| dc.description.abstract | Mental health disorders such as depression and anxiety affect one in five adults in the United States. According to the 2019 National Survey on Drug Use and Health (NSDUH), non-serious mental illnesses are found in 30.6% of young adults aged 18-25 years old and 25.3% of adults aged 26-49 years old. In 2020, the NSDUH found that only 44.8% of all adults living with non-serious mental illnesses sought treatment [1]. In 2020 and 2021 with the rise of the COVID-19 pandemic, 41.5% of US adults reported to have been struggling symptoms of an anxiety of depressive disorder [2]. With this added burden, the increase in social isolation during the pandemic, and unknown long term psychological effects of the past year and a half, the need for an effective remote psychotherapy treatment is even more evident. The objective of this research is to address the growing need for a remote psychotherapy solution that is both accessible for isolated patients and effective. One approach to therapeutic healing that is standard in counseling psychology is the use of psychotherapy based on common factors theory. This theory poses that there are several common factors that need to be addressed for healing to occur. This research focuses on two of the common factors that are most difficult to reproduce in remote psychotherapy: the therapeutic alliance and the therapeutic environment [3]–[5]. We hypothesize that the use of a virtual reality (VR) and neurofeedback based psychotherapy system specifically designed based on common factors theory will lead to better performance in the therapeutic alliance between therapists and patients and ultimately, better outcomes for remote psychotherapy patients. The following specific aims address this hypothesis:Specific Aim 1: Design and Develop a Common Factors Based Virtual Reality Therapy for Remote Psychotherapy Applications. A full common factors based VR psychotherapy system was developed using Unity3D, Autodesk Maya, and MATLAB. Key components of the design include three virtual environments designed based on key elements of restorative environments (Forest World, Log Cabin, and Freud Therapist Office), two therapist avatars based on Jungian archetypes for healing (Woman Healer, Sage), a neurofeedback system using electroencephalography (EEG), a therapist interface, and a patient interface. Success was measured based on the prototype’s ability to be a fully functional remote psychotherapy treatment, its adherence to restorative environments design elements, and its adherence to Jungian archetypes design elements. Specific Aim 2: Determine the functionality and usability of the novel common factors based VR therapy system for therapists. The first step to determining the efficacy of a novel treatment system in psychotherapy is to analyze the functionality and usability of the treatment for therapists. Specifically, this study examined if therapists are able to effectively use this system for the remote treatment of depression and general anxiety. A proof of concept study was conducted with 21 observing counselors in training to examine the functionality and usability of the VR enhanced therapy system for therapists. The session was conducted with a professional therapist and a patient using the VR system in another room. Measures from this study will include the 1. Client Reactions Systems, 2. Perceived Restorative Scale, 3. Session Evaluation Questionnaire, and 4. Presence Questionnaire. Success will be determined by examining the neutral score for each these metrics, and comparing the scores received by therapists to the average. The treatment was considered successful if the novel VR treatments preforms as well or better than the average across all metrics. Specific Aim 3: Determine the functionality and usability of the novel common factors based VR therapy system for patients. A proof of concept study was conducted to determine if the novel VR enhanced therapy is as good or better at reducing symptoms of depression and anxiety in patients in comparison to existing CBT effects and to determine whether the therapeutic alliance is enhanced in VR therapy. The study examined examine 30 adults in Lawrence, Kansas and the surrounding areas with counselors playing the role as therapists in a solution focused counseling session. The patients were split into two groups: a control Zoom video chat based remote therapy session and the novel VR based therapy session. Measures from this study will include the 1. Client Reactions Systems, 2. Perceived Restorative Scale, 3. Session Evaluation Questionnaire, and 4. Presence Questionnaire. The treatment was considered successful if the novel VR treatments preforms as well or better than the control across all metrics. Future Development and Research: Beyond this dissertation work, we plan to continue to develop more environments and avatars, determine relative efficacy of the therapy system through further human subjects’ studies, and explore its use in the treatment of other populations including the military and other conditions including post-traumatic stress disorder (PTSD). At this moment, we are also pursuing opportunities for the commercialization of this work including obtaining a provisional patent and submitting a full international patent, exploring a licensing agreement with a company, and examining the viability of starting a new venture in the field. | |
