| 1. |
- Bouchard, Stéphane, et al.
(författare)
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Mechanisms underlying the efficacy of exposure in virtual reality for anxiety disorders
- 2016
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Ingår i: EABCT 2016 Abstract Book. ; , s. 139-139
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Konferensbidrag (refereegranskat)abstract
- Many studies have documented the efficacy and effectiveness of using virtual reality to conduct exposure in the treatment of anxiety disorders (Wiederhold & Bouchard, 2014). However, the factors related to treatment outcome remain unclear. In this symposium, four studies will be presented in order to document: (a) the role of presence in the potential of virtual reality (VR) to induce anxiety reactions in people suffering from an anxiety disorder (PTSD); (b) mechanisms of change, including treatment expectations, in the cognitive behavior treatment (CBT) of panic disorder where VR and in vivo techniques were used to conduct exposure; (c) the role of cognitive changes and self-efficacy compared to other predictors of change, such as presence and treatment alliance, in the CBT of social anxiety using VR and in vivo exposure; and (d) expanding these findings on predictors of change to augmented reality exposure for specific phobia. The first study is based on an experimental anxiety induction protocol while the other three use randomized control trials. The findings highlight to contribution of a few factors specific to technology-based exposure and those common to CBT of anxiety disorders. Attendees to the symposium will benefit from a clear understanding of what are the few key factors they need to take into account when conducting exposure with VR and augmented reality.
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| 2. |
- Carraminana, Albert, et al.
(författare)
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Rationale and Study Design for an Individualized Perioperative Open Lung Ventilatory Strategy in Patients on One-Lung Ventilation (iPROVE-OLV)
- 2019
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Ingår i: Journal of Cardiothoracic and Vascular Anesthesia. - : W B SAUNDERS CO-ELSEVIER INC. - 1053-0770 .- 1532-8422. ; 33:9, s. 2492-2502
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this clinical trial is to examine whether it is possible to reduce postoperative complications using an individualized perioperative ventilatory strategy versus using a standard lung-protective ventilation strategy in patients scheduled for thoracic surgery requiring one-lung ventilation. Design: International, multicenter, prospective, randomized controlled clinical trial. Setting: A network of university hospitals. Participants: The study comprises 1,380 patients scheduled for thoracic surgery. Interventions: The individualized group will receive intraoperative recruitment maneuvers followed by individualized positive end-expiratory pressure (open lung approach) during the intraoperative period plus postoperative ventilatory support with high-flow nasal cannula, whereas the control group will be managed with conventional lung-protective ventilation. Measurements and Main Results: Individual and total number of postoperative complications, including atelectasis, pneumothorax, pleural effusion, pneumonia, acute lung injury; unplanned readmission and reintubation; length of stay and death in the critical care unit and in the hospital will be analyzed for both groups. The authors hypothesize that the intraoperative application of an open lung approach followed by an individual indication of high-flow nasal cannula in the postoperative period will reduce pulmonary complications and length of hospital stay in high-risk surgical patients. (C) 2019 Published by Elsevier Inc.
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| 3. |
- Fernández-Alvarez, J., et al.
(författare)
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Deterioration rates in virtual reality therapy : An individual patient data meta-analysis and implications for research and practice
- 2018
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Ample evidence supports the use of Virtual Reality for anxiety disorders. Throughout 20 years of research there have continuous advancements, not only in the quality of studies but also in the diversity of populations included as well as the technological progresses developed. All those steps forwards are accurately compiled in several meta-analysis, reviews and chapters. Nonetheless, there is no evidence yet on the potential negative effects and its moderators that Virtual Reality treatment strategies can provoke.From the diversity of negative effects’ operationalizations, this study uses the deterioration rates concept defined as the worsening of the clinical symptomatology from the pre-test scores to the post-test scores using the Reliable Change Index (RCI). An individual patient data meta-analyses (IPDMA) approach that systematically reviewed all the randomized control trials in Virtual Reality and gathered 16 datasets from the total 35 studies conducted within the field of research. A total of 846 patients constitutes the sample of the study. RCI’s for each primary outcome measure is performed as well as moderator analyses for demographic variables. In this talk the results will be discussed in terms of their clinical and research implications regarding the current status and future challenges of Virtual Reality therapy in the clinical psychology realm.
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| 4. |
- Karyotaki, Eirini, et al.
(författare)
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Efficacy of Self-guided Internet-Based Cognitive Behavioral Therapy in the Treatment of Depressive Symptoms A Meta-analysis of Individual Participant Data
- 2017
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Ingår i: JAMA psychiatry. - : AMER MEDICAL ASSOC. - 2168-6238 .- 2168-622X. ; 74:4, s. 351-359
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Self-guided internet-based cognitive behavioral therapy (iCBT) has the potential to increase access and availability of evidence-based therapy and reduce the cost of depression treatment. OBJECTIVES To estimate the effect of self-guided iCBT in treating adults with depressive symptoms compared with controls and evaluate the moderating effects of treatment outcome and response. DATA SOURCES A total of 13 384 abstracts were retrieved through a systematic literature search in PubMed, Embase, PsycINFO, and Cochrane Library from database inception to January 1, 2016. STUDY SELECTION Randomized clinical trials in which self-guided iCBT was compared with a control (usual care, waiting list, or attention control) in individuals with symptoms of depression. DATA EXTRACTION AND SYNTHESIS Primary authors provided individual participant data from 3876 participants from 13 of 16 eligible studies. Missing data were handled using multiple imputations. Mixed-effects models with participants nested within studies were used to examine treatment outcomes and moderators. MAIN OUTCOMES AND MEASURES Outcomes included the Beck Depression Inventory, Center for Epidemiological Studies-Depression Scale, and 9-item Patient Health Questionnaire scores. Scales were standardized across the pool of the included studies. RESULTS Of the 3876 study participants, the mean (SD) age was 42.0 (11.7) years, 2531 (66.0%) of 3832 were female, 1368 (53.1%) of 2574 completed secondary education, and 2262 (71.9%) of 3146 were employed. Self-guided iCBT was significantly more effective than controls on depressive symptoms severity (beta = -0.21; Hedges g = 0.27) and treatment response (beta = 0.53; odds ratio, 1.95; 95% CI, 1.52-2.50; number needed to treat, 8). Adherence to treatment was associated with lower depressive symptoms (beta = -0.19; P = .001) and greater response to treatment (beta = 0.90; P amp;lt; .001). None of the examined participant and study-level variables moderated treatment outcomes. CONCLUSIONS AND RELEVANCE Self-guided iCBT is effective in treating depressive symptoms. The use of meta-analyses of individual participant data provides substantial evidence for clinical and policy decision making because self-guided iCBT can be considered as an evidence-based first-step approach in treating symptoms of depression. Several limitations of the iCBT should be addressed before it can be disseminated into routine care.
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| 5. |
- Karyotaki, Eirini, et al.
(författare)
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Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis
- 2018
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Ingår i: Psychological Medicine. - : CAMBRIDGE UNIV PRESS. - 0033-2917 .- 1469-8978. ; 48:15, s. 2456-2466
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Forskningsöversikt (refereegranskat)abstract
- Background. Little is known about potential harmful effects as a consequence of self-guided internet-based cognitive behaviour therapy (iCBT), such as symptom deterioration rates. Thus, safety concerns remain and hamper the implementation of self-guided iCBT into clinical practice. We aimed to conduct an individual participant data (IPD) meta-analysis to determine the prevalence of clinically significant deterioration (symptom worsening) in adults with depressive symptoms who received self-guided iCBT compared with control conditions. Several socio-demographic, clinical and study-level variables were tested as potential moderators of deterioration. Methods. Randomised controlled trials that reported results of self-guided iCBT compared with control conditions in adults with symptoms of depression were selected. Mixed effects models with participants nested within studies were used to examine possible clinically significant deterioration rates. Results. Thirteen out of 16 eligible trials were included in the present IPD meta-analysis. Of the 3805 participants analysed, 7.2% showed clinically significant deterioration (5.8% and 9.1% of participants in the intervention and control groups, respectively). Participants in self-guided iCBT were less likely to deteriorate (OR 0.62, p amp;lt; 0.001) compared with control conditions. None of the examined participant- and study-level moderators were significantly associated with deterioration rates. Conclusions. Self-guided iCBT has a lower rate of negative outcomes on symptoms than control conditions and could be a first step treatment approach for adult depression as well as an alternative to watchful waiting in general practice.
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| 6. |
- Martin, Katherine Riley, et al.
(författare)
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Real World Observations Using Virtual Reality Treatments for Anxiety and Related Disorders
- 2018
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- This session will present recent advances in virtual reality therapy for depression, anxiety, and related disorders. Many of these advances are a result of a boom in personal consumer electronics. We will discuss both stationary (e.g. Virtually Better, Oculus Rift) and mobile (e.g. Samsung Gear) systems along with new stimuli and capture techniques. Together, these advances improve the efficacy and availability of high tech solutions to previous obstacles in the delivery of cognitive behavioral therapy. The first presentation is a randomized controlled trial of therapist and internet administered one-session virtual reality exposure therapy for public speaking anxiety. The second presentation is an Individual Patient Data Meta-Analysis (IPDMA) of 35 virtual reality studies with 846 patients. Outcome data include overall findings and deterioration rates along with moderators. The third presentation will describe the relationship between posttraumatic and depressive symptoms during virtual reality exposure therapy with a cognitive enhancer. The fourth presentation describes a study that examined the feasibility and efficacy of VRE in treating MST-related PTSD. The fifth presentation will discuss a randomized controlled trial of animated versus live action virtual reality therapy for anxiety & pain in a Level I Trauma Center. Finally, the discussant, who has decades of experience in the field of VRET, will cover implications and future directions in the field of VR in the treatment of mental disorders.
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