Introdução: A Esclerose Lateral Amiotrófica (ELA) é uma neuronopatia de curso progressivo, caracterizada pela morte dos neurônios motores superiores e inferiores. Devido a rápida progressão da doença e ao aparecimento dos sintomas de incapacidade funcional os indivíduos com ELA buscam uma forma alternativa de comunicação e interação. Com isso, o desenvolvimento tecnológico utilizando programas de realidade virtual com ajuda de dispositivos de interação pode viabilizar mais função e auxiliar indivíduos com ELA a obter autonomia, independência, melhor qualidade de vida e inclusão. Objetivo: Identificar qual dispositivo de interação virtual é melhor para propiciar desempenho e funcionalidade em uma tarefa de realidade virtual para indivíduos com ELA. Método: Participaram do estudo 30 indivíduos que formaram o grupo ELA e 30 indivíduos com desenvolvimento típico que formaram o grupo controle, com idade entre 44 a 74 anos, pareados por idade e sexo. A tarefa utilizada, foi um jogo no computador, que consiste em estourar o maior número de bolhas possíveis durante 30 segundos. Os indivíduos foram separados em 3 grupos, cada qual utilizando uma interface diferente (Kinect, Leap Motion Controller ou Touchscreen) na fase de aquisição e retenção da tarefa. Após essas fases, foi realizada a fase de transferência com a troca de dispositivos e assim todos os grupos tiveram contato com todas as interfaces. Para análise estatística utilizou-se o número de bolhas alcançadas para cada participante, durante as fases de aquisição, retenção e transferências. Resultados: Todos os participantes, tanto do grupo ELA como do grupo controle, apresentaram melhor performance motora na utilização do dispositivo Touchscreen, porém o grupo ELA apresentou desempenho inferior com a prática de todos os dispositivos. A prática com o dispositivo Touchscreen não permitiu a transferência para os dispositivos Leap Motion Controller e Kinect, isso significa que a prática com dispositivo de característica mais real (Touchscreen) não permitiu a transferência para os dispositivos com características mais virtuais (Kinect® e Leap Motion Controller®), porém considerando a prática com os dispositivos virtuais essa transferência ocorre. Conclusão: O trabalho apresenta um avanço na compreensão de dispositivos apropriados para a utilização na reabilitação da funcionalidade de indivíduos com ELA. O dispositivo Touchscreen foi o que apresentou melhor desempenho funcional para essa população, podendo oferecer mais funcionalidades para os indivíduos na execução de tarefas virtuais / Introdution: Amyotrophic Lateral Sclerosis (ALS) is a progressive course of neuronopathy, characterized by the motor neurons death (MN) upper and lower. Due to rapid disease progression and the onset of symptoms of functional disability individuals with ALS seek an alternative form of communication and interaction. Technological development using virtual reality programs with the help of interaction devices can offer more function and assist individuals with ALS to obtain autonomy, independence, quality of life and inclusion. Objective: to identify which low-cost non-immersive interaction device, using a virtual task, is better for providing performance and functionality for individuals with ALS. Method This is an analytical cross-sectional study. A total of 60 people participated in this study, 30 individuals with ALS (18 men and 12 women, mean age = 59 years, range 44-74 years), while 30 people with normal development that were matched for age and gender with individuals with ALS formed the control group. The task used was a computer game, which consists of blowing the largest possible number of bubbles for 30 seconds. The subjects were divided into 3 groups, each using a different interface (Kinect®, Leap Motion Controller® or Touchscreen) in the task acquisition and retention stage. After these phases was carried out the transfer phase with the switching devices, then all groups had contact with all interfaces. For statistical analysis we used the number of bubbles achieved for each participant during the phases of acquisition, retention and transfer. Results: All participants, both the ALS group, both the control group showed better motor performance in the use of the Touchscreen device, but the ALS group had underperformed the practice of all devices. Practice with the touchscreen device did not allow the transfer to the Leap Motion Controller® and Kinect® devices, this means that the practice more real feature device (Touchscreen) did not allow the transfer to devices with more virtual features (Kinect® and Leap Motion controller®), but considering the practice with virtual devices that transfer occurs. Conclusion: This work presents a breakthrough in the understanding of appropriate devices for use in the rehabilitation of people with ALS functionality. The Touchscreen device showed the best functional performance for this population and can offer more features for individuals in executing virtual tasks

A paralisia cerebral (PC) é uma desordem permanente do movimento, tônus muscular ou postura causada por dano ao cérebro imaturo ou em desenvolvimento. A pesquisa demonstrou que a tecnologia Realidade Virtual (RV) pode ser usada em reabilitação para apoiar a aquisição de habilidades motoras e a realização de tarefas funcionais. O objetivo deste estudo foi explorar melhorias no desempenho de indivíduos com PC com prática no uso de um jogo virtual em um telefone celular e comparar seu desempenho com o grupo controle. Materiais e Métodos: Vinte e cinco indivíduos com PC foram pareados por idade e sexo com vinte e cinco indivíduos com desenvolvimento tipico. Os participantes foram convidados a executar uma tarefa de labirinto virtual, o mais rápido possível, em um telefone celular. Todos os participantes realizaram 20 repetições na fase de aquisição com a mão dominante, após a fase de aquisição; houve 5 minutos de descanso, em que o indivíduo não teve contato com a tarefa. Então, os participantes foram convidados a realizar 5 repetições na fase de retenção de curto prazo, usando o mesmo labirinto de aquisição. Para a fase de transferência, houve 5 repetições, porém com um caminho do labirinto oposto à aquisição.Como resultado, o grupo PC melhorou seu desempenho na fase de aquisição, manteve o desempenho, que foi comprovadona fase de retenção; além disso, foram capazes de transferir o desempenho adquirido em um caminho de labirinto oposto. O grupo PC levou mais tempo para executar a tarefa de labirinto, comparado ao grupo controle em todas as fases do estudo. Conclusão: Indivíduos com Paralisia Cerebral realizaram um jogo de realidade virtual (tarefa de labirinto) utilizando um telefone celular e, apesar das diferenças do grupo de controle, esse tipo de dispositivo oferece novas possibilidades de uso em programas de reabilitação / Cerebral palsy (CP) is a permanent disorder of movement, muscle tone or posture that is caused by damage to the immature and developing brain. Research has shown that Virtual Reality (VR) technology can be used in rehabilitation to support the acquisition of motor skills and the achievement of functional tasks. The aim of this study was to explore for improvements in the performance of individuals with CP with practice in the use of a virtual game on a mobile phone and to compare their performance with that of the control group. Materials and Methods: Twenty-five individuals with CP were matched for age and sex with twenty-five, typically developing individuals. Participants were asked to complete a VR maze task as fast as possible on a mobile phone. All participants performed 20 repetitions in the acquisition phase with the dominant hand, after the acquisition phase; there was 5 minutes rest, in which the individual had no contact with the task. Then, participants were asked to complete 5 trials in the short-term retention phase using the same maze of acquisition. For the transfer phase, there were 5 trials with a path of the labyrinth opposed to the acquisition. As a result the CP group improved their performance in the acquisition phase and maintained the performance, which was shown by the retention test; in addition, they were able to transfer the performance acquired in an opposite maze path. The CP group had longer task-execution compared to the control group for all phases of the study. Conclusion: Individuals with cerebral palsy were able to learn a virtual reality game (maze task) using a mobile phone, and despite their differences from the control group, this kind of device offers new possibilities for use in rehabilitation programs

O Transtorno do Espectro do Autismo (TEA) é uma deficiência do desenvolvimento neurológico, em que tem sido relatada dificuldade com a integração multisensorial, o que pode dificultar as habilidades cognitivas e motoras para permitir aprendizagem de diferentes tarefas e comunicação social. Considerando a possibilidade de interação em tarefas 3D por meio de dispositivos que necessitem de contato físico ou não, optou-se por avaliar pessoas com TEA e com DT em uma tarefa virtual variando o dispositivo de interação em duas seqüências de prática. Objetivou-se verificar se as pessoas com TEA são capazes de melhorar o desempenho em uma tarefa executada em um ambiente mais virtual (sem contato físico) ou mais real (com contato físico), e se essa melhora de desempenho pode ser transferida entre esses ambientes. Para a realização deste trabalho foram avaliadas 100 pessoas, divididas em dois grupos: 50 no grupo TEA, com idade entre 7 e 15 anos (11,3 ± 2,4 anos), 38 do sexo masculino e 12 do sexo feminino; e 50 pessoas com desenvolvimento típico - grupo DT, pareados por idade e sexo ao grupo TEA. Todos os participantes que realizaram ambas as seqüências mostraram uma tendência de atraso de movimento, mas os participantes que realizaram a seqüência B - a tarefa na barra de espaço primeiro - apresentaram mais atraso (m = 511 ms) do que os participantes que realizaram a seqüência A - tarefa no kinect -primeiro (m = 305 ms). Para ambas as seqüências, o erro absoluto foi maior para a interface kinect. Além disso, o grupo TEA reduziu significativamente o EV com a prática, enquanto que para o grupo DT esta diferença não ocorreu. Para o erro absoluto na fase de transferência, os resultados mostraram diferenças significativas para o grupo TEA entre os blocos A1 para a interface barra de espaço na Seqüência A (m = 475 ms) e Seqüência B (m = 718 ms). Desta forma, a prática na interface kinect (ambiente mais virtual) promoveu um melhor desempenho na interface de pressionar a barra de espaço (ambiente mais real), mas apenas para pessoas com TEA. Podemos concluir que pessoas com TEA melhoraram o seu desempenho independente do ambiente estimulado, porém com desempenho inferior ao grupo com desenvolvimento típico. E apenas o grupo TEA conseguiu transferir a prática do ambiente com características mais virtuais para com características mais reais / Autism Spectrum Disorder (ASD) is a deficiency of neurological development, in which difficulty has been reported with multisensory integration, which may hamper cognitive and motor skills to allow learning of different tasks and social communication. Considering the possibility of interaction in 3D tasks through devices that require physical contact or not, we opted to evaluate people with ASD and DT in a virtual task by varying the interaction device in two practice sequences. The objective was to verify if people with ASD are able to improve performance in a task executed in a more virtual (no physical contact) or more real (with physical contact) environment, and if this improvement of performance can be transferred between these environments. For the accomplishment of this work 100 people were evaluated, divided into two groups: 50 in the TEA group, with ages between 7 and 15 years (11.3 ± 2.4 years), 38 males and 12 females; And 50 people with typical development - DT group, matched by age and sex to the TEA group. All participants who performed both sequences showed a tendency of movement delay, but the participants who performed the sequence B - the task in the space bar first - presented more delay (m = 511 ms) than the participants who performed the sequence A - task in kinect - first (m = 305 ms). For both sequences, the absolute error was higher for the kinect interface. In addition, the TEA group significantly reduced the EV with the practice, whereas for the DT group this difference did not occur. For the absolute error in the transfer phase, the results showed significant differences for the TEA group between blocks A1 for the space bar interface in Sequence A (m = 475 ms) and Sequence B (m = 718 ms). In this way, practice in the kinect interface (more virtual environment) promoted a better performance in the interface of pressing the space bar (more real environment), but only for people with ASD. We can conclude that people with ASD improved their performance independent of the stimulated environment, but with inferior performance to the group with typical development. And only the TEA group managed to transfer the practice of the environment with more virtual characteristics to more real characteristics

Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-19T17:12:32Z No. of bitstreams: 1 Jamile Benite Palma Lopes.pdf: 2604798 bytes, checksum: 02648b7db4e837bd186b6ad03db7b39b (MD5) / Made available in DSpace on 2018-07-19T17:12:32Z (GMT). No. of bitstreams: 1 Jamile Benite Palma Lopes.pdf: 2604798 bytes, checksum: 02648b7db4e837bd186b6ad03db7b39b (MD5) Previous issue date: 2017-10-26 / Objective: To perform a comparative analysis of the effects of manual reach training through virtual reality in the upper limb, with and without the association of transcranial stimulation by direct current of children with Down's Syndrome. Materials and methods: Study I: A systematic review was conducted with a search in four databases, according to: randomized controlled study; virtual reality, cerebral palsy; Down Syndrome published between 2010 and 2016. Study II: A systematic review was conducted with a search in four databases according to: randomized controlled study; cross-sectional study; evaluation; motion analysis; Dowm syndrome; Member published between 2010 and 2016. Study III: Detailed description of the protocol of a virtual reality intervention study associated with transcriana stimulation by direct current. Study IV: Comparative study between children with Down Syndrome and with typical Development, making a relation between the parameters of motor function of the upper limbs to the assessments constituted by single evaluation of three-dimensional analysis of the movement. Study V: ETCC anodic was performed with an intensity of 1 mA in bilateral M1 in a sample of 24 children with Down Syndrome, allocated in two groups (active and sham). The pacing protocol was performed with three training sessions per week, and the evaluations took place in three moments: pre, post-protocol and 1-month follow-up, consisting of three-dimensional analysis of manual upper limb movement, quality of manual skills and brain activity in the C3 and Cz regions of the cortex. Materials and methods: Study I: A systematic review was conducted with a search in four databases, according to: randomized controlled study; virtual reality, cerebral palsy; Down Syndrome published between 2010 and 2016. Study II: A systematic review was conducted with a search in four databases according to: randomized controlled study; cross-sectional study; evaluation; motion analysis; Dowm syndrome; Member published between 2010 and 2016. Study III: Detailed description of the protocol of a virtual reality intervention study associated with transcriana stimulation by direct current. Study IV: Comparative study among children with Down Syndrome and with typical Development, making a relation between the parameters of motor function of the upper limbs to the assessments constituted by single evaluation of three-dimensional analysis of the movement. Study V: ETCC was performed with an intensity of 1 mA in bilateral M1 in a sample of 24 children with Down Syndrome, allocated in two groups (active and sham). The pacing protocol was performed with three training sessions per week, and the evaluations took place in three moments: pre, post-protocol and 1-month follow-up, consisting of three-dimensional analysis of manual upper limb movement, quality of manual skills and brain activity in the C3 and Cz regions of the cortex. / Objetivo: Realizar uma análise comparativa dos efeitos do treino de alcance manual por meio da realidade virtual em membro superior, com e sem a associação da estimulação transcraniana por corrente contínua de crianças com Síndrome de Down. Materiais e método: Estudo I: Foi realizada uma revisão sistemática com uma busca em quatro bases de dados, de acordo com: estudo controlado randomizado; realidade virtual, paralisia cerebral; Síndrome de Down publicados entre 2010 e 2016. Estudo II: Foi realizada uma revisão sistemática com uma busca em quatro bases de dados de acordo com: estudo controlado randomizado; estudo transversal; avaliação; análise de movimento; Síndrome de Dowm; membro superior publicados entre 2010 e 2016. Estudo III: Descrição detalhada do protocolo de um estudo de intervenção de realidade virtual associada a estimulação transcriana por corrente contínua. Estudo IV: Estudo comparativo entre crianças com Síndrome de Down e com desenvolvimento típico, fazendo uma relação entre os parâmentros de função motora dos membros superiores às avaliações constituídas por única avaliação de análise tridimensional do movimento. Estudo V: ETCC anódica realizada com uma intensidade de 1 mA em M1 bilateral numa amostra de 24 crianças com Síndrome de Down, alocadas em dois grupos (ativo e sham) - RESULTADOS PRELIMARES. O protocolo de estimulação foi realizado com três sessões de treino por semana, sendo que as avaliações ocorreram em três momentos: pré, pós-protocolo e follow-up de 1 mês, sendo constituída por análise tridimensional do movimento de alcance manual dos membros superiores, qualidade das habilidades manuais e atividade cerebral nas regiões C3 e Cz do córtex. Resultados: Estudo I: cinco ensaios clínicos foram selecionados com uma qualidade metodológica de 4 pontos ou mais na escala PEDro, sendo aceito para publicação no periódico Journal of bodywork and Movement Therapies. Estudo II: cinco ensaios clínicos foram selecionados com uma qualidade metodológica avaliados pelo instrumento de Avaliação Crítica Crowe, sendo submetido ao Journal Infant Behavior. Estudo III: artigo de protocolo de estudo com metodologia de intervenção com estimulação transcraniana por corrente continua associada a treino motor de realidade virtual, publicado no periódico BMJOPEN. Estudo VI: Os resultados da análise da cinemática do movimento de alcance manual entre crianças com desenvolvimento típico e Sindrome de Down apresentaram diferenças no aspecto da velocidade, tempo e acurácia do movimento. Estudo V: Os resultados deste estudo demonstraram que o grupo de crianças com SD que recebeu o treinamento com o protocolo de 10 sessões de 20 minutos de ETCC anódica sobre o córtex motor primário (C3 e C4) com montagem extracefalica bilateral apresentou respostas positivas a esta intervenção nos aspectos funcionais e do movimento dos MMSS nas avaliações realizadas logo após o término do protocolo, bem como ao follow-up de um mês pós intervenção em comparação com o grupo que recebeu ETCC Sham durante o mesmo tipo de treino motor. Conclusão: A combinação de treinamento funcional do alcance manual e ETCC anódica sobre o córtex motor primário bilateral em crianças com SD demonstrou resultados encorajadores, tanto a curto quanto a longo prazo no que diz respeito à melhora do movimento do MS, como não houve resultado significativo quando analisados dados prelimares de parâmetros da cinemática do movimento e aumento da melhora da qualidade das habilidades e de MMSS.

Hintergrund: Angststörungen sind häufig, oft chronifizierend, jedoch auch gut behandelbar. Leitlinienbehandlung ist die auf Exposition fokussierende Verhaltenstherapie. In der ambulanten Versorgungspraxis finden Expositionen jedoch selten statt. Die Angst-Tagesklinik am Universitätsklinikum Dresden realisiert die evidenzbasierte Behandlung von Angststörungen. In einer 5-wöchigen Kurzzeitbehandlung werden wöchentlich 4 begleitete und zeitoffene Expositionssitzungen durchgeführt. Untersucht wurden die Symptomverläufe und die Responder-Raten. Methoden: Zu Therapieaufnahme und -ende sowie zur Katamnese nach 3 Monaten und 1 Jahr wurde die Entwicklung der Symptombelastung bei n = 332 PatientInnen untersucht, die von 2009 bis 2015 behandelt wurden. Etwa zwei Drittel waren psychotherapeutisch vorbehandelt. Eingesetzt wurden spezifische etablierte Fragebögen. Berechnet wurden Mixed Models, Effektstärken und Responder-Raten. Ergebnisse: 90% der PatientInnen schlossen die Behandlung regulär ab. Es zeigten sich signifikante Linderungen bei Belastungen durch Angst- und depressive Symptome. Die höchsten Effektstärken um 0,9 ergaben sich bei verhaltensbezogenen Skalen und besonders bei den Agoraphobien und Panikstörungen, die die größte Störungsgruppe ausmachen. Die Responseraten lagen bei 60%. Zu den Katamnesezeitpunkten waren die Symptomverbesserungen stabil und bei den kognitiven Symptomen weiter steigend. Schlussfolgerungen: Die Behandlung in spezialisierten (teil)stationären Versorgungssettings mit Fokus auf hochfrequente Exposition, wie hier beispielhaft vorgestellt, zeigt eine gute Akzeptanz und gute bis sehr gute und längerfristig stabile Veränderungen der Symptombelastung. Diese Settings erfordern eine besondere strukturelle Ausstattung und Ressourcen. / Intensive Exposure-Based Treatment of Anxiety Disorders in a Specialized Patient-Centered Day Hospital Background: Anxiety disorders are highly prevalent, often chronic, but effectively treatable by cognitive-behavioral therapy, especially by exposure therapy. However, exposure treatments rarely occur in outpatient healthcare. The day hospital for anxiety disorders at the University Hospital Dresden implemented an evidence-based treatment. Every week, 4 guided time-open exposure sessions, not timelimited, are conducted during the 5-week treatment period. Improvements in symptomatology and response rates were examined. Methods: The symptomatology of n = 332 patients, treated from 2009 till 2015, was assessed at pretreatment and posttreatment, and at the follow-ups after 3 months and 1 year. Two-thirds had previously had other psycho therapy treatments. Established questionnaires were used. Data was analyzed by calculating mixed models, effect sizes, and response rates. Results: 90% of the patients finished the treatment regularly. Significant improvements occurred in anxiety and depressive symptoms. The strongest effect sizes of about 0.9 were achieved for behavioral scales, especially for symptoms of agoraphobia and panic disorder, the most frequent disorders in the sample. The response rates were 60%. Improvements remained stable at the follow-ups and even increased further for cognitive symptoms. Conclusions: Specialized day hospital healthcare settings, like the one presented here, are associated with good to very good and stable improvements and also with good acceptance. These therapeutic settings require specific structural equipment and resources.

Cognitive behavioral therapy (CBT) is efficacious for panic disorder with agoraphobia (PD/A). Nevertheless, the active ingredients of treatment and the mechanisms through which CBT achieves its effects remain largely unknown. The mechanisms of action in CBT (MAC) study was established to investigate these questions in 369 patients diagnosed with PD/A. The MAC study utilized a multi-center, randomized controlled design, with two active treatment conditions in which the administration of exposure was varied, and a wait-list control group. The special feature of MAC is the way in which imbedded experimental, psychophysiological, and neurobiological paradigms were included to elucidate therapeutic and psychopathological processes. This paper describes the aims and goals of the MAC study and the methods utilized to achieve them. All aspects of the research design (e.g., assessments, treatment, experimental procedures) were implemented so as to facilitate the detection of active therapeutic components, and the mediators and moderators of therapeutic change. To this end, clinical, behavioral, physiological, experimental, and genetic data were collected and will be integrated.

No description available.

Military veterans and active-duty service members face high rates of posttraumatic stress disorder (PTSD), a chronic and debilitating condition that is comorbid with other negative psychological and social outcomes. PTSD symptomology in military careers is attributed to unique organizational factors and risks both during and post-deployment. Delivering modern, effective PTSD treatments derived from evidence-based research to the military population is a multi-faceted effort. Among these interventions, prolonged exposure therapy (PE) is a safe and effective trauma-focused treatment for veterans. To yield higher rates of PE success, common challenges faced by both military clients and their clinicians that may be impairing adoption were examined in this systematic review of 136 articles. While military clients face challenges related to treatment access and retention, clinicians entrusted to administer PTSD treatment report limited training and skepticism towards PE as barriers. When these complex barriers converge, PE, while shown successful at reducing PTSD symptomology in randomized controlled trials, may fail to achieve positive outcomes. To aid current understanding of this multi-level issue, a systematic review of existing client and clinician studies was conducted to synthesize common problems and facilitators to PE implementation. Findings suggest that low treatment readiness, complex symptom presentations, and time conflicts remain significant barriers. Providers could benefit from increased organizational support and training while clients experience better treatment retention and outcomes when a strong therapeutic alliance and social support is present.

Background: Although exposure-based cognitive-behavioral therapy for anxiety disorders has frequently been proven effective, only few studies examined whether it improves everyday behavioral outcomes such as social and physical activity. Methods: 126 participants (85 patients with panic disorder, agoraphobia, social anxiety disorder, or specific phobias, and 41 controls without mental disorders) completed smartphone-based ambulatory ratings (activities, social interactions, mood, physical symptoms) and motion sensor-based indices of physical activity (steps, time spent moving, metabolic activity) at baseline, during, and after exposure-based treatment. Results: Prior to treatment, patients showed reduced mood and physical activity relative to healthy controls. Over the course of therapy, mood ratings, interactions with strangers and indices of physical activity improved, while reported physical symptoms decreased. Overall results did not differ between patients with primary panic disorder/agoraphobia and social anxiety disorder. Higher depression scores at baseline were associated with larger changes in reported symptoms and mood ratings, but smaller changes in physical activity Conclusions: Exposure-based treatment initiates increased physical activity, more frequent interaction with strangers, and improvements in everyday mood. The current approach provides objective and fine-graded pro cess and outcome measures that may help to further improve treatments and possibly reduce relapse.

Specifik fobi är en vanlig psykiatrisk åkomma som kan leda till stora individuella begränsningar. Symtomen kan framgångsrikt behandlas med kognitiv beteendeterapi där 85–90 % blir kliniskt signifikant förbättrade. Forskning påvisar lovande behandlingsutfall för virtuell exponeringsbehandling (VRET) mot spindelfobi. Tekniken är intressant då den kringgår de problem med anskaffning och förvaring av fobiska stimuli som sedvanlig behandling medför och dessutom kan innebära ökad tillgänglighet och flexibilitet vid behandling. Syftet med föreliggande studie är att jämföra behandlingseffekten av ensessionsbehandling (OST) med en nyutvecklad spelifierad virtuell exponeringsbehandling (VIMSE), som sker under en fristående behandlingssession. Totalt randomiserades 73 deltagare mellan de två behandlingsmetoderna. Båda behandlingarna medförde statistiskt signifikanta förbättringar med stora effektstorlekar för såväl det beteendetest (BAT), som utgjorde det primära utfallsmåttet (OST d = 1,94; VIMSE d = 1,41), som för de sekundära utfallsmåtten Spider Phobia Questionnaire och Fear of Spiders Questionnaire. OST resulterade i signifikant fler kliniskt signifikant förbättrade än VIMSE. / VIMSE (VIrtual reality Method for Spider phobia Exposure therapy)