Brenda's Bytes - iACToR2024-03-29T08:30:37Zhttp://iactor.ning.com/forum/categories/brenda-s-bytes/listForCategory?feed=yes&xn_auth=noThe Potential for Virtual Reality to Improve Health Caretag:iactor.ning.com,2012-01-19:5103975:Topic:135172012-01-19T19:46:43.753ZJames Cullenhttp://iactor.ning.com/profile/JamesCullen
<p style="text-align: left;">By Prof. Dr. Brenda K. Wiederhold, Ph.D., MBA, BCIA</p>
<p style="text-align: center;"><em>…Improving the health of European citizens and increasing the</em><br></br> <em>competitiveness of European health-related industries and businesses, while</em><br></br> <em>addressing global health issues including emerging epidemics. Emphasis will</em><br></br> <em>be put on translational research (translation of basic discoveries into clinical</em><br></br> <em>applications), the…</em></p>
<p style="text-align: left;">By Prof. Dr. Brenda K. Wiederhold, Ph.D., MBA, BCIA</p>
<p style="text-align: center;"><em>…Improving the health of European citizens and increasing the</em><br/> <em>competitiveness of European health-related industries and businesses, while</em><br/> <em>addressing global health issues including emerging epidemics. Emphasis will</em><br/> <em>be put on translational research (translation of basic discoveries into clinical</em><br/> <em>applications), the development and validation of new therapies, methods for</em><br/> <em>health promotion and disease prevention, diagnostic tools and technologies,</em><br/> <em>as well as sustainable and efficient health care systems.</em><br/> <strong>From the 7th Framework</strong></p>
<p style="text-align: left;">Virtual Reality (VR) has the potential to support and integrate the guiding themes of the European Commission’s 7th Framework while improving health and increasing the competitiveness of European technology in the international economy.</p>
<p style="text-align: left;"><strong>Introduction:</strong><br/> Dr. Brenda K. Wiederhold, President of the Virtual Reality Medical Institute (VRMI), with offices in Brussels, Belgium, and Executive Director of the Virtual Reality Medical Center, with offices in San Diego, Palo Alto, and Los Angeles, California; is world renowned for her leadership in the field of VR. Working with European experts in the field, Dr. Wiederhold brings evidence to the European Commission on the integral role Virtual Reality (VR) must play to improve the health of European citizens and increase the competitiveness of European healthrelated industries and businesses.<br/> <br/> Dr. Wiederhold is a licensed clinical psychologist in California and Switzerland, and has a doctorate in Clinical Health Psychology as well as national certification in both biofeedback and neurofeedback. She is a Clinical Instructor in the Department of Psychiatry at the University of California, San Diego and is president of VRHealth, a woman-owned healthcare company. In addition, she serves on the editorial board for several renowned publications, including CyberPsychology & Behavior Journal, the International Journal of Virtual Reality, and Emerging Communication, a book series by IOS Press. She also serves on the advisory board for the International Child Art Foundation, and the advisory committee for the California Science Center’s exhibit on scientific and cultural aspects of fear.<br/> <br/> Dr. Wiederhold serves as Chief Executive Officer of the Interactive Media Institute (IMI) and the Interactive Media Institute-Europe (IMI-E), non-profit organizations dedicated to furthering the application of advanced technologies for patient care. Under IMI, she began the first VR and behavioral healthcare symposium at the Medicine Meets Virtual Reality (MMVR) conference, growing this into an independent International Conference, CyberTherapy, now in its 12th year. CyberTherapy brings together researchers, clinicians and funders to share and discuss the growing field of CyberTherapy. This conference was originally a specialized symposium at the Medicine Meets Virtual Reality Conference featuring presentations that dealt primarily with conceptual matters and future possibilities. The symposium has continued to grow over the years in both size and scientific evidence and is now an independent three-day conference. The 10th annual CyberTherapy Conference, held in June 2005 in Basel Switzerland, highlighted the 3 largest program ever presented on controlled clinical trials of virtual reality and other cuttingedge technologies in the areas of mental health, rehabilitation, disabilities, training, and education. It involved representatives from 19 countries, reflecting its truly international character. In 2006, the Conference attracted over 200 attendees to Gatineau, Canada.<br/> <br/> Dr. Wiederhold is recognized as an international leader in the treatment of anxiety, panic and phobias with virtual reality exposure and cognitive-behavioral therapy, and has completed over 5,000 virtual reality therapy sessions. In 2004 and 2005, Dr. Wiederhold was invited to address the National Institutes of Health in Washington, D.C. as one of the world’s leading specialists in the field of VR treatment for medical illness. In addition, she has shared her insights as an invited speaker in Belgium, Canada, China, Croatia, Denmark, France, Germany, Israel, Italy, Korea, Luxembourg, Slovenia, Spain, Sweden and Switzerland on the topic of technology in healthcare.<br/> <br/> Dr. Wiederhold currently has funded programs from the National Institute of Drug Abuse, NIH, National Science Foundation, Office of Naval Research, Defense Advanced Research Projects Agency, and Telemedicine and Advanced Technology Research Center in addition to serving as an unpaid consultant on several current research projects in Europe and Korea. <br/> <br/> Dr. Wiederhold is currently completing her ninth book and has over 100 publications. Her current project, a collaboration with Dr. Giuseppe Riva of Milan, Italy, and Spanish researchers Rosa Banos and Cristina Botella, on their important work with the application of VR in the treatment of eating disorders and obesity, will help to form the basis for a European network for translational research on healthcare applications of VR technology.</p>
<p>To read more, please download the following <a href="http://iactor.eu/downloads/WP%20The%20Potential%20for%20VR%20to%20Improve%20Healthcare.pdf" target="_blank">document.</a></p> Journal of CyberTherapy & Rehabilitation Editorial - Issue 4(4)tag:iactor.ning.com,2012-01-14:5103975:Topic:135072012-01-14T21:54:04.233ZJames Cullenhttp://iactor.ning.com/profile/JamesCullen
<p><span style="text-decoration: underline;"><strong>Editorial from the iACToR Secretary General and JCR Editor-In-Chief Prof. Dr. Brenda K. Wiederhold</strong></span><strong><br></br> <br></br></strong> First, let me define what I mean by the concept of mental wealth or mental capital. The Foresight Project on Mental Health and Well-being says that it “encompasses a person’s cognitive and emotional resources. It includes their cognitive ability, how flexi- ble and efficient they are at learning, and…</p>
<p><span style="text-decoration: underline;"><strong>Editorial from the iACToR Secretary General and JCR Editor-In-Chief Prof. Dr. Brenda K. Wiederhold</strong></span><strong><br/> <br/></strong> First, let me define what I mean by the concept of mental wealth or mental capital. The Foresight Project on Mental Health and Well-being says that it “encompasses a person’s cognitive and emotional resources. It includes their cognitive ability, how flexi- ble and efficient they are at learning, and their ‘emotional intelli- gence,’ such as their social skills and resilience in the face of stress. It therefore conditions how well an individual is able to contribute effectively to society, and also to experience a high personal qual- ity of life.” The study focused on the U.K., but the 20-year trends cited as affecting the mental wealth of that country are relevant to the rest of the EU, the U.S., and other parts of the world. Trends include the aging of the population (increasing dementia), changes in the global economy (rise of China and India, need for more training and work-life balance), the changing nature and expecta- tions of society and public services (balance of responsibility), and new science and technology (equal access to their benefits).<br/> <br/> These same themes emerge in the resulting study article, “The mental wealth of nations,” by Beddington et al., which reported on the group’s evaluation of the scientific evidence to produce this independent assessment involving 450 experts from 16 countries. The authors of this paper urged development of initiatives to sup- port early diagnosis and treatment of childhood learning problems, workplace environments that promote mental health and programs that advance learning among elders to slow cognitive decline. They noted, “How a nation develops and uses its mental capital not only has a significant effect on its economic competitiveness and prosperity but is also important for mental health and well- being and social cohesion and inclusion.”<br/> <br/> Pointing to a disproportionate share of investment in mental health relative to its disease burden, the U.S. National Institute of Mental Health (NIMH) created the Grand Challenges in Global Mental Health, identifying research priorities for the next 10 years that will make a difference in people’s mental health. These 25 specific challenges are grouped into broad goals that seek to:</p>
<ul>
<li>Identify root causes, risk and protective factors</li>
<li>Advance prevention and implementation of early interventions</li>
<li>Improve treatments and expand access to care</li>
<li>Raise awareness of the global burden</li>
<li>Build human resource capacity</li>
<li>Transform health-system and policy responses</li>
</ul>
<p>NIMH lists guiding principles for funding such research:</p>
<ul>
<li>Use a life-course approach to study</li>
<li>Use system-wide approaches to address suffering</li>
<li>Use evidence-based interventions</li>
<li>Understand environmental influences</li>
</ul>
<p><br/>So how can we, as clinical and research professionals with spe- cialties in, for example, psychology, physical medicine and reha- bilitation, or autism, help our clients boost their mental capital?</p>
<p>1. Improved access to education can help: “The [Foresight] Project has identified a number of technologies ... ubiquitous and mobile technologies; artificial intelligence; assessment technologies; and tools to support teachers in designing and exchanging learning ac- tivities.” A virtual environment to help children with autism learn to cross the street is one example of how we can use the technolo- gies we espouse for early intervention, the most cost-effective way to prevent mental ill health.</p>
<p>2. Although the mechanisms are not yet understood, a growing number of studies show that physical exercise may prevent or mit- igate the effects of depression, and a Stanford University study showed that a virtual representation of one’s self gaining or losing weight in proportion to the exercise completed motivated volun- teers to complete more exercise.</p>
<p>3. While we are just beginning to debate the legal and ethical im- plications of using pharmacological (smart drugs) means of im- proving mental wealth, use of these drugs in controlled clinical trials and publication of results that show minimal side effects from long-term use will pave the way for their mainstreaming.</p>
<p>4. Neurocognitive activation via cognitive training is a promising area of investigation, as I reported in my recent article co-authored with Dr. Mark Wiederhold. With the aid of fMRI-safe Virtual Re- ality goggles, we can study the brain while a patient interacts with a virtual environment, and learn how to tailor treatments to pro- duce the desired activations in that individual’s brain.</p>
<p>5. Finally, I would encourage you to continue to advocate for men- tal health funding by governments. As the Foresight study authors noted, “... a cross-governmental approach is needed to realize the full benefits ... Interventions may have long timescales before they see any returns. Implementing these recommendations will require significant changes in the nature of governance, placing mental capital and well-being at the heart of policy-making.”<br/> <br/> Brenda K. Wiederhold, Ph.D., MBA, BCIA <br/> Editor-in-Chief<br/> <i>Journal of CyberTherapy & Rehabilitation <br/></i> Virtual Reality Medical Institute</p>
<p><strong> </strong></p> Journal of CyberTherapy & Rehabilitation Editorial - Issue 4(3)tag:iactor.ning.com,2012-01-14:5103975:Topic:132092012-01-14T21:50:40.973ZJames Cullenhttp://iactor.ning.com/profile/JamesCullen
<p><span style="text-decoration: underline;"><strong>Editorial from the iACToR Secretary General and JCR Editor-In-Chief Prof. Dr. Brenda K. Wiederhold</strong></span><br></br>“When you undervalue who you are, the world will undervalue what you do and vice versa,” said financial guru Suze Orman. Is this true for small and medium sized enterprises (SMEs) that contribute to the attainment of information and communication technologies (ICT) goals in Europe? Read on, and judge for…</p>
<p><span style="text-decoration: underline;"><strong>Editorial from the iACToR Secretary General and JCR Editor-In-Chief Prof. Dr. Brenda K. Wiederhold</strong></span><br/>“When you undervalue who you are, the world will undervalue what you do and vice versa,” said financial guru Suze Orman. Is this true for small and medium sized enterprises (SMEs) that contribute to the attainment of information and communication technologies (ICT) goals in Europe? Read on, and judge for yourself.<br/><br/>According to UEAPME, the European association repre- senting crafts and SMEs, 99.8% of Europe’s 23 million en- terprises are SMEs. The most recent survey of SMEs, ending February 2011, showed that 21% more SMEs showed declining vs. increasing profits. That same survey pointed to causes such as the increased cost of oil and commodities, resulting in a 69% increase in production inputs, and an improving European economy resulting in a 46% increase in labor costs. Among the most common economic challenges reported by SMEs are finding customers, obtaining financing, and competition. The European Commission (EC), recognizing that SMEs provide 67% of all jobs in Europe, is committed to collecting these data to en- sure that SMEs have access to adequate financing.<br/><br/>Between 2002 and 2008, the SME job engine was churning, increasing by 1.9% annually vs. 0.8% for large companies. In 2008, the Small Business Act for Europe (COM[2008] 394 final) was launched, just before the economic slowdown brought this powerful job creation engine to a temporary halt.<br/><br/>So-called “micro” firms, employing an average of two people, are the mainstay of the European economy. The 2009 EC report found that “For micro enterprises, gross investment in tangible goods amounts to 24% of value added, compared to 19% for all firms ... higher than could be expected on the basis of their profitability, underlining their importance for the EU-economy.”<br/><br/>The value of SMEs to the EU is further underscored by the relative dearth of companies with revenue greater than €100 million. A 2008 article on ICT SMEs reported the number of large companies at 2,006 in the EU (for a population then numbering 310 million) vs. 3,176 large companies in the U.S. (for 291 million people). The EU ICT community has its own association of SMEs formed in 2007, PIN-SME (see <a href="http://pin-sme.eu/">http://pin-sme.eu/</a>): It currently represents 50,000 ICT SMEs that provide approximately 200,000 jobs.<br/><br/>Another organization for SMEs, founded in 1996, is SME UNION (see <a href="http://sme-union.org/">http://sme-union.org/</a>). It is the business organization of the European People’s Party, representing a network of pro-business politicians and political organizations. “Its top priority is to reform the legal framework for SMEs all over Europe and to promote and support the in- terests of small and medium-sized enterprises which – due to their willingness to take risks and responsibility – are the engine of the European economy, thereby contributing to eradicating unemployment and promoting economic growth in Europe.”<br/><br/>Efforts to promote economic parity made by the EC and organizations such as those mentioned above are essential to the economic security of SMEs. This is evidenced by the fact that although SMEs win 60% of public procure- ment contracts, the value of such contracts represents only 33% of market share. This EC study reported that the job- creating micro enterprises garnered just a 6% market share. Thus, SMEs are underrepresented by between 14-21% (based on 2006-2008 data) relative to their importance to the EU economy. This is not insubstantial when you consider that public procurement represents 19% of EU GDP.<br/><br/>As UEAPME Secretary General Andrea Benassi said in a recent statement, “The EU is not suffering from a shortage of entrepreneurship in ICT; but it is suffering from a short-age of ICT SMEs that are empowered to grow and innovate at international competitive levels.” As an owner of an EU SME, my future may depend on my willingness to take an activist role to ensure that my company is not undervalued, and I urge my colleagues to do the same.<br/><br/>Brenda K. Wiederhold, Ph.D., MBA, BCIA<br/>Editor-in-Chief<br/><i>Journal of CyberTherapy & Rehabilitation<br/></i>Virtual Reality Medical Institute</p> Journal of CyberTherapy & Rehabilitation Editorial - Issue 4(2)tag:iactor.ning.com,2012-01-14:5103975:Topic:135052012-01-14T21:45:49.919ZJames Cullenhttp://iactor.ning.com/profile/JamesCullen
<p><span style="text-decoration: underline;"><strong>Editorial from the iACToR Secretary General and JCR Editor-In-Chief Prof. Dr. Brenda K. Wiederhold</strong></span><br></br>Welcome to the Summer 2011 issue of the Journal of CyberTherapy & Rehabilitation (JCR). As you know, JCR is one of the two official journals of the International As- sociation of CyberPsychology, Training & Rehabilitation (iACToR). Now in its 16th year, the annual international CyberPsychology & CyberTherapy…</p>
<p><span style="text-decoration: underline;"><strong>Editorial from the iACToR Secretary General and JCR Editor-In-Chief Prof. Dr. Brenda K. Wiederhold</strong></span><br/>Welcome to the Summer 2011 issue of the Journal of CyberTherapy & Rehabilitation (JCR). As you know, JCR is one of the two official journals of the International As- sociation of CyberPsychology, Training & Rehabilitation (iACToR). Now in its 16th year, the annual international CyberPsychology & CyberTherapy Conference (CT16) agreed, in 2009, to become the official conference of iACToR. So, along with CyberPsychology, Behavior, & Social Networking Journal (CYBER), CyberTherapy & Rehabilitation (C&R) Magazine, and JCR, we celebrate our Combined Communications Platform. The journals, conference, magazine, and association combine into one powerful platform to address previous information deficits in the utilization of advanced technologies in healthcare. We will strive to speak with a united voice to inform and educate stakeholders about the uses of technologies in healthcare, as well as how technologies are impacting behavior and society.</p>
<p><br/> This year we are proud to be holding CT in Canada. Organized by the Interactive Media Institute (IMI), a 501c3 nonprofit organization, in cooperation with Université du Québec en Outoauais (UQO), CT16 is being held June 19-22, 2011 in Gatineau, Canada. This venue speaks to the continued growth and collaboration, not just amongst Europe and the U.S., but also amongst researchers and scholars worldwide. This year’s conference theme is two-fold: First, CT16 will explore technologies as enabling tools. This will include the uses of advanced technologies such as Virtual Reality (VR) simulations, videogames, telehealth, video-conferencing, the Internet, robotics, brain computer interfaces, wearable computing, non-invasive physiological moni- toring devices, in diagnosis, assessment, and prevention of mental and physical disorders. In addition, we will look at interactive media in training, education, rehabilitation, and therapeutic interventions. Second, CT16 will explore the impact of new technologies. CT16 will in- vestigate how new technologies are influencing behavior and society, for example, through healthy ageing initiatives, positive and negative effects of social networking tools, and online gaming.<br/> <br/> I would like to take this opportunity to thank all those who are helping to make this year’s conference possible through their tireless energy and drive – the Co-Organizer and Conference Co-Chair Professor Stéphane Bouchard; this year’s Scientific Chairs, Professors Paul Emmelkamp, Wijnand Ijsselsteijn and Giuseppe Riva; Exhibit Chair Professor Sun Kim; Workshop Chair Professor Heidi Sveistrup; Cyberarium Chair Geneviève Robillard; and Website Chair Professor Andrea Gaggioli. Many thanks also to the Scientific Committee, made up of prominent researchers from around the world, and the Local Advisory Committee in Gatineau, as well as all of the presenters and attendees. Finally, my gratitude to Geneviève Robillard, Emily Butcher and Jocel Rivera for overseeing the Conference Coordination, to Christina Valenti for editing related materials, and to the teams at Université du Québec en Outaouais, Interactive Media Institute, Virtual Reality Medical Center, and Virtual Realty Medical Institute for their time and contributions to all facets of the conference.<br/> <br/> To our sponsors, who continue to support our vision and help make it a reality, a warm and heartfelt thank you – 3dVia, Assemblée Nationale du Québec, Canada Research Chair in Clinical Cyberpsychology, Casino Lac- Leamy, the European Commission Information Society and Media, Gouvernement du Québec, Interactive Media Institute (IMI), International Association of CyberPsychology, Training & Rehabilitation (iACToR), INTERSTRESS, In Virtuo, Istituto Auxologico Italiano, Mary Ann Liebert, Inc. Publishers, National Institute on Drug Abuse (NIDA), Université du Québec en Outaouais (UQO), Ville de Gatineau, the Virtual Reality Medical Center (VRMC), the Virtual Reality Medical Institute (VRMI) and WorldViz.<br/> <br/> As integral parts of our Combined Communications Plat- form, the CT Conference series will continue to work together with iACToR, JCR, and C&R to inform and educate industry, academia, and government officials and the general public on the explosive growth of advanced technologies for therapy, training, education, prevention and rehabilitation.<br/> <br/> As in previous conferences, this year’s conference will be hosting an interactive exhibit area, the Cyberarium, which allows conference attendees and members of the press to try new technologies firsthand. To recognize outstanding achievements by students and new researchers, as well as lifetime achievement for a senior researcher, we will also be hosting awards during the conference and announcing the 2011-2012 iACToR officers during the General Assembly. Pre-conference workshops will focus on advanced topics including psychotherapeutic applications, brain computer interface de- vices, and rehabilitation, and there will also be an introduction to VR workshop for those newer to the area.<br/> <br/> As we approach CT16 with excitement, we begin too to look toward next year’s conference, CyberPsychology & CyberTherapy 17, to be held in Brussels, Belgium September 25-28, 2012. Thank you again for your commitment to the evolution of healthcare!<br/> <br/> Brenda K. Wiederhold, Ph.D., MBA, BCIA <br/> Editor-in-Chief<br/> <i>Journal of CyberTherapy & Rehabilitation <br/></i> Virtual Reality Medical Institute</p> Journal of CyberTherapy & Rehabilitation Editorial - Issue 4(1)tag:iactor.ning.com,2012-01-14:5103975:Topic:134022012-01-14T21:39:47.937ZJames Cullenhttp://iactor.ning.com/profile/JamesCullen
<p><span style="text-decoration: underline;"><strong>Editorial from the iACToR Secretary General and JCR Editor-In-Chief Prof. Dr. Brenda K. Wiederhold</strong></span><br></br> There is an emerging body of literature about the proliferation of social networking sites (SNS) and their effects on mental health. To date, much of it has focused on investigating the possible negative effects of SNS, such as Internet addiction. However, research also supports the benefits of SNS in mental health,…</p>
<p><span style="text-decoration: underline;"><strong>Editorial from the iACToR Secretary General and JCR Editor-In-Chief Prof. Dr. Brenda K. Wiederhold</strong></span><br/> There is an emerging body of literature about the proliferation of social networking sites (SNS) and their effects on mental health. To date, much of it has focused on investigating the possible negative effects of SNS, such as Internet addiction. However, research also supports the benefits of SNS in mental health, addictions, stigmatized identities, trauma and violence recovery, and grief support. As clinicians and researchers, we are just beginning to harness the power of SNS to promote mental wellbeing.<br/> <br/> Participation in SNS has increased dramatically over the past five years. A 2010 Pew report showed that 73% of online teens and 47% of online adults in the U.S. used SNS. Another survey conducted by Pew in April–May 2010 noted that Poland, Britain, and South Korea are close behind the U.S. in SNS usage, followed by France, Spain, Russia, and Brazil. Lower participation in other countries is due primarily to less-wired populations. No- table exceptions are Germany and Japan, where Internet usage is high but SNS usage is low.<br/> <br/> The European Union has been investing in e-Health since 2004, when outgoing Public Health and Consumer Protection Commissioner David Byrne said, “We need a ... Europe where people have easy access to clear and reliable information on how to be in good health and about diseases and treatment options.” An outgrowth of the European Parliament hearing at which he testified was the creation of the ICT (information and communi- cation technologies) for Health, enabling health service providers in different EU member states to work together to exploit these technologies. More recently, the First In- ternational E-Mental Health Summit in Amsterdam in 2009 organized by the Trimbos Institute in collaboration with the International Society for Research on Internet Interventions attracted 500 participants from more than 40 countries. In the U.S., the new healthcare reform law provides financial incentives for providers to use health information technology and electronic health records, and in March 2011 leaders in healthcare technology will share their innovations in San Diego and San Francisco, California for the Health 2.0 conference.<br/> <br/> In one such innovation, a researcher used a GPS-enabled phone and a location-aware SNS to design a system to help trainees with cognitive impairment who felt lost to find a nearby caregiver. These individuals were enrolled in a supported employment program that provided them with a job coach to help them get to and from work for the first few weeks. The system was programmed to send text messages to the job coach and time and location alarms to help the trainee get to work on time. This type of SNS could enable parents, guardians, and caregivers to watch loved ones unobtrusively.<br/> <br/> A recent study of 217 college-age participants in South Korea found that SNS network size was positively re- lated to subjective well-being, and the results suggest that this is due to self-disclosure. In the SNS context, it is postulated that the positive association with well-being results from the self-disclosure “confession effect,” the expectation of mutual self-disclosure, and the expectation of social support.<br/> <br/> A case study report found that deploying the Three Good Things positive psychology exercise as a Facebook application was viable, with a 1% dropout rate, which is similar to or better than other online wellness applications. In the exercise, people post three good things that happened, along with the reasons they think they happened. People found that sharing with others and viewing other’s posts were valuable, as long as they were able to choose which comments they made were public and which were private.<br/> <br/> Specialized health SNS such as PatientsLikeMe and Dai- lyStrength offer emotional support, social support, and patient empowerment; some also offer physician Q&A, quantified self-tracking, and clinical trials access. PatientsLikeMe includes support for mental disorders such as anxiety, bipolar affective disorder, depression, obsessive-compulsive disorder, and Posttraumatic Stress Disorder; DailyStrength provides support for an even broader array of mental health issues. In an online SNS, inhibitions may be lowered, anxiety may be lessened, and anonymity may be increased. This presents the ideal 24/7 support for treatment of people with disorders such as depression. Indeed, the Pew report showed that teens look online for health information about issues they find are embarrassing to talk about such as drugs, sex, and depression.<br/> <br/> Of course, there are cautions. One study found that people with depression who used an online SNS spiraled down if they had friends who were moderately or severely depressed and had a negative opinion of the SNS. The researchers concluded that the SNS could be helpful if people take a break from it if their posts elicit these reactions.<br/> <br/> A position paper on pervasive healthcare concludes that “[provided-designed systems and services] should include help for people to access peer-to-peer social support sharing and caring in order to encourage sustained engagement with self management to build positive healthy identities for themselves.” Online health consumers are beginning to rely on “patient opinion leaders” for advice on chronic conditions such as mental disorders, and we need to be there with them. Of course, we must be mindful of issues such as privacy and data accuracy as we cre- ate tools to help SNS participants balance their needs to share information with their needs to manage self-presentation. Nonetheless, as clinicians and researchers, we should take advantage of SNS to extend the practice of evidence based medicine and mental health.<br/> <br/> Brenda K. Wiederhold, Ph.D., MBA, BCIA<br/> Editor-in-Chief<br/> <i>Journal of CyberTherapy & Rehabilitation <br/></i> Virtual Reality Medical Institute</p> CyberTherapy & Rehabilitation Magazine Editorial - Issue 4(4)tag:iactor.ning.com,2012-01-14:5103975:Topic:135022012-01-14T20:02:01.040ZJames Cullenhttp://iactor.ning.com/profile/JamesCullen
<p><span style="text-decoration: underline;"><strong>Letter from the iACToR Secretary General and C&R Editor-In-Chief Prof. Dr. Brenda K. Wiederhold</strong></span></p>
<p>“Virtual worlds, both immersive and Web-based, are at the frontier of innovation in medical education,” wrote an anesthesiologist in 2008. As Richard Sata- va wrote 10 years ago, “The greatest power of Virtual Reality (VR) is the ability to try and fail without consequence to animal or patient. It is only through failure…</p>
<p><span style="text-decoration: underline;"><strong>Letter from the iACToR Secretary General and C&R Editor-In-Chief Prof. Dr. Brenda K. Wiederhold</strong></span></p>
<p>“Virtual worlds, both immersive and Web-based, are at the frontier of innovation in medical education,” wrote an anesthesiologist in 2008. As Richard Sata- va wrote 10 years ago, “The greatest power of Virtual Reality (VR) is the ability to try and fail without consequence to animal or patient. It is only through failure – and learning the cause of failure – that the true pathway to success lies.”<br/> <br/> Only recently, however, has the VR cost barrier been broken by the establishment of large, collaborative simulation centers, as these partnerships anticipate the influx of practitioners demanding VR training for certification. For example, the Israel Center for Medical Simulation is part of the licensing and accreditation process for various health professionals, including paramedics and anesthesiology residents. The Uniformed Services University National Capital Area Medical Simulation Center, which provides 346,000 hours of simulations per year, partners with the National Board of Medical Examiners, the American College of Surgeons (ACS), and the American Council of Obstetrics and Gynecology. The American Board of Internal Medicine adopted medical simulation (med sim) for use in its certification program for interventional cardiologists. Med sim reaches as far as Accra Ghana, West Africa, where a partnership with ACS created the Medical and Surgical Simulation Institute.<br/> <br/> A growing number of health professionals – physicians, nurses, dentists, EMTs, and others – have embraced VR med sim because of its ability to:</p>
<ul>
<li>Reduce serendipity in education and training – VR can even out the variability in training should a particular situation not present itself during the surgical residency.</li>
<li>Facilitate practice and rehearsal without patient consequence – The resident can practice on a 3-D, haptically-enhanced simulator that matches the pa- tient’s anatomy as many times as it takes to feel comfortable with the procedure.</li>
<li>Reduce medical errors – Interdisciplinary teams can train to reduce errors caused by team member communication gaps or unfamiliarity with new equipment.</li>
<li>Reduce reliance on animal models – Increasing pressure by PETA and scarcity of cadavers has ac- celerated the adoption of VR simulation.</li>
<li>Reduce healthcare costs – Med sim offers the potential to decrease time spent and consequent costs.</li>
</ul>
<p><br/>Before the advent of mainstream VR med sim, anesthesiologists enjoyed 10% premium reductions be- ginning in 2001 based on malpractice claims data collected after anesthesiologist errors were reduced based on their work with mannequins. Today, there is a 20% malpractice insurance rate differential between anesthesiologists training with simulators and those not trained with simulators, and the members of this latter group are in steady decline.<br/> <br/> In addition to anesthesiology, the use of VR med sim in endoscopic and laparoscopic surgery is producing promising results in terms of effectiveness and cost-effectiveness. One study of laparoscopic surgery found that trainees who studied on their own using a laparoscopic and endoscopic VR simulator achieved proficiency just as well as trainees who were proctored. The independent-study approach was less time consuming for trainees, and certainly minimized instructor time.<br/> <br/> There are significant benefits to simulation training, as one study focusing on endovascular procedures found. After nine residents trained for three days on the simulation, performance improved significantly from early on day one in three categories:</p>
<ul>
<li>Total procedure time decreased 54%</li>
<li>Volume of contrast decreased 44%</li>
<li>Fluoroscopy time decreased 48%</li>
</ul>
<div><p><br/>Endovascular simulation training is up to 16 times less expensive than similar training with animals, as found by researchers in an- other study. The economic analysis compared the rental of an animal laboratory to the purchase or rental of the sim- ulator Procedicus VIST (Men- tice). According to the re- searchers, consumption of stents for each procedure is the largest cost in the animal lab, as the stents cannot be retrieved from the animal.<br/> <br/> Most recently, a meta-analysis of more than 600 studies involving technology-enhanced simula- tion training showed consistently large effect sizes for knowledge, skill, and behavior outcomes, and moderate effects for patient-related outcomes. The authors of this JAMA study are currently re- searching how to use simulation-based teaching most cost-effectively, and we look forward to re- viewing the results of that research.</p>
</div>
<p><span class="font-size-5"><b><i><span class="font-size-3"><br/> Create your own reality!</span></i></b></span></p>
<p><span class="font-size-5"><em><span class="font-size-2">Prof. Dr. Brenda K. Wiederhold, Ph.D., MBA, BCIA</span></em></span></p>
<p><strong><br/></strong></p> CyberTherapy & Rehabilitation Magazine Editorial - Issue 4(3)tag:iactor.ning.com,2012-01-14:5103975:Topic:132052012-01-14T19:44:00.816ZJames Cullenhttp://iactor.ning.com/profile/JamesCullen
<p><span style="text-decoration: underline;"><strong>Letter from the iACToR Secretary General and C&R Editor-In-Chief Prof. Dr. Brenda K. Wiederhold</strong></span></p>
<p>Dear Reader,<br></br> <br></br> Most of you reading this editorial live in an affluent society. You probably have a desk job, which requires you to sit most of the day. You probably drive a car or take a train or bus to work rather than walk. You may have a long commute, which may tempt you to pick up fast food or convenience…</p>
<p><span style="text-decoration: underline;"><strong>Letter from the iACToR Secretary General and C&R Editor-In-Chief Prof. Dr. Brenda K. Wiederhold</strong></span></p>
<p>Dear Reader,<br/> <br/> Most of you reading this editorial live in an affluent society. You probably have a desk job, which requires you to sit most of the day. You probably drive a car or take a train or bus to work rather than walk. You may have a long commute, which may tempt you to pick up fast food or convenience food rather than cook healthy meals. The resulting poor nutrition and lack of exercise can lead to obesity, high blood pressure, and a general lack of fitness. Obesity predisposes individuals to heart disease, diabetes, and some types of cancer.<br/> <br/> Another factor contributing to so-called “diseases of affluence” is advances in medical care. Each generation has less exposure to infectious agents and pathogens and more exposure to antibiotics than the last, resulting in a lack of natural immunities. This can lead to diseases such as asthma, allergies, and autoimmune disorders.<br/> <br/> Finally, and most germane to our readers, is the toll that stress makes us pay. Stress, combined with comparatively independent lifestyles and the absence of strong social bonds, may lead people to turn to alcohol, tobacco, or other drugs to self-soothe, and depression is common.<br/> <br/> Increasingly, we are seeing these diseases of affluence not just in the affluent segments of societies, but in the poorest individuals of affluent countries. They live in neighborhoods that discourage walking and where fast food is plentiful and cheap. We are also seeing these diseases increase in countries experiencing rapid development, such as China and India. In China, the prevalence of obesity and hypertension almost doubled over the period 1991 to 2004, and became less concentrated in urban areas. In India, estimated deaths from non-communicable diseases are projected to rise from 40% of all deaths in 1990 to 67% of all deaths by 2020.<br/> <br/> A study of allergic rhinitis in Korea found a doubling of prevalence in the 10-year period between 1991 and 2001, noting that contributing factors might include exposure to indoor allergens including pet dander; outdoor air pollution; decreased consumption of fruits, vegetables, and fish; and a more sedentary lifestyle. A recent review concludes that while more data from intervention studies are needed, atopic diseases (hyperallergic reactions such as allergic rhinitis, asthma, and dermatitis) “appear, at least in part, to be the price paid for our relative freedom from infections and parasitic diseases in affluent societies.”<br/> <br/> I encourage our readers to pay special attention to the psychological costs of affluence. The proportionate share of the global burden of disease represented by psychiatric and neurologic conditions is projected to rise from 10.5% in 1990 to 14.7% in 2020. In some countries, even wealthy adults must still overcome the stigma associated with seeking help for mental health issues. Children in affluent families may manifest more substance abuse, anxiety, and depression.<br/> <br/> A recent study showed that psychological distress has been rising over time, and may be associated with being overweight. Half the British population view themselves as overweight, and happiness and mental health are worse among overweight people in both the UK and Germany. For each 10-point rise in BMI, there is a drop in psychological health of 0.3 General Health Questionnaire points. The authors note that while suggestive, this does not establish causality.<br/> <br/> Many disorders are associated with a dysfunction of the stress system: obesity, metabolic syndrome, and type 2 diabetes; hypertension; autoimmune disorders and allergies; anxiety, depression, and insomnia; and pain and fatigue syndromes. While society has evolved and our life expectancy has increased, our stress system remains mired in old evolutionary patterns. Malfunction of the stress system may impair growth, development, behavior, and metabolism, leading to various acute and chronic disorders. As researchers and clinicians engaged in cognitive rehabilitation, let us be mindful of the interrelationships among psychological and physical health as we work to combat these diseases of affluence.</p>
<p><br/> <span class="font-size-5"><b><i><span class="font-size-3">Create your own reality!</span></i></b></span></p>
<p><span class="font-size-5"><em><span class="font-size-2">Prof. Dr. Brenda K. Wiederhold, Ph.D., MBA, BCIA</span></em></span></p>
<p><strong><br/></strong></p> CyberTherapy & Rehabilitation Magazine Editorial - Issue 4(2)tag:iactor.ning.com,2012-01-14:5103975:Topic:132032012-01-14T19:31:25.418ZJames Cullenhttp://iactor.ning.com/profile/JamesCullen
<p><span style="text-decoration: underline;"><strong>Letter from the iACToR Secretary General and C&R Editor-In-Chief Prof. Dr. Brenda K. Wiederhold</strong></span></p>
<p>Dear Reader,<br></br> <br></br> Stress inoculation training (SIT) is a type of training used to prepare individuals for stressful situations and helps diminish the potential for a negative psychological reaction. In cognitive-behavioral therapy, SIT is accomplished through gradual, controlled, and repeated exposure to a stressor.…</p>
<p><span style="text-decoration: underline;"><strong>Letter from the iACToR Secretary General and C&R Editor-In-Chief Prof. Dr. Brenda K. Wiederhold</strong></span></p>
<p>Dear Reader,<br/> <br/> Stress inoculation training (SIT) is a type of training used to prepare individuals for stressful situations and helps diminish the potential for a negative psychological reaction. In cognitive-behavioral therapy, SIT is accomplished through gradual, controlled, and repeated exposure to a stressor. The goal behind this exposure is to desensitize or “inoculate” the person to the possible stimuli of a stressful situation, avoiding a panic or “fight or flight” response to the real thing. This repetition allows the individual to calmly and accurately accomplish the tasks at hand in a stressful environment. Developed in the late 1970s by Meichenbaum, controlled exposure to stress-related cues continues to be a key feature of resiliency training.<br/> <br/> Because SIT is a technique used to help harden indi- viduals to future potentially traumatizing stressors, it makes sense to use this method to help train those who must treat trauma patients. These personnel must often perform in extremely stressful environments, and optimum performance under such conditions requires effective management of physiological, psychological, and emotional responses to stressful stimuli. An acute stress reaction can occur during exposure to exceptionally stressful events, resulting in extreme sympathetic nervous system arousal and impaired performance. Longer-term reactions to these situations can include acute stress disorder, Posttraumatic Stress Disorder (PTSD), and burnout.<br/> <br/> One method to attenuate or prevent these reactions is Virtual Reality-enhanced SIT, in which personnel “experience” highly stressful situations in a virtual environment. Repeated exposure enables performers to gradually become desensitized to stimuli that may initially elicit such strong physiological arousal that performance is impeded (e.g., freezing under gunfire instead of moving a wounded soldier to safety), and therefore, psychological trauma should be less likely. Stress inoculation training is associated with a reduction in anxiety and an enhancement in work-related performance. Preliminary results of a study by Stetz and colleagues showed that virtual environments do succeed in stressing medics enough to produce an “inoculation” effect by increasing anxiety and dysphoria.<br/> <br/> There is evidence that SIT can reduce PTSD. In a 2000 study by Deahl and colleagues, a group of 106 male British soldiers preparing for a six-month tour of duty in Bosnia received a combination of pre-deployment stress training and post-deployment psychological debriefing. After deployment, participants demonstrated a drastically reduced incidence of PTSD and other psychopathology as compared to controls, approximately 10 times less than figures reported from other military samples. In fact, the level was so low that it precluded any possible debriefing effect.<br/> <br/> A recent Rand review of the evidence of effectiveness of various treatments for PTSD rated SIT as a Level A intervention as of 2000, based on two well-controlled and two less well-controlled studies in female sexual-assault survivors. Level A is the most rigorous, defined as “Evidence is based on randomized, well-controlled clinical trials for individuals with PTSD.”<br/> <br/> Evidence of the effectiveness of SIT is certain to grow with advances in the fields of psychophysiology and neurobiology. An example of the former is a recent study of Belgian Special Forces candidates, which showed robust increases in cortisol in a high-intensity stress (vs. a no-stress) group, with significant correlations to decreased performance on working memory and visuo-spatial tests.<br/> <br/> An example of the latter is a review article by Lyons and colleagues that uses their longitudinal work with squirrel monkeys to inform areas of investigation for human studies of resilience. Specifically, stress inoculation in monkeys enhances prefrontal-dependent cognitive control of behavior and increases ventromedial pre- frontal cortical volumes. These and other findings “suggest that early life stress inoculation triggers developmental cascades across multiple domains of adaptive functioning. Prefrontal myelination and cortical expansion induced by the process of coping with stress support broad and enduring trait-like transformations in cognitive, motivational, and emotional aspects of behavior.”<br/> <br/> Science points the way for those leading and studying trauma training: Transform such training, protecting the psychological well-being of first responders by including resilience training exercises such as SIT.<br/> <br/> <span class="font-size-5"><b><i><span class="font-size-3">Create your own reality!</span></i></b></span></p>
<p><span class="font-size-5"><em><span class="font-size-2">Prof. Dr. Brenda K. Wiederhold, Ph.D., MBA, BCIA</span></em></span></p> CyberTherapy & Rehabilitation Magazine Editorial - Issue 4(1)tag:iactor.ning.com,2012-01-14:5103975:Topic:133032012-01-14T19:17:19.354ZJames Cullenhttp://iactor.ning.com/profile/JamesCullen
<p><span style="text-decoration: underline;"><strong>Letter from the iACToR Secretary General and C&R Editor-In-Chief Prof. Dr. Brenda K. Wiederhold</strong></span></p>
<p>Dear Reader,<br></br> <br></br> In just two more years, people will access the Internet from their cell phones more often than from their PCs. Now that some of the early chal- lenges such as compact-format data, data synchro- nization, and secure data transmission protocols have been met, patients and providers are looking to…</p>
<p><span style="text-decoration: underline;"><strong>Letter from the iACToR Secretary General and C&R Editor-In-Chief Prof. Dr. Brenda K. Wiederhold</strong></span></p>
<p>Dear Reader,<br/> <br/> In just two more years, people will access the Internet from their cell phones more often than from their PCs. Now that some of the early chal- lenges such as compact-format data, data synchro- nization, and secure data transmission protocols have been met, patients and providers are looking to cell phones as a cost-effective delivery system to manage a variety of chronic conditions, including mental disorders.</p>
<p><br/> Mobile health is variously known as mHealth, ubiqui- tous or pervasive healthcare computing, “edge” care (care in homes, workplaces, or mobile environments), or personal health systems. To be sure, health providers have been using handheld technology for almost 15 years to manage patients at nonclinical sites. Four years ago, the European Commission con- vened a Personal Health Systems conference, which attracted 400 participants. What is new in 2011 is the move to empower patients by putting mental health applications on their cell phones.<br/> <br/> In an overview of the potential for wireless mental health monitoring, Varshney (2009) proposes that certain mental health conditions – such as posttrau- matic stress disorder (PTSD), obsessive-compulsive disorder, panic disorder, eating disorder, and major depression — are particularly well suited to remote monitoring. A context-based algorithm could be used, for example, to weight activity monitoring and sleep monitoring variables that might suggest the possibility of PTSD.<br/> <br/> The U.S. Army is made up of 86% males, and 68% of soldiers are less than 29 years of age – the profile of the typical smartphone user. The RAND study found that 14% of Operation Enduring Freedom/Operation Iraqi Freedom veterans screened positive for PTSD, 14% screened positive for major depression, and 19% reported a probable traumatic brain injury during deployment. The use of smartphones is perceived as a way to overcome the stigma attached to seeking mental healthcare for this highly mobile, computer- literate population. In addition to scheduling and reminder capabilities, smartphones are evolving into devices capable of delivering podcasts, engaging patients in game-like simulations, and providing automated assessments and other evidence-based tools. Smartphones can provide immediate self-man- agement of mild symptoms, as well as immediate two-way contact with support systems during crisis.</p>
<p><br/> In the U.S., insurance reimbursement is the biggest barrier to adoption, with Food & Drug Administration regulations, liability questions, and an entrenched healthcare establishment, among other barriers. Conversely, mHealth enablers include the rise in the number of smartphone users, next- generation wireless chips that will make healthcare delivery more seamless, algorithms enabling richer and more useful data sets, and the government’s interest in wireless health. Indeed, support for wire- less mental health was originally included in President Obama’s healthcare plan.<br/> <br/> Europe was ahead of the curve on mHealth, and today the European Union is supporting research into personal health systems under the Seventh Framework Programme (FP7). The U.S. is catching up quickly, convening a Digital Health Summit at the January 2011 International Consumer Electronic Show. Today, there are about 5,000 health-related applications for smartphones.<br/> <br/> In both Europe and the U.S., the cost of caring for aging populations is a driver of mHealth. The total cost of chronic diseases in the U.S. is more than $1.4 trillion. By 2014, using mHealth, public and private payers may save up to $6 billion.<br/> <br/> A recent report summarizes: “This new approach to healthcare will reduce financial strain throughout the system (providers, payers and patients) while promoting far better overall health. In practice, edge care will enable better preventative care so that many patients will avoid major problems altogther. Patients will be far more knowledgeable about their own health status, and empowered and motivated to maintain their health. All of this should lead to greatly reduced spending while providing improved patient outcomes. <br/> <br/> I invite C&R readers and researchers to look at the cell phone in your hand and embrace it as an extension of your arm, enabling you to begin to change eHealth into iHealth, truly individualized healthcare.<br/> <br/> <span class="font-size-5" style="font-size: 19px;"><b><i><span class="font-size-3">Create your own reality!</span></i></b></span></p>
<p><span class="font-size-5" style="font-size: 19px;"><em><span class="font-size-2">Prof. Dr. Brenda K. Wiederhold, Ph.D., MBA, BCIA</span></em><b><i><br/></i></b></span></p>