Immersive virtual reality in anxiety psychotherapy and ocular rehabilitation. A transdisciplinary approach

Abstract

Immersive virtual reality (iVR) can be used not only as a guideline intervention in certain anxiety disorders but also as a brain stimulating interface, triggering neuroplasticity mechanisms and facilitating the rehabilitation of sensorimotor disorders. iVR’s potential was recently harnessed in treating or diagnosing amblyopia or in remote measuring of patient-related outcomes. We present the case of Mr. L.A., a 69-year-old man, a former academic, political and civic movement figure, currently performing successful writing. His right eye had posterior chamber pseudophakia and was treated for glaucoma, and his left eye had an evolving cataract. The right eye’s optical coherence tomography (OCT) revealed the impact of glaucoma and also the loss of nerve fibers and cells impairing signal conduction, while the combined results explained the high level of impairment of binocular vision. The impaired vision caused a very high level of concurring anxiety derived from the inability to perform daily tasks, directing him toward psychotherapy. The personalized iVR approach was preceded by cybersickness evaluation using VRQTest (Vectorush Studio). For relaxation, we used an artificial intelligence massage chair with body scanning mimicking Jacobson progressive relaxation and a specific pranayama yoga already familiar to the patient. Every session used a different iVR software for further distractibility and immersivity. The best-tolerated visual rehabilitation software was Vision Therapy, developed by Cerverum INC. The hardware used consisted of an Oculus Rift virtual reality headset and a Dell Alienware 17 R4 laptop. The patient was able to conduct daily tasks after the nineth session. The tolerance was associated with a massive improvement in eyesight of the left eye, from a visual acuity of 0.2 to 0.6 measured after the 20th psychotherapeutic session. To our knowledge, this is the first reported case of using this type of consecutive dual approach to anxiety and ocular rehabilitation.