The brain becomes overexcitable/
sensitive
Theoretical Psychological
Framework Reducept was developed
to offer patients both
pain education and pain management
skills. Since the 1970s,
both behavioural and cognitive
approaches have been used to
manage chronic pain (Melzack
& Wall, 1965). Nowadays,
these methods are widely used
within multidisciplinary pain
management (van Dessel et al.,
2014). Cognitive behavioural
therapy (CBT) is the most widely
known treatment and this has
been proven to be an effective
treatment for patients with
chronic pain (van Dessel et al.,
2014; Morley, Eccleston, &
Williams, 1999; Thorn, 2017;
Thorn et al., 2018; Williams,
Eccleston, & Morley, 2012). In
short, CBT focuses on how cognitive,
behavioral and emotional
processes interact and how a
patient can positively influence
these processes.
The theoretical framework that
is used to describe the psychological
effect of Reducept on
the patient is integrative CGT
(ICBT) (ten Broeke, & Korrelboom,
2004). ICBT theory can
be seen as being a
'psychological programming
language' to create and to test
hypotheses for emotional problems.
Hypotheses described in
ICBT also allow other treatment
methods apart from traditional
CBT exercises to be tested,
making it a valuable method to
be incorporated and systematically
test innovative treatment
methods.
Although the context of VR differs
from traditional psychotherapy,
the idea of how change
takes place is the same. Reducept
is built on three different
psychotherapeutic techniques,
where each framework of training
is directly linked to therapeutic
exercises (Fennema &
Zantema, 2019). These exercises
have been redesigned in the
context of VR, using the unique
features and opportunities that
VR has to offer. The immersion
of VR gives us the unique ability
to better influence the cognitions
and emotions of patients
with chronic pain. Being able to
direct the patients experience
makes it possible for patients to
always achieve success in their
training. Especially for patients
who have had many negative
treatment experiences, this is of
great importance for obtaining a
positive growth mindset. Every
aspect of the training is theoretically
substantiated (Fennema &
Zantema, 2019).
During the design cycle, the
Participatory Design (PD) method
is used to guarantee psychological
and technical requirements
regarding both the development
and the use of Reducept
in clinical and home settings
(Heapy et al., 2015a, 2015b;
Kuipers, Wartena, Dijkstra,
Prins, & Pierie, 2013; Robertson
& Simonsen, n.d.). This
means that relevant stakeholders
-including adults with chronic
pain, therapists, physicians,
nurses and game developers-are
concurrently involved in the
design process. This process
includes research, decisionmaking,
development of ideas
for the application and for testing
of Reducept during and after
the development process.
Research findings In collaboration
with healthcare centers in
the Netherlands, tests were conducted
between January 2018
and June 2019. During this testing
period, patients with chronic
pain could train with Reducept
in different care settings such as
specialist centers, physiotherapy