Enhance the Effectiveness of Mindfulness Training to Treat Anxiety Disorders with Virtual Reality
By John M. de Castro, Ph.D.
“Mindfulness allows us to interrupt automatic, reflexive fight, flight, or freeze reactions—reactions that can lead to anxiety, fear, foreboding, and worry.” – Bob Stahl
Anxiety disorders are the most common mental illness in the United States, affecting 40 million adults, or 18% of the population. A characterizing feature of anxiety disorders is that the suffer overly identifies with and personalizes their thoughts. The sufferer has recurring thoughts, such as impending disaster, that they may realize are unreasonable, but are unable to shake. Health anxiety is a fear of a serious illness can interfere with their daily life. It often leads to seeking unnecessary testing and to spend days consumed by worry. Health anxiety is a relatively common condition, affecting 4% to 5% of both men and women equally.
Anxiety disorders have generally been treated with drugs. But there are considerable side effects and these drugs are often abused. There are a number of psychological therapies for anxiety. But, about 45% of the patients treated do not respond to the therapy. So, there is a need to develop alternative treatments. Recently, it has been found that mindfulness training can be effective for anxiety disorders.
Technology has recently been applied to training in mindfulness. Indeed, mindfulness training carried out completely on-line has been shown to be effective for as number of conditions. But, now virtual reality (VR) devices are improving and becoming readily available. Previously it has been shown the virtual reality (VR) can be helpful in treating phobias. and Borderline Personality Disorder (BPD). But, it is not known if VR can enhance the effectiveness of mindfulness training in the treatment of Anxiety Disorders.
In today’s Research News article “Evaluation of a Mindfulness-Based Intervention With and Without Virtual Reality Dialectical Behavior Therapy® Mindfulness Skills Training for the Treatment of Generalized Anxiety Disorder in Primary Care: A Pilot Study.” (See summary below or view the full text of the study at: https://www.frontiersin.org/articles/10.3389/fpsyg.2019.00055/full?utm_source=F-AAE&utm_medium=EMLF&utm_campaign=MRK_896935_69_Psycho_20190131_arts_A ), Navarro-Haro and colleagues recruited adults with Generalized Anxiety Disorder (GAD) and provided them with a group based once per week 90 minute mindfulness training session for 7 weeks. Half the participants were randomly assigned to receive an additional 10-minute virtual reality session (mindful river world) in combination with mindfulness instructions. They were measured before and after training for mindfulness, generalized anxiety disorder, depression, emotion regulation, and interoceptive awareness. In addition, before and after the virtual reality sessions they were measured for emotional state and sense of presence.
They found that the addition of virtual reality significantly increased the completion rates for the treatment, where 70% of the mindfulness treatment group completed the program, 100% of the participants who received additional virtual reality completed participation. They also found that both groups had large and significant improvements in generalized anxiety disorder, mindfulness, depression, emotion regulation, and interoceptive awareness. But the virtual reality group had significantly greater improvements in the non-judging facet of mindfulness and in interference in emotion regulation. The first virtual reality session produced significant improvements in the participants’ emotional states. But by the last session the improvements across the session markedly diminished.
The results are interesting and suggest that mindfulness training is effective for the treatment of generalized anxiety disorders. They further suggest that the addition of virtual reality training significantly improves non-judging mindfulness and the ability to not let strong negative emotions interfere with concentration and everyday tasks. Importantly, the addition of virtual reality significantly improved the completion rate. To have a maximum impact on generalized anxiety disorder completing the therapy program is important. The improved engagement in the mindfulness program provided by the addition of virtual reality sessions suggests that this addition is important for maximizing the treatment’s effectiveness.
So, enhance the effectiveness of mindfulness training to treat anxiety disorders with virtual reality.
“Anxiety is the “check engine light” on our psychophysiological dashboard. It lets us know the system needs some balancing. Agitation is therefore not our enemy; ideally, we see it as a wake up call for mindfulness practice.” – Mitch Abblett
CMCS – Center for Mindfulness and Contemplative Studies
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Navarro-Haro MV, Modrego-Alarcón M, Hoffman HG, López-Montoyo A, Navarro-Gil M, Montero-Marin J, García-Palacios A, Borao L and García-Campayo J (2019) Evaluation of a Mindfulness-Based Intervention With and Without Virtual Reality Dialectical Behavior Therapy® Mindfulness Skills Training for the Treatment of Generalized Anxiety Disorder in Primary Care: A Pilot Study. Front. Psychol. 10:55. doi: 10.3389/fpsyg.2019.00055
Generalized Anxiety Disorder (GAD) is a very prevalent disorder in primary care (PC). Most patients with GAD never seek treatment, and those who do seek treatment often drop out before completing treatment. Although it is an understudied treatment, Mindfulness-Based Interventions (MBIs) indicate preliminary efficacy for the treatment of GAD symptoms, but many patients with GAD present other associated symptoms (e.g., attention deficits) that complicate the treatment. Virtual Reality DBT® Mindfulness Skills learning has recently been developed to make learning mindfulness easier for patients with emotion dysregulation who have trouble concentrating. Virtual Reality (VR) might serve as a visual guide for practicing mindfulness as it gives patients the illusion of “being there” in the 3D computer generated world. The main goal of this study was to evaluate the effect of two MBIs (a MBI in a group setting alone and the same MBI plus 10 min VR DBT® Mindfulness skills training) to reduce GAD symptoms. A secondary aim was to explore the effect in depression, emotion regulation, mindfulness, and interoceptive awareness. Other exploratory aims regarding the use of VR DBT® Mindfulness skills were also carried out. The sample was composed of 42 patients (roughly half in each group) with GAD attending PC visits. After treatment, both groups of patients showed significant improvements in General Anxiety Disorder measured by the GAD-7 using mixed regression models [MBI alone (B = -5.70; p < 0.001; d = -1.36), MBI+VR DBT® Mindfulness skills (B = -4.38; p < 0.001; d = -1.33)]. Both groups also showed significant improvements in anxiety, depression, difficulties of emotion regulation and several aspects of mindfulness and interoceptive awareness. Patients in the group that received additional 10 min VR DBT Mindfulness Skills training were significantly more adherent to the treatment than those receiving only standard MBI (100% completion rate in MBI + VR vs. 70% completion rate in MBI alone; Fisher = 0.020). Although randomized controlled studies with larger samples are needed, this pilot study shows preliminary effectiveness of MBI to treat GAD, and preliminary evidence that adjunctive VR DBT® Mindfulness Skills may reduce dropouts.