@article{moinnereauSubjectiveObjectiveAssessment2025,

title = {Subjective and Objective Assessment of the Impact of Stress and Mental Workload on Cybersickness During Virtual Reality Training},

author = {M. -A. Moinnereau and A. Tiwari and D. Benesch and N. Bolt and G. P. Krätzig and S. Paré and T. H. Falk},

url = {https://www.scopus.com/pages/publications/105031119708?origin=resultslist},

doi = {10.54941/ahfe1006348},

issn = {27710718 (ISSN)},

year  = {2025},

date = {2025-01-01},

journal = {Applied Human Factors and Ergonomics International},

volume = {178},

pages = {87–98},

publisher = {AHFE International},

abstract = {Cybersickness is an issue in immersive virtual reality (VR), akin to motion and simulator sickness, resulting in symptoms such as nausea, dizziness, and eye strain. Cybersickness has been shown to affect a significant portion of VR users. In training scenarios involving demanding tasks (e.g., for first responders’ training), however, reports of cybersickness symptoms are higher than those for the average user. It is hypothesized that the stress and mental workload generated by these scenarios may be the cause for this increased propensity for cybersickness. In this study, we investigate the impact of stress alone, mental workload alone, and their combined impact on cybersickness levels. The levels of stress and mental workload are manipulated while participants perform a driving simulator task. In the high mental workload condition, the driver has to keep an eye on the road while driving from one location to another, as well as monitor and count the number of pedestrians wearing a certain colour shirt. In the high stress condition, traffic conditions become heavy, background noise increases, and sudden breaks are needed to avoid accidents (e.g., from a ball rolling into the road to a car suddenly changing lanes). Lastly, the combined condition contains all the elements of the previous two conditions. In all cases, a baseline driving period is present (without stress or workload) and is used for comparisons within each subject. Both self-report and neurophysiological measurements are used to gauge the impact of these three conditions on cybersickness. Self-report questionnaires are used to assess stress (DASS-21), mental workload (NASA-TLX), and cybersickness symptoms (SSQ) at several instances during the experiment. In turn, an instrumented Meta Quest 3 VR headset is used equipped with 16 electroencephalography (EEG) and electro-oculography (EOG) sensors, while wearable devices are used to monitor photoplethysmography (PPG), electrocardiography (ECG), and respiration signals. These neurophysiological signals are used to continuously extract measures of mental workload, stress, and other cognitive/affective states almost in real-time. In this paper, we describe the experimental setup, the instrumented headset, the EEG and biosignal metrics that are computed, and provide preliminary subjective and objective findings based on the first 12 participants (four per condition). The study is ongoing and aims to collect data from 60 participants (20 per condition). It is hoped that these preliminary insights will help the research community refine VR training protocols, making them more comfortable and effective for students. © 2025. Published by AHFE Open Access. All rights reserved.},

keywords = {Biosensors, cybersickness, Electroencephalography, Mental workload, Stress, virtual reality, VR training},

pubstate = {published},

tppubtype = {article}

}

@article{rosannePreprocessNotPreprocess2025,

title = {To pre-process or not to pre-process? On the role of EEG enhancement for cybersickness characterization and the importance of amplitude modulation features},

author = {O. Rosanne and D. Benesch and G. Kratzig and S. Paré and N. Bolt and T. H. Falk},

url = {https://www.scopus.com/pages/publications/85217703600?origin=resultslist},

doi = {10.3389/frvir.2025.1468971},

issn = {26734192 (ISSN)},

year  = {2025},

date = {2025-01-01},

journal = {Frontiers in Virtual Reality},

volume = {6},

publisher = {Frontiers Media SA},

abstract = {Virtual Reality (VR) has expanded beyond the entertainment field and has become a valuable tool across different verticals, including healthcare, education, and professional training, just to name a few. Despite these advancements, widespread usage of VR systems is still limited, mostly due to motion sickness symptoms, such as dizziness, nausea, and headaches, which are collectively termed “cybersickness”. In this paper, we explore the use of electroencephalography (EEG) as a tool for real-time characterization of cybersickness. In particular, we aim to answer three research questions: (1) what neural patterns are indicative of cybersickness levels, (2) do EEG amplitude modulation features convey more important and explainable patterns, and (3) what role does EEG pre-processing play in overall cybersickness characterization. Experimental results show that minimal pre-processing retains artifacts that may be useful for cybersickness detection (e.g., head and eye movements), while more advanced methods enable the extraction of more interpretable neural patterns that may help the research community gain additional insights on the neural underpinnings of cybersickness. Our experiments show that the proposed amplitude modulation features comprise roughly 60% of the top-selected features for EEG-based cybersickness detection. Copyright © 2025 Rosanne, Benesch, Kratzig, Paré, Bolt and Falk.},

keywords = {amplitude modulation, artifact removal, cybersickness, Electroencephalography, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{bogie_using_2024,

title = {Using virtual reality to improve verbal episodic memory in schizophrenia: A proof-of-concept trial},

author = {B. J. M. Bogie and C. Noël and F. Gu and S. Nadeau and C. Shvetz and H. Khan and M. -C. Rivard and S. Bouchard and M. Lepage and S. Guimond},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85186986986&doi=10.1016%2fj.scog.2024.100305&partnerID=40&md5=a15c598b45b8f44a40b25fe5fd078a06},

doi = {10.1016/j.scog.2024.100305},

issn = {22150013 (ISSN)},

year  = {2024},

date = {2024-01-01},

journal = {Schizophrenia Research: Cognition},

volume = {36},

publisher = {Elsevier Inc.},

abstract = {Background: Schizophrenia is associated with impairments in verbal episodic memory. Strategy for Semantic Association Memory (SESAME) training represents a promising cognitive remediation program to improve verbal episodic memory. Virtual reality (VR) may be a novel tool to increase the ecological validity and transfer of learned skills of traditional cognitive remediation programs. The present proof-of-concept study aimed to assess the feasibility, acceptability, and preliminary efficacy of a VR-based cognitive remediation module inspired by SESAME principles to improve the use of verbal episodic memory strategies in schizophrenia. Methods: Thirty individuals with schizophrenia/schizoaffective disorder completed this study. Participants were randomized to either a VR-based verbal episodic memory training condition inspired by SESAME principles (intervention group) or an active control condition (control group). In the training condition, a coach taught semantic encoding strategies (active rehearsal and semantic clustering) to help participants remember restaurant orders in VR. In the active control condition, participants completed visuospatial puzzles in VR. Attrition rate, participant experience ratings, and cybersickness questionnaires were used to assess feasibility and acceptability. Trial 1 of the Hopkins Verbal Learning Test – Revised was administered pre- and post-intervention to assess preliminary efficacy. Results: Feasibility was demonstrated by a low attrition rate (5.88 %), and acceptability was demonstrated by limited cybersickness and high levels of enjoyment. Although the increase in the number of semantic clusters used following the module did not reach conventional levels of statistical significance in the intervention group, it demonstrated a notable trend with a medium effect size (t = 1.48},

note = {Publisher: Elsevier Inc.},

keywords = {adult, article, clinical article, clinical assessment, Cognitive remediation therapy, cybersickness, disease severity, dizziness, Ecological treatment, Episodic memory, exclusion VR criteria questionnaire, feasibility study, female, Hopkins verbal learning test, human, male, mini international neuropsychiatric interview, nausea, outcome assessment, Positive and Negative Syndrome Scale, Proof of concept, questionnaire, randomized controlled trial, schizophrenia, scoring system, Semantic encoding, Semantics, task performance, training, Verbal memory, virtual reality, vr experience questionnaire},

pubstate = {published},

tppubtype = {article}

}

@article{bogieUsingVirtualReality2024,

title = {Using virtual reality to improve verbal episodic memory in schizophrenia: A proof-of-concept trial},

author = {B. J. M. Bogie and C. Noël and F. Gu and S. Nadeau and C. Shvetz and H. Khan and M. -C. Rivard and S. Bouchard and M. Lepage and S. Guimond},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85186986986&doi=10.1016%2fj.scog.2024.100305&partnerID=40&md5=a15c598b45b8f44a40b25fe5fd078a06},

doi = {10.1016/j.scog.2024.100305},

issn = {22150013 (ISSN)},

year  = {2024},

date = {2024-01-01},

journal = {Schizophrenia Research: Cognition},

volume = {36},

publisher = {Elsevier Inc.},

abstract = {Background: Schizophrenia is associated with impairments in verbal episodic memory. Strategy for Semantic Association Memory (SESAME) training represents a promising cognitive remediation program to improve verbal episodic memory. Virtual reality (VR) may be a novel tool to increase the ecological validity and transfer of learned skills of traditional cognitive remediation programs. The present proof-of-concept study aimed to assess the feasibility, acceptability, and preliminary efficacy of a VR-based cognitive remediation module inspired by SESAME principles to improve the use of verbal episodic memory strategies in schizophrenia. Methods: Thirty individuals with schizophrenia/schizoaffective disorder completed this study. Participants were randomized to either a VR-based verbal episodic memory training condition inspired by SESAME principles (intervention group) or an active control condition (control group). In the training condition, a coach taught semantic encoding strategies (active rehearsal and semantic clustering) to help participants remember restaurant orders in VR. In the active control condition, participants completed visuospatial puzzles in VR. Attrition rate, participant experience ratings, and cybersickness questionnaires were used to assess feasibility and acceptability. Trial 1 of the Hopkins Verbal Learning Test – Revised was administered pre- and post-intervention to assess preliminary efficacy. Results: Feasibility was demonstrated by a low attrition rate (5.88 %), and acceptability was demonstrated by limited cybersickness and high levels of enjoyment. Although the increase in the number of semantic clusters used following the module did not reach conventional levels of statistical significance in the intervention group, it demonstrated a notable trend with a medium effect size (t = 1.48},

keywords = {adult, article, clinical article, clinical assessment, Cognitive remediation therapy, cybersickness, disease severity, dizziness, Ecological treatment, Episodic memory, exclusion VR criteria questionnaire, feasibility study, female, Hopkins verbal learning test, human, male, mini international neuropsychiatric interview, nausea, outcome assessment, Positive and Negative Syndrome Scale, Proof of concept, questionnaire, randomized controlled trial, schizophrenia, scoring system, Semantic encoding, Semantics, task performance, training, Verbal memory, virtual reality, vr experience questionnaire},

pubstate = {published},

tppubtype = {article}

}

@article{banville_using_2023,

title = {Using Virtual Reality to Improve Nurses’ Students’ Clinical Surveillance in a Critical Care Context: A Psychological Perspective on Learning},

author = {F. Banville and D. Milhomme and A. Perron and J. Pinard and J. Houle and D. Therrien and G. Peguero-Rodriguez and S. Charette and B. -A. Ménélas and M. Trépanier and S. Bouchard},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85182468511&partnerID=40&md5=65f6f32f45ade940105c06386edd7a1c},

issn = {15548716},

year  = {2023},

date = {2023-01-01},

journal = {Annual Review of CyberTherapy and Telemedicine},

volume = {21},

pages = {245–251},

publisher = {Interactive Media Institute},

abstract = {Nurse’s clinical judgement is important to provide optimal and safe care, particularly in a critical care unit. Clinical surveillance is an activity that nurses use every day and which requires crucial components to manage patients' risk of complications. To carry out this process, several cognitive functions and psychological attitudes are needed such as information and attention processing, judgement, decision-making, stress, and anxiety regulation. Since 2018, Milhomme, Banville et al. have been working to develop a Virtual Care Unit (VCU), using immersive virtual reality, intended to train future nurses to improve their competence towards clinical surveillance process skills. The aim of this qualitative descriptive study was to determine the pertinence to use VCU simulation with graduating nurses’ students to improve clinical surveillance skills in a critical care context. Thirteen nursing students were recruited to test the scenario through the VCU. Participants were instructed to carry surveillance process on a specific patient who suffer of an instability after a surgery. An interview guide of 11 questions was used for the data collection. The results show there are 10 facilitating and 9 restricting factors in the VCU that may play a role in nursing students’ learning clinical surveillance processes. Among these elements, four of them have an important link with a psychological perspective: 1) sense of presence; 2) cybersickness; 3) reflexive environment; 4) stress reduction. Results show an important contribution of several cognitive function in the clinical surveillance process learning by the virtual reality technology. © 2023, Interactive Media Institute. All rights reserved.},

note = {Publisher: Interactive Media Institute},

keywords = {article, clinical monitoring, cognition, controlled study, cybersickness, female, human, human experiment, intensive care, intensive care unit, interview, male, normal human, nursing student, psychological aspect, qualitative analysis, qualitative research, recovery room, skill, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{maneuvrier_virtual_2023,

title = {Virtual reality and neuropsychological assessment: an analysis of human factors influencing performance and perceived mental effort},

author = {A. Maneuvrier and H. Ceyte and P. Renaud and R. Morello and P. Fleury and L. M. Decker},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85138552678&doi=10.1007%2fs10055-022-00698-4&partnerID=40&md5=631390bbdefb4b05de9565fb986e1923},

doi = {10.1007/s10055-022-00698-4},

issn = {13594338},

year  = {2023},

date = {2023-01-01},

journal = {Virtual Reality},

volume = {27},

number = {2},

pages = {849–861},

publisher = {Springer Science and Business Media Deutschland GmbH},

abstract = {This study aimed to compare a neuropsychological test tapping into executive control function, the Wisconsin Card Sorting Test (WCST), performed in either traditional paper-and-pencil (PP) or virtual reality (VR) modality, and to determine the role of human factors (i.e., sense of presence, cybersickness, field (in)dependence and video game experience) as contributors to performance and perceived mental effort. Indeed, if virtual assessment might bring the ecological dimension to controlled laboratory research, it is often suggested that human factors might bias performance. WCST performance and its associated perceived mental effort were compared between the two modalities (N = 107). In the VR modality (N = 52), a correlation matrix was conducted as well as a cluster analysis in order to build two experimental groups, or profiles, based on their subjective experience of VR. WCST performance and perceived mental effort were then compared between these two groups while controlling for age and education. Results outlined a similar WCST performance and perceived mental effort between the PP and VR modalities. However, when comparing the two VR groups, results suggest that an unfavorable profile for VR, i.e., less sense of presence, more cybersickness, more visual field dependence and less video game experience, is associated with greater perceived mental effort. These experimental findings enable outlining a new conceptual and methodological framework for the assessment of executive control task performance in VR. Results could help users to take human factors into consideration in order to fully exploit or predict the benefits of this tool. © 2022, The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.},

note = {Publisher: Springer Science and Business Media Deutschland GmbH},

keywords = {Cluster Analysis, cybersickness, Executive control of attention, Field dependence, Field dependence–independence, Game experience, Human computer interaction, Human engineering, Interactive computer graphics, Mental effort, Sense of presences, Video game experience, Video-games, virtual reality, WISCONSIN},

pubstate = {published},

tppubtype = {article}

}

@article{bouchard_arguing_2021,

title = {Arguing in Favor of Revising the Simulator Sickness Questionnaire Factor Structure When Assessing Side Effects Induced by Immersions in Virtual Reality},

author = {S. Bouchard and M. Berthiaume and G. Robillard and H. Forget and C. Daudelin-Peltier and P. Renaud and C. Blais and D. Fiset},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85119514106&doi=10.3389%2ffpsyt.2021.739742&partnerID=40&md5=83c5198937636133854ac31ad7f749a5},

doi = {10.3389/fpsyt.2021.739742},

issn = {16640640 (ISSN)},

year  = {2021},

date = {2021-01-01},

journal = {Frontiers in Psychiatry},

volume = {12},

publisher = {Frontiers Media S.A.},

abstract = {Two issues are increasingly of interest in the scientific literature regarding unwanted virtual reality (VR) induced side effects: (1) whether the latent structure of the Simulator Sickness Questionnaire (SSQ) is comprised of two or three factors, and (2) if the SSQ measures symptoms of anxiety that can be misattributed to unwanted negative side effects induced by immersions in VR. Study 1 was conducted with a sample of 876 participants. A confirmatory factor analysis clearly supported a two-factor model composed of nausea and oculomotor symptoms instead of the 3-factor structure observed in simulators. To tease-out symptoms of anxiety from unwanted negative side effects induced by immersions in VR, Study 2 was conducted with 88 participants who were administered the Trier Stress Social Test in groups without being immersed in VR. A Spearman correlation showed that 11 out of 16 side effects correlated significantly with anxiety. A factor analysis revealed that items measuring general discomfort, difficulty concentrating, sweating, nausea, and vertigo loaded significantly on the anxiety factor comprised of items from the State-Trait Anxiety Inventory. Finally, a multiple regression indicated that the items measuring general discomfort and difficulty concentrating significantly predicted increases in anxiety. The overall results support the notion that side effects associated with immersions in VR consist mostly of a nausea and an oculomotor latent structure and that a few items are confounding anxiety and cybersickness. The data support the suggestion to revise the scoring procedures of the Simulator Sickness Questionnaire when using this instrument with immersions in VR. Copyright © 2021 Bouchard, Berthiaume, Robillard, Forget, Daudelin-Peltier, Renaud, Blais and Fiset.},

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

keywords = {adult, Anxiety, Anxiety disorder, article, attention disturbance, blurred vision, confounding variable, controlled study, correlational study, cybersickness, disease association, dizziness, eye movement disorder, fatigue, female, headache, human, hypersalivation, immersion, major clinical study, male, nausea, scoring system, simulator sickness, Simulator Sickness Questionnaire, State Trait Anxiety Inventory, stomach disease, sweat gland disease, sweating, Trier Stress Social Test, vertigo, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{bouchardArguingFavorRevising2021,

title = {Arguing in Favor of Revising the Simulator Sickness Questionnaire Factor Structure When Assessing Side Effects Induced by Immersions in Virtual Reality},

author = {S. Bouchard and M. Berthiaume and G. Robillard and H. Forget and C. Daudelin-Peltier and P. Renaud and C. Blais and D. Fiset},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85119514106&doi=10.3389%2ffpsyt.2021.739742&partnerID=40&md5=83c5198937636133854ac31ad7f749a5},

doi = {10.3389/fpsyt.2021.739742},

issn = {16640640 (ISSN)},

year  = {2021},

date = {2021-01-01},

journal = {Frontiers in Psychiatry},

volume = {12},

publisher = {Frontiers Media S.A.},

abstract = {Two issues are increasingly of interest in the scientific literature regarding unwanted virtual reality (VR) induced side effects: (1) whether the latent structure of the Simulator Sickness Questionnaire (SSQ) is comprised of two or three factors, and (2) if the SSQ measures symptoms of anxiety that can be misattributed to unwanted negative side effects induced by immersions in VR. Study 1 was conducted with a sample of 876 participants. A confirmatory factor analysis clearly supported a two-factor model composed of nausea and oculomotor symptoms instead of the 3-factor structure observed in simulators. To tease-out symptoms of anxiety from unwanted negative side effects induced by immersions in VR, Study 2 was conducted with 88 participants who were administered the Trier Stress Social Test in groups without being immersed in VR. A Spearman correlation showed that 11 out of 16 side effects correlated significantly with anxiety. A factor analysis revealed that items measuring general discomfort, difficulty concentrating, sweating, nausea, and vertigo loaded significantly on the anxiety factor comprised of items from the State-Trait Anxiety Inventory. Finally, a multiple regression indicated that the items measuring general discomfort and difficulty concentrating significantly predicted increases in anxiety. The overall results support the notion that side effects associated with immersions in VR consist mostly of a nausea and an oculomotor latent structure and that a few items are confounding anxiety and cybersickness. The data support the suggestion to revise the scoring procedures of the Simulator Sickness Questionnaire when using this instrument with immersions in VR. Copyright © 2021 Bouchard, Berthiaume, Robillard, Forget, Daudelin-Peltier, Renaud, Blais and Fiset.},

keywords = {adult, Anxiety, Anxiety disorder, article, attention disturbance, blurred vision, confounding variable, controlled study, correlational study, cybersickness, disease association, dizziness, eye movement disorder, fatigue, female, headache, human, hypersalivation, immersion, major clinical study, male, nausea, scoring system, simulator sickness, Simulator Sickness Questionnaire, State Trait Anxiety Inventory, stomach disease, sweat gland disease, sweating, Trier Stress Social Test, vertigo, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{bouchard_side_2009,

title = {Side effects of immersions in virtual reality for people suffering from anxiety disorders},

author = {S. Bouchard and J. St-Jacques and P. Renaud and B. K. Wiederhold},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-79951669278&partnerID=40&md5=95f1086038ef0b2259780162f8c2082f},

issn = {17849934},

year  = {2009},

date = {2009-01-01},

journal = {Journal of Cyber Therapy and Rehabilitation},

volume = {2},

number = {2},

pages = {127–137},

abstract = {Side effects caused by immersions in virtual reality (VR) have been documented in experimental studies and with healthy people. With the growing interest of VR applications to assess and treat mental disorders, empirical information on side effects in clinical populations is needed. Three studies were conducted to: (a) describe symptoms and scores on the Simulator Sickness Questionnaire (SSQ) in a sample of 157 adults immersed in VR to treat their phobias, (b) compare exposure treatments involving more or less actions and motions (N = 34); and (c) document the usefulness of assessing symptoms prior to the immersion in VR and following up 26 phobic patients 24 hours post-immersion. Overall, results show that most participants experienced slight side effects, symptoms were strong even before immersion in VR and there are no reasons to be generally concerned with health and safety issues within 24 hours after therapy sessions. Exposure in VR to treat fear of flying was associated with fewer side effects than for other anxiety disorders. The scores on the SSQ were much higher than in studies conducted with non-clinical samples, raising several research questions. Side effects should not be a source of worries but they must be closely monitored and systematically reported in outcome studies. © Virtual Reality Medical Institute.},

keywords = {Anxiety disorder, article, body movement, clinical feature, cybersickness, disorientation, Fear, human, intermethod comparison, medical assessment, motion sickness, named inventories, nausea, patient safety, phobia, questionnaires and rating scales, Simulator Sickness Questionnaire, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{bouchardSideEffectsImmersions2009,

title = {Side effects of immersions in virtual reality for people suffering from anxiety disorders},

author = {S. Bouchard and J. St-Jacques and P. Renaud and B. K. Wiederhold},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-79951669278&partnerID=40&md5=95f1086038ef0b2259780162f8c2082f},

issn = {17849934},

year  = {2009},

date = {2009-01-01},

journal = {Journal of Cyber Therapy and Rehabilitation},

volume = {2},

number = {2},

pages = {127–137},

abstract = {Side effects caused by immersions in virtual reality (VR) have been documented in experimental studies and with healthy people. With the growing interest of VR applications to assess and treat mental disorders, empirical information on side effects in clinical populations is needed. Three studies were conducted to: (a) describe symptoms and scores on the Simulator Sickness Questionnaire (SSQ) in a sample of 157 adults immersed in VR to treat their phobias, (b) compare exposure treatments involving more or less actions and motions (N = 34); and (c) document the usefulness of assessing symptoms prior to the immersion in VR and following up 26 phobic patients 24 hours post-immersion. Overall, results show that most participants experienced slight side effects, symptoms were strong even before immersion in VR and there are no reasons to be generally concerned with health and safety issues within 24 hours after therapy sessions. Exposure in VR to treat fear of flying was associated with fewer side effects than for other anxiety disorders. The scores on the SSQ were much higher than in studies conducted with non-clinical samples, raising several research questions. Side effects should not be a source of worries but they must be closely monitored and systematically reported in outcome studies. © Virtual Reality Medical Institute.},

keywords = {Anxiety disorder, article, body movement, clinical feature, cybersickness, disorientation, Fear, human, intermethod comparison, medical assessment, motion sickness, named inventories, nausea, patient safety, phobia, questionnaires and rating scales, Simulator Sickness Questionnaire, virtual reality},

pubstate = {published},

tppubtype = {article}

}