical, emotional,
social, and temporal context of the office visits. A fifth limitation is that current
exposure therapy methods, do not address overgeneralization of the fear response.
Augmented Reality Augmented reality (AR) is the next wave of interactive human-computer
technology that provides an opportunity of mixing virtually created objects with reality.
Instead of creating a completely synthetic environment, AR adds virtually created objects to
the real non-synthetic context. These elements become part of the real context, or cover some
of its components. AR technology ultimately becomes less expensive than virtual reality (VR)
technology because it does not require modeling the whole environment.
The investigators have developed a proof of concept prototype. The prototype that includes a
scenario for treatment of fear of spiders (arachnophobia), and fear of snakes. Software
platform connects the patient to a clinician who is located in the same or a different
physical space, the patient wears the AR device, the clinician is able to see the patient's
field of view, and positions a virtual spider/snake on a surface in the patient's
environment, clinician determines direction/velocity of motions of the virtual spider/snake,
clinician leads patient through the process of exposure therapy process until patient is
desensitized to the view of the spider/snake. Exposure can then advance to higher number of
spiders/snakes, or larger ones.
Subject Recruitment: Subject recruitment will happen at the Wayne State University (WSU)
Department of Psychiatry and Behavioral Neurosciences (DPBN) psychiatry clinic, through
flyers spread on the campus, and advertisement on Wayne State's student website. The
investigators aim to pre-screen a minimum of 50 individuals. The actual number of
participants to be enrolled is 50, and the investigators have a minimum pre-screening of 50
anticipating that some may not qualify.
Treatment will take place at the Stress, Trauma, and Anxiety Research Clinic at the WSU
department of psychiatry in Detroit. Participants will do 1-4 sessions of augmented reality
exposure therapy (ARET), each lasting 90 minutes. The first session will include a short
refresher on principles of exposure therapy, and training the use of the AR equipment.
At any time the level of distress due to exposure is determined too high, both patient and
the provider can abort the exposure. This will be done similarly to any other conventional
exposure therapy method.
form of anxiety disorder including phobias, PTSD, and OCD. These disorders chronically limit
one's ability to function and enjoy life. In addition to the common prevalence, wars in Iraq
and Afghanistan have left about 13% of the returning veterans with combat PTSD, and even more
with partial symptoms. Lifetime prevalence of PTSD is as high as 10% in women. Economic
burden of anxiety disorders is between 42 to 52 billion dollars, one third of the country's
total mental health bill. Near 30% of this money is spent in treatment costs. Burden of lost
workdays only for PTSD is $3 billion.
Exposure therapy is the most effective treatment for cue-related anxiety disorders such as
specific phobias, social phobia, OCD, and PTSD. The core principle is exposure to the feared
objects/situations guided by a clinician. For example, in arachnophobia (fear of spiders)
patient is exposed to picture of a spider on a computer, or from distance in the office, and
gradually, with help of the clinician, they tolerate view of the spider from a closer
distance. Clinician has a crucial role as the social safety cue in this process.
Although exposure therapy is very effective in treatment of phobias, OCD, and PTSD, there are
limitations. Access and adherence to, and efficacy of exposure therapy are limited to 50% by
multiple factors: First, there is a national shortage of psychiatrists and psychotherapists;
patients often have to be on waiting list for weeks to months, and in many geographical
locations such services are extremely scarce or do not exist. More than 50% of clinicians are
not trained in exposure therapy, and there is usually geographical barriers for access to
skilled therapists. In general, more than half of the US counties are unable to recruit
mental health providers. Very frequently patients only receive medication or supportive
therapy for several years before they can see a specialist trained in exposure therapy.
Certain conditions like social phobia or PTSD make it increasingly difficult to leave the
house and go to the clinic. Second, the feared objects are not always available in office for
exposure and exposure most of the times is limited to pictures, movie clips, imagination,
narrative, or memories. Imaginary exposure commonly lacks the level of arousal that is
required for development of new safety learning. Third, patients have to practice real-life
exposure on their own. In vivo treatment is commonly limited: often patients do not create
situations that elicit the optimal safety learning, do not know how to create exposure
situations, or simply do not follow through because of high anxiety in the absence of someone
to coach them. This gap between exposure in the office, and real-life exposure remains a
significant roadblock in successful exposure therapy. Fourth, clinicians are usually unable
to provide treatment across multiple physical, temporal and social contexts that can promote
contextualization of safety learning. Exposure mostly happens in the physical, emotional,
social, and temporal context of the office visits. A fifth limitation is that current
exposure therapy methods, do not address overgeneralization of the fear response.
Augmented Reality Augmented reality (AR) is the next wave of interactive human-computer
technology that provides an opportunity of mixing virtually created objects with reality.
Instead of creating a completely synthetic environment, AR adds virtually created objects to
the real non-synthetic context. These elements become part of the real context, or cover some
of its components. AR technology ultimately becomes less expensive than virtual reality (VR)
technology because it does not require modeling the whole environment.
The investigators have developed a proof of concept prototype. The prototype that includes a
scenario for treatment of fear of spiders (arachnophobia), and fear of snakes. Software
platform connects the patient to a clinician who is located in the same or a different
physical space, the patient wears the AR device, the clinician is able to see the patient's
field of view, and positions a virtual spider/snake on a surface in the patient's
environment, clinician determines direction/velocity of motions of the virtual spider/snake,
clinician leads patient through the process of exposure therapy process until patient is
desensitized to the view of the spider/snake. Exposure can then advance to higher number of
spiders/snakes, or larger ones.
Subject Recruitment: Subject recruitment will happen at the Wayne State University (WSU)
Department of Psychiatry and Behavioral Neurosciences (DPBN) psychiatry clinic, through
flyers spread on the campus, and advertisement on Wayne State's student website. The
investigators aim to pre-screen a minimum of 50 individuals. The actual number of
participants to be enrolled is 50, and the investigators have a minimum pre-screening of 50
anticipating that some may not qualify.
Treatment will take place at the Stress, Trauma, and Anxiety Research Clinic at the WSU
department of psychiatry in Detroit. Participants will do 1-4 sessions of augmented reality
exposure therapy (ARET), each lasting 90 minutes. The first session will include a short
refresher on principles of exposure therapy, and training the use of the AR equipment.
At any time the level of distress due to exposure is determined too high, both patient and
the provider can abort the exposure. This will be done similarly to any other conventional
exposure therapy method.
Inclusion Criteria:
- Primary diagnosis of specific phobia of small animals (i.e. spiders or snakes),
according to diagnostic and statistical manual version 5 (DSM-V) criteria. Both
genders, ages 18-45, who are able and willing to consent for involvement in the study.
Exclusion Criteria:
- Subjects who refuse or are unable to consent to participate in the study.
- Active abuse of substances or meet criteria for substance use disorder in the past 6
months
- Current or previous diagnosis of psychotic disorder, schizophrenia,
obsessive-compulsive disorder, bipolar disorder, mental retardation, active abuse of
substances or meet criteria for substance use disorder in the past six months
substance use, or PTSD.
- Unstable behavior that, in the opinion of the investigator, would place the subject at
increased risk or preclude the subject's full compliance with or completion of the
study, e.g. significant Axis II disorder or suicidal behavior.
- Visual or auditory disabilities limiting ability use of AR goggles
- Current use of antidepressant medications, mood stabilizers, or benzodiazepines
- History of seizures or a condition that would increase likelihood for seizures
- Serious medical or neurological illness
- Wards of the court
We found this trial at
1
site
60 Farnsworth Street
Detroit, Michigan 48197
Detroit, Michigan 48197
Phone: 313-577-1396
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