PDF(Pubmed)
Abstract：
BACKGROUND: Trauma-focused cognitive behavioral therapy (TF-CBT) strategies are common interventions to treat child trauma and a posttraumatic stress disorder (PTSD) diagnosis in children with histories of sexual and physical abuse. With the advent of COVID-19, the disruption of child development combined with intense exposure to technology and screen time indicate a need for delivering other novel approaches to treat pediatric PTSD. Virtual reality (VR) has been used with evidence-based TF-CBT as an intervention in lab-based settings, but never as telehealth. Such technologies, including a VR head-mounted device (HMD) programmed with novel TheraVR software, for psychotherapy and treating trauma-related symptoms could redefine how pediatric populations respond to treatment.
OBJECTIVE: The aim of this exploratory single-case study was to reflect symptom improvement and patient engagement using VR as telehealth.
METHODS: The patient was a 10-year-old girl of Middle Eastern descent diagnosed with trauma and comorbid medical conditions. The patient was in divorced joint parental custody and a Child Protective Services report was made with referral for therapy. Night terrors, hallucinations, depression, anxiety, isolation, and encopresis symptoms were assessed at the beginning of treatment. Clinical analysis met the criteria for a diagnosis of early onset PTSD, which was treated over the course of 7 months using TF-CBT. A cross-analysis design was used to compare improved effectiveness in treatment and patient outcomes when moving from delivery of care with telehealth using desktop and tablet synchronous technology to 2D VR desktop telehealth with TheraVR software and subsequently HMD VR telehealth with TheraVR software. Sessions were conducted in private practice providing psychotherapy for remote patient care, collateral care with the family, and coordination of clinical care with the patient\'s pediatrician. Safety and protocols for reducing triggers were clinically monitored by the provider.
RESULTS: Over the course of treatment, and moving from standard telehealth to 2D VR to TheraVR with a standalone HMD, there was a significant reduction in PTSD symptoms. The transfer from using the standard video conferencing with face-to-face video to using customizable avatar technology with an assigned scene environment presented an increase in patient retention and follow-through with the treatment goals. The continuous use of delivery of care using VR with the TheraVR software demonstrated breakthrough clinical observations where the patient devised her own interventions for coping with mood, emotional regulation, and negative cognitive processes using the 10 different VR environments.
CONCLUSIONS: This study shows the potential efficacy in using VR specifically for younger populations as a better modality of pediatrics care, while improving engagement with the provider through telehealth. These findings suggest the value of further research through larger clinical trials including pediatric patients diagnosed with severe trauma or trauma-related symptoms to assess the effectiveness of TheraVR software.
OBJECTIVE: The aim of this exploratory single-case study was to reflect symptom improvement and patient engagement using VR as telehealth.
METHODS: The patient was a 10-year-old girl of Middle Eastern descent diagnosed with trauma and comorbid medical conditions. The patient was in divorced joint parental custody and a Child Protective Services report was made with referral for therapy. Night terrors, hallucinations, depression, anxiety, isolation, and encopresis symptoms were assessed at the beginning of treatment. Clinical analysis met the criteria for a diagnosis of early onset PTSD, which was treated over the course of 7 months using TF-CBT. A cross-analysis design was used to compare improved effectiveness in treatment and patient outcomes when moving from delivery of care with telehealth using desktop and tablet synchronous technology to 2D VR desktop telehealth with TheraVR software and subsequently HMD VR telehealth with TheraVR software. Sessions were conducted in private practice providing psychotherapy for remote patient care, collateral care with the family, and coordination of clinical care with the patient\'s pediatrician. Safety and protocols for reducing triggers were clinically monitored by the provider.
RESULTS: Over the course of treatment, and moving from standard telehealth to 2D VR to TheraVR with a standalone HMD, there was a significant reduction in PTSD symptoms. The transfer from using the standard video conferencing with face-to-face video to using customizable avatar technology with an assigned scene environment presented an increase in patient retention and follow-through with the treatment goals. The continuous use of delivery of care using VR with the TheraVR software demonstrated breakthrough clinical observations where the patient devised her own interventions for coping with mood, emotional regulation, and negative cognitive processes using the 10 different VR environments.
CONCLUSIONS: This study shows the potential efficacy in using VR specifically for younger populations as a better modality of pediatrics care, while improving engagement with the provider through telehealth. These findings suggest the value of further research through larger clinical trials including pediatric patients diagnosed with severe trauma or trauma-related symptoms to assess the effectiveness of TheraVR software.
摘要：
背景：创伤聚焦认知行为疗法（TF-CBT）策略是治疗儿童创伤和创伤后应激障碍（PTSD）诊断的常见干预措施。随着COVID-19的出现，儿童发育的中断加上对技术和屏幕时间的强烈接触表明需要提供其他新方法来治疗小儿PTSD。虚拟现实（VR）已与基于证据的TF-CBT一起用作基于实验室的设置的干预，但从来没有像远程医疗一样。这些技术,包括用新型TheraVR软件编程的VR头戴式设备（HMD），对于心理疗法和创伤相关症状的治疗,可以重新定义儿科人群对治疗的反应.
目的：这项探索性单病例研究的目的是使用VR作为远程健康来反映症状改善和患者参与。
方法：患者是一名10岁的中东裔女孩，被诊断患有创伤和合并症。该患者处于离婚的父母共同监护之下，并提交了儿童保护服务报告，并转诊治疗。夜惊，幻觉,抑郁症,焦虑,隔离,并在治疗开始时评估包治病症状。临床分析符合早发性创伤后应激障碍的诊断标准,使用TF-CBT治疗7个月。使用交叉分析设计来比较从使用台式机和平板电脑同步技术的远程医疗提供护理到使用TheraVR软件的2DVR桌面远程医疗以及随后使用TheraVR软件的HMDVR远程医疗时，治疗效果和患者结果的改善。会议是在私人诊所进行的，为远程患者护理提供心理治疗，与家人的附带护理，并与患者的儿科医生协调临床护理。安全性和减少触发因素的方案由提供者进行临床监测。
结果：在治疗过程中，从标准的远程医疗到2DVR，再到带有独立HMD的TheraVR，PTSD症状显著减轻.从使用具有面对面视频的标准视频会议到使用具有分配的场景环境的可定制的化身技术的转变呈现了患者保留和对治疗目标的跟进的增加。使用VR和TheraVR软件持续使用提供护理，证明了突破性的临床观察结果，患者设计了自己的干预措施来应对情绪，情绪调节,以及使用10种不同VR环境的负面认知过程。
结论：这项研究表明，将VR作为一种更好的儿科护理方式，特别是针对年轻人群的潜在疗效。同时通过远程医疗改善与提供者的互动。这些发现表明，通过更大的临床试验进行进一步研究的价值，包括被诊断为严重创伤或创伤相关症状的儿科患者，以评估TheraVR软件的有效性。
目的：这项探索性单病例研究的目的是使用VR作为远程健康来反映症状改善和患者参与。
方法：患者是一名10岁的中东裔女孩，被诊断患有创伤和合并症。该患者处于离婚的父母共同监护之下，并提交了儿童保护服务报告，并转诊治疗。夜惊，幻觉,抑郁症,焦虑,隔离,并在治疗开始时评估包治病症状。临床分析符合早发性创伤后应激障碍的诊断标准,使用TF-CBT治疗7个月。使用交叉分析设计来比较从使用台式机和平板电脑同步技术的远程医疗提供护理到使用TheraVR软件的2DVR桌面远程医疗以及随后使用TheraVR软件的HMDVR远程医疗时，治疗效果和患者结果的改善。会议是在私人诊所进行的，为远程患者护理提供心理治疗，与家人的附带护理，并与患者的儿科医生协调临床护理。安全性和减少触发因素的方案由提供者进行临床监测。
结果：在治疗过程中，从标准的远程医疗到2DVR，再到带有独立HMD的TheraVR，PTSD症状显著减轻.从使用具有面对面视频的标准视频会议到使用具有分配的场景环境的可定制的化身技术的转变呈现了患者保留和对治疗目标的跟进的增加。使用VR和TheraVR软件持续使用提供护理，证明了突破性的临床观察结果，患者设计了自己的干预措施来应对情绪，情绪调节,以及使用10种不同VR环境的负面认知过程。
结论：这项研究表明，将VR作为一种更好的儿科护理方式，特别是针对年轻人群的潜在疗效。同时通过远程医疗改善与提供者的互动。这些发现表明，通过更大的临床试验进行进一步研究的价值，包括被诊断为严重创伤或创伤相关症状的儿科患者，以评估TheraVR软件的有效性。
