Virtual Reality is one of the modules utilized by the patented VRsano method. VR is a clinically effective method for distracting patients from the distress of the medical environment and refocusing their attention onto a pleasing and relaxing alternative experience.
In this series of blog posts we break down each of the three main modules of the VRsano method – VR, neurofeedback, and clinical hypnosis. We explain how they are each used traditionally, their benefits and limitations, and how VRsano is employing them in a new, maximally efficient way.
Virtual Reality in medical settings has grown in popularity in recent years. Numerous studies have shown how VR can help significantly reduce pain, anxiety, and discomfort for patients with various conditions, with the greatest concentration of studies demonstrating VR’s positive effects on burn pain, cancer pain, phantom limb pain, chronic pain, rehabilitation, and pain attenuation with various other causalities (1).
VR treatment involves using a VR device such as goggles or a helmet that blocks out the patient’s view of the hospital setting to deliver computer-generated images via screens within the headgear to a patient who is experiencing significant pain, stress, or discomfort. The idea is to refocus the patient’s attention from the aversive experiences of their treatment onto a perceptually pleasant alternative world (2). The VR headgear is attached to a computer using special software which uses 3D graphics to engage patients’ attention by guiding them through a world full of various characters, landscapes, and activities.
Benefits
Patients exposed to VR treatment consistently report feeling less pain, less time thinking about their pain, and even experiencing fun during painful treatments (3, 2, 4, 5, 6). The experience of pain arises from the neural processing of signals from pain receptors, which means that attentional resources play an important role in creating the subjective feeling of pain (7). VR engages a significant amount of these resources and therefore leaves less of them available to focus on pain. Scientists have used fMRI to observe whether the brain behaves differently when a patient is engaged in VR while being made to feel pain, and they have found is that along with a subjective rating of significantly less pain, objective measures of neural activity showed 50% or greater reductions in pain-related brain activity in the anterior cingulate cortex, insula, thalamus, the primary and the secondary somatosensory cortex (8).
The effectiveness of VR approach has been proven significant and generalizable. The scope of existing research shows that patients in VR treatments report experiencing an average of 35-50% less pain than patients being treated as usual (1). Research has also found that the analgesic effects of VR existed equally for people irrespective of age, sex, ethnicity (5) and hypnotizability (9), a neural characteristic which determines the effectiveness of hypnosis.
Limitations
Although proven as effective in some instances and pain conditions, shortcomings of the VR approach used alone also limit its widespread use in medical settings. Some of its limitations are the following:
1) Since its power is primarily in distraction, the alleviating effects are generally confined to the duration of the VR exposure. Therefore there is no accumulative, educational and learning effect manifested via changed expectations, health-related abilities and attitudes or neurogenesis and brain plasticity that is observed in bio/neurofeedback and in hypnosis.
2) VR is applicable primarily for distraction from pain/discomfort and therefore is of limited use in pre-, during, and post- surgery and in any other treatment that requires more holistic or continuous change of the patient’s psychosomatic state.
3) The patient is a simple recipient of the VR stimuli and does not develop a sense of mastery or self-efficacy over their bodies, thus the method will not have a continuous and significant effect over the distressed psychosomatic state.
VRsano
VRsano’s design enhances the benefits of VR while compensating for its weaknesses via the other two modules employed – neurofeedback and clinical hypnosis. The neurofeedback module allows the patient to regain a sense of agency which the vulnerability of their medical state takes away from them. By engaging with the neurofeedback mechanism within the relaxing VR landscape, patients learn how to change their brainwaves which also results in needed physiological changes. In this way they begin to feel empowered to resume a sense of control over their healing process and overall health, instead of feeling victimized by their ailment and merely subjected to medical procedures in which they take no part (for more on neurofeedback see Blog Post 2).
In addition, the hypnosis module leads patients to alter the state of the problematic target area in a way that is conducive for the particular treatment and which helps the healing process before, during and after the medical procedures. Hypnosis allows patients to achieve a significantly deeper state of relaxation and stress/symptoms relief than VR can accomplish alone and it teaches patients how to beneficially alter their state outside of the virtual environment. This new mastery over their symptoms and bodies lasts beyond the duration of the VRsano session and therefore makes it possible for the patient to achieve long-term benefits (for more on hypnosis see Blog Post 3).
References
1. Sulea, C., Soomro, A., Boyd, C., Wiederhold, B. K. (2014). Pain management in virtual reality: a comprehensive research chart. Cyberpsychology, Behavior, and Social Networking, 17(6), 402-413.
2. Hoffman, H. G., Chambers, G. T., Meyer III, W. J., Arceneaux, L. L., Russel, W. J., Seibel, E. J., Richards, T. L., Sharar, S. R., Patterson, D. R. (2011). Virtual reality as an adjunctive non-pharmacologic analgesic for acute burn pain during medical procedures. Annals of Behavioral Medicine, 41(2), 183-191.
3. Hoffman H. G., Meyer III W. J., Ramirez M., Roberts L., Seibel E. J., Atzori B., Sharar S. R., and Patterson D. R. (2014). Feasibility of articulated arm mounted oculus rift virtual reality goggles for adjunctive pain control during occupational therapy in pediatric burn patients. Cyberpsychology, Behavior, and Social Networking, 17(6), 397-401.
4. Maani, C., Hoffman, H. G., DeSocio, P. A., (2008). Pain control during wound care for combat-related burn injuries using custom articulated arm mounted virtual reality goggles. Journal of CyberTherapy and Rehabilitation, 1:193-198.
5. Flores A., Hoffman H. G., Russell W., (2008). Longer, multiple virtual reality pain distraction treatments of Hispanic and Caucasian children with large severe burns. CyberTherapy Conference. San Diego, Calif.
6. Sharar, S. R., Carrougher, G. J., Nakamura, D., Hoffman, H. G., Blough, D. K., Patterson, D. R. (2007). Factors influencing the efficacy of virtual reality distraction analgesia during postburn physical therapy: preliminary results from 3 ongoing studies. Archives of Physical Medicine & Rehabilitation, 88(12), s43-s49.
7. Eccleston, C., Crombez, G. (1999). Pain demands attention: a cognitive-affective model of the interruptive function of pain. Psychological Bulletin, 125:356-366.
8. Hoffman H. G., Richards T. L., Bills A. R., (2006). Using FMRI to study the neural correlates of virtual reality analgesia. CNS Spectrums 11:45-51
9. Patterson, D. R.; Hoffman, H. G.; Palacios, A. Garcia; Jensen, M. J. (2006). Analgesic effects of posthypnotic suggestions and virtual reality distraction on thermal pain. Journal of Abnormal Psychology, Vol 115(4). 834-841.