There are distinct markers in the brain activity of patients suffering from anxiety disorders like Generalized anxiety disorder (GAD) or panic attacks which could be identified during their seizures. GAD is an anxiety disorder characterized by excessive, uncontrollable and often irrational worry, that is, apprehensive expectation about events or activities (DSM-5). This excessive worry often interferes with daily functioning, as individuals with GAD typically anticipate disaster and are overly concerned about everyday matters such as health issues, money, and death or family problems. Individuals additionally exhibit a variety of physical symptoms, including feeling tired, headaches, numbness in hands and feet, muscle tension, breathing difficulty, difficulty concentrating, trembling, irritability, sweating, restlessness or sleeping difficulties. There is evidence from imaging and anatomical studies that the midcingulate cortex (MCC) is a dynamic hub lying at the interface of affect and cognition. In a series of meta-analyses, researchers show how recent human electrophysiological research provides compelling evidence that frontal-midline theta signals reflecting MCC activity are moderated by anxiety and predict adaptive behavioral adjustments (Cavanagh et al., 2015; Putman et al., 2010).
Another very popular anxiety disorder is called panic attack. Panic attacks are sudden periods of intense fear that may include palpitations, sweating, shaking, shortness of breath, numbness, or a feeling that something bad is going to happen. There are studies showing that patients suffering from panic attacks often show slow EEG waves in the gamma band (Hayashi et al., 2010; Syed et al., 2019; Kane et al., 2019) . Based on these findings distinct anxiety related brain markers could be used as a control signal to start the VR based game.
Of course such anxiety disorders are difficult to prevent, but many techniques are available to help relieve and manage anxiety. For example many sufferers have found ease by relaxation exercises, deep breathing practice, and meditation. Among others these techniques could be trained by the proposed brain based VR game. There are plenty of studies showing the potential of VR to treat e.g. post-traumatic stress disorder (Jaycox et al., 1998; Zinzow et al., 2018; Carl et al., 2019) and also the potential of VR to enhance states for meditation (Murdoch et al., 2019; Kazzi et al., 2018).
Summarizing the idea of the proposed project is to develop a brain based VR game for people suffering from GAD or panic attacks to reduce their symptoms in real time. Moreover to reduce the anxiety related stress level and improve quality of life an additional feature, namely a telemedicine module, will be implemented in the system. Telemedicine is the use of telecommunication and information technology to provide clinical health care from a distance. (Matusitz et al., 2007). Telemedicine allows health care professionals to evaluate, diagnose and treat patients in remote locations using telecommunications technology. It allows patients in remote locations to access medical expertise quickly, efficiently and without travel. Our system will be extended with an internet connection to a therapist station to get immediately support and assistance in highly threatening situations during the VR training. It is an optional feature which could be selected by the patient at the beginning of the training session.