La Realtà Virtuale. Strumento per elicitare processi neurocognitivi per il trattamento in ambito riabilitativo

The virtual reality (VR) is scientifically recognized as an interactive tool and simulation that allows a specific form of communication. Recently it has been considered as a tool of therapy in the rehabilitation of neurodegenerative and some psychological disorders, making it a useful adjunct (and not replacing) of the classic techniques of psychotherapy, in that, acting as a Cognitive-Experiential Therapy, succeeds is to mediate between the study of the therapist and the real world, both to overcome some obstacles related to some classic treatments exhibition of imaginative type. The recreated environments using the VR technology, in fact, may represent a further context for social interaction through which the user has the opportunity to experience real-life situations, objects and feared contexts, to have feelings, emotions and thoughts (past or present) on his psychological distress and increase the level of self-esteem, self-efficacy and safety, testing new adaptation strategies. And the VR protocol can also be useful as an additional diagnostic tool than traditional methods, since it allows to acquire specific information regarding the cognitive and behavioral sphere of patients undergoing these investigations. For this reason, even today, clinical psychology can utilize VR as a valid means of assessment, diagnosis and interventio

Virtual worlds and virtual reality. An analysis in the healthcare education

In the last six years Virtual Reality (VR) and Virtual Environment (VE) became more technologically advanced and accessible being cheaper. In Healthcare, VR is mainly used for students training, professionals training (simulators); rehabilitation/therapy; treatment/diagnosis and pain management. In this review we analyzed 2,252 articles published between 2012 and 2019 on PubMed and we organized them in sections: simulation for students; simulation for residents/novice; advanced simulation for professionals; application in the medical/dental/nursing field (soft skills); review and meta-analysis on simulations or VR and planning of presurgical/surgical or diagnostic cases. We have found that the greater use of VR is about: students/residents training and professionals skills improvement. A small part of VR is used to teach soft skills. This analysis demonstrates the versatility of these instruments. Mondi virtuali e realtà virtuale. Un’analisi del fenomeno nella formazione sanitariaNegli ultimi sei anni la realtà virtuale (VR) e i mondi virtuali (VE) sono diventati sempre più tecnologicamente avanzati e molto più accessibili per quel che riguarda l’accesso economico. In sanità essi vengono utilizzati principalmente per cinque scopi: formazione degli studenti; formazione dei professionisti (simulatori); riabilitazione/terapia; cura/diagnosi e gestione del dolore. In questa review abbiamo analizzato 2.252 articoli pubblicati tra il 2012 e il 2019 su PubMed ed abbiamo organizzato gli articoli nelle aree simulazione per studenti; simulazione per specializzandi; simulazione avanzata per professionisti; applicazioni nei campi medico/dentale/infermieristico (soft skills); review e meta-analisi sulle simulazioni o VR e la pianificazione di casi pre-chirurgici/chirurgici o diagnostici. L’utilizzo maggiore riguarda la formazione degli studenti/specializzandi ed il miglioramento delle abilità dei professionisti. Una piccola parte della VR si sta dedicando anche all’insegnamento delle soft skills. Questa analisi dimostra la versatilità di tali strumenti che potrebbero ben essere utilizzati in altre discipline universitarie

Mondi virtuali e realtà virtuale. Un’analisi del fenomeno nella formazione sanitaria

Negli ultimi sei anni la realtà virtuale (VR) e i mondi virtuali (VE) sono diventati sempre più tecnologicamente avanzati e molto più accessibili per quel che riguarda l’accesso economico. In sanità essi vengono utilizzati principalmente per cinque scopi: formazione degli studenti; formazione dei professionisti (simulatori); riabilitazione/terapia; cura/diagnosi e gestione del dolore. In questa review abbiamo analizzato 2.252 articoli pubblicati tra il 2012 e il 2019 su PubMed ed abbiamo organizzato gli articoli nelle aree simulazione per studenti; simulazione per specializzandi; simulazione avanzata per professionisti; applicazioni nei campi medico/dentale/infermieristico (soft skills); review e meta-analisi sulle simulazioni o VR e la pianificazione di casi pre-chirurgici/chirurgici o diagnostici. L’utilizzo maggiore riguarda la formazione degli studenti/specializzandi ed il miglioramento delle abilità dei professionisti. Una piccola parte della VR si sta dedicando anche all’insegnamento delle soft skills. Questa analisi dimostra la versatilità di tali strumenti che potrebbero ben essere utilizzati in altre discipline universitarie.In the last six years Virtual Reality (VR) and Virtual Environment (VE) became more technologically advanced and accessible being cheaper. In Healthcare, VR is mainly used for students training, professionals training (simulators); rehabilitation/therapy; treatment/diagnosis and pain management. In this review we analyzed 2,252 articles published between 2012 and 2019 on PubMed and we organized them in sections: simulation for students; simulation for residents/novice; advanced simulation for professionals; application in the medical/dental/nursing field (soft skills); review and meta-analysis on simulations or VR and planning of presurgical/surgical or diagnostic cases. We have found that the greater use of VR is about: students/residents training and professionals skills improvement. A small part of VR is used to teach soft skills. This analysis demonstrates the versatility of these instruments

Contributions to Neuropsychotherapy of the Combined Use of Neuroimaging and Virtual Exposure for Assessment in Psychological Treatments

Neuropsychotherapy is a new philosophy in the treatment of mental disorders that bases its principles in the application of the information we have about the brain activations and brain functioning to adjust the therapy to them, in order to center the process in how the brain evolves to its normal activations. New tools in the field of neuroimaging have helped in this process, providing accurate and detailed information about how the particular brain of each patient works. Between the many neuroimaging techniques available nowadays, the functional magnetic resonance (fMRI) stands out by its high spatial resolution, which allows a better knowledge of which brain area is activated before each stimulus or while performing each activity. The disadvantages this technique presents in terms of size of the scanner and restriction of movements give light to another technique, more suitable in certain domains: the electroencephalography (EEG), which provides a greater freedom of movement and higher temporal resolution. For the purposes of this PhD Thesis, both techniques will be compared, in order to find which one better suits our interests. For doing so, another factor will be taken into account. Due to the limitations the neuroimaging techniques have in terms of presentation of the stimuli, we are not able to expose the subject to certain kinds of real life situations. There is where the virtual reality (VR) enters the scene. With VR we are able to move the subject to a virtual world where any kind of stimulus is possible. In the case of neuropsychotherapy, it will allow the exposition of the patient to a situation related to his disorder, in a safer and more controlled environment. In fact, virtual reality has been widely used for the treatment of psychological disorders; but, until now, it has not been applied during the assessment of the disease. For the aims of this Thesis, virtual environments will be used for the assessment of subjects before and after undergoing a psychological treatment for a specific disorder, using neuroimaging techniques to find useful information that could help during the therapeutic process. As an example of disorder, the phobia to small animals (spiders and cockroaches) has been chosen, although the conclusions of this study could be extended to other kinds of psychological disorders. Before being able to assure that the brain activations obtained are related to the disorder and not to other issues, it is needed to measure the sense of presence the subjects felt during the virtual experience. This is why before the assessment of a psychological disorder, a study of the sense of presence in a virtual environment was introduced. This study also helped in the decision of which neuroimaging technique apply in the second part of the Thesis. EEG and fMRI were used for the measure of presence in the same virtual environments, and the results in terms of brain activations were compared. Presence was also measured by means of questionnaires, the traditional subjective way of measuring it. As a result of this study it is expected to check if VR could effectively stimulate presence and which neuroimaging technique is more appropriate for the targets of this Thesis. To sum up, the initial hypotheses of this Thesis are that: 1- The new neuroimaging techniques can provide of useful information to use during neuropsychotherapy. 2- Virtual reality would help in the assessment of the disorder, improving the accuracy in the way the subjects are exposed to the stimuli. 3- The environments used would be immersive enough so the patient will feel present in them and feel them as real. For fulfilling these objectives, each of the two courses of work (study of presence and assessment of a mental disorder) was divided in two parts. In total, four studies were developed: 1- Study of the sense of presence in a virtual environment using fMRI: the aim of this part of the Thesis was to check if the environments were able to stimulate the sense of presence, correlating the results with those given to questionnaires. 2- Study of the sense of presence in a virtual environment using EEG: the aim here was to compare the brain activations obtained with EEG with those from the previous study, and if the responses of the questionnaires were equivalent despite being in a less intrusive scanner. As a result of these two studies, it was decided that the environments were immersive enough to induce the sense of presence, and that the best neuroimaging technique for the next part of the Thesis was the fMRI, due to the higher spatial resolution it brought. 3- Assessment of a psychological disorder, pre-treatment: once decided the study will continue with fMRI, the areas related to a specific disorder (small animals¿ phobia) were studied using VR as stimulus. Until now, the assessment has been done using real animals as stimuli but not using VR, which here is hypothesized to allow a better approach to the phobic experience than the view of photographs or videos of real animals. 4- Assessment of the state of subjects with a psychological disorder, post-treatment: once the patients had underwent a treatment to cure the disorder, they were assessed again to check if the brain areas related to the phobia stopped being activated after it. As a result of this second part of the Thesis, the brain areas related to the phobia (that stopped being activated after the treatment) were obtained, and this information is hoped to be useful in future neuropsychotherapeutic works, for the better adjustment of the disorder. In conclusion, this PhD Thesis studies the advantages that the new neuroimaging techniques and virtual reality could bring to the study of neuropsychotherapy.Clemente Bellido, M. (2014). Contributions to Neuropsychotherapy of the Combined Use of Neuroimaging and Virtual Exposure for Assessment in Psychological Treatments [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/37234TESI

Los trastornos de la conducta alimentaria y el espectro obsesivo-compulsivo: intrusiones mentales, egodistonía y creencias

Las investigaciones a nivel psicopatológicos de la relación entre los Trastornos Alimentarios (TA) y el Trastorno Obsesivo-Compulsivo (TOC) son muy escasas. La presente tesis se enmarca precisamente dentro del análisis de dicha relación. Objetivos: 1.Analizar la Egosintonía y Egodistonía asociada a las intrusiones mentales de TA y TOC. 2.Analizar las creencias nucleares y creencias asociadas al TOC y su relación con Egosintonía y Egodistonía. Participantes: Un grupo de población general (n=349), de donde se extrajeron: Población subclínica-TA (n=12), población subclínica-TOC (n=18), y población sin riesgo de TA ni TOC(n=50). Contamos con dos muestras de mujeres con diagnóstico de TA (DSM-IV-TR), la primera compuesta por 106 pacientes (61 españolas y 45 inglesas), y la segunda, compuesta por 76 mujeres españolas. También se contó con un grupo de 20 mujeres recuperadas de TA. Instrumentos: Actitudes hacia la comida(EAT-26), Cuestionario de Relaciones Multidimensionales Cuerpo-mí mismo(MBSRQ), Actitudes frente al Cambio(ACTA), Inventario de Obsesiones y Compulsiones de Clark-Beck(CBOCI), Inventario de Depresión de Beck(BDI-II), Inventario de Ansiedad de Beck(BAI), Inventario de Creencias Obsesivas(ICO), Cuestionario de Esquemas de Young(YSQ), Escala de Ideas Sobrevaloradas(OVIS), Inventario de Pensamientos Intrusos Obsesivos(INPIOS) y el Inventario de Pensamientos Intrusos Alimentarios(INPIAS). Resultados: Se construyeron dos cuestionarios para evaluar Egosintonía(CES) y Egodistonía(CED-Reducido) de las intrusiones mentales. Los AFE y AFC mostraron una estructura de tres factores en espejo (CED-R: F1.Indeseabilidad del pensamiento. F2.Irracionalidad e incoherencia con la personalidad. F3.Inmoralidad. CES: F1.Deseabilidad. F2.Racionalidad y coherencia. F3.Moralidad). Los ANOVAS con el INPIAS mostraron un continuo: las pacientes obtuvieron puntuaciones significativamente más altas, seguido por el grupo subclínico-TA, y las mujeres recuperadas y población sin riesgo. Sin embargo, todos menos el grupo sin riesgo valoraron sus intrusiones alimentarias como Racionales e Indeseables. En pacientes, la egosintonía se asoció a estar ocupado con el pensamiento, interfiriendo en su concentración(R2=0,14), y a hacer lo que indica la intrusión(R2=0,20). Mientras que en el grupo sin riesgo se asoció a la frecuencia(R2=0,24) y a la importancia otorgada al mismo(R2=0,11). La Egodistonía fue predicha en pacientes por valorar el pensamiento como inaceptable(R2=0,16), y por el empleo de estrategias de control tipo ansioso(R2=0,20). En población sin riesgo destaca la relación con los intentos de supresión(R2=0,20). Además, en pacientes la Egosintonía se asoció(p<0,001) principalmente a una baja motivación al cambio y la preocupación por el sobrepeso, mientras que la Egodistonía se asoció(p<0,001) a la satisfacción por la apariencia. A nivel subclínico TA y TOC, ambos grupos evaluaron sus intrusiones como Racionales e Indeseables. Finalmente, Egosintonía/Egodistonía no se relacionaron con creencias nucleares, aunque la Egosintonía si correlacionó(p<0,01) con creencias TOC(Importancia de controlar los pensamientos, Intolerancia a la incertidumbre y Perfeccionismo). Conclusiones: Los datos señalan que las intrusiones alimentarias no son completamente Egosintónicas, al menos en todos los aspectos. Además, la Egodistonía parece ser un factor de buen pronóstico, mientras que la Egosintonía se asocia a un bajo insight. Tanto pacientes como mujeres recuperadas de TA valoran de manera similar la Egosintonía y Egodistonía, quizá señalando un posible factor de vulnerabilidad. Por otra parte, en población no clínica, la Egosintonía de las intrusiones se asocia a un mayor riesgo de TA.Objectives: 1.To examine Egosyntonicity and Egodystonicity of Eating Disorder (ED) and Obsessive-Compulsive Disorder (OCD) unwanted intrusive cognitions. 2.To analyze core beliefs and obsessive beliefs and their relationships with egosyntonicity/egodystonicity. Participants: The sample consisted of a general population group (n=349), a Subclinical-ED group (n=12), a Subclinical-OCD group (n=18), and people without risk of ED or OCD (n=50). The clinical samples included two groups of ED patients (DSM-IV-TR): 106 ED patients (61 Spanish-45 English), and 76 Spanish ED patients. Finally, a group of 20 women had recovered from ED. Instruments: EAT-26, MBSRQ, Attitudes towards change in ED (ACTA), CBOCI, BDI-II, BAI, Obsessive Beliefs Inventory (ICO), Young Schema Questionnaire (YSQ), Overvalued Idea Scale (OVIS), Eating Intrusive Thoughts Inventory (INPIAS), and Obsessive Intrusive Thoughts Inventory (INPIOS). Results: The Egosyntonicity Questionnaire (CES) and Egodystonicity Questionnaire (CED-Reduced) showed that these constructs are better represented as two different dimensions but with common aspects. Patients showed the highest scores on intrusive thoughts and associated variables, followed by the Subclinical-ED, Recovered, and no-risk groups. Every group except the no-risk group rated their intrusions as Rational (Egosyntonicity) and Undesirable (Egodystonicity). In patients and no-risk groups Egosyntonicity/Egodystonicity showed a different pattern of associations, but in both cases the relationships with thought control strategies stand out. Egosyntonicity and Egodystonicity were not associated with core beliefs, but with some obsessive beliefs. Conclusions: Our data indicate that Eating intrusive thoughts are not completely Egosyntonic. Egodystonicity seems to be a good prognosis factor, whereas Egosyntonicity is associated with low insight. In the non clinical population, egosyntonicity is related to a higher risk of developing an ED