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      Virtual Reality Objectifies the Diagnosis of Psychiatric Disorders: A Literature Review

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          Abstract

          Background

          To date, a diagnosis in psychiatry is largely based on a clinical interview and questionnaires. The retrospective and subjective nature of these methods leads to recall and interviewer biases. Therefore, there is a clear need for more objective and standardized assessment methods to support the diagnostic process. The introduction of virtual reality (VR) creates the possibility to simultaneously provoke and measure psychiatric symptoms. Therefore, VR could contribute to the objectivity and reliability in the assessment of psychiatric disorders.

          Objective

          In this literature review, we will evaluate the assessment of psychiatric disorders by means of VR environments. First, we investigate if these VR environments are capable of simultaneously provoking and measuring psychiatric symptoms. Next, we compare these measures with traditional diagnostic measures.

          Methods

          We performed a systematic search using PubMed, Embase, and Psycinfo; references of selected articles were checked for eligibility. We identified studies from 1990 to 2016 on VR used in the assessment of psychiatric disorders. Studies were excluded if VR was used for therapeutic purposes, if a different technique was used, or in case of limitation to a non-clinical sample.

          Results

          A total of 39 studies were included for further analysis. The disorders most frequently studied included schizophrenia ( n = 15), developmental disorders ( n = 12), eating disorders ( n = 3), and anxiety disorders ( n = 6). In attention-deficit hyperactivity disorder, the most comprehensive measurement was used including several key symptoms of the disorder. Most of the studies, however, concerned the use of VR to assess a single aspect of a psychiatric disorder.

          Discussion

          In general, nearly all VR environments studied were able to simultaneously provoke and measure psychiatric symptoms. Furthermore, in 14 studies, significant correlations were found between VR measures and traditional diagnostic measures. Relatively small clinical sample sizes were used, impeding definite conclusions. Based on this review, the innovative technique of VR shows potential to contribute to objectivity and reliability in the psychiatric diagnostic process.

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          Most cited references61

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          The positive and negative syndrome scale (PANSS) for schizophrenia.

          The variable results of positive-negative research with schizophrenics underscore the importance of well-characterized, standardized measurement techniques. We report on the development and initial standardization of the Positive and Negative Syndrome Scale (PANSS) for typological and dimensional assessment. Based on two established psychiatric rating systems, the 30-item PANSS was conceived as an operationalized, drug-sensitive instrument that provides balanced representation of positive and negative symptoms and gauges their relationship to one another and to global psychopathology. It thus constitutes four scales measuring positive and negative syndromes, their differential, and general severity of illness. Study of 101 schizophrenics found the four scales to be normally distributed and supported their reliability and stability. Positive and negative scores were inversely correlated once their common association with general psychopathology was extracted, suggesting that they represent mutually exclusive constructs. Review of five studies involving the PANSS provided evidence of its criterion-related validity with antecedent, genealogical, and concurrent measures, its predictive validity, its drug sensitivity, and its utility for both typological and dimensional assessment.
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            Virtual reality exposure therapy in anxiety disorders: a quantitative meta-analysis.

            Virtual reality exposure therapy (VRET) is a promising intervention for the treatment of the anxiety disorders. The main objective of this meta-analysis is to compare the efficacy of VRET, used in a behavioral or cognitive-behavioral framework, with that of the classical evidence-based treatments, in anxiety disorders. A comprehensive search of the literature identified 23 studies (n = 608) that were included in the final analysis. The results show that in the case of anxiety disorders, (1) VRET does far better than the waitlist control; (2) the post-treatment results show similar efficacy between the behavioral and the cognitive behavioral interventions incorporating a virtual reality exposure component and the classical evidence-based interventions, with no virtual reality exposure component; (3) VRET has a powerful real-life impact, similar to that of the classical evidence-based treatments; (4) VRET has a good stability of results over time, similar to that of the classical evidence-based treatments; (5) there is a dose-response relationship for VRET; and (6) there is no difference in the dropout rate between the virtual reality exposure and the in vivo exposure. Implications are discussed. © 2011 Wiley Periodicals, Inc.
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              Virtual Reality for Enhanced Ecological Validity and Experimental Control in the Clinical, Affective and Social Neurosciences

              An essential tension can be found between researchers interested in ecological validity and those concerned with maintaining experimental control. Research in the human neurosciences often involves the use of simple and static stimuli lacking many of the potentially important aspects of real world activities and interactions. While this research is valuable, there is a growing interest in the human neurosciences to use cues about target states in the real world via multimodal scenarios that involve visual, semantic, and prosodic information. These scenarios should include dynamic stimuli presented concurrently or serially in a manner that allows researchers to assess the integrative processes carried out by perceivers over time. Furthermore, there is growing interest in contextually embedded stimuli that can constrain participant interpretations of cues about a target’s internal states. Virtual reality environments proffer assessment paradigms that combine the experimental control of laboratory measures with emotionally engaging background narratives to enhance affective experience and social interactions. The present review highlights the potential of virtual reality environments for enhanced ecological validity in the clinical, affective, and social neurosciences.
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                Author and article information

                Contributors
                URI : http://frontiersin.org/people/u/425329
                URI : http://frontiersin.org/people/u/437393
                URI : http://frontiersin.org/people/u/45392
                Journal
                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                1664-0640
                05 September 2017
                2017
                : 8
                : 163
                Affiliations
                [1] 1Academic Medical Center, Department of Psychiatry, University of Amsterdam , Amsterdam, Netherlands
                [2] 2The Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences , Amsterdam, Netherlands
                Author notes

                Edited by: Roumen Kirov, Bulgarian Academy of Sciences, Bulgaria

                Reviewed by: Dalena Van Heugten – Van Der Kloet, Oxford Brookes University, United Kingdom; Jose Gutierrez-Maldonado, University of Barcelona, Spain

                *Correspondence: Martine J. van Bennekom, m.j.vanbennekom@ 123456amc.uva.nl

                Specialty section: This article was submitted to Psychopathology, a section of the journal Frontiers in Psychiatry

                Article
                10.3389/fpsyt.2017.00163
                5591833
                28928677
                1cf1244a-03ec-45bb-a803-7d970d340221
                Copyright © 2017 van Bennekom, de Koning and Denys.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 18 May 2017
                : 21 August 2017
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 70, Pages: 7, Words: 6840
                Categories
                Psychiatry
                Review

                Clinical Psychology & Psychiatry
                virtual reality,psychiatry,diagnosis,assessment,review
                Clinical Psychology & Psychiatry
                virtual reality, psychiatry, diagnosis, assessment, review

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