***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Virtual reality (VR)-based therapy has emerged as a potentially useful means to treat  post-traumatic stress disorder ( PTSD ) , but r and omized studies have been lacking for Service Members from Iraq or Afghanistan . This study documents a small , r and omized , controlled trial of VR- grade d exposure therapy ( VR-GET ) versus treatment as usual ( TAU ) for PTSD in Active Duty military personnel with combat-related PTSD . Success was gauged according to whether treatment result ed in a 30 percent or greater improvement in the PTSD symptom severity as assessed by the Clinician Administered PTSD Scale ( CAPS ) after 10 weeks of treatment . Seven of 10 participants improved by 30 percent or greater while in VR-GET , whereas only 1 of the 9 returning participants in TAU showed similar improvement . This is a clinical ly and statistically significant result ( χ(2 ) = 6.74 , p < 0.01 , relative risk 3.2 ) . Participants in VR-GET improved an average of 35 points on the CAPS , whereas those in TAU averaged a 9-point improvement ( p < 0.05 ) . The results are limited by small size , lack of blinding , a single therapist , and comparison to a relatively uncontrolled usual care condition , but did show VR-GET to be a safe and effective treatment for combat-related PTSD Emotion  regulation ( ER ) has become a relevant construct to underst and ing paranoia . While the ER strategy called expressive suppression ( e.g. , poker face ) may foster state paranoia by increasing arousal , another strategy called re appraisal ( e.g. , changing the perspective on situations ) may reduce negative emotions and state paranoia when adaptively used . However , if re appraisal fails , this could increase paranoia . The aim of this study was to test the proposed effects of the ER strategies on state paranoia in the socially stressful situation of being excluded in paranoia-prone individuals . We conducted an experimental online study with N=116 participants who were r and omized to a social inclusion or an exclusion condition using a virtual Cyberball ball-tossing game .  They completed question naires on paranoia proneness and habitual ER strategies . Before and after the Cyberball task , participants rated their level of state paranoia . The impact of habitual ER strategies , paranoia proneness , and social stress on changes in state paranoia was investigated using linear regression analysis . The three-way interaction of social stress , paranoia proneness , and habitual re appraisal use significantly predicted state paranoia , t(114)=2.62 , p=0.010 . The decomposition of the interaction term revealed that in the social stress condition , the impact of re appraisal on state paranoia was moderated by the level paranoia proneness . Specifically , in high paranoia-prone individuals the use of re appraisal predicted higher state paranoia . The findings regarding habitual use of suppression were not significant . Although re appraisal is generally considered a functional strategy , its use in distressing social situations seems to be impaired in persons with higher paranoia proneness . A working model of emotion dysregulation in delusions is presented and possible implication s for cognitive therapy of psychosis are discussed OBJECTIVE Despite the frequent use of the Positive and Negative Syndrome Scale ( PANSS ) for rating the symptoms of schizophrenia , the clinical meaning of its total score and of the cut-offs that are used to define treatment response ( e.g. at least 20 % or 50 % reduction of the baseline score ) are as yet unclear . We therefore compared the PANSS with simultaneous ratings of Clinical Global Impressions ( CGI ) . METHOD PANSS and CGI ratings at baseline ( n = 4091 ) , and after one , two , four and six weeks of treatment taken from a pooled data base of seven pivotal , multi-center antipsychotic drug trials on olanzapine or amisulpride in patients with exacerbations of schizophrenia were compared using equipercentile linking . RESULTS Being considered " mildly ill " according to the CGI approximately corresponded to a PANSS total score of 58 , " moderately ill " to a PANSS of 75 , " markedly ill " to a PANSS of 95 and severely ill to a PANSS of 116 . To be " minimally improved " according to the CGI score was associated with a mean percentage PANSS reduction of 19 % , 23 % , 26 % and 28 % at weeks 1 , 2 , 4 and 6 , respectively . The corresponding figures for a CGI rating " much improved " were 40 % , 45 % , 51 % and 53 % . CONCLUSIONS The results provide a better framework for underst and ing the clinical meaning of the PANSS total score in drug trials of schizophrenia patients with acute exacerbations . Such studies may ideally use at least a 50 % reduction from baseline cut-off to define response rather than lower thresholds . In treatment resistant population s , however , even a small improvement can be important , so that a 25 % cut-off might be appropriate Patients with schizophrenia have consistently been found to exhibit cognitive deficits , particularly in memory , which have been suggested to mediate functional outcomes . Several recent review s of cognitive retraining have concluded that these deficits respond to training , although the sustainability of cognitive improvement following completion of training has not been adequately evaluated . Most studies had small sample s and very short follow-up periods . As part of a larger study , we examined performance on two memory tasks in two groups of participants : those who received computerized cognitive remediation training in addition to work therapy ( n=45 ) , vs. those who only received work therapy ( n=49 ) .  Computerized cognitive remediation included hierarchical training on a computerized digit span task and a computerized words serial position task . Assessment s using the same computerized tasks were made at three time points : baseline , end of active intervention , and 6-month follow-up . Compared to the active control condition ( work therapy only ) , the group receiving computerized cognitive remediation in addition to work therapy showed significantly greater improvements on the trained digit span task following training . These improvements were maintained at the 6-month follow-up . There were no significant group differences on the word serial position task at any time point . Results indicate that computerized training can lead to sustained improvements on some , but not all , training tasks PURPOSE / OBJECTIVES To find the most effective methods of providing social support for women diagnosed with breast cancer by testing the effectiveness of a telephone social support and education intervention to promote emotional and interpersonal adaptation to breast cancer . DESIGN Multisite , two-group experimental study with repeated measures . SETTING Arkansas and New Jersey . SAMPLE The Arkansas sample consisted of 106 women who entered the study two to four weeks postsurgery for nonmetastatic breast cancer and were r and omly assigned to an experimental or control group . The comparison group consisted of 91 women from New Jersey who had participated in a previously completed study that used the same interventions and found that telephone support result ed in more positive , statistically significant adaptation to the disease . METHODS The experimental group received 13 months of telephone social support and education . Both groups received educational material s via a mailed re source kit . The Profile of Mood States ; Visual Analogue Scale-Worry ; Relationship Change Scale ; University of California , Los Angeles , Loneliness Scale-Version 3 ; and the modified Symptom Distress Scale provided data regarding the variables of interest . Data analysis included descriptive statistics , t tests , and multivariate analysis of variance with repeated measures . MAIN RESEARCH VARIABLES Mood , worry , relationships with significant others , loneliness , and symptoms . FINDINGS Data analysis showed no significant differences between groups , and both improved on some of the outcomes . Significant time-by-location interaction effects were found when comparing the Arkansas and New Jersey sample s , thereby supporting the need to consider regional differences when developing interventions . CONCLUSIONS The mailed educational re source kit alone appeared to be as effective as the telephone social support provided by oncology nurses in conjunction with the mailed re source kit . IMPLICATION S FOR NURSING Mailed educational re source kits may be the most efficient and cost-effective way to provide educational support to newly diagnosed patients with breast cancer , but their effect may differ according to region The isolated effect of Virtual Reality Based Exposure Therapy ( VRBET ) for agoraphobia was analyzed through a comparative trial involving the first 10 agoraphobic participants . The participants were r and omly assigned to two groups : VREBT only and VREBT combined with cognitive therapy . All the required Virtual Environments ( VE ) were created with an inexpensive Game Level Editor ( GLE ) . Outcome measures supported the immersive effect of the VEs . Question naires , behavioral tests and physiological measures indicated a positive effect of VRBET alone . The addition of cognitive therapy to VREBT did not appear to generate any significant differences . Consequences for future research and practice are discussed The authors estimated components of variance and intraclass correlation coefficients ( ICCs ) to aid in the design of complex surveys and community intervention studies by analyzing data from the Health Survey for Engl and 1994 . This cross-sectional survey of English adults included data on a range of lifestyle risk factors and health outcomes . For the survey , households were sample d in 720 postal code sectors nested within 177 district health authorities and 14 regional health authorities . Study subjects were adults aged 16 years or more .  ICCs and components of variance were estimated from a nested r and om-effects analysis of variance . Results are presented at the district health authority , postal code sector , and household levels . Between-cluster variation was evident at each level of clustering . In these data , ICCs were inversely related to cluster size , but design effects could be substantial when the cluster size was large . Most ICCs were below 0.01 at the district health authority level , and they were mostly below 0.05 at the postal code sector level . At the household level , many ICCs were in the range of 0.0 - 0.3 . These data may provide useful information for the design of epidemiologic studies in which the units sample d or allocated range in size from households to large administrative areas OBJECTIVE This study examined the use of a uniquely design ed Web site and home computers to deliver online multifamily psychoeducational therapy to persons with schizophrenia and their informal supports ( family and friends ) . Web site usage and outcome benefits are reported . METHODS Thirty-one persons with schizophrenia or schizoaffective disorder and 24 support persons were r and omly assigned to the online intervention ( telehealth ) or treatment as usual ( usual care ) condition . At three , six , and 12 months , interviewer-administered assessment s were conducted with participants . Intention-to-treat analyses compared persons with schizophrenia in the two study conditions on severity of positive symptoms and knowledge of schizophrenia . Support persons in the two study conditions were compared on knowledge of schizophrenia . Each participant 's usage of the Web site was logged . RESULTS Persons with schizophrenia in the telehealth condition had a large and significant reduction in positive symptoms ( p=.042 , d=-.88 ) and a large and significant increase in knowledge of schizophrenia compared with their counterparts in the usual care condition . Support persons in the telehealth condition showed a large and significant increase in knowledge about prognosis compared with those in the usual care condition ( p=.036 , d=1.94 ) . Persons with schizophrenia used the Web site to a much greater extent ( pages viewed and time spent ) than support persons . CONCLUSIONS These findings suggest that online delivery of psychotherapeutic treatment and educational re sources to consumers ' homes has considerable potential to improve consumer well-being and offers several advantages over st and ard clinic-based delivery models Although social skills training ( SST ) is an effective approach for improving social skills for schizophrenia , the motivational deficit attenuates its efficacy . Virtual reality ( VR ) applications have allowed individuals with mental disabilities to enhance their motivation for rehabilitation . We compared SST using VR role-playing ( SST-VR ) to SST using traditional role-playing ( SST-TR ) . This r and omized , controlled trial included 91 in patients with schizophrenia who were assigned to either  SST-VR ( n=46 ) or SST-TR ( n=45 ) . Both groups were administered over 10 semiweekly group sessions . An experienced , blinded rater assessed vocal , nonverbal and conversational skills . We also obtained data on motivation for SST and various social abilities . Throughout the 10 sessions , the SST-VR group ( n=33 ) showed greater interest in SST and generalization of the skills than the SST-TR group ( n=31 ) . After SST , the SST-VR group improved more in conversational skills and assertiveness than the SST-TR group , but less in nonverbal skills . The VR application in role-plays of SST for schizophrenia may be particularly beneficial in terms of improving the conversational skills and assertiveness , possibly through its advantages in enhancing motivation for SST and generalization of the skills , and thus it may be a useful supplement to traditional SST BACKGROUND It has been difficult to improve care for severe mental illness ( SMI ) in usual care setting s because clinical information is not reliably and efficiently managed . Methods are needed for efficiently collecting this information to evaluate and improve health care quality . Audio computer-assisted self-interviewing ( ACASI ) can facilitate this data collection and has improved outcomes for a number of disorders , suggesting the need to test its accuracy and reliability in people with SMI . METHOD Ninety patients with DSM-IV schizophrenia or schizoaffective disorder ( N = 45 ) or bipolar disorder ( N = 45 ) recruited between Oct. 15 , 2002 , and July 1 , 2003 , were r and omly assigned to 1 of 2 study groups and completed 2 st and ardized symptom surveys ( Revised Behavior and Symptom Identification Scale and the symptom severity scale of the Schizop 
    Output:
    
There is no clear good quality evidence for or against using virtual reality for treatment compliance among people with serious mental illness .