Embodied Virtual Reality Therapy for Functional Neurological Symptom/ Conversion Disorder

Stanford University15 enrolled

Overview

The purpose of this study is to design and test the safety and feasibility of virtual reality technologies and experiences of egocentric avatar embodiment in the application of physical and cognitive behavior therapy in functional neurological symptom/conversion disorder. Investigators hypothesize that patients will safely use and accept this modality of treatment and will show evidence of a decrease in symptom frequency.

This is a treatment development trial, participants randomly assigned to active treatment will be enrolled in embodied Virtual Reality therapy. The therapy will be based on principals of exposure and behavioral shaping therapies and mirror visual feedback therapy. The therapy will be delivered over 8 sessions and modified as indicated by clinical feedback. A fixed protocol will be developed with exact methods to be used to be determined. After a fixed protocol has been established, a treatment manual will be created to use in further controlled trials.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Enrollment

Conditions

Conversion Disorder Psychogenic Movement Disorder Functional Movement Disorder

Interventions

Embodied Virtual Reality TherapyOTHER

Participants will be asked to play a game in Stanford's Virtual Reality Human Interaction Lab that engages visual pathways and involves body tracking and controlled sensory feedback reinforcing movement in real and virtual time by immersive head mounted displays. This game will have subjects fully embody and inhabit an avatar from an egocentric perspective. In addition, over consecutive sessions subjects will be asked to use a mobile smart phone based virtual reality program designed to deliver various and customized emotionally provocative stimuli.

Virtual realityOTHER

Participants will be asked to play a game in Stanford's Virtual Reality Human Interaction Lab that engages visual pathways.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adults 18-65 years, who are diagnosed with functional neurologic symptom or conversion disorder. If diagnosis of seizure type then video EEG with diagnosis confirmed by board-certified neurologist with subspecialty training in epilepsy and clinical neurophysiology using the criteria of the International Classification of the Epilepsies is required. If diagnosis of motor type, documented and clinically established levels of diagnostic certainty (Williams,1995) confirmed by 2 neurologists is required. * Participants must have at least one symptom per month in the month prior to enrollment * Fluency in English spoken language Exclusion Criteria: * Nonfluency or inability to communicate in English spoken language * Inability to participate or attend biweekly 30 minute session over 14 weeks * Frank psychosis * Active self harm urges * Serious medical illness * Active substance or alcohol use or dependence that could interfere with participation * Diagnoses of mental retardation, dementia or delirium * Pregnant women

Outcomes

Primary Outcomes

Adherence

Number of sessions attended over 12 weeks recorded by therapist

Time frame: Number of sessions attended over 12 weeks

Secondary Outcomes

General Self-Efficacy Scale

self-report

Time frame: baseline, biweekly for 6weeks, then 6,9,12 months

Global Assessment of Functioning (GAF)

physician administered Global Assessment of Functioning (GAF) is a numeric scale (1 through 100) used by mental health clinicians and physicians to rate subjectively the social, occupational, and psychological functioning of adults

Time frame: baseline, 6weeks, then 6,9,12 months

Generalized Anxiety Disorder 7-item (GAD-7) scale

A 7 item self-complete questionnaire with very good sensitivity (89%) and specificity (82%) for Generalised Anxiety Disorder (GAD)

Time frame: baseline, biweekly for 6weeks then 6,9,12 months

Patient Health Questionnaire-9 (PHQ-9)

self-report

Time frame: baseline, biweekly for 6weeks then 6,9,12 months

Oxford Handicap Scale

physician administered

Time frame: baseline, 6weeks, then 6,9,12 months

Frequency and severity of functional symptoms

self-report weekly log format

Time frame: baseline, biweekly for 6 weeks then 6,9,12 months

Frequency of adverse events

physician and subject report