Virtual Reality Exposure Therapy is extremely safe for the general population. A small percentage of the population may experience motion sickness (nausea, vomiting, ataxia, disorientation, eye strain and vertigo) due to “sensory cue incongruity”. That is due to differences between what they are perceiving in the virtual environment being different from what their body is experiencing. However, it should be noted that improvements in the lag time between the virtual images and head movements have reduced these side effects for many people.
There are some issues and disorders that are contraindicated for this type of procedure (see below for contraindications). Please read through the following list of medical conditions. Please answer “yes” or “no” for each item. If you’ve been diagnosed with or believe you suffer from any of the following medical conditions,please inform Dr. Howard Gurr.
Clients diagnosed with any of the following conditions are contraindicated and therefore should NOT use Virtual Reality Therapy.
__An infectious disease
__Severe Motion Sickness or Vertigo
__Extreme vison or hearing impairment
__Agitated Depression
__Psychosis
__ Schizophrenia
__ Borderline Personality Disorder
__Unstable Dissociative Disorder
__Acute or Chronic Brain Syndromes
__Seizure Disorder
__Dementia
__Delirium
__Attempted Suicide
__Epilepsy
If you have any further questions, please ask Dr. Howard Gurr before indicating your acceptance by signing this consent form.
Consent
I have read, or had read to me, and understand the information provided to me by Dr. Howard Gurr
Signed: ________________________________________________
Date: _____/_____/_____