Geriatrics

Virtual reality is a technology used to synthetically reproduce real or imaginary environments. In this sense, the immersion enjoyed by the mental health user will lead them to expose themselves to stimuli in complete safety.

This type of exposure gave birth to the 4th wave of cognitive-behavioral therapies: therapies through exposure to virtual reality.

The first scientifically validated protocol dates from 1992. However, until the 2000s, virtual reality was relatively little known and used. Thanks to technological progress and the interest of researchers and clinicians, it is today in an increasing phase of democratization.

In order to use virtual reality, it is necessary to immerse yourself in a virtual environment. There are several ways to do this.

Indeed, the use of CAVE, a 3D system composed of several screen walls, was mainly used in the past.

The user finds himself totally immersed in the virtual world and his movements are detected in real time. This solution has the drawback of being very expensive and not very accessible.

Since around 2016, with the appearance of the Oculus Rift and the HTC Vive, virtual reality headsets, its use has become much more accessible. It allows you to immerse yourself in virtual reality thanks to a blackout screen on which virtual images are projected. The user's head movements are taken into account, allowing them to turn their head to look around them as in the real world.

Exposure is a behavioral method based on the principle of habituation. It is defined as the reduction of a reaction following repetition of the stimulus that arouses it.

Concretely, it involves confronting the subject according to strict rules with the stimuli triggering the dysfunctional response. This makes it possible to obtain extinction of the latter via the activation of habituation.

Several forms of exhibition exist, such as exhibition by imagination. That is to say, we invite the patient to imaginatively confront feared situations (being behind the wheel of a car on the highway, speaking in public during a meeting).

Then, in vivo exposure. We place the subject in a concrete exhibition situation.

For a patient afraid of dogs, the therapist will first confront him with a small dog placed behind a fence. Gradually, it will reduce the existing proximity between the patient and the dog.

Finally, the last form of existing exhibition is the virtual reality exhibition. Through a synthetic concretization of real environments, the patient will be able to expose himself to situations provoking the dysfunctional emotional response.

This last technique has the considerable advantage of combining the advantages of in vivo exposure while benefiting from unique qualities (accessibility of environments, security, controllability).

A virtual environment allows the user to be immersed in various situations of places or spaces. Depending on the functionalities, the user will be able to move and interact with avatars.

The therapist, for his part, has control over the exposure scenario. He can in fact modify certain elements of the environment, add or remove stimuli (visual, sound) or program interactions.

The primary objective is to reproduce environments that are difficult to access from the therapist's office. Thanks to this technology, new perspectives, then limited by the reality on the ground, are offered to caregivers and patients: relaxation environments or personifications of abstract substrates (hallucinations, complex anxieties, etc.).

Depending on the VR headsets, other devices may be required. Standalone headsets, like the Pico Neo 4, can be used as-is without needing to connect them to other devices.

For wired headsets such as the HP Reverb G2, it is necessary to connect the headset to a “gaming” type computer.

Depending on the therapeutic objectives, you can also equip yourself with additional modules such as a pedal board and a steering wheel in the case of treating amaxophobia (fear of driving).

Numerous studies confirm the non-dangerous use of virtual reality. However, there are some restrictions to protect users from possible negative consequences.

Therefore, people with epilepsy cannot benefit from this type of therapy. Regarding the development of a possible addiction, the sessions are ideally carried out once a week. They are under the supervision of a therapist who will be able to assess the risks, thanks to his expertise.

Consequently, the risk of developing an addiction following TERV is almost zero.

Anxiety disorders and phobias can be treated in virtual reality. The patient will be exposed to anxiety-provoking situations in different environments in a gradual and progressive manner, while remaining in a safe place. A feeling of habituation will thus be created little by little until the anxiety diminishes or even disappears.

Behavioral and substance addictions are pathologies that can be treated by virtual reality. Indeed, thanks to synthetic stimuli placed in environments and provoking the craving response, patients in a situation of addiction will be able to work on their craving in order to attenuate the consumption response.

In addition, the multiple situations (bar, casino, social contexts) allow cognitive work on dysfunctional beliefs linked to the singularity of each temptation situation.

Concerning eating disorders, virtual reality software makes it possible to target essential etiological factors such as dysmorphophobia, the allocentric lock (tendency to focus attention on others rather than oneself) and food craving.

Furthermore, in TERV care, we currently have multiple software programs responding to important psychiatric, psychological and neuropsychological determinants: relaxation, cognitive stimulation, behavioral activation, social skills, etc.

Reminiscence is a major therapeutic lever in the treatment of depression. By offering your patients the opportunity to relive the sensations linked to formerly enjoyable activities (sport, driving, travel) you enable the stimulation of hypo-activated brain areas and thus promote therapeutic success. Virtual reality appears to be a very interesting mediator for initiating investment in pleasure activities.

Furthermore, cognitive stimulation in the elderly is also a possibility offered by virtual reality. Facilitated by technology making stimulation activities more fun and easy, EHPAD patients and residents will be able to work on their executive functions and memory via applications created for the specific needs of this patient population.

Today, virtual reality in the field of mental health is progressing at high speed. Researchers, clinicians and developers are working on new pathological targets to soon offer new therapeutic devices.

Many health professionals are affected by this technology. Today, psychiatrists, psychologists and psychotherapists are the professionals most represented as experts in therapies through exposure to virtual reality.

However, the software is also aimed at nurses, psychomotor therapists, physiotherapists, dieticians, sophrologists and hypnotherapists.

The applications make it possible to act in addition to their methods with the aim of maximizing the therapeutic benefits.

The therapist, by equipping himself with devices allowing the realization of therapies by exposure to virtual reality (TERV), thereby enhances his field of skills. Indeed, TERV is a treatment technique in its own right.

Adopting this therapeutic solution also means making yourself known to prescribers and distinguishing yourself from the most popular care offers.

Furthermore, far from being just a strategic asset for the development of a practice or an establishment, TERVs benefit from the scientific validity of cognitive-behavioral therapies. In the reality of clinical practice, it is an asset promoting therapeutic engagement thanks to its playful aspect.

In addition, this technology offers considerable time savings since many exposure environments are directly accessible from the therapist's office.

One of the considerable advantages of virtual reality is that it is effective on a wide spectrum of populations. Existing data from the literature on the subject shows us that it is entirely possible to expose a wide age group to virtual reality, with real therapeutic benefits.

The studies attest, in fact, to excellent feasibility and significant results; particularly in adults, in the treatment of anxiety disorders (including school phobia), autism, addictions, eating disorders, neuropsychological disorders, psychotic disorders and mood disorders.

The results are identical for adolescents with a significant added value concerning therapeutic engagement where virtual reality promotes adolescents' interest in their therapy.

Among elderly subjects, study results encourage the use of virtual reality with the aim of working on cognitive stimulation, on behavioral disorders but also on anxiety.