Hunter Hoffman - Academia.edu (original) (raw)

Papers by Hunter Hoffman

Frontiers in Human Neuroscience, 2020

Interactive Eye-Tracked Virtual Reality Analgesia via interactive eye tracking significantly incr... more Interactive Eye-Tracked Virtual Reality Analgesia via interactive eye tracking significantly increased how effectively VR reduced worst pain during a brief thermal pain stimulus. Although attention was not directly measured, the pattern of pain ratings, presence ratings, and fun ratings are consistent with an attentional mechanism for how VR reduces pain. Whether the current results generalize to clinical patient populations is another important topic for future research. Additional research and development is recommended.

International Journal of Environmental Research and Public Health, 2022

The current study evaluated the effectiveness of VR analgesia among pediatric and adolescent pati... more The current study evaluated the effectiveness of VR analgesia among pediatric and adolescent patients with kidney disease undergoing venipuncture. Patients at an Italian Children’s hospital (N = 82, age range 7–17 years) undergoing venipuncture were randomly assigned to a No VR group (non-medical conversation) vs. a Yes VR group (VR analgesia). After the procedure, patients gave 0–10 Verbal Numeric Pain Scale ratings. Compared with patients in the No VR Group, patients in the Yes VR group reported significantly lower “Pain intensity”(No VR mean = 2.74, SD = 2.76 vs. Yes VR mean = 1.56, SD = 1.83) and the VR group also rated “Pain unpleasantness” significantly lower than the No VR group (No VR mean = 2.41, SD = 0.94 vs. Yes VR mean = 1.17, SD = 1.80). Patients distracted with VR also reported having significantly more fun during the venipuncture procedure. No side effects emerged. In addition to reducing pain intensity, VR has the potential to make venipuncture a more fun and less un...

Telemedicine and e-Health, 2021

Background: Social distancing restrictions imposed due to the Novel Coronavirus 2019 (COVID-19) p... more Background: Social distancing restrictions imposed due to the Novel Coronavirus 2019 (COVID-19) pandemic resulted in a rapid shift in the delivery of psychological interventions from in-person to telehealth. Much of the research on this transition has been conducted with English-speaking mental health providers, leaving a gap in understanding related to how this shift has impacted Spanish-speaking treatment providers. Methods: Fifty non-U.S. Spanish-speaking therapists completed a survey related to their use of telecommunication modalities; client population characteristics; professional, ethical, and legal/regulatory issues; and telehealth training and practice. Participants completed the survey at one time point and retrospectively described their use of telehealth both pre-pandemic and during the pandemic. Results: Most of the 50 Spanish-speaking therapists surveyed reported using telepsychology 58% before COVID-19 versus 84% during the COVID-19 pandemic (v 2 = 5.76, p < 0.05). Compared with pre-pandemic, the number of hours therapists spent using telepsychology per week increased significantly for early adopter therapists (those who began using telehealth before the pandemic began) (Z =-3.18, p = 0.001) and also for late adopter therapists who only began using telehealth during the pandemic (Z =-3.74, p < 0.001). Many therapists reported equity issues. Most participants also reported ethical and regulatory concerns regarding security/confidentiality or Health Insurance Porability and Accountability Act. Conclusions: The rapid adoption of technology to deliver therapy during COVID-19 has spurred growing pains for Spanish-speaking therapists and their underserved clients, and more research is needed to better understand and improve the therapists' adoption of these technologies with diverse patient populations.

Cyberpsychology, behavior and social networking, Jan 18, 2018

This study aggregated data from three randomized control trials to explore the differential effic... more This study aggregated data from three randomized control trials to explore the differential efficacy of three forms of exposure therapy, namely, in vivo (iVET), virtual reality (VRET), and augmented reality (ARET), in the treatment of small animal phobia. Additionally, baseline patient characteristics were used to detect subgroups of patients who showed a differential response to certain treatment modalities. Primary measures were distance covered, anxiety during the behavioral avoidance test (BAT), and overall fear of small animals. A repeated-measures analysis of variance was used to explore the overall treatment effect across the exposure modalities. A cluster analysis and an analysis of moderation were conducted to explore differential response to treatments. The main study finding was that the three treatment conditions were similarly efficacious in the treatment of small animal phobia for all study outcomes. Only for distance covered, our results revealed a tendency for iVET t...

Frontiers in behavioral neuroscience, 2017

A recent NIH epidemiology study found the lifetime prevalence of alcohol use disorder in the Unit... more A recent NIH epidemiology study found the lifetime prevalence of alcohol use disorder in the United States to be 29%. Alcohol drinking behavior is strongly "learned" via pleasure center activation/reinforcement. Alcohol craving is a powerful desire to drink alcoholic beverages. Craving was added as one of the defining criteria for alcohol use disorder in DSM5, and craving reduction is becoming an increasingly important treatment goal. In the current study, patients with alcohol use disorder received 10 days of inpatient multi-modal treatments at Schick Shadel Hospital (SSH) of Seattle. The treatments included five chemical aversion conditioning sessions that associated alcohol cues (and alcohol) with nausea and emesis. All patients met DSM4 criteria for alcohol use disorder, were heavy drinkers, and reported craving alcohol pre-treatment. Craving reduction was one of the primary treatment goals. This is the first fMRI study to measure the effects of chemical aversion thera...

PloS one, 2017

Regular mindfulness practice benefits people both mentally and physically, but many populations w... more Regular mindfulness practice benefits people both mentally and physically, but many populations who could benefit do not practice mindfulness. Virtual Reality (VR) is a new technology that helps capture participants' attention and gives users the illusion of "being there" in the 3D computer generated environment, facilitating sense of presence. By limiting distractions from the real world, increasing sense of presence and giving people an interesting place to go to practice mindfulness, Virtual Reality may facilitate mindfulness practice. Traditional Dialectical Behavioral Therapy (DBT®) mindfulness skills training was specifically designed for clinical treatment of people who have trouble focusing attention, however severe patients often show difficulties or lack of motivation to practice mindfulness during the training. The present pilot study explored whether a sample of mindfulness experts would find useful and recommend a new VR Dialectical Behavioral Therapy (DBT...

Frontiers in Psychology, 2017

Sustaining a burn injury increases an individual's risk of developing psychological problems such... more Sustaining a burn injury increases an individual's risk of developing psychological problems such as generalized anxiety, negative emotions, depression, acute stress disorder, or post-traumatic stress disorder. Despite the growing use of Dialectical Behavioral Therapy ® (DBT ®) by clinical psychologists, to date, there are no published studies using standard DBT ® or DBT ® skills learning for severe burn patients. The current study explored the feasibility and clinical potential of using Immersive Virtual Reality (VR) enhanced DBT ® mindfulness skills training to reduce negative emotions and increase positive emotions of a patient with severe burn injuries. The participant was a hospitalized (in house) 21-year-old Spanish speaking Latino male patient being treated for a large (>35% TBSA) severe flame burn injury. Methods: The patient looked into a pair of Oculus Rift DK2 virtual reality goggles to perceive the computer-generated virtual reality illusion of floating down a river, with rocks, boulders, trees, mountains, and clouds, while listening to DBT ® mindfulness training audios during 4 VR sessions over a 1 month period. Study measures were administered before and after each VR session.

Frontiers in Psychology, 2016

Borderline personality disorder (BPD) is a severe mental disorder characterized by a dysfunctiona... more Borderline personality disorder (BPD) is a severe mental disorder characterized by a dysfunctional pattern of affective instability, impulsivity, and disturbed interpersonal relationships. Dialectical Behavior Therapy (DBT ®) is the most effective treatment for Borderline Personality Disorder, but demand for DBT ® far exceeds existing clinical resources. Most patients with BPD never receive DBT ®. Incorporating computer technology into the DBT ® could help increase dissemination. Immersive Virtual Reality technology (VR) is becoming widely available to mainstream consumers. This case study explored the feasibility/clinical potential of using immersive virtual reality technology to enhance DBT ® mindfulness skills training of a 32 year old female diagnosed with BPD. Prior to using VR, the patient experienced difficulty practicing DBT ® mindfulness due to her emotional reactivity, and difficulty concentrating. To help the patient focus her attention, and to facilitate DBT ® mindfulness skills learning, the patient looked into virtual reality goggles, and had the illusion of slowly "floating down" a 3D computer-generated river while listening to DBT ® mindfulness training audios. Urges to commit suicide, urges to self harm, urges to quit therapy, urges to use substances, and negative emotions were all reduced after each VR mindfulness session and VR mindfulness was well accepted/liked by the patient. Although case studies are scientifically inconclusive by nature, results from this feasibility study were encouraging. Future controlled studies are needed to quantify whether VR-enhanced mindfulness training has long term benefits e.g., increasing patient acceptance and/or improving therapeutic outcome. Computerizing some of the DBT ® skills treatment modules would reduce cost and increase dissemination.

CNS Spectrums, 2006

ABSTRACTExcessive pain during medical procedures, such as burn wound dressing changes, is a wides... more ABSTRACTExcessive pain during medical procedures, such as burn wound dressing changes, is a widespread medical problem and is especially challenging for children. This article describes the rationale behind virtual reality (VR) pain distraction, a new non-pharmacologic adjunctive analgesia, and gives a brief summary of empirical studies exploring whether VR reduces clinical procedural pain. Results indicate that patients using VR during painful medical procedures report large reductions in subjective pain. A neuroimaging study measuring the neural correlates of VR analgesia is described in detail. This functional magnetic resonance imaging pain study in healthy volunteers shows that the large drops in subjective pain ratings during VR are accompanied by large drops in pain-related brain activity. Together the clinical and laboratory studies provide converging evidence that VR distraction is a promising new non-pharmacologic pain control technique.

Scientific American, 2004

In the science-fiction thriller The Matrix, the heroes "plugged in" to a virtual world. While the... more In the science-fiction thriller The Matrix, the heroes "plugged in" to a virtual world. While their bodies rested in reclining chairs, their minds fought martial-arts battles, dodged bullets and drove motorcycles in an elaborately constructed software program. This cardinal virtue of virtual reality-the ability to give users the sense that they are "somewhere else"-can be of great value in a medical setting. Researchers are finding that some of the best applications of the software focus on therapy rather than entertainment. In essence, virtual reality can ease pain, both physical and psychological. For the past several years, I have worked with David R. Patterson, a pain expert at the University of Washington School of Medicine, to determine whether severely burned patients, who often face unbearable pain, can relieve their discomfort by engaging in a virtual-reality program during wound treatment. The results have been so promising that a few hospitals are now preparing to explore the use of virtual reality as a tool for pain control. In other projects, my colleagues and I are using virtual-reality applications to help phobic patients overcome their irrational fear of spiders and to treat post-traumatic stress disorder (PTSD) in survivors of terrorist attacks. At least two software companies are already leasing virtual-reality programs and equipment to psychologists for phobia treatment in their offices. And the Virtual Reality Medical Center, a chain of clinics in California, has used similar programs to successfully treat more than 300 patients suffering from phobias and anxiety disorders. Although researchers must conduct more studies to gauge the effectiveness of these applications, it seems clear that virtual therapy offers some very real benefits.

2014 IEEE Virtual Reality (VR), 2014

Chilldren/adults with severe burn wounds often endure uncontrolled pain during wound care. Bandag... more Chilldren/adults with severe burn wounds often endure uncontrolled pain during wound care. Bandages are changed, and wounds cleaned frequently to prevent infection. Physical therapy skin stretching exercises can also be painful. Immersive virtual reality is proving valuable as an adjunctive non-pharmacologic analgesic. Patients "go into" the computer generated world to escape their pain. Results of controlled studies

Virtual Reality, 2008

The Human Interface Technology Laboratory (HIT Lab) is a multidisciplinary research and developme... more The Human Interface Technology Laboratory (HIT Lab) is a multidisciplinary research and development lab whose work centers on novel approaches to human interface technology. Lab researchers represent a wide range of disciplines from across the University of Washington campus, including engineering, medicine, education, social sciences, architecture, and the design arts. We describe here a representative sampling of past and current HIT Lab research and development activities related to medicine, including virtual reality and augmented/mixed reality applications for direct patient therapy, tools for basic medical education and procedure training, novel approaches to medical image acquisition and display, and new visualization methods in medical informatics.

Pain, 2004

Excessive pain during medical procedures performed in unanesthetized patients is frequently repor... more Excessive pain during medical procedures performed in unanesthetized patients is frequently reported, but can be reduced with virtual reality (VR) distraction. Increasing the person's illusion of going into the virtual world may increase how effectively VR distracts pain. Healthy volunteers aged 18-20 years participated in a double-blind between-groups design. Each subject received a brief baseline thermal pain stimulus, and the same stimulus again minutes later with either a Low Tech or a High Tech VR distraction. Each subject provided subjective 0-10 ratings of cognitive, sensory and affective components of pain, and rated their illusion of going inside the virtual world. Subjects in the High Tech VR group reported a stronger illusion of going into the virtual world (VR presence) than subjects in the Low Tech VR group, (4.2 vs. 2.5, respectively, P ¼ 0:009) and more pain reduction (reduction of worst pain is 3.1 for High Tech VR vs. 0.7 for Low Tech VR, P , 0:001). Across groups, the amount of pain reduction was positively and significantly correlated with VR presence levels reported by subjects (r ¼ 0:48 for 'worst pain', P , 0:005).

Pain, 2012

Recent research indicates that immersive virtual reality (VR) can be used tool in treating acute ... more Recent research indicates that immersive virtual reality (VR) can be used tool in treating acute pain [10,25,23]. For example, VR-based behavioral interventions have been used to decrease acute pain among individuals undergoing painful medical procedures (e.g. wound cleaning of burn injuries [14,15,22,10], urological endoscopies (36)), physical therapy (e.g. for blunt force trauma [16], for burned skin [12,13]), and dental pain [11,5], and experimental pain in healthy volunteers (e.g. thermal pain) [17,18]. Although these data suggest that VR has promise as a tool to help reduce acute pain, there has been limited investigation on the use of VR in the treatment of patients with persistent pain.

Journal of Burn Care & Research, 2009

Few studies have empirically investigated the effects of immersive virtual reality (VR) on postbu... more Few studies have empirically investigated the effects of immersive virtual reality (VR) on postburn physical therapy pain control and range of motion (ROM). We performed a prospective, randomized controlled study of the effects of adding VR to standard therapy in adults receiving active-assisted ROM physical therapy, by assessing pain scores and maximal joint ROM immediately before and after therapy on two consecutive days. Thirty-nine inpatients, aged 21 to 57 years (mean 35 years), with a mean TBSA burn of 18% (range, 3-60%) were studied using a within-subject, crossover design. All patients received their regular pretherapy pharmacologic analgesia regimen. During physical therapy sessions on two consecutive days (VR one day and no VR the other day; order randomized), each patient participated in active-assisted ROM exercises with an occupational or physical therapist. At the conclusion of each session, patients provided 0 to 100 Graphic Rating Scale measurements of pain after each 10-minute treatment condition. On the day with VR, patients wore a head-position-tracked, medical care environment-excluding VR helmet with stereophonic sound and interacted in a virtual environment conducive to burn care. ROM measurements for each joint exercised were recorded before and after each therapy session. Because of nonsignificant carryover and order effects, the data were analyzed using simple paired t-tests. VR reduced all Graphic Rating Scale pain scores (worst pain, time spent thinking about the pain, and pain unpleasantness by 27, 37, and 31% respectively), relative to the no VR condition. Average ROM improvement was slightly greater with the VR condition; however, this difference failed to reach clinical or statistical significance (P = .243). Ninety-seven percent of patients reported zero to mild nausea after the VR session. Immersive VR effectively reduced pain and did not impair ROM during postburn physical therapy. VR is easily used in the hospital setting and offers a safe, nonpharmacologic adjunctive analgesic treatment.

International Journal of Human-Computer Interaction, 2003

Tactile augmentation is a simple, safe, inexpensive interaction technique for adding physical tex... more Tactile augmentation is a simple, safe, inexpensive interaction technique for adding physical texture and force feedback cues to virtual objects. This study explored whether virtual reality (VR) exposure therapy reduces fear of spiders and whether giving patients the illusion of physically touching the virtual spider increases treatment effectiveness. Eight clinically phobic students were randomly assigned to one of 3 groups-(a) no treatment, (b) VR with no tactile cues, or (c) VR with a physically "touchable" virtual spider-as were 28 nonclinically phobic students. Participants in the 2 VR treatment groups received three 1-hr exposure therapy sessions resulting in clinically significant drops in behavioral avoidance and subjective fear ratings. The tactile augmentation group showed the greatest progress on behavioral measures. On average, participants in this group, who only approached to 5.5 ft of a live spider on the pretreatment Behavioral Avoidance Test (Garcia-Palacios, 2002), were able to approach to 6 in. of the spider after VR exposure treatment and did so with much less anxiety (see www.vrpain.com for details). Practical implications are discussed.

IEEE Computer Graphics and Applications, 2001

Expert Review of Neurotherapeutics, 2008

The pain associated with burn injuries is intense, unremitting and often exacerbated by anxiety, ... more The pain associated with burn injuries is intense, unremitting and often exacerbated by anxiety, depression and other complicating patient factors. On top of this, modern burn care involves the repetitive performance-often on a daily basis for weeks to months-of painful and anxietyprovoking procedures that create additional treatment-related pain, such as wound care, dressing changes and rehabilitation activities. Pain management in burn patients is primarily achieved by