Slide
Centre Interdisciplinaire
de Recherche et d’Innovation
en Cybersécurité et Société
de Recherche et d’Innovation
en Cybersécurité et Société
1.
António, H.; Albuquerque, S.; de Castro, M. Vieira; Bouchard, S.; Gamito, P.; Pinto, R. J.
In: Psychiatry International, vol. 7, no. 4, 2026, ISSN: 26735318 (ISSN).
Abstract | Links | BibTeX | Tags: adult, Anxiety, article, cross-sectional study, decision making, Depression, DSM-5, female, Global Severity Index, hostility, human, human experiment, Latent Class Analysis, LEC-5, major clinical study, male, paranoia, phobia, police, Positive symptom distress index, Positive symptom total, posttraumatic stress disorder, posttraumatic stress disorder checklist, Proximal Traumatic Exposure, psychological distress, psychosis, PTSD, questionnaire, receiver operating characteristic, Security, security professionals, self report, sociodemographics, trauma exposure
@article{antonioLatentClassesProximal2026,
title = {Latent Classes of Proximal Traumatic Exposure Among Portuguese Police and Security Professionals: Associations with PTSD Symptoms and Psychological Distress},
author = {H. António and S. Albuquerque and M. Vieira de Castro and S. Bouchard and P. Gamito and R. J. Pinto},
url = {https://www.scopus.com/pages/publications/105048524559?origin=resultslist},
doi = {10.3390/psychiatryint7040173},
issn = {26735318 (ISSN)},
year = {2026},
date = {2026-01-01},
journal = {Psychiatry International},
volume = {7},
number = {4},
publisher = {Multidisciplinary Digital Publishing Institute (MDPI)},
abstract = {Background: Police and security professionals are routinely exposed to potentially traumatic events as part of occupational duties, placing them at increased risk for post-traumatic stress and broader psychological difficulties. This study aimed to identify latent classes of proximal traumatic exposure among Portuguese police/security professionals and examine their associations with PTSD symptoms and general psychological distress. Methods: A cross-sectional online survey was conducted with Portuguese police/security professionals (N = 644). Latent class analysis (LCA) was applied to 17 indicators of potentially traumatic events coded as directly experienced or witnessed, derived from the Life Events Checklist for DSM-5. PTSD symptoms were assessed using the PTSD Checklist for DSM-5, and general psychological distress was assessed using the Brief Symptom Inventory. Exploratory receiver operating characteristic (ROC) analyses examined whether counts of proximal traumatic events could approximate the LCA-derived classes. Results: A three-class solution was identified, comprising low proximal exposure (37.3%), moderate proximal exposure (40.7%), and high proximal/cumulative exposure (22.0%) classes. The classes reflected a graded cumulative pattern of exposure across traumatic event categories, rather than clearly distinct qualitative configurations defined by specific event types. Higher exposure classes were associated with progressively higher PTSD symptoms and psychological distress, and these associations remained significant after adjustment for sociodemographic and occupational variables. Exploratory receiver operating characteristic (ROC) analyses showed that a simple count of proximal traumatic event categories closely approximated the empirically derived class structure within the present sample. However, the resulting thresholds are sample-specific, exploratory, and should not be interpreted as validated screening cutoffs. Conclusions: Proximal traumatic exposure among police/security professionals appears to follow a graded cumulative structure associated with increased PTSD symptoms and psychological distress. The person-centered analysis provided an empirical test of whether exposure was organized according to qualitatively distinct event configurations or primarily along a cumulative gradient. In this sample, cumulative exposure burden emerged as the dominant organizing dimension. The count-based approximation requires external validation before any screening or decision-making application can be considered. © 2026 by the authors.},
keywords = {adult, Anxiety, article, cross-sectional study, decision making, Depression, DSM-5, female, Global Severity Index, hostility, human, human experiment, Latent Class Analysis, LEC-5, major clinical study, male, paranoia, phobia, police, Positive symptom distress index, Positive symptom total, posttraumatic stress disorder, posttraumatic stress disorder checklist, Proximal Traumatic Exposure, psychological distress, psychosis, PTSD, questionnaire, receiver operating characteristic, Security, security professionals, self report, sociodemographics, trauma exposure},
pubstate = {published},
tppubtype = {article}
}
Background: Police and security professionals are routinely exposed to potentially traumatic events as part of occupational duties, placing them at increased risk for post-traumatic stress and broader psychological difficulties. This study aimed to identify latent classes of proximal traumatic exposure among Portuguese police/security professionals and examine their associations with PTSD symptoms and general psychological distress. Methods: A cross-sectional online survey was conducted with Portuguese police/security professionals (N = 644). Latent class analysis (LCA) was applied to 17 indicators of potentially traumatic events coded as directly experienced or witnessed, derived from the Life Events Checklist for DSM-5. PTSD symptoms were assessed using the PTSD Checklist for DSM-5, and general psychological distress was assessed using the Brief Symptom Inventory. Exploratory receiver operating characteristic (ROC) analyses examined whether counts of proximal traumatic events could approximate the LCA-derived classes. Results: A three-class solution was identified, comprising low proximal exposure (37.3%), moderate proximal exposure (40.7%), and high proximal/cumulative exposure (22.0%) classes. The classes reflected a graded cumulative pattern of exposure across traumatic event categories, rather than clearly distinct qualitative configurations defined by specific event types. Higher exposure classes were associated with progressively higher PTSD symptoms and psychological distress, and these associations remained significant after adjustment for sociodemographic and occupational variables. Exploratory receiver operating characteristic (ROC) analyses showed that a simple count of proximal traumatic event categories closely approximated the empirically derived class structure within the present sample. However, the resulting thresholds are sample-specific, exploratory, and should not be interpreted as validated screening cutoffs. Conclusions: Proximal traumatic exposure among police/security professionals appears to follow a graded cumulative structure associated with increased PTSD symptoms and psychological distress. The person-centered analysis provided an empirical test of whether exposure was organized according to qualitatively distinct event configurations or primarily along a cumulative gradient. In this sample, cumulative exposure burden emerged as the dominant organizing dimension. The count-based approximation requires external validation before any screening or decision-making application can be considered. © 2026 by the authors.
2.
Scholten, W.; Seldenrijk, A.; Hoogendoorn, A.; Bosman, R.; Muntingh, A.; Karyotaki, E.; Andersson, G.; Berger, T.; Carlbring, P.; Furmark, T.; Bouchard, S.; Goldin, P.; Kampmann, I.; Morina, N.; Kocovski, N.; Leibing, E.; Leichsenring, F.; Stolz, T.; Balkom, A. Van; Batelaan, N.
In: JAMA Psychiatry, vol. 80, no. 8, pp. 822–831, 2023, ISSN: 2168622X (ISSN), (Publisher: American Medical Association).
Abstract | Links | BibTeX | Tags: adult, antidepressant agent, Anxiety disorder, article, avoidant personality disorder, clinical outcome, cognitive behavioral therapy, comorbidity, cycloserine, Depression, disease severity, female, hospital admission, human, Humans, Liebowitz Social Anxiety Scale, male, meta analysis, paroxetine, phobia, Preferred Reporting Items for Systematic Reviews and Meta-Analyses, procedures, psychotropic agent, randomized controlled trial (topic), Randomized Controlled Trials as Topic, semi structured interview, Social, social anxiety, social phobia, Structured Clinical Interview for DSM Disorders, symptom, systematic review, treatment response, Waiting Lists
@article{scholten_baseline_2023,
title = {Baseline Severity as a Moderator of the Waiting List-Controlled Association of Cognitive Behavioral Therapy with Symptom Change in Social Anxiety Disorder: A Systematic Review and Individual Patient Data Meta-analysis},
author = {W. Scholten and A. Seldenrijk and A. Hoogendoorn and R. Bosman and A. Muntingh and E. Karyotaki and G. Andersson and T. Berger and P. Carlbring and T. Furmark and S. Bouchard and P. Goldin and I. Kampmann and N. Morina and N. Kocovski and E. Leibing and F. Leichsenring and T. Stolz and A. Van Balkom and N. Batelaan},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85166386036&doi=10.1001%2fjamapsychiatry.2023.1291&partnerID=40&md5=c279c8b0ff2d3b4558c6f8803cdda0af},
doi = {10.1001/jamapsychiatry.2023.1291},
issn = {2168622X (ISSN)},
year = {2023},
date = {2023-01-01},
journal = {JAMA Psychiatry},
volume = {80},
number = {8},
pages = {822–831},
publisher = {American Medical Association},
abstract = {Importance: Social anxiety disorder (SAD) can be adequately treated with cognitive behavioral therapy (CBT). However, there is a large gap in knowledge on factors associated with prognosis, and it is unclear whether symptom severity predicts response to CBT for SAD. Objective: To examine baseline SAD symptom severity as a moderator of the association between CBT and symptom change in patients with SAD. Data Sources: For this systematic review and individual patient data meta-analysis (IPDMA), PubMed, PsycInfo, Embase, and the Cochrane Library were searched from January 1, 1990, to January 13, 2023. Primary search topics were social anxiety disorder, cognitive behavior therapy, and randomized controlled trial. Study Selection: Inclusion criteria were randomized clinical trials comparing CBT with being on a waiting list and using the Liebowitz Social Anxiety Scale (LSAS) in adults with a primary clinical diagnosis of SAD. Data Extraction and Synthesis: Authors of included studies were approached to provide individual-level data. Data were extracted by pairs of authors following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline, and risk of bias was assessed using the Cochrane tool. An IPDMA was conducted using a 2-stage approach for the association of CBT with change in LSAS scores from baseline to posttreatment and for the interaction effect of baseline LSAS score by condition using random-effects models. Main Outcomes and Measures: The main outcome was the baseline to posttreatment change in symptom severity measured by the LSAS. Results: A total of 12 studies including 1246 patients with SAD (mean [SD] age, 35.3 [10.9] years; 738 [59.2%] female) were included in the meta-analysis. A waiting list-controlled association between CBT and pretreatment to posttreatment LSAS change was found (b = -20.3; 95% CI, -24.9 to -15.6; P <.001; Cohen d = -0.95; 95% CI, -1.16 to -0.73). Baseline LSAS scores moderated the differences between CBT and waiting list with respect to pretreatment to posttreatment symptom reductions (b = -0.22; 95% CI, -0.39 to -0.06; P =.009), indicating that individuals with severe symptoms had larger waiting list-controlled symptom reductions after CBT (Cohen d = -1.13 [95% CI, -1.39 to -0.88] for patients with very severe SAD; Cohen d = -0.54 [95% CI, -0.80 to -0.29] for patients with mild SAD). Conclusions and Relevance: In this systematic review and IPDMA, higher baseline SAD symptom severity was associated with greater (absolute but not relative) symptom reductions after CBT in patients with SAD. The findings contribute to personalized care by suggesting that clinicians can confidently offer CBT to individuals with severe SAD symptoms.. © 2023 American Medical Association. All rights reserved.},
note = {Publisher: American Medical Association},
keywords = {adult, antidepressant agent, Anxiety disorder, article, avoidant personality disorder, clinical outcome, cognitive behavioral therapy, comorbidity, cycloserine, Depression, disease severity, female, hospital admission, human, Humans, Liebowitz Social Anxiety Scale, male, meta analysis, paroxetine, phobia, Preferred Reporting Items for Systematic Reviews and Meta-Analyses, procedures, psychotropic agent, randomized controlled trial (topic), Randomized Controlled Trials as Topic, semi structured interview, Social, social anxiety, social phobia, Structured Clinical Interview for DSM Disorders, symptom, systematic review, treatment response, Waiting Lists},
pubstate = {published},
tppubtype = {article}
}
Importance: Social anxiety disorder (SAD) can be adequately treated with cognitive behavioral therapy (CBT). However, there is a large gap in knowledge on factors associated with prognosis, and it is unclear whether symptom severity predicts response to CBT for SAD. Objective: To examine baseline SAD symptom severity as a moderator of the association between CBT and symptom change in patients with SAD. Data Sources: For this systematic review and individual patient data meta-analysis (IPDMA), PubMed, PsycInfo, Embase, and the Cochrane Library were searched from January 1, 1990, to January 13, 2023. Primary search topics were social anxiety disorder, cognitive behavior therapy, and randomized controlled trial. Study Selection: Inclusion criteria were randomized clinical trials comparing CBT with being on a waiting list and using the Liebowitz Social Anxiety Scale (LSAS) in adults with a primary clinical diagnosis of SAD. Data Extraction and Synthesis: Authors of included studies were approached to provide individual-level data. Data were extracted by pairs of authors following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline, and risk of bias was assessed using the Cochrane tool. An IPDMA was conducted using a 2-stage approach for the association of CBT with change in LSAS scores from baseline to posttreatment and for the interaction effect of baseline LSAS score by condition using random-effects models. Main Outcomes and Measures: The main outcome was the baseline to posttreatment change in symptom severity measured by the LSAS. Results: A total of 12 studies including 1246 patients with SAD (mean [SD] age, 35.3 [10.9] years; 738 [59.2%] female) were included in the meta-analysis. A waiting list-controlled association between CBT and pretreatment to posttreatment LSAS change was found (b = -20.3; 95% CI, -24.9 to -15.6; P <.001; Cohen d = -0.95; 95% CI, -1.16 to -0.73). Baseline LSAS scores moderated the differences between CBT and waiting list with respect to pretreatment to posttreatment symptom reductions (b = -0.22; 95% CI, -0.39 to -0.06; P =.009), indicating that individuals with severe symptoms had larger waiting list-controlled symptom reductions after CBT (Cohen d = -1.13 [95% CI, -1.39 to -0.88] for patients with very severe SAD; Cohen d = -0.54 [95% CI, -0.80 to -0.29] for patients with mild SAD). Conclusions and Relevance: In this systematic review and IPDMA, higher baseline SAD symptom severity was associated with greater (absolute but not relative) symptom reductions after CBT in patients with SAD. The findings contribute to personalized care by suggesting that clinicians can confidently offer CBT to individuals with severe SAD symptoms.. © 2023 American Medical Association. All rights reserved.
3.
Scholten, W.; Seldenrijk, A.; Hoogendoorn, A.; Bosman, R.; Muntingh, A.; Karyotaki, E.; Andersson, G.; Berger, T.; Carlbring, P.; Furmark, T.; Bouchard, S.; Goldin, P.; Kampmann, I.; Morina, N.; Kocovski, N.; Leibing, E.; Leichsenring, F.; Stolz, T.; Balkom, A. Van; Batelaan, N.
In: JAMA Psychiatry, vol. 80, no. 8, pp. 822–831, 2023, ISSN: 2168622X (ISSN).
Abstract | Links | BibTeX | Tags: adult, antidepressant agent, Anxiety disorder, article, avoidant personality disorder, clinical outcome, cognitive behavioral therapy, comorbidity, cycloserine, Depression, disease severity, female, hospital admission, human, Humans, Liebowitz Social Anxiety Scale, male, meta analysis, paroxetine, phobia, Preferred Reporting Items for Systematic Reviews and Meta-Analyses, procedures, psychotropic agent, randomized controlled trial (topic), Randomized Controlled Trials as Topic, semi structured interview, Social, social anxiety, social phobia, Structured Clinical Interview for DSM Disorders, symptom, systematic review, treatment response, Waiting Lists
@article{scholtenBaselineSeverityModerator2023,
title = {Baseline Severity as a Moderator of the Waiting List-Controlled Association of Cognitive Behavioral Therapy with Symptom Change in Social Anxiety Disorder: A Systematic Review and Individual Patient Data Meta-analysis},
author = {W. Scholten and A. Seldenrijk and A. Hoogendoorn and R. Bosman and A. Muntingh and E. Karyotaki and G. Andersson and T. Berger and P. Carlbring and T. Furmark and S. Bouchard and P. Goldin and I. Kampmann and N. Morina and N. Kocovski and E. Leibing and F. Leichsenring and T. Stolz and A. Van Balkom and N. Batelaan},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85166386036&doi=10.1001%2fjamapsychiatry.2023.1291&partnerID=40&md5=c279c8b0ff2d3b4558c6f8803cdda0af},
doi = {10.1001/jamapsychiatry.2023.1291},
issn = {2168622X (ISSN)},
year = {2023},
date = {2023-01-01},
journal = {JAMA Psychiatry},
volume = {80},
number = {8},
pages = {822–831},
publisher = {American Medical Association},
abstract = {Importance: Social anxiety disorder (SAD) can be adequately treated with cognitive behavioral therapy (CBT). However, there is a large gap in knowledge on factors associated with prognosis, and it is unclear whether symptom severity predicts response to CBT for SAD. Objective: To examine baseline SAD symptom severity as a moderator of the association between CBT and symptom change in patients with SAD. Data Sources: For this systematic review and individual patient data meta-analysis (IPDMA), PubMed, PsycInfo, Embase, and the Cochrane Library were searched from January 1, 1990, to January 13, 2023. Primary search topics were social anxiety disorder, cognitive behavior therapy, and randomized controlled trial. Study Selection: Inclusion criteria were randomized clinical trials comparing CBT with being on a waiting list and using the Liebowitz Social Anxiety Scale (LSAS) in adults with a primary clinical diagnosis of SAD. Data Extraction and Synthesis: Authors of included studies were approached to provide individual-level data. Data were extracted by pairs of authors following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline, and risk of bias was assessed using the Cochrane tool. An IPDMA was conducted using a 2-stage approach for the association of CBT with change in LSAS scores from baseline to posttreatment and for the interaction effect of baseline LSAS score by condition using random-effects models. Main Outcomes and Measures: The main outcome was the baseline to posttreatment change in symptom severity measured by the LSAS. Results: A total of 12 studies including 1246 patients with SAD (mean [SD] age, 35.3 [10.9] years; 738 [59.2%] female) were included in the meta-analysis. A waiting list-controlled association between CBT and pretreatment to posttreatment LSAS change was found (b = -20.3; 95% CI, -24.9 to -15.6; P <.001; Cohen d = -0.95; 95% CI, -1.16 to -0.73). Baseline LSAS scores moderated the differences between CBT and waiting list with respect to pretreatment to posttreatment symptom reductions (b = -0.22; 95% CI, -0.39 to -0.06; P =.009), indicating that individuals with severe symptoms had larger waiting list-controlled symptom reductions after CBT (Cohen d = -1.13 [95% CI, -1.39 to -0.88] for patients with very severe SAD; Cohen d = -0.54 [95% CI, -0.80 to -0.29] for patients with mild SAD). Conclusions and Relevance: In this systematic review and IPDMA, higher baseline SAD symptom severity was associated with greater (absolute but not relative) symptom reductions after CBT in patients with SAD. The findings contribute to personalized care by suggesting that clinicians can confidently offer CBT to individuals with severe SAD symptoms.. © 2023 American Medical Association. All rights reserved.},
keywords = {adult, antidepressant agent, Anxiety disorder, article, avoidant personality disorder, clinical outcome, cognitive behavioral therapy, comorbidity, cycloserine, Depression, disease severity, female, hospital admission, human, Humans, Liebowitz Social Anxiety Scale, male, meta analysis, paroxetine, phobia, Preferred Reporting Items for Systematic Reviews and Meta-Analyses, procedures, psychotropic agent, randomized controlled trial (topic), Randomized Controlled Trials as Topic, semi structured interview, Social, social anxiety, social phobia, Structured Clinical Interview for DSM Disorders, symptom, systematic review, treatment response, Waiting Lists},
pubstate = {published},
tppubtype = {article}
}
Importance: Social anxiety disorder (SAD) can be adequately treated with cognitive behavioral therapy (CBT). However, there is a large gap in knowledge on factors associated with prognosis, and it is unclear whether symptom severity predicts response to CBT for SAD. Objective: To examine baseline SAD symptom severity as a moderator of the association between CBT and symptom change in patients with SAD. Data Sources: For this systematic review and individual patient data meta-analysis (IPDMA), PubMed, PsycInfo, Embase, and the Cochrane Library were searched from January 1, 1990, to January 13, 2023. Primary search topics were social anxiety disorder, cognitive behavior therapy, and randomized controlled trial. Study Selection: Inclusion criteria were randomized clinical trials comparing CBT with being on a waiting list and using the Liebowitz Social Anxiety Scale (LSAS) in adults with a primary clinical diagnosis of SAD. Data Extraction and Synthesis: Authors of included studies were approached to provide individual-level data. Data were extracted by pairs of authors following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline, and risk of bias was assessed using the Cochrane tool. An IPDMA was conducted using a 2-stage approach for the association of CBT with change in LSAS scores from baseline to posttreatment and for the interaction effect of baseline LSAS score by condition using random-effects models. Main Outcomes and Measures: The main outcome was the baseline to posttreatment change in symptom severity measured by the LSAS. Results: A total of 12 studies including 1246 patients with SAD (mean [SD] age, 35.3 [10.9] years; 738 [59.2%] female) were included in the meta-analysis. A waiting list-controlled association between CBT and pretreatment to posttreatment LSAS change was found (b = -20.3; 95% CI, -24.9 to -15.6; P <.001; Cohen d = -0.95; 95% CI, -1.16 to -0.73). Baseline LSAS scores moderated the differences between CBT and waiting list with respect to pretreatment to posttreatment symptom reductions (b = -0.22; 95% CI, -0.39 to -0.06; P =.009), indicating that individuals with severe symptoms had larger waiting list-controlled symptom reductions after CBT (Cohen d = -1.13 [95% CI, -1.39 to -0.88] for patients with very severe SAD; Cohen d = -0.54 [95% CI, -0.80 to -0.29] for patients with mild SAD). Conclusions and Relevance: In this systematic review and IPDMA, higher baseline SAD symptom severity was associated with greater (absolute but not relative) symptom reductions after CBT in patients with SAD. The findings contribute to personalized care by suggesting that clinicians can confidently offer CBT to individuals with severe SAD symptoms.. © 2023 American Medical Association. All rights reserved.
4.
Clemmensen, L.; Bouchard, S.; Rasmussen, J.; Holmberg, T. T.; Nielsen, J. H.; Jepsen, J. R. Mø.; Lichtenstein, M. B.
In: BMC Psychiatry, vol. 20, no. 1, 2020, ISSN: 1471244X, (Publisher: BioMed Central).
Abstract | Links | BibTeX | Tags: adult, Anxiety, article, clinical effectiveness, cognitive behavioral therapy, controlled study, exposure, follow up, health program, human, Humans, in vivo study, outcome assessment, phobia, psychologist, questionnaire, randomized controlled trial, relaxation training, Social, Social Interaction Anxiety Scale, social phobia, treatment outcome, virtual reality, virtual reality exposure therapy, Young Adult
@article{clemmensen_study_2020,
title = {Study protocol: Exposure in virtual reality for social anxiety disorder-a randomized controlled superiority trial comparing cognitive behavioral therapy with virtual reality based exposure to cognitive behavioral therapy with in vivo exposure},
author = {L. Clemmensen and S. Bouchard and J. Rasmussen and T. T. Holmberg and J. H. Nielsen and J. R. Mø. Jepsen and M. B. Lichtenstein},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85078711155&doi=10.1186%2fs12888-020-2453-4&partnerID=40&md5=28b076f10bf189f7c90b8bed4c719200},
doi = {10.1186/s12888-020-2453-4},
issn = {1471244X},
year = {2020},
date = {2020-01-01},
journal = {BMC Psychiatry},
volume = {20},
number = {1},
publisher = {BioMed Central},
abstract = {Background: Social Anxiety Disorder (SAD) is characterized by an intense fear of negative judgement by others. Cognitive Behavioral Therapy (CBT) is recommended for treatment, but a substantial part of individuals with SAD either do not seek treatment or drop-out. CBT with Virtual Reality (VR)-based exposure has several advantages compared to traditional exposure methods, mainly due to increased control of situational elements. The aim of the current study is to develop a CBT program containing VR-based exposure. The intervention is targeted to adult patients suffering from SAD and treatment effect will be assessed by changes in SAD symptoms. Methods: This article describes the study protocol of a Randomized Controlled Trial with three arms: 1) CBT with VR exposure based on 360° videos 2) CBT with in vivo exposure and 3) VR relaxation therapy. There will be 30 participants in each arm with a crossover at the end of the treatment period during which the participants in the third group will be randomly re-Allocated to one of the two former groups. The treatment program consists of 10 weekly individual sessions with a psychologist, and a six month follow-up consisting of a questionnaire. The primary outcome measure is reduction in SAD symptoms which will be assessed with the Social Interaction Anxiety Scale (SIAS). Discussion: There are currently no published studies on CBT with VR exposure based on 360° videos for SAD treatment. Furthermore, the current study will be the first Danish SAD treatment program that includes VR technology. Trial registration: clinicaltrials.gov (NCT03973541) June 3rd 2019. © 2020 The Author(s).},
note = {Publisher: BioMed Central},
keywords = {adult, Anxiety, article, clinical effectiveness, cognitive behavioral therapy, controlled study, exposure, follow up, health program, human, Humans, in vivo study, outcome assessment, phobia, psychologist, questionnaire, randomized controlled trial, relaxation training, Social, Social Interaction Anxiety Scale, social phobia, treatment outcome, virtual reality, virtual reality exposure therapy, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Background: Social Anxiety Disorder (SAD) is characterized by an intense fear of negative judgement by others. Cognitive Behavioral Therapy (CBT) is recommended for treatment, but a substantial part of individuals with SAD either do not seek treatment or drop-out. CBT with Virtual Reality (VR)-based exposure has several advantages compared to traditional exposure methods, mainly due to increased control of situational elements. The aim of the current study is to develop a CBT program containing VR-based exposure. The intervention is targeted to adult patients suffering from SAD and treatment effect will be assessed by changes in SAD symptoms. Methods: This article describes the study protocol of a Randomized Controlled Trial with three arms: 1) CBT with VR exposure based on 360° videos 2) CBT with in vivo exposure and 3) VR relaxation therapy. There will be 30 participants in each arm with a crossover at the end of the treatment period during which the participants in the third group will be randomly re-Allocated to one of the two former groups. The treatment program consists of 10 weekly individual sessions with a psychologist, and a six month follow-up consisting of a questionnaire. The primary outcome measure is reduction in SAD symptoms which will be assessed with the Social Interaction Anxiety Scale (SIAS). Discussion: There are currently no published studies on CBT with VR exposure based on 360° videos for SAD treatment. Furthermore, the current study will be the first Danish SAD treatment program that includes VR technology. Trial registration: clinicaltrials.gov (NCT03973541) June 3rd 2019. © 2020 The Author(s).
5.
Tardif, N.; Therrien, C. -E.; Bouchard, S.
Re-Examining Psychological Mechanisms Underlying Virtual Reality-Based Exposure for Spider Phobia Journal Article
In: Cyberpsychology, Behavior, and Social Networking, vol. 22, no. 1, pp. 39–45, 2019, ISSN: 21522715, (Publisher: Mary Ann Liebert Inc.).
Abstract | Links | BibTeX | Tags: animal, Animals, Fear, Heart Rate, human, Humans, phobia, Phobic Disorders, physiology, psychology, questionnaire, spider, Spiders, Surveys and Questionnaires, virtual reality exposure therapy
@article{tardif_re-examining_2019,
title = {Re-Examining Psychological Mechanisms Underlying Virtual Reality-Based Exposure for Spider Phobia},
author = {N. Tardif and C. -E. Therrien and S. Bouchard},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85060171246&doi=10.1089%2fcyber.2017.0711&partnerID=40&md5=43737ac357efea6e35bd5668eb17e040},
doi = {10.1089/cyber.2017.0711},
issn = {21522715},
year = {2019},
date = {2019-01-01},
journal = {Cyberpsychology, Behavior, and Social Networking},
volume = {22},
number = {1},
pages = {39–45},
publisher = {Mary Ann Liebert Inc.},
abstract = {The proposed study aims at expanding results from a previous study on mechanisms of change after exposure in virtual reality (VR) and documenting the impact of adding tactile and haptic feedback. It was predicted that change in the severity of spider phobia according to the Fear of Spiders Questionnaire (FSQ) would be significantly predicted by change in dysfunctional beliefs toward spiders and self-efficacy, over and above the variance explained by a physiological measure of fear during exposure (heart rate) and presence during the immersion. Participants (N = 59) were randomly assigned to the presentation of visual stimuli only, visual plus tactile stimuli, or visual, tactile plus haptic feedback stimuli. A standard multiple regression was conducted to predict change on the FSQ using the following predictors: beliefs about spiders, beliefs about one's own behavior when facing spiders, perceived self-efficacy, disgust, presence, and heart rate. Only changes in beliefs about spiders and in perceived self-efficacy significantly predicted the reduction in fear of spiders. This result enhances our understanding of the mechanisms involved in exposure conducted in VR. Analyses of variance also show that participants reported statistically significant changes in their clinical condition, with little added value to the addition of tactile and haptic feedback. The advantages of tactile and haptic stimulation are questioned, at least in the context of only one brief exposure session and the equipment used. © 2019, Mary Ann Liebert, Inc.},
note = {Publisher: Mary Ann Liebert Inc.},
keywords = {animal, Animals, Fear, Heart Rate, human, Humans, phobia, Phobic Disorders, physiology, psychology, questionnaire, spider, Spiders, Surveys and Questionnaires, virtual reality exposure therapy},
pubstate = {published},
tppubtype = {article}
}
The proposed study aims at expanding results from a previous study on mechanisms of change after exposure in virtual reality (VR) and documenting the impact of adding tactile and haptic feedback. It was predicted that change in the severity of spider phobia according to the Fear of Spiders Questionnaire (FSQ) would be significantly predicted by change in dysfunctional beliefs toward spiders and self-efficacy, over and above the variance explained by a physiological measure of fear during exposure (heart rate) and presence during the immersion. Participants (N = 59) were randomly assigned to the presentation of visual stimuli only, visual plus tactile stimuli, or visual, tactile plus haptic feedback stimuli. A standard multiple regression was conducted to predict change on the FSQ using the following predictors: beliefs about spiders, beliefs about one's own behavior when facing spiders, perceived self-efficacy, disgust, presence, and heart rate. Only changes in beliefs about spiders and in perceived self-efficacy significantly predicted the reduction in fear of spiders. This result enhances our understanding of the mechanisms involved in exposure conducted in VR. Analyses of variance also show that participants reported statistically significant changes in their clinical condition, with little added value to the addition of tactile and haptic feedback. The advantages of tactile and haptic stimulation are questioned, at least in the context of only one brief exposure session and the equipment used. © 2019, Mary Ann Liebert, Inc.
6.
Tardif, N.; Therrien, C. -E.; Bouchard, S.
Re-Examining Psychological Mechanisms Underlying Virtual Reality-Based Exposure for Spider Phobia Journal Article
In: Cyberpsychology, Behavior, and Social Networking, vol. 22, no. 1, pp. 39–45, 2019, ISSN: 21522715.
Abstract | Links | BibTeX | Tags: animal, Animals, Fear, Heart Rate, human, Humans, phobia, Phobic Disorders, physiology, psychology, questionnaire, spider, Spiders, Surveys and Questionnaires, virtual reality exposure therapy
@article{tardifReExaminingPsychologicalMechanisms2019,
title = {Re-Examining Psychological Mechanisms Underlying Virtual Reality-Based Exposure for Spider Phobia},
author = {N. Tardif and C. -E. Therrien and S. Bouchard},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85060171246&doi=10.1089%2fcyber.2017.0711&partnerID=40&md5=43737ac357efea6e35bd5668eb17e040},
doi = {10.1089/cyber.2017.0711},
issn = {21522715},
year = {2019},
date = {2019-01-01},
journal = {Cyberpsychology, Behavior, and Social Networking},
volume = {22},
number = {1},
pages = {39–45},
publisher = {Mary Ann Liebert Inc.},
abstract = {The proposed study aims at expanding results from a previous study on mechanisms of change after exposure in virtual reality (VR) and documenting the impact of adding tactile and haptic feedback. It was predicted that change in the severity of spider phobia according to the Fear of Spiders Questionnaire (FSQ) would be significantly predicted by change in dysfunctional beliefs toward spiders and self-efficacy, over and above the variance explained by a physiological measure of fear during exposure (heart rate) and presence during the immersion. Participants (N = 59) were randomly assigned to the presentation of visual stimuli only, visual plus tactile stimuli, or visual, tactile plus haptic feedback stimuli. A standard multiple regression was conducted to predict change on the FSQ using the following predictors: beliefs about spiders, beliefs about one's own behavior when facing spiders, perceived self-efficacy, disgust, presence, and heart rate. Only changes in beliefs about spiders and in perceived self-efficacy significantly predicted the reduction in fear of spiders. This result enhances our understanding of the mechanisms involved in exposure conducted in VR. Analyses of variance also show that participants reported statistically significant changes in their clinical condition, with little added value to the addition of tactile and haptic feedback. The advantages of tactile and haptic stimulation are questioned, at least in the context of only one brief exposure session and the equipment used. © 2019, Mary Ann Liebert, Inc.},
keywords = {animal, Animals, Fear, Heart Rate, human, Humans, phobia, Phobic Disorders, physiology, psychology, questionnaire, spider, Spiders, Surveys and Questionnaires, virtual reality exposure therapy},
pubstate = {published},
tppubtype = {article}
}
The proposed study aims at expanding results from a previous study on mechanisms of change after exposure in virtual reality (VR) and documenting the impact of adding tactile and haptic feedback. It was predicted that change in the severity of spider phobia according to the Fear of Spiders Questionnaire (FSQ) would be significantly predicted by change in dysfunctional beliefs toward spiders and self-efficacy, over and above the variance explained by a physiological measure of fear during exposure (heart rate) and presence during the immersion. Participants (N = 59) were randomly assigned to the presentation of visual stimuli only, visual plus tactile stimuli, or visual, tactile plus haptic feedback stimuli. A standard multiple regression was conducted to predict change on the FSQ using the following predictors: beliefs about spiders, beliefs about one's own behavior when facing spiders, perceived self-efficacy, disgust, presence, and heart rate. Only changes in beliefs about spiders and in perceived self-efficacy significantly predicted the reduction in fear of spiders. This result enhances our understanding of the mechanisms involved in exposure conducted in VR. Analyses of variance also show that participants reported statistically significant changes in their clinical condition, with little added value to the addition of tactile and haptic feedback. The advantages of tactile and haptic stimulation are questioned, at least in the context of only one brief exposure session and the equipment used. © 2019, Mary Ann Liebert, Inc.
7.
Bouchard, S.
Author’s reply: Journal Article
In: British Journal of Psychiatry, vol. 213, no. 4, pp. 617, 2018, ISSN: 00071250 (ISSN), (Publisher: Cambridge University Press).
Links | BibTeX | Tags: cost effectiveness analysis, gold standard, hospital admission, human, Humans, letter, Liebowitz Social Anxiety Scale, phobia, self report, Social, social phobia, speech, virtual reality
@article{bouchard_authors_2018,
title = {Author’s reply:},
author = {S. Bouchard},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85054728668&doi=10.1192%2fbjp.2018.192&partnerID=40&md5=11905e8a9bb8578e1df964a26b9930d4},
doi = {10.1192/bjp.2018.192},
issn = {00071250 (ISSN)},
year = {2018},
date = {2018-01-01},
journal = {British Journal of Psychiatry},
volume = {213},
number = {4},
pages = {617},
publisher = {Cambridge University Press},
note = {Publisher: Cambridge University Press},
keywords = {cost effectiveness analysis, gold standard, hospital admission, human, Humans, letter, Liebowitz Social Anxiety Scale, phobia, self report, Social, social phobia, speech, virtual reality},
pubstate = {published},
tppubtype = {article}
}
8.
Bouchard, S.
Author’s reply: Journal Article
In: British Journal of Psychiatry, vol. 213, no. 4, pp. 617, 2018, ISSN: 00071250 (ISSN).
Links | BibTeX | Tags: cost effectiveness analysis, gold standard, hospital admission, human, Humans, letter, Liebowitz Social Anxiety Scale, phobia, self report, Social, social phobia, speech, virtual reality
@article{bouchardAuthorsReply2018,
title = {Author’s reply:},
author = {S. Bouchard},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85054728668&doi=10.1192%2fbjp.2018.192&partnerID=40&md5=11905e8a9bb8578e1df964a26b9930d4},
doi = {10.1192/bjp.2018.192},
issn = {00071250 (ISSN)},
year = {2018},
date = {2018-01-01},
journal = {British Journal of Psychiatry},
volume = {213},
number = {4},
pages = {617},
publisher = {Cambridge University Press},
keywords = {cost effectiveness analysis, gold standard, hospital admission, human, Humans, letter, Liebowitz Social Anxiety Scale, phobia, self report, Social, social phobia, speech, virtual reality},
pubstate = {published},
tppubtype = {article}
}
9.
Ikic, V.; Bélanger, C.; Bouchard, S.; Gosselin, P.; Langlois, F.; Labrecque, J.; Dugas, M. J.; Marchand, A.
Reduction in costs after treating comorbid panic disorder with agoraphobia and generalized anxiety disorder Journal Article
In: Journal of Mental Health Policy and Economics, vol. 20, no. 1, pp. 11–20, 2017, ISSN: 10914358, (Publisher: ICMPE).
Abstract | Links | BibTeX | Tags: adult, agoraphobia, Anxiety disorder, Anxiety Disorders, article, cognitive behavioral therapy, cognitive therapy, comorbidity, controlled study, dysthymia, economics, female, follow up, generalized anxiety disorder, health care cost, Health Care Costs, human, Humans, major clinical study, major depression, male, Mental health, obsessive compulsive disorder, panic, Panic Disorder, phobia, posttraumatic stress disorder, procedures, Quebec, social phobia, statistics and numerical data
@article{ikic_reduction_2017,
title = {Reduction in costs after treating comorbid panic disorder with agoraphobia and generalized anxiety disorder},
author = {V. Ikic and C. Bélanger and S. Bouchard and P. Gosselin and F. Langlois and J. Labrecque and M. J. Dugas and A. Marchand},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85018690998&partnerID=40&md5=0d0600e6dd4e2a381f733ac063d639dc},
issn = {10914358},
year = {2017},
date = {2017-01-01},
journal = {Journal of Mental Health Policy and Economics},
volume = {20},
number = {1},
pages = {11–20},
publisher = {ICMPE},
abstract = {Background: Panic disorder with agoraphobia (PDA) and generalized anxiety disorder (GAD) are impairing and costly disorders that are often misdiagnosed and left untreated despite multiple consultations. These disorders frequently co-occur, but little is known about the costs associated with their comorbidity and the impact of cognitive-behavioral therapy (CBT) on cost reduction. Aims of the Study: The first objective of this study was to assess the mental health-related costs associated with the specific concomitance of PDA and GAD. The second aim was to determine whether there is a reduction in direct and indirect mental healthrelated costs following conventional CBT for the primary disorder only (PDA or GAD) or combined CBT adapted to the comorbidity (PDA and GAD). Methods: A total of 123 participants with a double diagnosis of PDA and GAD participated in this study. Direct and indirect mental health-related costs were assessed and calculated from a societal perspective at the pre-Test, the post-Test, and the three-month, sixmonth and one-year follow-ups. Results: At the pre-Test, PDA-GAD comorbidity was found to generate a mean total cost of CAD2,000.48 (SD = 2,069.62) per participant over a three-month period. The indirect costs were much higher than the direct costs. Both treatment modalities led to significant and similar decreases in all cost categories from the pretest to the post-Test. This reduction was maintained until the oneyear follow-up. Discussion: Methodological choices may have underestimated cost evaluations. Nonetheless, this study supports the cost offset effects of both conventional CBT for primary PDA or GAD and combined CBT for PDA-GAD comorbidity. Implications for Healthcare Provision and Use: Treatment of comorbid and costly disorders with evidence-based treatments such as CBT may lead to considerable economic benefits for society. Implications for Health Policies: Considering the limited resources of healthcare systems, it is important to make choices that will lead to better accessibility of quality services. The application of CBT for PDA, GAD or both disorders and training mental health professionals in this therapeutic approach should be encouraged. Additionally, it would be favorable for insurance plans to reimburse employees for expenses associated with psychological treatment for anxiety disorders. Implications for Further Research: In addition to symptom reduction, it would be of great pertinence to explore which factors can contribute to reducing direct and indirect mental health-related costs. © 2017 ICMPE.},
note = {Publisher: ICMPE},
keywords = {adult, agoraphobia, Anxiety disorder, Anxiety Disorders, article, cognitive behavioral therapy, cognitive therapy, comorbidity, controlled study, dysthymia, economics, female, follow up, generalized anxiety disorder, health care cost, Health Care Costs, human, Humans, major clinical study, major depression, male, Mental health, obsessive compulsive disorder, panic, Panic Disorder, phobia, posttraumatic stress disorder, procedures, Quebec, social phobia, statistics and numerical data},
pubstate = {published},
tppubtype = {article}
}
Background: Panic disorder with agoraphobia (PDA) and generalized anxiety disorder (GAD) are impairing and costly disorders that are often misdiagnosed and left untreated despite multiple consultations. These disorders frequently co-occur, but little is known about the costs associated with their comorbidity and the impact of cognitive-behavioral therapy (CBT) on cost reduction. Aims of the Study: The first objective of this study was to assess the mental health-related costs associated with the specific concomitance of PDA and GAD. The second aim was to determine whether there is a reduction in direct and indirect mental healthrelated costs following conventional CBT for the primary disorder only (PDA or GAD) or combined CBT adapted to the comorbidity (PDA and GAD). Methods: A total of 123 participants with a double diagnosis of PDA and GAD participated in this study. Direct and indirect mental health-related costs were assessed and calculated from a societal perspective at the pre-Test, the post-Test, and the three-month, sixmonth and one-year follow-ups. Results: At the pre-Test, PDA-GAD comorbidity was found to generate a mean total cost of CAD2,000.48 (SD = 2,069.62) per participant over a three-month period. The indirect costs were much higher than the direct costs. Both treatment modalities led to significant and similar decreases in all cost categories from the pretest to the post-Test. This reduction was maintained until the oneyear follow-up. Discussion: Methodological choices may have underestimated cost evaluations. Nonetheless, this study supports the cost offset effects of both conventional CBT for primary PDA or GAD and combined CBT for PDA-GAD comorbidity. Implications for Healthcare Provision and Use: Treatment of comorbid and costly disorders with evidence-based treatments such as CBT may lead to considerable economic benefits for society. Implications for Health Policies: Considering the limited resources of healthcare systems, it is important to make choices that will lead to better accessibility of quality services. The application of CBT for PDA, GAD or both disorders and training mental health professionals in this therapeutic approach should be encouraged. Additionally, it would be favorable for insurance plans to reimburse employees for expenses associated with psychological treatment for anxiety disorders. Implications for Further Research: In addition to symptom reduction, it would be of great pertinence to explore which factors can contribute to reducing direct and indirect mental health-related costs. © 2017 ICMPE.
10.
Bouchard, S.; Dumoulin, S.; Robillard, G.; Guitard, T.; Klinger, E.; Forget, H.; Loranger, C.; Roucaut, F. X.
Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: A three-arm randomised controlled trial Journal Article
In: British Journal of Psychiatry, vol. 210, no. 4, pp. 276–283, 2017, ISSN: 00071250, (Publisher: Royal College of Psychiatrists).
Abstract | Links | BibTeX | Tags: adult, article, avoidance behavior, clinical outcome, cognitive therapy, comparative effectiveness, comparative study, computer interface, controlled study, cost, devices, female, hospital admission, human, Humans, Implosive Therapy, in vivo study, major clinical study, male, Middle Aged, outcome assessment, Outcome Assessment (Health Care), phobia, procedures, randomized controlled trial, Social, social phobia, User-Computer Interface, virtual reality, virtual reality exposure therapy
@article{bouchard_virtual_2017,
title = {Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: A three-arm randomised controlled trial},
author = {S. Bouchard and S. Dumoulin and G. Robillard and T. Guitard and E. Klinger and H. Forget and C. Loranger and F. X. Roucaut},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85018214603&doi=10.1192%2fbjp.bp.116.184234&partnerID=40&md5=245751bf4ef3f8ae014a9c5816a585c3},
doi = {10.1192/bjp.bp.116.184234},
issn = {00071250},
year = {2017},
date = {2017-01-01},
journal = {British Journal of Psychiatry},
volume = {210},
number = {4},
pages = {276–283},
publisher = {Royal College of Psychiatrists},
abstract = {Background: People with social anxiety disorder (SAD) fear social interactions and may be reluctant to seek treatments involving exposure to social situations. Social exposure conducted in virtual reality (VR), embedded in individual cognitive-behavioural therapy (CBT), could be an answer. Aims: To show that conducting VR exposure in CBT for SAD is effective and is more practical for therapists than conducting exposure in vivo. Method: Participants were randomly assigned to either VR exposure (n =17), in vivo exposure (n=22) or waiting list (n= 20). Participants in the active arms received individual CBT for 14 weekly sessions and outcome was assessed with questionnaires and a behaviour avoidance test. (Trial registration number ISRCTN99747069.) Results: Improvements were found on the primary (Liebowitz Social Anxiety Scale) and all five secondary outcome measures in both CBT groups compared with the waiting list. Conducting exposure in VR was more effective at post-treatment than in vivo on the primary outcome measure and on one secondary measure. Improvements were maintained at the 6-month follow-up. VR was significantly more practical for therapists than in vivo exposure. Conclusions: Using VR can be advantageous over standard CBT as a potential solution for treatment avoidance and as an efficient, cost-effective and practical medium of exposure. Declaration of interest S.B. and G.R. are consultants to and own equity in Cliniques et Développement In Virtuo, which develops virtual environments; however, Cliniques et Développement In Virtuo did not create the virtual environments used in this study. The terms of these arrangements were reviewed and approved by Universitédu Québec en Outaouais, in accordance with its policy on conflicts of interest. © The Royal College of Psychiatrists 2017.},
note = {Publisher: Royal College of Psychiatrists},
keywords = {adult, article, avoidance behavior, clinical outcome, cognitive therapy, comparative effectiveness, comparative study, computer interface, controlled study, cost, devices, female, hospital admission, human, Humans, Implosive Therapy, in vivo study, major clinical study, male, Middle Aged, outcome assessment, Outcome Assessment (Health Care), phobia, procedures, randomized controlled trial, Social, social phobia, User-Computer Interface, virtual reality, virtual reality exposure therapy},
pubstate = {published},
tppubtype = {article}
}
Background: People with social anxiety disorder (SAD) fear social interactions and may be reluctant to seek treatments involving exposure to social situations. Social exposure conducted in virtual reality (VR), embedded in individual cognitive-behavioural therapy (CBT), could be an answer. Aims: To show that conducting VR exposure in CBT for SAD is effective and is more practical for therapists than conducting exposure in vivo. Method: Participants were randomly assigned to either VR exposure (n =17), in vivo exposure (n=22) or waiting list (n= 20). Participants in the active arms received individual CBT for 14 weekly sessions and outcome was assessed with questionnaires and a behaviour avoidance test. (Trial registration number ISRCTN99747069.) Results: Improvements were found on the primary (Liebowitz Social Anxiety Scale) and all five secondary outcome measures in both CBT groups compared with the waiting list. Conducting exposure in VR was more effective at post-treatment than in vivo on the primary outcome measure and on one secondary measure. Improvements were maintained at the 6-month follow-up. VR was significantly more practical for therapists than in vivo exposure. Conclusions: Using VR can be advantageous over standard CBT as a potential solution for treatment avoidance and as an efficient, cost-effective and practical medium of exposure. Declaration of interest S.B. and G.R. are consultants to and own equity in Cliniques et Développement In Virtuo, which develops virtual environments; however, Cliniques et Développement In Virtuo did not create the virtual environments used in this study. The terms of these arrangements were reviewed and approved by Universitédu Québec en Outaouais, in accordance with its policy on conflicts of interest. © The Royal College of Psychiatrists 2017.