➣ By Mark D. Wiederhold & Brenda K. Wiederhold
Over the last decade the use of functional magnetic resonance imaging, or fMRI, has become an increasingly popular tool among researchers, who continue to be amazed at findings reinforcing the brain’s neuroplasticity, its ability to adapt by forming new pathways and synapses. For psychologists, it has yielded new insight into the investigation of navigation, pain, anxiety, and cue exposure, and in suggesting ways to improve rehabilitation after brain injury.
What is fMRI?
MRI uses a powerful magnetic field, radio frequency pulses, and a computer to produce detailed pictures of organs, soft tissues, bone, and virtually all other internal body structures. Detailed images allow physicians to evaluate various parts of the body and determine the presence of certain diseases. Functional magnetic resonance imaging is a relatively new procedure that uses MR imaging to measure the tiny metabolic changes that take place in an active part of the brain. It has traditionally been used as a diagnostic tool for physicians to examine the anatomy of the brain such as assessing the effects of stroke, trauma, or degenerative disease (such as Alzheimer’s) on brain function as well as to monitor the growth and function of brain tumors.
When a brain area is more active it consumes more oxygen, and to meet this increased demand blood flow increases to the active area. fMRI can be used to produce activation maps showing which parts of the brain are involved in a particular mental process. These are indications that a particular part of the brain is processing information and giving commands to the body. As a patient performs a particular task, the metabolism will increase in the brain area responsible for that task, changing the signal in the MRI image. So by performing specific tasks that correspond to different functions, scientists can locate the part of the brain that governs that function.
fMRI in Psychology Research
There have been several reasons for the increased use of this new tool in psychology research. First, the improvement in fMRI technique during the last decade has made fMRI data more precise and reliable. Second, it is noninvasive, relatively safe, and user-friendly in comparison to other neuroimaging tools. Third, fMRI allows for the continuous collection of data, which is useful for research purposes that require the tracking of ongoing processes.
The need for objective measures within the field has increased its popularity among researchers. Compared to the traditional questionnaire methods of psychological evaluation, fMRI is far less biased.
Virtual Reality Research and fMRI
One area of research currently being investigated is using fMRI to evaluate the effectiveness of virtual reality (VR) techniques to improve current VR systems that aid in creating more effective treatments for patients. Previous studies have consistently shown that the combination of VR with traditional therapies results in more successful outcomes for patients with a wide range of diagnoses. The most common measures used today to determine the effectiveness of VR therapies are self-report, simple cognitive testing, and physiological measurements including skin conductance, peripheral skin temperature, respiration rate, and heart rate.
Some of our early work showed that peripheral physiology did not always correlate with brain activity. We saw examples during VR therapy where signs of physiological arousal were desynchronous in the neural correlates and observed peripheral physiological levels, indicating that some patients manifested peripheral arousal while others exhibited central arousal. These different arousal
patterns are helpful in planning the therapeutic approach for these patients. We also noted distinct patterns of EEG waves which suggest differences in the perception of realness when patients are exposed to a virtual environment.
Early work by Pine and colleagues used fMRI to map brain regions engaged during memory-guided navigation in a VR environment in adolescents and adults. By 2004, Hoffman and colleagues had demonstrated direct modulation of human brain pain responses by VR distraction. Another early study by Lee and colleagues evaluated cue induced smoking cravings, concluding from fMRI-highlighted areas of the brain that virtual environments were more immersive and evoked smoking craving more effectively than traditionally used methods. An unexpected finding in this study showed that even when patients are motionless in the MRI experience, virtual walking can activate the cerebellar motor cortex.
By combining treatment with imaging of the brain itself, not only can the severity of the disorder be evaluated, and the treatment adjusted accordingly, but also outcomes may be improved through the creation of VR scenarios tailored to how the brain responds to stimuli. Use of brain imaging with VR provides an opportunity to see what is actually occurring in the brain before, during, and after treatment in a way that has never been possible in the past and which can help to create more effective and appropriate treatments in the future. An update to a 2008 report on fMRI-VR studies is contained in the table that follows.
|Point of interest
|Navigation and Spatial Processing
|Beck, Wolter, Mungard, Vohn, Staedtgen, Kuhlen, Sturm
|Differences in brain processing between VR and the real world have to be taken into account when designing VR therapy tools and measuring their effect on recovery
|Evaluation of spatial processing in virtual reality using functional magnetic resonance imaging (fMRI)
|Cyberpsychol Behav Soc Netw 2010; 13(2):211–215
|Weniger, Ruhleder, Lange, Wolf, Irle
|Suggests that specific VR tasks could be designed to predict conversion from mild cognitive impairment to dementia
|Egocentric and allocentric
memory as assessed by virtual reality in individuals with amnestic mild cognitive impairment
|Neuropsychologia. 2011; 49(3):518–527
|Hung, Vetivelu, Hird, Yan, Tam, Graham, et al.
|Cerebellum-damaged drivers drove more slowly than controls, yet functional compensation (neuroplasticity) preserved their driving ability
|Using fMRI virtual-reality technology to predict driving ability after brain damage: A preliminary report
|Neurosci Lett 2014; 558:41–46
|Hoffman, Richards, Bills, Van Oostrom, Magula, Weibel, Sharar
|Large drops in subjective pain ratings during VR are accompanied by large drops in pain-related brain activity
|Using fMRI to study the neural correlates of virtual reality analgesia
|CNS Spectr 2006; 11(1):45–51
|Hoffman, Richards, Van Oostrom, Coda, Jensen, Blough, Sharar
|Patterns of pain-related brain activity support the significant subjective analgesic effects of VR distraction when used as an adjunct to opioid analgesia
|The analgesic effects of opioids and immersive virtual reality distraction; evidence from subjective and functional brain imaging assessments
|Anesth Analg 2007; 105(6):1776–1783
|Anxiety, Fear, PTSD
|Andreano, Liang, Kong, Hubbard, Wiederhold BK, Wiederhold MD
|As an experience becomes more immersive, additional brain areas related to memory are activated
|Auditory cues increase the hippocampal response to unimodal virtual reality
|Cyberpsychol Behav 2009; 12(3):309–313
|Roy, Francis, Friedlander, Banks-Williams, Lande, et al.
|Clinical Global Impression scores and scans indicated significant improvement in PTSD from both VR therapy and imaginal exposure, PTSD Scale score improvements were not significant
|Improvement in cerebral function with treatment of posttraumatic stress disorder
|Ann N Y Acad Sci 2010; 1208:142–149
|Alvarez, Chen, Bodurka, Kaplan, Grillon
|Only unpredictable threats activated brain structures associated with emotions and stress
|Phasic and sustained fear in humans elicits distinct patterns of brain activity
|Neuroimage 2011; 55(1):389–400
|Schweizer, Kan, Hung, Tam, Nagile, & Graham
|During distracted driving, brain activation shifted dramatically from the posterior, visual and spatial areas to the prefrontal cortex
|Brain activity during driving with distraction: an immersive fMRI study
|Front Hum Neurosci 2013;7(53):1-11.
|Saleh, Bagce, Qiu, Fluet, Merians, Adamovich, tunik
|Piloted a way to study neural plasticity by tracking finger movement during a motor task in the scanner and giving online visual feedback
|Mechanisms of neural reorganization in chronic stroke subjects after virtual reality training
|Conf Proc IEEE Eng Med Biol Soc 2011; 2011:8118–8121
|Hanten, Cook, Orsten, Chapman, Li, Wilde, et al.
|Results suggest an integrated approach in both behavioral analysis
and neuroimaging to delineate specific mechanisms relating to social problem solving and decision making
|Effects of traumatic brain injury on a virtual reality social problem solving task and relations to cortical thickness in adolescence
|Neuropsychologia 2011; 49(3):486–497
|Nocchi, Gazzellini, Grisolia, Petrarca, Cannatà, Canna, et al.
|Showed that processing of nonbiological movements relies on the same structures as those involved in biological motion processing
|Brain network involved in visual processing of movement stimuli used in upper limb robotic training: An fMRI study
|J Neuroeng Rehabil 2012; 9:49
| Prochnow, Bermúdez i Badia,
Schmidt, Duff, Brunheim, et al.
|Supports the hypothesis that this novel neurorehabilitation approach engages human mirror mechanisms that can be employed for visuomotor training
|A functional magnetic resonance imaging study of visuomotor processing
in a virtual reality-based paradigm: Rehabilitation Gaming System
|Eur J Neurosci 2013; 37(9):1441–1447
|Orihuela-Espina, Fernández del Castillo, Palafox, Pasaye, Sánchez-Villavicencio, et al.
|The relation between behavioral and brain changes suggests that those with stronger impairment benefit the most from this paradigm
|Neural reorganization accompanying upper limb motor rehabilitation from stroke with virtual reality-based gesture therapy
|Top Stroke Rehabil 2013; 20(3):197–209
|Tunik, Saleh, Adamovich
|Data suggest that manipulation of visual feedback of one’s own hand movement may be used to facilitate activity in select brain networks and aid in recovery during VR training
|Visuomotor discordance during visually-guided hand movement in Virtual Reality modulates sensorimotor cortical activity in healthy and hemiparetic subjects
|IEEE Trans Neural Syst Rehabil Eng 2013; 21(2): 198–207
|Alcohol and Smoking Studies
|Virtual-environment cue exposure appears to be an effective method of treating nicotine craving
|Cue exposure treatment in a virtual environment to reduce nicotine craving: A functional MRI study
|Cyberpsychol Behav 2009; 12(1):43–45.
|Lee, Lim, Wiederhold, Graham
|Virtual-environment cue exposure activates brain regions more effectively than 2D smoking cues
|A Functional Magnetic Resonance Imaging (fMRI) Study of Cue-Induced Smoking Craving in Virtual Environments
|Applied Psychophysiology and Biofeedback 2005; 30(3):195-204
About Brenda Wiederhold
President of Virtual Reality Medical Institute (VRMI) in Brussels, Belgium. Executive VP Virtual Reality Medical Center (VRMC), based in San Diego and Los Angeles, California. CEO of Interactive Media Institute a 501c3 non-profit Clinical Instructor in Department of Psychiatry at UCSD Founder of CyberPsychology, CyberTherapy, & Social Networking Conference Visiting Professor at Catholic University Milan.