Virtual Reality to Treat Anxiety in Parkinson’s Disease

CBT-VR Intervention with Homebased mobile-VR: The new CBT-VR intervention with homebased applications and biofeedback is a modification of our existing manualised CBT for anxiety in Parkinson's disease (PD) patients which is described in our previously registered study (ACTRN12616000764437: Randomised wait-list controlled trial of Cognitive Behaviour Therapy (CBT) for Anxiety in Parkinson's Disease). This new package will incorporate individually tailored methods to reduce anxiety. The package will target anxiety disorders common to PD. Participants will be required to attend 8 CBT sessions, once per week over 8 weeks with individually tailored immersive VR view, chosen from a library of VR applications, including VR applications widely used for the treatment of anxiety subtypes and tailored VR applications readily available for PD (e.g. VR walk on travelling in a train where PD patients often experience panic attacks). Each CBT-VR session lasting for 90 minutes maximum will be conducted at the University of Queensland clinical centres and will be facilitated by a clinical psychologist or a provisionally registered psychologist undergoing advanced postgraduate training at the School of Psychology, University of Queensland. In the proposed project, carers will be included more explicitly. Each session will have handout material with further information, and instructions for homebased anxiety treatment including use of mobile-VR coupled with a biofeedback watch. Home Based Anxiety Treatment using Biofeedback: PD patients in the CBT-VR intervention group - will take home a VR headset to home view the relaxation VR environment experienced during in-person clinic sessions. Participants will be asked to practise at least for 10 minutes daily. However, the frequency and duration of home based practise will vary for each individual. Participants are to record their use in a practise log. Training and instruction handouts will be provided for all participants. For biofeedback, Patients will be asked to wear the Garmin Smart Watch for the whole duration of the study period for anxiety monitoring, and for biofeedback alerts during high anxiety states. Patients will be given the option of either viewing the mobile-VR using VR headsets for an immersive experience or without VR-headsets for a non-immersive VR experience. PD patients in the waitlist control group - will also receive a watch to record heart rate to compare data. However, during the wait period they will not have the alerting program. We will provide a demonstration of the use of all equipment to patients and carers at baseline assessments. All PD patients will be asked to practice techniques gained in the in-person sessions at home and will be asked to maintain a practise log and monitoring of any side effects throughout the study. This practise log will be developed as part of the development phase of the study.