Slide
Centre Interdisciplinaire
de Recherche et d’Innovation
en Cybersécurité et Société
de Recherche et d’Innovation
en Cybersécurité et Société
1.
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},
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.
2.
Giroux, I.; Faucher-Gravel, A.; St-Hilaire, A.; Boudreault, C.; Jacques, C.; Bouchard, S.
Gambling exposure in virtual reality and modification of urge to gamble Journal Article
In: Cyberpsychology, Behavior, and Social Networking, vol. 16, no. 3, pp. 224–231, 2013, ISSN: 21522715.
Abstract | Links | BibTeX | Tags: article, behavior therapy, clinical trial, computer interface, female, Gambling, human, Humans, Implosive Therapy, male, methodology, Middle Aged, Psychiatric Status Rating Scales, psychological aspect, psychological rating scale, questionnaire, Questionnaires, Self Concept, Self Efficacy, User-Computer Interface
@article{giroux_gambling_2013,
title = {Gambling exposure in virtual reality and modification of urge to gamble},
author = {I. Giroux and A. Faucher-Gravel and A. St-Hilaire and C. Boudreault and C. Jacques and S. Bouchard},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84875176361&doi=10.1089%2fcyber.2012.1573&partnerID=40&md5=b9473a795bb3b95cb98fa04afb34c2c7},
doi = {10.1089/cyber.2012.1573},
issn = {21522715},
year = {2013},
date = {2013-01-01},
journal = {Cyberpsychology, Behavior, and Social Networking},
volume = {16},
number = {3},
pages = {224–231},
abstract = {The urge to gamble is a psychological, physiological, and emotional state involved in the maintenance of pathological gambling. The ability of repeated exposure to a virtual gambling environment to modify the urge to gamble and perceived self-efficacy (PSE) is investigated. Ten video lottery players move throughout a virtual bar with five video lottery terminals five times. The urge to gamble and PSE do not significantly vary during exposure to the gambling environment. However, the desire to gamble significantly increases when passing from the practice environment to the gambling environment. These findings suggest that virtual reality is viable for use in exposure, but that a sole 20-minute session does not set the extinction process into motion. Future studies should be conducted on virtual exposure over the course of several sessions, with the addition of a cognitive restructuring intervention. © Copyright 2013, Mary Ann Liebert, Inc. 2013.},
keywords = {article, behavior therapy, clinical trial, computer interface, female, Gambling, human, Humans, Implosive Therapy, male, methodology, Middle Aged, Psychiatric Status Rating Scales, psychological aspect, psychological rating scale, questionnaire, Questionnaires, Self Concept, Self Efficacy, User-Computer Interface},
pubstate = {published},
tppubtype = {article}
}
The urge to gamble is a psychological, physiological, and emotional state involved in the maintenance of pathological gambling. The ability of repeated exposure to a virtual gambling environment to modify the urge to gamble and perceived self-efficacy (PSE) is investigated. Ten video lottery players move throughout a virtual bar with five video lottery terminals five times. The urge to gamble and PSE do not significantly vary during exposure to the gambling environment. However, the desire to gamble significantly increases when passing from the practice environment to the gambling environment. These findings suggest that virtual reality is viable for use in exposure, but that a sole 20-minute session does not set the extinction process into motion. Future studies should be conducted on virtual exposure over the course of several sessions, with the addition of a cognitive restructuring intervention. © Copyright 2013, Mary Ann Liebert, Inc. 2013.
3.
Robillard, G.; Bouchard, S.; Dumoulin, S.; Guitard, T.
The development of the SWEAT questionnaire: a scale measuring costs and efforts inherent to conducting exposure sessions. Journal Article
In: Studies in health technology and informatics, vol. 167, pp. 105–110, 2011, ISSN: 09269630.
Abstract | Links | BibTeX | Tags: adult, Anxiety disorder, Anxiety Disorders, article, behavior therapy, clinical effectiveness, computer assisted therapy, computer interface, Computer Simulation, Computer-Assisted, controlled study, cost benefit analysis, economics, exposure, female, human, Humans, Implosive Therapy, in vivo study, male, methodology, psychologist, Psychometrics, psychometry, questionnaire, Questionnaires, reliability, reproducibility, Reproducibility of Results, specific work for exposure applied in therapy questionnaire, Therapy, User-Computer Interface, virtual reality
@article{robillard_development_2011,
title = {The development of the SWEAT questionnaire: a scale measuring costs and efforts inherent to conducting exposure sessions.},
author = {G. Robillard and S. Bouchard and S. Dumoulin and T. Guitard},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-80054121010&partnerID=40&md5=10bd1de5d9c38b5a975dab3b477c1d4d},
issn = {09269630},
year = {2011},
date = {2011-01-01},
journal = {Studies in health technology and informatics},
volume = {167},
pages = {105–110},
abstract = {For decades, empirical studies have shown the effectiveness of exposure techniques when used in cognitive-behavioral therapy (CBT) treatment for anxiety disorders. A few studies are now suggesting that using Virtual Reality (VR) may be an effective way to conduct exposure and overcome some of the limitations of in vivo exposure. The aim of this study is to validate the Specific Work for Exposure Applied in Therapy (SWEAT) questionnaire that measures costs and efforts required to conduct in vivo and in virtuo exposure. A total of 265 exposure sessions (in vivo = 140; in virtuo = 125) were rated by experienced psychologists. Reliability analysis revealed three main factors in the construct of the SWEAT questionnaire. Results also showed that conducting exposure in VR is less of a burden and more readily adapted to the patients' needs than in vivo.},
keywords = {adult, Anxiety disorder, Anxiety Disorders, article, behavior therapy, clinical effectiveness, computer assisted therapy, computer interface, Computer Simulation, Computer-Assisted, controlled study, cost benefit analysis, economics, exposure, female, human, Humans, Implosive Therapy, in vivo study, male, methodology, psychologist, Psychometrics, psychometry, questionnaire, Questionnaires, reliability, reproducibility, Reproducibility of Results, specific work for exposure applied in therapy questionnaire, Therapy, User-Computer Interface, virtual reality},
pubstate = {published},
tppubtype = {article}
}
For decades, empirical studies have shown the effectiveness of exposure techniques when used in cognitive-behavioral therapy (CBT) treatment for anxiety disorders. A few studies are now suggesting that using Virtual Reality (VR) may be an effective way to conduct exposure and overcome some of the limitations of in vivo exposure. The aim of this study is to validate the Specific Work for Exposure Applied in Therapy (SWEAT) questionnaire that measures costs and efforts required to conduct in vivo and in virtuo exposure. A total of 265 exposure sessions (in vivo = 140; in virtuo = 125) were rated by experienced psychologists. Reliability analysis revealed three main factors in the construct of the SWEAT questionnaire. Results also showed that conducting exposure in VR is less of a burden and more readily adapted to the patients' needs than in vivo.
4.
St-Jacques, J.; Bouchard, S.; Bélanger, C.
In: Journal of Clinical Psychiatry, vol. 71, no. 7, pp. 924–931, 2010, ISSN: 01606689.
Abstract | Links | BibTeX | Tags: Adolescent, Animals, article, Child, clinical article, clinical trial, cognitive therapy, Combined Modality Therapy, Computer-Assisted, controlled clinical trial, controlled study, exposure, female, follow up, human, Humans, Implosive Therapy, Internal-External Control, male, motivation, outcome assessment, phobia, Phobic Disorders, predictor variable, priority journal, psychotherapy, randomized controlled trial, school child, Spiders, Therapy, treatment outcome, User-Computer Interface, virtual reality
@article{st-jacques_is_2010,
title = {Is virtual reality effective to motivate and raise interest in phobic children toward therapy? A clinical trial study of in vivo with in virtuo versus in vivo only treatment exposure},
author = {J. St-Jacques and S. Bouchard and C. Bélanger},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-77955295979&doi=10.4088%2fJCP.08m04822blu&partnerID=40&md5=d542122407b00dcaecc8c51dcaf40610},
doi = {10.4088/JCP.08m04822blu},
issn = {01606689},
year = {2010},
date = {2010-01-01},
journal = {Journal of Clinical Psychiatry},
volume = {71},
number = {7},
pages = {924–931},
abstract = {Objective: The first objective of this study was to assess if a combined treatment with mostly virtual reality-based (in virtuo) exposure increases phobic children's motivation toward therapy compared to children who only receive in vivo exposure. Another objective was the assessment of motivation as a predictor of treatment outcome. Method: Thirty-one DSM-IV-diagnosed arachnophobic participants aged from 8 to 15 years were randomly assigned to 1 of 2 treatment conditions: in vivo exposure alone or in virtuo plus in vivo exposure. Measures of motivation were taken at pretest and at the end of each part of the treatment; some other measures were taken at each session. The "Why Are You in Therapy?" questionnaire for children was the target measure of motivation and the main variable in the study. Outcome measures were taken at pretest, at the end of each part of the treatment, and at the 6-month follow-up. This study was conducted between September 2006 and March 2007. Results: The results showed that children who received in virtuo exposure did not show a higher level of motivation toward their treatment than those who received in vivo exposure, but statistically significant interactions were found for both parts of the treatment. Multiple regression analysis confirmed that motivation was a significant predictor of outcome (P < .01), especially extrinsic integrated motivation. Participants in the combined treatment were significantly more phobic before beginning treatment, but both treatments appeared successful (P < .001). Conclusions: In this study, the use of virtual reality did not increase motivation toward psychotherapy. At the end of the second part of therapy, all participants were comparably efficient in facing a live tarantula. These results bear important clinical implications concerning how to use virtual reality with children and concerning motivation of children toward therapy in general. They are discussed in the light of how to present in virtuo therapy to children. Trial Registration: controlled-trials.com Identifier: ISRCTN87716831. © Copyright 2010 Physicians Postgraduate Press, Inc.},
keywords = {Adolescent, Animals, article, Child, clinical article, clinical trial, cognitive therapy, Combined Modality Therapy, Computer-Assisted, controlled clinical trial, controlled study, exposure, female, follow up, human, Humans, Implosive Therapy, Internal-External Control, male, motivation, outcome assessment, phobia, Phobic Disorders, predictor variable, priority journal, psychotherapy, randomized controlled trial, school child, Spiders, Therapy, treatment outcome, User-Computer Interface, virtual reality},
pubstate = {published},
tppubtype = {article}
}
Objective: The first objective of this study was to assess if a combined treatment with mostly virtual reality-based (in virtuo) exposure increases phobic children's motivation toward therapy compared to children who only receive in vivo exposure. Another objective was the assessment of motivation as a predictor of treatment outcome. Method: Thirty-one DSM-IV-diagnosed arachnophobic participants aged from 8 to 15 years were randomly assigned to 1 of 2 treatment conditions: in vivo exposure alone or in virtuo plus in vivo exposure. Measures of motivation were taken at pretest and at the end of each part of the treatment; some other measures were taken at each session. The "Why Are You in Therapy?" questionnaire for children was the target measure of motivation and the main variable in the study. Outcome measures were taken at pretest, at the end of each part of the treatment, and at the 6-month follow-up. This study was conducted between September 2006 and March 2007. Results: The results showed that children who received in virtuo exposure did not show a higher level of motivation toward their treatment than those who received in vivo exposure, but statistically significant interactions were found for both parts of the treatment. Multiple regression analysis confirmed that motivation was a significant predictor of outcome (P < .01), especially extrinsic integrated motivation. Participants in the combined treatment were significantly more phobic before beginning treatment, but both treatments appeared successful (P < .001). Conclusions: In this study, the use of virtual reality did not increase motivation toward psychotherapy. At the end of the second part of therapy, all participants were comparably efficient in facing a live tarantula. These results bear important clinical implications concerning how to use virtual reality with children and concerning motivation of children toward therapy in general. They are discussed in the light of how to present in virtuo therapy to children. Trial Registration: controlled-trials.com Identifier: ISRCTN87716831. © Copyright 2010 Physicians Postgraduate Press, Inc.
5.
Michaliszyn, D.; Marchand, A.; Bouchard, S.; Martel, M. -O.; Poirier-Bisson, J.
A randomized, controlled clinical trial of in virtuo and in vivo exposure for spider phobia Journal Article
In: Cyberpsychology, Behavior, and Social Networking, vol. 13, no. 6, pp. 689–695, 2010, ISSN: 21522723 (ISSN).
Abstract | Links | BibTeX | Tags: Adolescent, adult, analysis of variance, animal, Animals, article, behavior therapy, clinical trial, computer interface, Computer Simulation, controlled clinical trial, controlled study, Diagnostic and Statistical Manual of Mental Disorders, female, follow up, Follow-Up Studies, hospitalization, human, Humans, Implosive Therapy, Intention to Treat Analysis, interview, male, methodology, Middle Aged, phobia, Phobic Disorders, psychologic test, Psychological, questionnaire, Questionnaires, randomized controlled trial, Severity of Illness Index, spider, Spiders, treatment outcome, User-Computer Interface
@article{michaliszyn_randomized_2010,
title = {A randomized, controlled clinical trial of in virtuo and in vivo exposure for spider phobia},
author = {D. Michaliszyn and A. Marchand and S. Bouchard and M. -O. Martel and J. Poirier-Bisson},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-78650262716&doi=10.1089%2fcyber.2009.0277&partnerID=40&md5=8efc6b65de8b3477ca3cd0fa8fcab93a},
doi = {10.1089/cyber.2009.0277},
issn = {21522723 (ISSN)},
year = {2010},
date = {2010-01-01},
journal = {Cyberpsychology, Behavior, and Social Networking},
volume = {13},
number = {6},
pages = {689–695},
abstract = {The present study compared the efficacy of virtual reality (VR) in virtuo exposure and in vivo exposure in the treatment of spider phobia. Two treatment conditions were compared to a waiting-list condition. A 3-month follow-up evaluation was conducted in order to assess the durability of the treatment effects. Participants were randomly assigned to the treatment groups. A total of 16 participants received the in virtuo treatment, and 16 received the in vivo treatment. The waiting-list condition included 11 participants. Participants received eight 1.5-hour treatment sessions. Efficacy was measured with the Fear of Spiders Questionnaire, the Spider Beliefs Questionnaire (SBQ-F), and a Behavioral Avoidance Test (BAT). In addition, a clinician administered the Structured Interview for DSM-IV to assess DSM-IV's criteria for specific phobia and severity. Clinical and statistically significant improvements were found for both groups. Differences in treatment groups were found on one of five measures of fear: greater improvement on the SBQ-F beliefs subscale was associated with in vivo exposure. Copyright 2010, Mary Ann Liebert, Inc.},
keywords = {Adolescent, adult, analysis of variance, animal, Animals, article, behavior therapy, clinical trial, computer interface, Computer Simulation, controlled clinical trial, controlled study, Diagnostic and Statistical Manual of Mental Disorders, female, follow up, Follow-Up Studies, hospitalization, human, Humans, Implosive Therapy, Intention to Treat Analysis, interview, male, methodology, Middle Aged, phobia, Phobic Disorders, psychologic test, Psychological, questionnaire, Questionnaires, randomized controlled trial, Severity of Illness Index, spider, Spiders, treatment outcome, User-Computer Interface},
pubstate = {published},
tppubtype = {article}
}
The present study compared the efficacy of virtual reality (VR) in virtuo exposure and in vivo exposure in the treatment of spider phobia. Two treatment conditions were compared to a waiting-list condition. A 3-month follow-up evaluation was conducted in order to assess the durability of the treatment effects. Participants were randomly assigned to the treatment groups. A total of 16 participants received the in virtuo treatment, and 16 received the in vivo treatment. The waiting-list condition included 11 participants. Participants received eight 1.5-hour treatment sessions. Efficacy was measured with the Fear of Spiders Questionnaire, the Spider Beliefs Questionnaire (SBQ-F), and a Behavioral Avoidance Test (BAT). In addition, a clinician administered the Structured Interview for DSM-IV to assess DSM-IV's criteria for specific phobia and severity. Clinical and statistically significant improvements were found for both groups. Differences in treatment groups were found on one of five measures of fear: greater improvement on the SBQ-F beliefs subscale was associated with in vivo exposure. Copyright 2010, Mary Ann Liebert, Inc.
6.
Côté, S.; Bouchard, S.
Cognitive mechanisms underlying virtual reality exposure Journal Article
In: Cyberpsychology and Behavior, vol. 12, no. 2, pp. 121–129, 2009, ISSN: 10949313 (ISSN).
Abstract | Links | BibTeX | Tags: Adaptation, adult, aged, Animals, arachnophobia, Arousal, article, avoidance behavior, cardiovascular response, clinical article, cognition, Culture, female, Heart Rate, human, Humans, Implosive Therapy, male, Middle Aged, Personality Assessment, phobia, Phobic Disorders, prediction, Psychological, questionnaire, Questionnaires, regression analysis, scoring system, Self Efficacy, spider, Spiders, structured interview, task performance, treatment outcome, User-Computer Interface, virtual reality, Young Adult
@article{cote_cognitive_2009,
title = {Cognitive mechanisms underlying virtual reality exposure},
author = {S. Côté and S. Bouchard},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-64749106909&doi=10.1089%2fcpb.2008.0008&partnerID=40&md5=e9bd263ea9e1940b66910d9651bd119e},
doi = {10.1089/cpb.2008.0008},
issn = {10949313 (ISSN)},
year = {2009},
date = {2009-01-01},
journal = {Cyberpsychology and Behavior},
volume = {12},
number = {2},
pages = {121–129},
abstract = {Many studies have assessed virtual reality exposures efficacy, but very few examined its treatment processes. The addition of objective measures of arousal and information processing mechanisms would be a valuable contribution in order to provide a more complete and detailed picture. The goal of this study was to better document the cognitive mechanisms associated with therapeutic change after an in virtuo exposure treatment. Twenty-eight adults suffering from arachnophobia were assessed and received an exposure-based treatment using virtual reality. General outcome and specific processes measures included a battery of standardized questionnaires, a pictorial emotional Stroop task, a Behavioral Avoidance Test, and a measure of participants' cardiac response while they looked at a live tarantula. The analyses showed that changes in perceived self-efficacy and dysfunctional beliefs were the best predictors of change in general outcome and cardiac response; change in dysfunctional beliefs were the best predictor of change in behavioral avoidance. These innovative results provide a very detailed and organized picture of the complex cognitive mechanisms involved in therapeutic change following in virtuo exposure for arachnophobia. © 2009 Mary Ann Liebert, Inc.},
keywords = {Adaptation, adult, aged, Animals, arachnophobia, Arousal, article, avoidance behavior, cardiovascular response, clinical article, cognition, Culture, female, Heart Rate, human, Humans, Implosive Therapy, male, Middle Aged, Personality Assessment, phobia, Phobic Disorders, prediction, Psychological, questionnaire, Questionnaires, regression analysis, scoring system, Self Efficacy, spider, Spiders, structured interview, task performance, treatment outcome, User-Computer Interface, virtual reality, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Many studies have assessed virtual reality exposures efficacy, but very few examined its treatment processes. The addition of objective measures of arousal and information processing mechanisms would be a valuable contribution in order to provide a more complete and detailed picture. The goal of this study was to better document the cognitive mechanisms associated with therapeutic change after an in virtuo exposure treatment. Twenty-eight adults suffering from arachnophobia were assessed and received an exposure-based treatment using virtual reality. General outcome and specific processes measures included a battery of standardized questionnaires, a pictorial emotional Stroop task, a Behavioral Avoidance Test, and a measure of participants' cardiac response while they looked at a live tarantula. The analyses showed that changes in perceived self-efficacy and dysfunctional beliefs were the best predictors of change in general outcome and cardiac response; change in dysfunctional beliefs were the best predictor of change in behavioral avoidance. These innovative results provide a very detailed and organized picture of the complex cognitive mechanisms involved in therapeutic change following in virtuo exposure for arachnophobia. © 2009 Mary Ann Liebert, Inc.