焦虑障碍的虚拟现实暴露疗法研究述评_王广新

2012,Vol.20,No.8,1277–1286AdvancesinPsychologicalScienceDOI:10.3724/SP.J.1042.2012.012771277焦虑障碍的虚拟现实暴露疗法研究述评*(,100083)虚拟现实暴露疗法(VRET)是传统的行为疗法的一种转换形式,也是经典的现实情境暴露疗法的替代性治疗形式。虚拟现实整合了即时计算机图形学、身体感觉传感、视觉成像技术,给来访者提供近似真实的、可以沉浸(immersion)和交互作用的虚拟环境。研究者采用虚拟现实暴露疗法治疗幽闭恐怖症、恐高症、飞行恐怖症、创伤后应激障碍、惊恐障碍等焦虑障碍,并且关注虚拟现实暴露疗法的认知机制以及心理生理机制。实验研究表明,虚拟现实暴露疗法在治疗焦虑障碍时是有效的。被试经过治疗之后,对情境的控制感和自我效能感提升,消极自我评价降低,对创伤事件的容忍力提高,重新获得对情境的控制感。与心率指标相比,皮肤电是预测虚拟现实暴露疗法治疗效果更好的指标。虚拟现实暴露疗法还处于实验验证阶段,并没有应用到实际临床中,需要更加规范的实验设计验证该疗法的认知机制以及心理生理机制。虚拟现实暴露疗法结合功能磁共振成像(FMRI)用于心理治疗,会是未来发展的新方向。虚拟现实暴露疗法;焦虑障碍;认知行为疗法;认知机制;心理生理机制R3951引言,10%~15%(,2004),5.6%(5.0%~6.3%),,,(exposuretherapy,EX);(systematicdesensitization,SD);(Stressinclusiontraining,SIT);(CPT);(cognitivetherapy,CT);(AT);(BIO);(relax);SIT/EX;EX/relax/CT;CT/EX(Foa,Keane,&Friedman,2010):2011-10-12*(11YJC190024)(HJ2010-21):,E-mail:[e-mail],,,,,,,,EX,,,,(VERT),,1992,(North,M.M.,North,S.M.,&Coble,1996),,127820,,,(,,1995),(,,2005;,2008),,2008,,,,,2虚拟现实暴露疗法治疗焦虑障碍,,,,,,,(Meyerbröker&Emmelkamp,2010),,(BAT),,,(Côté&Bouchard,2005)(Rothbaum,Hodges,Smith,Lee,&Price,2000)(Klingeretal.,2003)(Botellaetal.,2007)2.1幽闭恐怖症,2,8(Botellaetal.,1998)35~458(1)2m×5m;(2)4m×5m();(3)3m×3m();(4),,,1m2,,,Botella318,;;;35~45,,,1~3,,,表1虚拟现实暴露疗法治疗幽闭恐怖症()Botella(1998)1VRE108FAS,FCSM,PRIQSETBM,TAM,SUDS,Botella(2000)1VRE408PRIQ,ASI,BAT,SETCS,SUDS,VREFAS(,1);FCSM(1);PRIQ;SETBM(1);TAM(1);SUDS();SETCS8:12792.2恐高症,4,4,,,(Jangetal.,2000),,(3,1),,(Kamphuis,Emmelkamp,&Krijn,2002)-,VRET(7;35~45,n=12),(n=8),,(Rothbaumetal.,2000)EmmelkampVERT(Emmelkamp,Bruynzeel,Drost,&vanderMast,2001),(n=10)(1),(1),,18,,,,,37(HMD),(CAVE),,(Krijnetal.,2004)CoelhoSilva,(n=10)(n=5),,,(Coelho,Silva,Santos,Tichon,&Wallis,2008)2.3飞行恐怖症,,,,-,(Rothbaumetal.,2000)84,4,,,,,(),,,612,,,4,,,,,(Rothbaum,Hodges,Anderson,Price,&Smith,2002),88,(Műhlberge,Bűlthoff,Wiedemann,&Pauli,2007)2.4创伤后应激障碍128020,14,,,,,,(Rothbaumetal.,1999)Difede9·11(Difedeetal.,2007)DSM-IV-TR(CAPS),(n=13)(n=8),CAPS,(p0.01),PTSD,,Wood(Woodetal.,2007)(VRMC)3;,();PTSD()(PHQ-9)(BAI),,PTSDPHQ-9BAI,,14(Rothbaumetal.,2008)14PTSD,14PTSD,3,,2010,Ready,PTSD11()11()(,)(Ready,Gerardi,Backscheider,Mascaro,&Rothbaum,2010)(),,,611,PTSD2.5惊恐障碍Botella,(PDA),(PD)37,,9,,,,,Botella,23虚拟现实暴露疗法的机制,(Emmelkamp,2004),FoaKozak,,,,,,,8:1281表2虚拟现实暴露法治疗惊恐障碍N()Botella(2007)37VRET(n=12)(n=12)(n=13)9PDSSASIFQVRET=12,Peñate,Pitti,Bethencourt,delaFuente,&Gracia(2008)27VRET(n=15)CBT(n=13)11AQACQVRET=CBT3,Pitti(2008)28VRET(n=18)CBT(n=19)11AIACQVRET=CBTVRET;CBT;PDSS;ASI;FQ();ACQ;AI3.1虚拟现实暴露疗法的认知机制(Foa&Kozak,1986),,,,,,,(),()(Schuemieetal.,2000),,,,,,,,,,(1)图片Stroop任务Côté,,(n=28)(Côté&Bouchard,2005)3,;15cm30cm,;,,(……)Stroop,,48(4),();();();(),,,(2)自我效能感和恐惧相关信念,(Côté&Bouchard,2009),(),(BAT),,,,,(BAT),,,128220BanduraWilliams(Bandura,1997;Williams,1996)(3)积极的自我评价和消极的自我评价,(vanHout,Emmelkamp,Koopmans,Bögels,&Bouman,2001),(n=14)(n=20),4(4,50),,4,,3.2虚拟现实暴露疗法的心理生理机制,,Gray(Gray,1975)Fowles,,,(Fowles,1988)Wilhelm86(Wilhelmetal.,2005)(n=11)(n=9)(),,(),(),,,,,,,/(Moore,Wiederhold,Wiederhold,&Riva,2002),9(),,,,,,,,,,(n=33)(n=22),,(),(Wiederhold,Jang,Kim&Wiederhold,2002),,(n=15,)(n=15),,,(Műhlbergeretal.,2007),,,,,4总结与展望4.1治疗效果以及治疗机制评估,,(),(Katharinaetal.,2010),,8:1283,,,,,,Stroop(Olatunji,Sawchuk,Lee,Lohr,&Tolin,2008;Wiers,Teachman,&DeHouwer,2007),4.2虚拟现实技术治疗焦虑障碍的优势(1)虚拟的安全环境,,,,,,“”,,,,,,,,(2)可控的、个体化的焦虑唤醒,,“”,,(3)虚拟真实应对来访者回避行为PTSD,PTSD,,,,,,,,4.3虚拟现实技术治疗焦虑障碍的局限(1)治疗设备以及保养费用昂贵,,,,,-,(2)对治疗师有很高的要求,,,,,4.4虚拟现实技术作为新疗法的展望(1)继续评估虚拟现实暴露疗法的治疗效果,,,,,,,,,,,,,(2)深入研究虚拟现实暴露疗法的机制,Stroop,,,128420,Stroop(Olatunjietal.,2008;Wiersetal.,2007),,,-(,,2008),,,,,(Műhlbergeretal.,2007),,,,(3)虚拟现实与FMRI的结合,(fMRI)(Clementeetal.,2010)fMRI,,,,,戴琴,冯正直.(2008).抑郁患者的注意偏向.心理科学进展,16,260–265.[美]Foa,E.B.,Keane,T.M.,&Friedman,M.J.(2010).创伤后应激障碍的治疗(谭庆荣、张樟进译).北京:人民军医出版社.李江予,张侃.(1999).虚拟现实条件下网上购物环境设计的工程心理学分析.人类工效学,5(4),1–4.柳菁.(2008).虚拟现实技术应用于心理治疗领域的最新进展.心理科学,31(3),762–764.许百华,赵业.(2005).虚拟现实技术在心理治疗中的应用.心理科学,28(3),654–655.王雯,王国强.(2008).虚拟现实技术在空间认知心理学研究中的发展与应用现状.新西部,(8),223–224.Bandura,A.(1997).Self-efficacy:Theexerciseofcontrol.NewYork:W.H.Freeman.Botella,C.,Baños,R.M.,Perpiñá,C.,Villa,H.,Alcañiz,M.,&Rey,A.(1998).Virtualrealitytreatmentofclaustrophobia:Acasereport.BehaviourResearchandTherapy,36,239–246.Botella,C.,Baños,R.M.,Villa,H.,Perpiñá,C.,García-Palacios,A.(2000).Virtualrealityinthetreatmentofclaustrophobicfear:Acontrolled,multiple-baselinedesign.BehaviorTherapy,31,583–595.Botella,C.,García-Palacios,A.,Villa,H.,Baños,R.M.,Quero,S.,Alcañiz,M.,etal.(2007).Virtualrealityexposureinthetreatmentofpanicdisorderandagoraphobia:Acontrolledstudy.ClinicalPsychologicalPsychotherapy,14,164–175.Clemente,M.,Rey,B.,Alcañiz,M.,Bretón-López,J.,Moragrega,I.,Baños,R.M.,etal.(2010).Contributionsoffunctionalmagneticresonanceinthefieldofpsychologicaltreatmentswithvirtualreality.StudiesinHealthTechnologyandInformatics,154,197–201.Coelho,C.M.,Silva,C.F.,Santos,J.A.,Tichon,J.,&Wallis,G.(2008).Contrastingtheeffectivenessandefficiencyofvirtualrealityandrealenvironmentsinthetreatmentofacrophobia.PsychNologyJournal,6,203–216.Cô