Virtual reality is currently used as a therapeutic strategy in common phobia as agoraphobia or acrophobia, since it permits to have a better control (on occurrence of events or on the environment) during the therapy than in "in vivo" therapy. Our hypothesis here is that we can improves the therapeutic effects of the virtual exposure by giving control to acrophobic patients during their exposure.
The study is based on the exposure of acrophobic patients to virtual environments. During the study, several groups of patients will be distributed according to different conditions: exposure to anxiogenous virtual environments and exposure with the ability to control and secure the anxiogenous virtual environments. The interest of this project is to improve therapy by exposure to virtual reality. Our project offers a systematic therapeutic approach (using virtual reality and the concept of control) where current therapy are too often approximate. We aim to demonstrate the effectiveness of the control of virtual environments on symptomatic and psychophysiological levels, to evaluate the adoption of these methods in the couple patients-caregivers and also to understand the brain mechanisms (including those prefrontal) involved in this therapy.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
60
The anxiogenous environments are defined by several levels of possible anxiety classified progressively and independently by each patient at the beginning of the study. The exposure is applied during the 8 sessions for each of the arms "Exposure to anxiogenous environments (with or without control)".
Subjects will be submitted to 1 session of fMRI during their first visit, in order to identify and evaluate the activation of cerebral fields involved during the exposure to anxiogenous environments.
Subjects will be submitted to 1 session of PET-scanner during their first visit, in order to measure the synaptic activity during the exposure to anxiogenous environments.
Service hospitalo-universitaire de psychologie médicale de psychiatrie d'adultes du Pr Lançon - CHU Marseille
Marseille, France
RECRUITINGBehavioural Avoidance Test (BAT)
Objective measure of behavior scored on 10 points in response to a virtual environment representing a situation feared by acrophobic patients. This virtual environment is a flat landscape with a platform overlooking a canyon of 800 meters.
Time frame: 1 year (4 times)
Brain activity (functional MRI)
Anatomical and functional : brain activity in several cortical and subcortical areas with fMRI (BOLD signal intensity)
Time frame: 12 weeks (2 times)
Synaptic activity (PET-scan)
Metabolic and functional : synaptic activity with PET scanner
Time frame: 12 weeks (2 times)
Cognitive measurements
Attentional bias (DOT test)
Time frame: 12 weeks (2 times)
Cognitive measurements
Emotional valence (emotional congruence task)
Time frame: 12 weeks (2 times)
Cognitive measurements
Questionnaire on acrophobia (AQ: Acrophobia Questionnaire)
Time frame: 1 year (4 times)
Cognitive measurements
Questionnaire on acrophobia (ATHQ: Attitude Towards Heights Questionnaire)
Time frame: 1 year (4 times)
Cognitive measurements
Questionnaire on anxiety (STAI: Spielberger Trait Anxiety Inventory)
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Patients will be submitted to 1 session of fMRI during a follow-up visit, in order to identify and evaluate the activation of cerebral fields involved during the exposure to anxiogenous environments.
Patients will be submitted to 1 session of PET-scanner during a follow-up visit, in order to measure the synaptic activity during the exposure to anxiogenous environments.
Time frame: 1 year (4 times)
Cognitive measurements
Questionnaire on depression (BDI: Beck Depression Inventory)
Time frame: 1 year (4 times)
Quality of life
Quality of Life (SF-12: Medical Outcome Study Short Form)
Time frame: 1 year (4 times)
Cognitive measurements
During the 8 sessions of exposure to virtual reality: Questionnaires on anxiety (SUD: Subjective Unit of Discomfort)
Time frame: 10 weeks (8 times)
Cognitive measurements
During the 8 sessions of exposure to virtual reality: Progression recorded and time to progression from one environment to another during sessions (number of environments completed, time of execution, others ..)
Time frame: 10 weeks (8 times)
Ergonomy
During the 8 sessions of exposure to virtual reality: Questionnaire on the applicability / realism / ergonomy (PQ: Questionnaire on the state of Presence).
Time frame: 10 weeks (8 times)
Psychophysiological
During the 8 sessions of exposure to virtual reality: Psychophysiological objective measurements during exposure to virtual reality (electrodermal activity, electrocardiography, breathing rate)
Time frame: 10 weeks (8 times)
Adverse events
Assessment and description of all the occurrence of adverse events during the study.
Time frame: 1 year