President’s Note

➣ Professor Dr. Brenda K. Wiederhold

Dear Reader,

I would firstly like to warmly thank new and returning readers to CyberTherapy & Rehabilitation Magazine (C&R), the official voice of the International Association of CyberPsychology, Training and Rehabilitation (iACToR). Main focuses of iACToR include the promotion of Virtual Reality (VR) and advanced technologies to be used as an adjunct to more traditional forms of healthcare, as well as the resulting issues of technologies on an individual, as well as societal, level.

In this issue of C&R, we explore the emerging field of cognitive enhancement. Much attention has been given to cognitive enhancement drugs and their various applications. There is emerging evidence that combining off-label drug therapy with VR therapy will produce faster and more lasting results for a variety of conditions. For example:

– A VR/drug Posttraumatic Stress Disorder (PTSD) protocol could begin with a single, intensive session in which the patient takes a pill before retelling his/her experience, then reenacts it in a VR world. Such a study could document the combined effects of VR with propranolol through physiological monitoring, perhaps producing remission in as few as two sessions. The drug blocks the naturally occurring hormone adrenaline, which is released when there is intense emotion (e.g., fear), thus giving memories their emotional charge.

– To prevent PTSD in combat troops, VR researchers have tested stress inoculation protocols in which the service member completes simulated training (e.g., clearing a building) while under enemy attack, learning techniques such as combat breathing. A study conducted by the Virtual Reality Medical Center (VRMC) showed that troops trained via the VRMC simulation cleared a real-world building four times faster than those not receiving simulated training. Using this VR simulation in combination with a drug such as modafinil (Provigil) will increase alertness and may produce an even faster building-clearance rate and steeper learning curve.

– Using a drug in combination with VR may improve outcomes in stroke patients. Under a National Science Foundation grant, a mixed reality (MR) rehabilitation system for stroke patients is being designed and developed. In mixed reality, virtual enhancements, overlays, and contexts rendered through a head-mounted display convert the real world into an altered reality without losing the properties of a physical setting. This MR system includes both hardware and software designed to increase upper-arm movement and result in positive brain changes through continued use. A future study protocol could add small doses of amphetamines, administered a half-hour before a therapy session to promote neuroplasticity, thus accelerating stroke patients’ relearning of motor skills.

For the most part, researchers have discovered these and other uses of “neuroceuticals” serendipitously, while conducting unrelated studies. As the 75 million Baby Boomers in America turn 60 and fear the consequences of Alzheimer’s and other types of dementia, interest in neuroceuticals’ brain-enhancing potential may turn this into a significant niche industry. Already, classifications have been proposed – cogniceuticals to improve memory, learning, attention, and decision-making processes, emoticeuticals to affect awareness, mood, feelings, and motivation, and sensoceuticals to enhance and restore our senses. Marketing neuroceuticals for these purposes will likely be successful, as this new group of neuromodulators has negligent side effects and emerging evidence of high efficacy. To learn more about cognitive enhancement drugs, see our Product Comparison Chart on page 23.

Of course, ethical questions remain. For example, if drugs can erase horrifying memories, sharpen attention, and enhance physical therapy, should physicians prescribe them? If we know an airline pilot will have a better safety record after taking a drug to increase alertness while using VR in a simulator, will we choose the airline that advertises that its pilots are trained this way?

At C&R, we believe in letting efficacy drive the market for neuroceuticals. Some of the most promising results are emerging from animal studies, and need to be proven in human subjects. To accomplish this, government and industry must earmark adequate funds to conduct large-scale studies of these off-label uses of existing drugs, both as standalone therapy and when combined with other technologies such as VR therapy. In this manner, we can improve the outcomes for various diagnoses and produce attendant cost savings. For example, we may be able to avert or at least delay the onset of Alzheimer’s and other dementias, which cost Americans $148 billion per year.

For my part, I think I’ll raid the medicine cabinet, pop that pill, and play that VR brain game tonight.

Create your own reality!

Brenda Wiederhold