Development Of A Virtual Environment Based On The Perceived Characteristics Of Pain In Patients With Fibromyalgia

Fibromyalgia (FM) is a disorder characterized by chronic phys ical pain.The perception of this pain has psychological effects on mood, anxiety, and the degree of perceived control. In turn, these factors may increase the experience of pain. This study aims to develop a new virtual environment for the treatment of FM in order to enhance the therapeutic effects of traditional interventions. The first phase included a sample of 19 patients in order to identify common characteristics of the representation of pain and absence of pain, through drawing. The results showed that patients used different colors and different physical states to depict pain (red, motionless) and the absence of pain (blue, in motion). These features were then included in a 3D representation of the human body. ANOVA analysis showed that the degree of anxiety and depression influenced the perceived characteristic of movement

Virtual reality-based software for the treatment of fibromyalgia: a case study

The aim of this study was to explore the efficacy and acceptance of virtual reality-based software for pain reduction (VirtualPain) in a 53-year-old female with fibromyalgia (FM), a chronic pain syndrome. Treatment consisted of four 60-minute sessions. Each session involved 40 minutes of cognitive behavioral therapy (CBT) and 20 minutes of exposure to VirtualPain software. VirtualPain consists of a recreation of the human body in which the pain or lack of pain experienced by the participant in each body part (e.g., hand or knee) is represented by color, movement and sound. During exposure, the patient modified these characteristics to increase her sensation of control over the pain. In our study, the software was displayed on a stereoscopic laptop with a 17' screen. Pain intensity was assessed on a visual analog scale (VAS, from 0 to 10). Before and after the treatment, the patient completed the Pain Anxiety Symptoms Scale Short Form (PASS-20), the Pain Catastrophizing Scale (PCS) and the Pain Self-Efficacy Scale (CPSS). During each session, the patient reported the amount of extra medication for pain consumed during the week. Follow-up was conducted at 6 and 12 months. The patient showed a substantial reduction in anxiety, catastrophic thoughts and pain perception, and improved selfefficacy after treatment. Most importantly, at 6-month follow-up (after six months without treatment) results were maintained, but at 12-month follow-up (after the patient had been allowed to use VirtualPain at home for 6 months) the clinical improvements increased. The addition of VirtualPain to a CBT intervention reduced pain intensity and psychological symptoms (anxiety, catastrophism and low selfefficacy) in a patient with FM. Controlled studies with large samples are now needed to assess the specific additional contribution of VirtualPain to CBT in the treatment of fibromyalgia

External eating as a predictor of cue-reactivity to food-related virtual environments

The objective of this study was to assess the association between external eating style and food craving experienced during exposure to food cues in virtual reality (VR) environments in both clinical and non-clinical samples. According to the externality theory, people with external eating experience higher reactivity when exposed to food cues, which in turn increases the probability of overeating. Forty patients with eating disorders (23 with bulimia nervosa and 17 with binge eating disorder) and 78 undergraduate students were exposed to 10 different food cues in four VR environments (kitchen, dining room, bedroom, and café). After 30 seconds of exposure to each VR environment, food craving was assessed using a visual analog scale. External, emotional and restrictive eating styles were also assessed using the DEBQ. The results showed a strong association between external eating and cue-elicited food craving. After controlling for the presence of eating disorder diagnosis, external eating was the best predictor of reported food craving. The results lend support to the externality theory but highlight the need for further research in specific patterns of functioning in patients with bulimia nervosa and binge eating disorder

Eating behavior style predicts craving and anxiety experienced in food-related virtual environments by patients with eating disorders and healthy controls

Eating behavior style (emotional, restrictive, or external) has been proposed as an explanation for the differences in response to food-related cues between people who overeat and those who do not, and has been also considered a target for the treatment of eating disorders (EDs) characterized by lack of control over eating and weightrelated (overweight/obesity) conditions. The aim of this study was to analyze the relationship between eating behavior style and psychophysiological responses (self-reported food craving and anxiety) to food-related virtual reality (VR) environments in outpatients with bulimia nervosa (BN) and binge eating disorder (BED) and to compare them with healthy participants. Fifty-eight outpatients and 135 healthy participants were exposed to palatable foods in four experimental everyday real-life VR environments (kitchen, dining room, bedroom and café). During exposure, cue-elicited food craving and anxiety were assessed. Participants also completed standardized instruments for the study purposes. ED patients reported significantly higher levels of craving and anxiety when exposed to the virtual food than healthy controls. Eating behavior styles showed strong associations with cue-elicited food craving and anxiety. In the healthy group, external eating was the only predictor of cue-elicited craving and anxiety. In participants with BN and BED, external and emotional eating were the best predictors of cue-elicited craving and anxiety, respectively

Manipulación de una representación virtual del dolor para mejorar la ansiedad y la autoeficacia de los pacientes con fibromialgia

[spa] La Fibromialgia (FM) es un trastorno que cursa con dolor crónico generalizado, fatiga, problemas para conciliar y mantener el sueño y problemas de atención y memoria. Además, el dolor está influenciado por diversos factores como el ejercicio físico, la ansiedad, el estado de ánimo, el catastrofismo, la autoeficacia y el afrontamiento. Los tratamientos actuales están dirigidos a paliar la sintomatología de la FM. Las tres intervenciones eficaces son el tratamiento farmacológico, el tratamiento cognitivo- conductual (TCC) y el ejercicio físico. Se desarrolló un entorno de realidad virtual (RV) para representar tanto de la percepción del dolor como la ausencia del dolor con la finalidad de poder establecer una continuidad entre ambas representaciones. El paciente pudo visualizar la percepción de dolor como un gradiente, facilitándole la conceptualización del dolor como una variable continua, no como una categórica. Esta conceptualización del dolor permitió definir el dolor operativamente y generar metas de tratamiento más realistas. Así, el paciente tenía como objetivo la reducción del dolor, no la extinción. En la presente tesis se elaboraron cuatro estudios que tenían la finalidad de desarrollar un entorno virtual que pudiera representar el dolor, validar que dicho entorno para medir el dolor y adjuntarlo en una intervención para valorar si se obtenía una mejoría terapéutica. El primero se centró en realizar un análisis exploratorio para poder extraer los factores relevantes en la descripción del dolor y de la ausencia de dolor. Los resultados de este estudio indicaron que tenía una elevada relevancia el color en el que la persona imaginaba el dolor. Así mismo, también tiene mucha importancia la capacidad de movimiento de la persona, dado que una elevada intensidad de dolor reduce el movimiento. Mediante los resultados del primer estudio, se elaboró el programa informático específico para afrontar y reducir el dolor percibido por pacientes con FM: VirtualPain. El segundo estudio se centró en la validación del programa informático con personas sanas a las cuales se les indujo dolor experimental a fin de conocer si las características del programa informático tenían la capacidad de representar y cuantificar la percepción del dolor. Los resultados mostraron que las tres características del programa informático (el color, el movimiento y el sonido) correlacionaron con la intensidad del dolor. El tercer estudio tuvo como objetivo validar VirtualPain con una muestra compuesta por pacientes con FM para ver si las características de VirtualPain correlacionaban con el dolor de la FM y con la ansiedad ante el dolor, el catastrofismo y la autoeficacia ante el dolor. Se observó que todas las características de VirtualPain correlacionaban con el dolor, la ansiedad, el catastrofismo y la autoeficacia. Con ambos estudios se pudo concluir que las características de VirtualPain fueron capaces de representar la percepción del dolor y cuantificar su intensidad. Finalmente, el cuarto estudio se centró en incluir el sistema informático desarrollado en un TCC a fin de valorar si su adjunción potenciaba los beneficios del TCC. Los pacientes con FM se aleatorizaron en dos grupos de intervención: TCC con VirtualPain y TCC con un sistema informático control. Los resultados de la intervención mostraron que en ambos grupos se reducía la intensidad del dolor, la ansiedad, el catastrofismo y el miedo al movimiento y aumentaba la autoeficacia. En conclusión, VirtualPain mostró ser una herramienta válida para representar el dolor percibido y cuantificar la intensidad del mismo. Al adjuntarlo en una intervención con TCC no se encontró una mayor eficacia que al aplicar sólo TCC. catastrofismo y la autoeficacia. Con ambos estudios se pudo concluir que las características de VirtualPain fueron capaces de representar la percepción del dolor y cuantificar su intensidad. Finalmente, el cuarto estudio se centró en incluir el sistema informático desarrollado en un TCC a fin de valorar si su adjunción potenciaba los beneficios del TCC. Los pacientes con FM se aleatorizaron en dos grupos de intervención: TCC con VirtualPain y TCC con un sistema informático control. Los resultados de la intervención mostraron que en ambos grupos se reducía la intensidad del dolor, la ansiedad, el catastrofismo y el miedo al movimiento y aumentaba la autoeficacia. En conclusión, VirtualPain mostró ser una herramienta válida para representar el dolor percibido y cuantificar la intensidad del mismo. Al adjuntarlo en una intervención con TCC no se encontró una mayor eficacia que al aplicar sólo TCC.[eng] Fibromyalgia (FM) is a syndrome which causes generalized chronic pain, fatigue, problems to reconciling and maintaining sleep and attention, and memory problems. Furthermore, pain is influenced by other factors such as physical exercise, anxiety, mood, catastrophism, self- efficacy and coping with it. Current treatments are focused to reduce symptomatology of FM. The three effective ones are pharmacological treatment, cognitive-behavioral treatment (CBT) and physical exercise. A Virtual Reality environment (VR) was developed to represent both the perception of pain and the absence of pain, so a continuum between both representations could be established. The patient was able to visualize the perception of pain as a gradient, easing the conceptualization of pain as a continuous variable, not as a categorical one. This conceptualization of pain allowed to define pain operationally and generated more realistic treatment goals. Thus, the patient aimed to decrease pain, not pain extinction. On this thesis four studies were proposed in order to make a virtual environment that could represent pain, validate that the environment was valid to measure pain, and using this environment on an intervention to assess its efficacy. First one was aimed to make an exploratory analysis to extract relevant factors of the description of pain and absence of pain. The results of this study indicated that the color in which the person imagined the color had a highly relevance. Likewise, the person's ability to move is also very important, since a high pain intensity reduces movement. By using the results of the first study, the specific computer program was developed to face and reduce the pain perceived by patients with FM: VirtualPain. The second study focused on the validation of the computer program with healthy people who were induced experimental pain, in order to validate if the characteristics of the computer program had the ability to represent and quantify the perception of pain. The results showed the three characteristics of the computer program (color, movement and sound) correlated with pain intensity. The third study aimed to validate VirtualPain with a sample composed by FM patients to see if the characteristics of VirtualPain correlated with FM pain and anxiety over pain, catastrophism and self-efficacy against pain. It was observed that all the characteristics of the computer system correlated with pain, anxiety, catastrophism and self-efficacy against pain. It was also observed that all the characteristics of VirtualPain correlated with pain, anxiety, catastrophism and self-efficacy. With both studies it can be concluded that VirtualPain characteristics were able to represent the perception of pain and quantify its intensity. Finally, the fourth study focused on including the developed computer on a CBT therapy in order to assess whether its attachment enhanced the benefits of CBT. Patients with FM were randomized into two intervention groups: CBT with VirtualPain and CBT with a computerized control system. The results of the intervention showed that in both groups pain intensity, anxiety, catastrophism and fear of movement were reduced and self-efficacy increased. In conclusion, VirtualPain proved to be a valid tool to represent the perception of pain and quantify its intensity. When attached to a CBT intervention no improvement in its efficacy was found

Validation of VR-Based software for binge eating treatment: preliminary data

This study shows preliminary data on the validity of a new virtual reality-based application for cue-exposure treatment of binge eating in bulimia nervosa and binge eating disorder. Thirty-eight undergraduate students without eating disorders were exposed to several virtual environments with different foods in four different contexts (kitchen, dining-room, bedroom, and bakery/café). Participants were asked to indicate the level of food craving experienced in each situation. They also completed the Spanish version of the State and Trait Food Cravings Questionnaires. The results suggest that virtual reality is an effective technology for eliciting food craving, especially in the case of participants with high reactivity to food cues, and those who were hungry or experienced strong desire to eat during the experiment

Validation of VR-Based software for binge eating treatment: preliminary data

This study shows preliminary data on the validity of a new virtual reality-based application for cue-exposure treatment of binge eating in bulimia nervosa and binge eating disorder. Thirty-eight undergraduate students without eating disorders were exposed to several virtual environments with different foods in four different contexts (kitchen, dining-room, bedroom, and bakery/café). Participants were asked to indicate the level of food craving experienced in each situation. They also completed the Spanish version of the State and Trait Food Cravings Questionnaires. The results suggest that virtual reality is an effective technology for eliciting food craving, especially in the case of participants with high reactivity to food cues, and those who were hungry or experienced strong desire to eat during the experiment

A Randomized Trial of Virtual Reality-Based Cue Exposure Second-Level Therapy and Cognitive Behavior Second-Level Therapy for Bulimia Nervosa and Binge-Eating Disorder: Outcome at Six-Month Followup

This article reviews the 6-month followup data of a randomized, multicenter, parallel-group study conducted at five clinical sites in three European cities, which compared two second-level treatments for bulimia nervosa (BN) and binge eating disorder (BED): virtual reality-based cue exposure therapy (VR-CET) versus additional cognitive behavioral therapy (A-CBT). Post-treatment outcomes of this study were already published in Ferrer- Garcia et al. (2017) and details of its design can be found at clinicaltrials.gov (identifier: NCT02237300, https:// clinicaltrials.gov). This article focuses on the evolution of symptoms assessed after 6 months of followup in a subgroup of 58 patients from the original study. In this study (Ferrer-Garcia et al., 2017) 64 patients with eating disorders (EDs) (35 with BN and 29 with BED), who still showed active episodes of binge eating by the end of a structured CBT program (first-level treatment), were randomly assigned to one of two second-level treatments (A-CBT or VR-CET). Frequency of binge and purge episodes, and attitudinal features of binge-related EDs (bulimia, drive for thinness, and body dissatisfaction) were assessed before starting the second-level treatment (n = 64), at the end (n = 64), and at 6-month followup (n = 58). Mixed between-within subject analyses of variance were used to compare outcomes of both second-level treatments over time. Although both treatment conditions showed statistically significant improvements at the end and after 6-month followup, obtained reductions were greater after VR-CET, regarding binge and purge episodes, as well as the decrease of selfreported tendency to engage in overeating episodes. Accordingly, abstinence from binge episodes were higher in VR-CET than A-CBT at followup (70 percent vs. 26 percent, respectively; v2 = 11.711, p = 0.001). These results provide further support for the use of VR-CET as an effective second-level intervention for BN and BED treatment-resistant patients

Trait and state craving as indicators of validity of VR-based software for binge eating treatment

The aim of this study was to establish whether virtual reality (VR) exposure to food cues is able to produce craving levels consistent with state-craving and trait-craving as assessed by the Spanish and Italian versions of the State and Trait Food Craving Questionnaires (FCQ-T/S). The results were compared in 40 patients with eating disorders (17 with binge eating disorder, 23 with bulimia nervosa) and 78 healthy control subjects without eating disorders. Controls and patients with higher levels of trait-craving and state-craving both showed a greater desire to eat during VR exposure. Results also showed that trait and state craving assessed by FCQ-T/S were able to predict the total mean craving experienced during exposure to the VR software in both clinical and control samples. These findings present preliminary evidence about the validity of a new virtual reality-based application for cue-exposure treatment in patients with eating disorders

Eating behavior style predicts craving and anxiety experienced in food-related virtual environments by patients with eating disorders and healthy controls

Eating behavior style (emotional, restrictive, or external) has been proposed as an explanation for the differences in response to food-related cues between people who overeat and those who do not, and has been also considered a target for the treatment of eating disorders (EDs) characterized by lack of control over eating and weight-related (overweight/obesity) conditions. The aim of this study was to analyze the relationship between eating behavior style and psychophysiological responses (self-reported food craving and anxiety) to food-related virtual reality (VR) environments in outpatients with bulimia nervosa (BN) and binge eating disorder (BED) and to compare them with healthy participants. Fifty-eight outpatients and 135 healthy participants were exposed to palatable foods in four experimental everyday real-life VR environments (kitchen, dining room, bedroom and cafe). During exposure, cue-elicited food craving and anxiety were assessed. Participants also completed standardized instruments for the study purposes. ED patients reported significantly higher levels of craving and anxiety when exposed to the virtual food than healthy controls. Eating behavior styles showed strong associations with cue-elicited food craving and anxiety. In the healthy group, external eating was the only predictor of cue-elicited craving and anxiety. In participants with BN and BED, external and emotional eating were the best predictors of cue-elicited craving and anxiety, respectively. 2017 Elsevier Ltd. All rights reserved