Provider Perceptions of Virtual Reality as a Therapeutic Tool

Introduction: Virtual reality (VR) can be an effective healthcare tool, particularly applied to anxiety and pain management. Despite significant interest in VR, lack of resources and knowledge regarding feasibility are barriers to implementation. This study aims to understand the current clinical usage of VR and the achievability of VR as a standardized therapy, by assessing VR healthcare providers. Methods: An online, self-administered questionnaire with five sections—respondent demographics, VR value, onboarding, billing, and clinical use—was distributed. Providers, identified on VR application websites, were contacted via email. Inclusion criteria was providers in the United States using VR actively or in the past year as a therapeutic tool. Twenty-two responses were received, and four excluded due to incomplete data. Results: Providers most commonly reported using VR for acute pain/anxiety (N=11, 61.1%), followed by specific and social phobia (N=6, 33.3% each). Providers expressed greatest interest in extending VR use to chronic and acute pain patients. All providers agreed VR is a valuable tool they would recommend to colleagues. The majority (N=15, 93.8%) believed VR helped their patients progress in treatment, compared with other methods. Providers cited the ability to individualize treatment (N=14, 87.5%) and increase patient engagement (N=15, 93.8%) as main benefits of VR. A minority reported negative feedback from patients (N=4, 25.0% content-related; N=6, 37.5% technology-related), whereas all reported some form of positive feedback. Discussion: VR is a treatment adjunct that is well-received by patients and providers, allowing increased patient engagement and treatment individualization

Engineering Virtuous Health Habits Using Emotion and Neurocognition: Flexibility for Lifestyle Optimization and Weight Management (EVEN FLOW)

Interventions to preserve functional independence in older adults are critically needed to optimize \u27successful aging\u27 among the large and increasing population of older adults in the United States. For most aging adults, the management of chronic diseases is the most common and impactful risk factor for loss of functional independence. Chronic disease management inherently involves the learning and adaptation of new behaviors, such as adopting or modifying physical activity habits and managing weight. Despite the importance of chronic disease management in older adults, vanishingly few individuals optimally manage their health behavior in the service of chronic disease stabilization to preserve functional independence. Contemporary conceptual models of chronic disease management and health habit theory suggest that this lack of optimal management may result from an underappreciated distinction within the health behavior literature: the behavioral domains critical for initiation of new behaviors (Initiation Phase) are largely distinct from those that facilitate their maintenance (Maintenance Phase). Psychological factors, particularly experiential acceptance and trait levels of openness are critical to engagement with new health behaviors, willingness to make difficult lifestyle changes, and the ability to tolerate aversive affective responses in the process. Cognitive factors, particularly executive function, are critical to learning new skills, using them effectively across different areas of life and contextual demands, and updating of skills to facilitate behavioral maintenance. Emerging data therefore suggests that individuals with greater executive function are better able to sustain behavior changes, which in turn protects against cognitive decline. In addition, social and structural supports of behavior change serve a critical buffering role across phases of behavior change. The present review attempts to address these gaps by proposing a novel biobehavioral intervention framework that incorporates both individual-level and social support system-level variables for the purpose of treatment tailoring. Our intervention framework triangulates on the central importance of self-regulatory functioning, proposing that both cognitive and psychological mechanisms ultimately influence an individuals\u27 ability to engage in different aspects of self-management (individual level) in the service of maintaining independence. Importantly, the proposed linkages of cognitive and affective functioning align with emerging individual difference frameworks, suggesting that lower levels of cognitive and/or psychological flexibility represent an intermediate phenotype of risk. Individuals exhibiting self-regulatory lapses either due to the inability to regulate their emotional responses or due to the presence of executive functioning impairments are therefore the most likely to require assistance to preserve functional independence. In addition, these vulnerabilities will be more easily observable for individuals requiring greater complexity of self-management behavioral demands (e.g. complexity of medication regimen) and/or with lesser social support. Our proposed framework also intuits several distinct intervention pathways based on the profile of self-regulatory behaviors: we propose that individuals with intact affect regulation and impaired executive function will preferentially respond to \u27top-down\u27 training approaches (e.g., strategy and process work). Individuals with intact executive function and impaired affect regulation will respond to \u27bottom-up\u27 approaches (e.g., graded exposure). And individuals with impairments in both may require treatments targeting caregiving or structural supports, particularly in the context of elevated behavioral demands

Getting on the Same Page: Strategies from DBT to Manage Conflict Between Patients & Providers

Overview Big WHY What is DBT Validation & how it helps Cautionary notes How to stay flexible & get out of threat 2 DBT Interpersonal Effectiveness Skills Summary & take-home nugget

Provider experiences of virtual reality in clinical treatment

Background: Virtual reality (VR) has proven effective in the treatment of specific phobias and trauma particularly when in-vivo exposure therapy might be costly (e.g. fear of flying, combat scenes). Similarly, VR has been associated with improvement of chronic pain and of acute pain during medical procedures. Despite its effectiveness as a healthcare tool, VR technology is not well-integrated into common practice. This qualitative study aims to explore the provider perception of the value of VR and identify barriers to VR implementation among healthcare providers. Methods: A 66-item self-report survey was created to examine application of VR to clinical practice, perceived value of this treatment, ease of learning the technology, billing considerations, and other obstacles. 128 providers (MDs and PhDs) who were located in the United States and had used VR as a therapeutic tool in the past year were identified through research papers, as well as user lists and news articles from VR application websites. Of the 128 providers contacted, 17% (22) completed our online self-report measure. Of these, 13% of respondents (N = 17) completed greater than 75% of the questionnaire and were considered completers. Provider responses were collected over a one-month period and qualitatively analyzed. Results: The majority of providers were from an academic institution (n = 12, 70.6%), and all providers practiced in the outpatient setting. Providers most commonly reported using VR for the treatment of acute pain and/or anxiety related to medical procedures (n = 11, 64.7%), followed by specific phobia (n = 6, 35.3%) and social phobia (n = 6, 35.3%). All providers agreed VR is a valuable tool they would recommend to colleagues. The majority (n = 15, 93.8%) believed VR helped their patients progress in treatment, compared with other methods. Providers cited the ability to individualize treatment (n = 14, 87.5%) and increase patient engagement (n = 15, 93.8%) as main benefits of VR. A minority reported negative feedback from patients about content (n = 4, 25%) or about the technology in general (n = 6, 37.5%), whereas all reported some form of positive feedback. The slight majority (n = 10, 58.8%) of providers did not find transitioning to VR difficult. Of those who did, cost was the most commonly cited barrier (n = 6). Regarding reimbursement, only 17.6% (n = 3) of providers reported the ability to bill for VR sessions. Most providers (n = 15, 88.2%) received training on their VR platform which they found beneficial. Comparing the trained and untrained groups found no significant difference in VR comfort level (p = 0.5058), the value of VR in practice (p = 0.551) or whether providers would recommend VR to others (p = 0.551), though sample sizes were small. Conclusions: In corroboration with previous research, this study demonstrates that VR is well-received by patients and providers, allowing increased patient engagement and treatment individualization. However, associated costs, including an inability to bill for this service, can present a barrier to further implementation. These findings will guide further development of virtual reality as a standardized tool in psychiatry and pain management

Behavioral Health for the Front Line: Lessons from the Covid-19 Pandemic

A large, university-based health system reorganized and expanded its behavioral health services to respond to the special needs of health care workers, students, faculty, patients,and caregivers across the Covid-19 pandemic. While patient services did not require much structural change, mental health support for employees, specifically frontline health care workers, required significant development. The Department of Psychiatry and Human Behavior, along with HR, launched a wide variety of mental health offerings at different levels of engagement beginning in March 2020. They adopted a four-tiered “pyramid” approach, with self-care resources (Tier 1) at the base; Tier 2 programs to teach supervisors how to support their employees; Tier 3 programs for peer support; and professional therapy at Tier 4. Most of the program development efforts targeted Tiers 1and 3. Tier 1 self-care resources were well used, but Tier 3 group and individual support programs struggled with scheduling issues. They relaunched several programs in summer2020 by moving scheduling responsibility to team leaders and managers, who were better able to determine the needs of their employees and the best times for everyone to gather.They adapted the programs to large-group and workshop formats. They established behavioral health liaisons for larger teams and departments to coordinate requests for services. They created four specialty targeted partnerships with the cancer center, the student counseling center, a new assisted coping program for health care providers, and institutional leadership, which has adopted mental health and wellness as a top priority