Virtual Reality Medical Center Newsletter

The Virtual News, Volume 3(1)

2003

Current Events at VRMC:

In November of 2003, the Virtual Reality Medical Center opened its third clinic in Palo Alto. This new clinic offers virtual reality treatment for fear of flying, public speaking, heights, and thunderstorms to those living in the Bay Area. In addition to the above treatments, the Santa Monica Clinic is now offering treatments for fear of driving, panic and agoraphobia, as well as posttraumatic stress disorder following motor vehicle accidents.

VRMC has been awarded several grants over the past few months. Our expertise in therapy is now being extended to research and development into how virtual reality and simulations can be used to enhance learning and training. One of these grants will fund research that examines how to maximize learning in virtual reality environments. Another will go towards supporting a partnership with the UCSD Burn Center in order to use virtual reality with children as they undergo wound care. Because changing dressings and examining wounds is such a painful process for all burn patients, it is hoped that the use of virtual reality will act as a distraction from pain for these children. The Centers for Disease Control grant that was awarded to the Virtual Reality Medical Center last summer is going well, with over 75 high school students being trained using virtual reality driving simulators by VRMC staff.

VRMC staff have been very busy speaking about virtual reality therapy for anxiety disorders at various conferences. Presentations included "VR Therapy" at the Scripps Research Institute, and "New Techniques in VR Therapy" at the Association for Advancement of Behavioral Therapy annual conference. Brenda was an invited speaker at the 11th annual Medicine Meets Virtual Reality Conference in Newport Beach in January, and VRMC staff will attend the Anxiety Disorders Association of America international conference in March in Toronto where current research results will be presented.

Dr. Brenda Wiederhold wrote a guest editorial for the September 2002 issue of IEEE Transactions on Information Technology in Biomedicine Journal. In addition, she co-authored two articles in that issue, "The Treatment of Fear of Flying: A Controlled Study of Imaginal and Virtual Reality Graded Exposure Therapy" and "The Development of Virtual Reality Therapy System for the Treatment of Acrophobia and Therapeutic Case."

Our biggest news is the successful completion of the 1st international conference, CyberTherapy 2003. The Interactive Media Institute, VRMC's affiliated 501c3 non-profit organization, organized the CyberTherapy 2003 conference on January 19-21 of this year in Rancho Santa Fe. Due to the incredible response to the Call for Papers, the original conference duration of two days had to be extended to three days. Presentation topics included the use of virtual reality for pain distraction, rehabilitation, phobia and anxiety disorder treatment, treatment for autistic spectrum disorders and more. Exhibitors also presented new virtual technology and software. Abstracts may be viewed at www.vrphobia.com under the CyberTherapy link.

An entire half-day of the conference was dedicated to presenting research about the efficacy of virtual reality therapy in the treatment of anxiety disorders. Disorders discussed during this session included Social Anxiety Disorder, Generalized Anxiety Disorder, Flying, Heights, Driving Phobia, Public Speaking, Posttraumatic Stress Disorder due to a Motor Vehicle Accident, Agoraphobia, and Panic Disorder. All presenters offered promising clinical and research results in this regard.

Another issue addressed by several presenters was the use of functional Magnetic Resonance Imaging with virtual reality. By developing VR technology that is compatible with fMRI tools, researchers are able to elucidate brain changes that occur during virtual reality therapy. In doing this, scientists hope to gather quantitative data about the physical effects of virtual reality therapy. Other presenters spoke about clinical trials that included the use of objective physiological measurements in order to further this goal.

The conference included presenters and attendees from thirteen different countries, enabling discussion and information exchange to take place among professionals from around the globe. We would like to extend our sincere gratitude and congratulations to all who made the conference a success, including this year's sponsors---DARPA, Institute for Interventional Informatics, Istituto Auxologico Italiano, MindTel, National Institute on Drug Abuse, and Naval Research Lab. Next year's conference will be held in San Diego in January 2004.

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What is stress, and why is it ruining my life?

According to the American Institute of Stress, "the stress response of the body is somewhat like an airplane readying for take-off. Virtually all systems (e.g., the heart and blood vessels, the immune system, the lungs, the digestive system, the sensory organs, and brain) are modified to meet the perceived danger."

Responses to Stress

A person's response to stress encompasses both physiological and psychological components. It is important to remember that each person responds to stress in a unique manner. Stress can affect a person's health in surprising ways. Significant and constant stress has been found to have significant affects on weight, the immune system, the digestive system, pain, sex and reproduction, skin conditions, sleep, risk of heart disease and stroke, and emotional disorders.

For example, one response to stress is production of cortisol, a stress hormone. Cortisol increases appetite and causes excess calories to be stored as fat around the abdomen, increasing weight and risk for heart disease and diabetes. Cortisol also suppresses the immune system, causing one to be vulnerable to illness. The muscle tension associated with stress can lead to headaches, body pain, insomnia and sexual dysfunction. In addition, the nerve endings in the skin make it especially vulnerable to stress-related conditions (e.g. acne, eczema, hives, etc).

In spite of this, stress is not always a bad thing. Though stress and anxiety can produce harmful effects, a minimum balance of stress is necessary for us to grow emotionally. A low level of anxiety before an exam or oral presentation helps the brain to be alert and responsive, improving performance. It is when this low level rises to an extreme that physiological or psychological problems may result.

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Stress Myths

1. Stress only affects those that live successful, high-pressure lives.
Many individuals experience the constant stress of worry, regardless of high-pressure situations. One may worry about leading an unfulfilled life, or not being where they would like to be.

2. One can always tell if they are under stress.
Often people become so accustomed to stress that they are not aware of it. Many suffer the debilitating effects of stress even though they do not notice or feel the tension. Stress can change the way that people treat others and can cause physical damage even without feelings of anxiety.

3. Stress is caused by the events that we experience.
Events are perceived in as many different ways as there are people who experience them. It is one's perspective on a situation, not the incident itself, which causes the emotional reaction.

4. Emotions cannot be controlled.
Changing behaviors or thoughts can result in a change in emotions. Creating a new view of a situation can make it less stressful.

5. The only way to reduce stress is to change your surroundings or take medication.
Altering one's outlook on life is an effective way of reducing stress. More helpful tools for stress management are provided on the next page.

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What can you do?

There are many tools available for controlling stress. Some address the physical effects of stress and some the psychological. Using a combination of these methods can lead to a calmer, less-stressed life.

Biofeedback

This type of treatment is best for people who want to control their own lives and their own body. It involves the practice of self-regulating bodily functions that people are typically unaware of (muscle tension, heart rate, respiration, blood flow). This form of therapy involves the use of a machine that measures physiological conditions. A therapist works with the patient to control these bodily systems by using the information "feedback" from the machine to monitor progress. The goal is to be able to relax or energize the body using only the mind.

Self-hypnosis/ Relaxation Imagery

Of course, one can attempt to relax the body without the use of a machine. Often, this is done through guided imagery or self-hypnosis. In guided imagery, a therapist takes the patient through a relaxation process. This includes bringing attention to breathing and muscle tension. The patient then aims to calm their thoughts, repeating an affirmation or visualizing a comforting scene while continuing deep breathing and muscle relaxation. Self-hypnosis simply refers to completing this process without the aid of a therapist.

Exercise

Physical activity relieves tension, improves mood, and makes your body more resistant to the effects of stress. Try to include aerobic exercise to keep the heart healthy along with yoga or tai chi for relaxation.

Eat Well

Though you may think that you need it to get through a high stress day, caffeine (and alcohol) are both stress aggravators. Instead, drink six to eight glasses of water per day to keep yourself hydrated and ready for anything. Foods that are rich in magnesium (whole grains, beans, nuts and veggies) help relax muscles that can become tense from stress. Take a good multivitamin to strengthen your immune system. Most importantly, eat small meals and snacks throughout the day to avoid dips in blood sugar in the afternoon.

GET HELP if you need it

If you have difficulty coping with the symptoms and effects of stress, please seek help from a mental health or medical professional. There are so many tools available for the treatment of this condition that you need not suffer alone.

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Dr. Brenda K. Wiederhold, Ph.D., MBA, BCIA	Dr. Mark D. Wiederhold, M.D., Ph.D., FACP	Ruth Kogen
Executive Director	Medical Director	Research Editor

Donations to support research and training opportunities combining technology and psychology may be made to our 501c3 nonprofit organization—the Interactive Media Institute.
Donations are tax deductible, and a letter will be provided for tax purposes.