@article{onita_autonomic_2025,

title = {Autonomic and Neuroendocrine Reactivity to VR Game Exposure in Children and Adolescents with Obesity: A Factor Analytic Approach to Physiological Reactivity and Eating Behavior},

author = {C. A. Onita and D. -V. Matei and L. -M. Trandafir and D. Petrescu-Miron and C. Corciova and R. Fuior and L. -M. Manole and B. -M. Mihai and C. -G. Dascalu and M. Tarcea and S. Bouchard and V. Mocanu},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-105013574948&doi=10.3390%2Fnu17152492&partnerID=40&md5=d1e974dae00d424b9f6fae86b8a7cc6a},

doi = {10.3390/nu17152492},

issn = {20726643 (ISSN)},

year  = {2025},

date = {2025-01-01},

journal = {Nutrients},

volume = {17},

number = {15},

abstract = {Background/Objectives: The aim was to identify patterns of autonomic and neuroendocrine reactivity to an immersive virtual reality (VR) social-emotional stressor and explore their associations with perceived stress and eating behavior. Methods: This one-group pretest–posttest study included 30 children and adolescents with obesity (15 boys and 15 girls), aged 8 to 17 years. The VR protocol consisted of two consecutive phases: a 5 min relaxation phase using the Forest application and a 5 min stimulation phase using a cognitively engaging VR game designed to elicit social-emotional stress. Physiological responses were measured using heart rate variability (HRV) indices and salivary stress biomarkers, including cortisol and alpha amylase. Subjective stress and eating responses were assessed via visual analogue scales (VAS) administered immediately post-exposure. The Three-Factor Eating Questionnaire (TFEQ-R21C) was used to evaluate cognitive restraint (CR), uncontrolled eating (UE), and emotional eating (EE). Results: The cortisol reactivity was blunted and may reflect both the attenuated HPA axis responsiveness characteristic of pediatric obesity and the moderate psychological challenge of the VR stressor used in this study. Two distinct autonomic response patterns were identified via exploratory factor analysis: (1) parasympathetic reactivity, associated with increased RMSSD and SDNN and decreased LF/HF, and (2) sympathetic activation, associated with increased heart rate and alpha-amylase levels and reduced RR intervals. Parasympathetic reactivity was correlated with lower perceived stress and anxiety, but also paradoxically with higher uncontrolled eating (UE). In contrast, sympathetic activation was associated with greater cognitive restraint (CR) and higher anxiety ratings. Conclusions: This study demonstrates that immersive VR game exposure elicits measurable autonomic and subjective stress responses in children and adolescents with obesity, and that individual differences in physiological reactivity are relevantly associated with eating behavior traits. The findings suggest that parasympathetic and sympathetic profiles may represent distinct behavioral patterns with implications for targeted intervention. © 2025 by the authors.},

keywords = {Adolescent, adolescent obesity, alpha amylase saliva isoenzyme, alpha-Amylases, amylase, anthropometry, anxiety assessment, appetite, article, Autonomic Nervous System, autonomic nervous system function, chemistry, Child, childhood obesity, clinical article, controlled study, craving, eating behavior, Electrophysiology, emotional eating, emotional stress, exploratory factor analysis, Factor Analysis, feeding behavior, female, Heart Rate, heart rate variability, human, Humans, Hydrocortisone, hypothalamus hypophysis adrenal system, immersive VR game, male, mental stress, metabolism, neuroendocrine system, Neurosecretory Systems, pathophysiology, Pediatric Obesity, physiology, Psychological, psychology, Saliva, salivary alpha-amylase, salivary cortisol, social stress, Statistical, Stress, stress assessment, subjective stress, three-factor eating questionnaire (TFEQ), Three-Factor-Eating-Questionnaire, video game, Video Games, virtual reality, virtual reality exposure therapy, visual analog scale},

pubstate = {published},

tppubtype = {article}

}

@article{quintana_engaging_2023,

title = {Engaging in Awkward Social Interactions in a Virtual Environment Designed for Exposure-Based Psychotherapy for People with Generalized Social Anxiety Disorder: An International Multisite Study},

author = {P. Quintana and S. Bouchard and C. Botella and G. Robillard and B. Serrano and A. Rodriguez-Ortega and M. Torp Ernst and B. Rey and M. Berthiaume and G. Corno},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85165033932&doi=10.3390%2fjcm12134525&partnerID=40&md5=7b0f59b46ff7680611d5a64e18909651},

doi = {10.3390/jcm12134525},

issn = {20770383 (ISSN)},

year  = {2023},

date = {2023-01-01},

journal = {Journal of Clinical Medicine},

volume = {12},

number = {13},

publisher = {Multidisciplinary Digital Publishing Institute (MDPI)},

abstract = {The effectiveness of in virtuo exposure-based treatment of performance-only social anxiety disorder (SAD) has been demonstrated in several studies. However, few studies have validated virtual environments with participants suffering from generalized SAD. The goal of this study is to confirm the potential of a virtual environment in inducing anxiety in adults suffering from generalized SAD, compared to adults without SAD, when engaged in awkward social interactions. Differences between participants from two different countries were also explored. The sample consisted of 15 participants with SAD from Canada, 17 participants without SAD from Canada, 16 participants with SAD from Spain, and 21 participants without SAD from Spain. All participants were immersed in a control virtual environment and in an experimental virtual environment considered potentially anxiety-inducing for individuals with generalized SAD. As hypothesized, results showed that the experimental virtual environment induced a higher level of anxiety than the control environment among participants with SAD compared to those without SAD. The impact on anxiety of each socially threatening task performed during the experimental immersion was statistically significant. In terms of anxiety responses, no significant differences were found between participants from Canada and Spain. However, spatial presence and ecological validity were higher in Canadians than in Spaniards. Unwanted negative side effects induced by immersions in virtual reality were higher in the SAD group. This study highlights the importance for therapists to engage people with SAD in clinically relevant tasks while immersed in VR psychotherapeutic applications. © 2023 by the authors.},

note = {Publisher: Multidisciplinary Digital Publishing Institute (MDPI)},

keywords = {adult, anxiety assessment, article, Canada, clinical article, controlled study, cultural differences, ecological validity, exposure, female, generalized social anxiety, human, immersion, male, multicenter study, psychotherapy, self report, social anxiety, social interaction, social phobia, Spain, virtual reality, virtual reality exposure therapy},

pubstate = {published},

tppubtype = {article}

}

@article{maiano_validation_2023,

title = {Validation of an Adapted Version of the Glasgow Anxiety Scale for People with Intellectual Disabilities (GAS-ID)},

author = {C. Maïano and A. J. S. Morin and C. Gagnon and E. Olivier and D. Tracey and R. G. Craven and S. Bouchard},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85125069450&doi=10.1007%2fs10803-021-05398-7&partnerID=40&md5=7347eb15e719941ce5eca046eb7f4564},

doi = {10.1007/s10803-021-05398-7},

issn = {01623257},

year  = {2023},

date = {2023-01-01},

journal = {Journal of Autism and Developmental Disorders},

volume = {53},

number = {4},

pages = {1560–1572},

publisher = {Springer},

abstract = {The objective of the study was to validate adapted versions of the Glasgow Anxiety Scale for people with Intellectual Disabilities (GAS-ID) simultaneously developed in English and French. A sample of 361 youth with mild to moderate intellectual disability (ID) (M = 15.78 years) from Australia (English-speaking) and Canada (French-speaking) participated in this study. The results supported the factor validity and reliability, measurement invariance (between English and French versions), a lack of differential items functioning (as a function of youth’s age and ID level, but not sex in the English-Australian sample), temporal stability (over one year interval), and convergent validity (with global self-esteem and school loneliness) of a bi-factor exploratory structural equation modeling representation of the GAS-ID. The present study supports the psychometric properties of the English-Australian and French-Canadian versions of the adapted GAS-ID. © 2022, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.},

note = {Publisher: Springer},

keywords = {Adolescent, adult, Anxiety, anxiety assessment, article, Australia, autism, Autism Spectrum Disorder, Canada, Child, confirmatory factor analysis, controlled study, convergent validity, emotion assessment, English (language), exploratory structural equation modeling, female, French (language), glasgow anxiety scale, human, Humans, instrument validation, Intellectual Disability, intellectual impairment, intelligence quotient, loneliness, major clinical study, male, Psychometrics, psychometry, reliability, reproducibility, Reproducibility of Results, school child, school loneliness scale, self description questionnaire 1, self esteem, self report, self-concept assessment, statistical analysis, validity, Young Adult},

pubstate = {published},

tppubtype = {article}

}

@article{orskov_cognitive_2022,

title = {Cognitive behavioral therapy with adaptive virtual reality exposure vs. cognitive behavioral therapy with in vivo exposure in the treatment of social anxiety disorder: A study protocol for a randomized controlled trial},

author = {P. T. Ørskov and M. B. Lichtenstein and M. T. Ernst and I. Fasterholdt and A. F. Matthiesen and M. Scirea and S. Bouchard and T. E. Andersen},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85140322564&doi=10.3389%2ffpsyt.2022.991755&partnerID=40&md5=1dacd4e05081f4790ccd5e0d7224e0ca},

doi = {10.3389/fpsyt.2022.991755},

issn = {16640640 (ISSN)},

year  = {2022},

date = {2022-01-01},

journal = {Frontiers in Psychiatry},

volume = {13},

publisher = {Frontiers Media S.A.},

abstract = {Background: Social anxiety disorder (SAD) has a high prevalence and an early onset with recovery taking decades to occur. Current evidence supports the efficacy of cognitive behavioral therapy (CBT) with virtual reality (VR) exposure. However, the evidence is based on a sparse number of studies with predominantly small sample sizes. There is a need for more trials investigating the optimal way of applying VR based exposure for SAD. In this trial, we will test the efficacy of CBT with adaptive VR exposure allowing adjustment of the exposure based on real-time monitoring of the participants's anxiety level. Methods: The trial is a randomized controlled, assessor-blinded, parallel-group superiority trail. The study has two arms: (1) CBT including exposure in vivo (CBT-Exp), (2) CBT including exposure therapy using individually tailored VR-content and a system to track anxiety levels (CBT-ExpVR). Treatment is individual, manual-based and consists of 10 weekly sessions with a duration of 60 min. The study includes 90 participants diagnosed with SAD. Assessments are carried out pre-treatment, mid-treatment and at follow-up (6 and 12 months). The primary outcome is the mean score on the Social Interaction Anxiety Scale (SIAS) with the primary endpoint being post-treatment. Discussion: The study adds to the existing knowledge by assessing the efficacy of CBT with adaptive VR exposure. The study has high methodological rigor using a randomized controlled trial with a large sample size that includes follow-up data and validated measures for social anxiety outcomes. Clinical trial registration: ClinicalTrials.gov, identifier: NCT05302518. Copyright © 2022 Ørskov, Lichtenstein, Ernst, Fasterholdt, Matthiesen, Scirea, Bouchard and Andersen.},

note = {Publisher: Frontiers Media S.A.},

keywords = {adult, aged, Alcohol Use Disorders Identification Test, anxiety assessment, Anxiety disorder, article, behavior disorder assessment, cognitive behavioral therapy, comparative effectiveness, controlled study, Depression, Drug Use Disorders Identification Test, electrodermal activity, exposure, Fear of Negative Evaluation, follow up, health economics, Heart Rate, human, Leibowitz Anxiety Scale, Machine learning, major clinical study, psychological distress assessment, psychophysiological measurements, randomized controlled trial, Simulator Sickness Questionnaire, social anxiety, Social Interaction Anxiety Scale, social phobia, Subjective Units of Distress Scale, therapy effect, treatment duration, treatment outcome, virtual reality, virtual reality exposure therapy, Working Alliance Inventory},

pubstate = {published},

tppubtype = {article}

}

@article{moise-richard_real_2021,

title = {Real and virtual classrooms can trigger the same levels of stuttering severity ratings and anxiety in school-age children and adolescents who stutter},

author = {A. Moïse-Richard and L. Ménard and S. Bouchard and A. -L. Leclercq},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85101691118&doi=10.1016%2fj.jfludis.2021.105830&partnerID=40&md5=e05dd193c76b1bad1d453aad4d87cc51},

doi = {10.1016/j.jfludis.2021.105830},

issn = {0094730X},

year  = {2021},

date = {2021-01-01},

journal = {Journal of Fluency Disorders},

volume = {68},

publisher = {Elsevier Inc.},

abstract = {Purpose: Many school-age children and adolescents who stutter experience the fear of public speaking. Treatment implications include the need to address this problem. However, it is not always possible to train repeatedly in front of a real audience. The present study aimed to assess the relevance of using a virtual classroom in clinical practice with school-age children and adolescents who stutter. Methods: Ten children and adolescents who stutter (aged 9–17 years old) had to speak in three different situations: in front of a real audience, in front of a virtual class and in an empty virtual apartment using a head-mounted display. We aimed to assess whether the self-rated levels of anxiety while speaking in front of a virtual audience reflect the levels of anxiety reported while speaking in front of a live audience, and if the stuttering level while speaking to a virtual class reflects the stuttering level while speaking in real conditions. Results: Results show that the real audience creates higher anticipatory anxiety than the virtual class. However, both the self-reported anxiety levels and the stuttering severity ratings when talking in front of a virtual class did not differ from those observed when talking to a real audience, and were significantly higher than when talking in an empty virtual apartment. Conclusion: Our results support the feasibility and relevance of using a virtual classroom to expose school-age children and adolescents who stutter to a feared situation during cognitive behavioral therapy targeting the fear of public speaking. © 2021 Elsevier Inc.},

note = {Publisher: Elsevier Inc.},

keywords = {Adolescent, anticipatory anxiety, Anxiety, anxiety assessment, Anxiety disorder, Anxiety Disorders, article, Child, clinical article, controlled study, disease severity, female, human, Humans, male, psychological rating scale, Public speaking, school, school child, Schools, self report, software, speech, Stuttering, virtual learning environment},

pubstate = {published},

tppubtype = {article}

}

@article{guitard_exposure_2019,

title = {Exposure to a standardized catastrophic scenario in virtual reality or a personalized scenario in imagination for Generalized Anxiety Disorder},

author = {T. Guitard and S. Bouchard and C. Bélanger and M. Berthiaume},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85073896961&doi=10.3390%2fjcm8030309&partnerID=40&md5=b80f2e6602416c35dd8e36fd8b19c803},

doi = {10.3390/jcm8030309},

issn = {20770383 (ISSN)},

year  = {2019},

date = {2019-01-01},

journal = {Journal of Clinical Medicine},

volume = {8},

number = {3},

publisher = {MDPI},

abstract = {The cognitive behavioral treatment of generalized anxiety disorder (GAD) often involves exposing patients to a catastrophic scenario depicting their most feared worry. The aim of this study was to examine whether a standardized scenario recreated in virtual reality (VR) would elicit anxiety and negative affect and how it compared to the traditional method of imagining a personalized catastrophic scenario. A sample of 28 participants were first exposed to a neutral non-catastrophic scenario and then to a personalized scenario in imagination or a standardized virtual scenario presented in a counterbalanced order. The participants completed questionnaires before and after each immersion. The results suggest that the standardized virtual scenario induced significant anxiety. No difference was found when comparing exposure to the standardized scenario in VR and exposure to the personalized scenario in imagination. These findings were specific to anxiety and not to the broader measure of negative affect. Individual differences in susceptibility to feel present in VR was a significant predictor of increase in anxiety and negative affect. Future research could use these scenarios to conduct a randomized control trial to test the efficacy and cost/benefits of using VR in the treatment of GAD. © 2019 by the authors. Licensee MDPI, Basel, Switzerland.},

note = {Publisher: MDPI},

keywords = {adult, anxiety assessment, article, avoidance behavior, clinical article, cognitive avoidance questionnaire, cognitive behavioral therapy, Cognitive exposure, disease severity, DSM-IV, Exposure in virtual reality, fatigue, female, gatineau presence questionnaire, generalized anxiety disorder, Generalized Anxiety Disorder (GAD), human, human experiment, imagination, immersive tendencies questionnaire, Likert scale, male, Middle Aged, mini international neuropsychiatric interview, penn state worry questionnaire, Personalized scenario, Positive and Negative Affect Schedule, Positive and Negative Syndrome Scale, Presence Questionnaire, psychotherapy, questionnaire, Simulator Sickness Questionnaire, Standardized scenario, task performance, test retest reliability, time series analysis, virtual reality},

pubstate = {published},

tppubtype = {article}

}