@article{delangle_speaking_2026,

title = {Speaking face-to-face with a virtual avatar to reduce anxiety in students who stutter: Tool development and pilot study results},

author = {M. Delangle and A. Moïse-Richard and A. -L. Leclercq and D. Labbé and S. Bouchard and S. Andrews and L. Ménard},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-105028302364&doi=10.1016%2Fj.jfludis.2026.106194&partnerID=40&md5=af0d246f9187ee19796f36456887400b},

doi = {10.1016/j.jfludis.2026.106194},

issn = {0094730X (ISSN)},

year  = {2026},

date = {2026-01-01},

journal = {Journal of Fluency Disorders},

volume = {87},

abstract = {Purpose Speaking in class is challenging for students who stutter. Cognitive-behavioral therapy (CBT) with exposure in virtual reality (VR) emerges as a promising intervention for treating speaking anxiety in pediatric populations. This pilot study tested if real-time avatar-based VR can elicit anxiety responses while remaining acceptable to youth who stutter. Method Twelve students who stutter (aged 9–18) were randomly assigned to a single training session conducted either (1) in VR with a realistic avatar controlled live by their SLP, or (2) in role-play with their SLP, before facing a real actor. We assessed system acceptability, anxiety levels and perceived self-efficacy. Results The VR system was well accepted and elicited physiological arousal comparable to real-life interactions. Although participants reported experiencing less anxiety during VR, skin conductance level showed higher arousal; suggesting a divergence between the subjective report and physiological response. Finally, one training session (either in VR or with the SLP) did not produce gains in self-efficacy or decrease in anxiety related to the final real-actor conversation. Conclusion This study demonstrates evidence that the potential use of immersive VR could represent an acceptable and viable complementary strategy for SLP treatment, that could control exposure parameters while evoking physiological responses similar to real-life contexts. The differences between subjective and physiological measures suggest that VR is inducing anxiety responses differently than it was perceived. Further research could investigate the use of VR as anxiety interventions for students who stutter and should be explored across multi-session studies to understand their therapeutic effect. © 2026 The Authors.},

keywords = {Adolescent, adult, Anxiety, Arousal, article, Avatar, avoidance behavior, Canada, Child, clinical article, cognitive behavioral therapy, complication, controlled study, distance learning, ecological validity, electrocardiogram, electrodermal response, exposure, female, Heart Rate, heart rate variability, human, Humans, Liebowitz Social Anxiety Scale, Likert scale, male, nonverbal communication, physiological stress, Pilot Projects, pilot study, procedures, psychology, questionnaire, randomized controlled trial, role playing, School-age children, Self Concept, Self Efficacy, self report, Signal processing, skin conductance, social anxiety, speech, student, Students, Stuttering, Therapy, treatment outcome, virtual reality, virtual reality exposure therapy},

pubstate = {published},

tppubtype = {article}

}

@article{alessandra_preselected_2026,

title = {Preselected and preferred immersive virtual reality versus narrative alone to induce post-stress relaxation in patients with pulmonary arterial hypertension: A pilot study on perceived stress and heart rate},

author = {G. Alessandra and D. M. Beatrice and C. Sara and M. Roberta and V. Martina and K. Patrycja and B. Maurizio and B. Luca and D. V. Laura Adelaide and B. Stéphane},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-105029595132&doi=10.1111%2Fbjhp.70059&partnerID=40&md5=b86f0151066a7923d8854913cbd54318},

doi = {10.1111/bjhp.70059},

issn = {1359107X (ISSN)},

year  = {2026},

date = {2026-01-01},

journal = {British Journal of Health Psychology},

volume = {31},

number = {1},

abstract = {Objectives: Several studies have shown the effectiveness of immersive virtual reality (IVR)-based relaxation techniques in alleviating stress within the general population. However, few data are available on patients, or on the effectiveness of different scenarios in inducing relaxation. This pilot study aims to compare the effectiveness of three relaxation techniques—preselected IVR (IVR-PS), preferred IVR (i.e. chosen by the participant from different alternatives—IVR-PR), and narrative alone (CTR)—in reducing physiological and psychological stress in 16 pulmonary arterial hypertension (PAH) female patients (N = 16, average age: 46 ± 10.66 years; average education: 13.31 ± 3.8 years; mean duration of illness: 8.56 ± 5.24 years) following an acute stress. Methods: Patients performed a mental stress test followed by three different relaxation sessions presented in a randomized order on three separate occasions. Self-perceived stress, level of relaxation, and heart rate (HR) were monitored during the sessions. Participants' ratings of their experiences were also collected. Results: The results indicated that the three relaxation methods were equally effective in reducing perceived stress induced by acute stress and in lowering HR. However, greater cognitive activation was reported in the two IVR conditions compared with the narrative condition. Conclusions: This is the first study to show evidence of the impact of IVR on a rare population. Despite the lack of significant differences between the two IVR and narrative-alone conditions in physiological and subjective relaxation, more than half of the participants expressed a subjective preference for the virtual experience, especially for the preferred one. © 2026 The Author(s). British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.},

keywords = {adult, controlled study, female, Heart Rate, human, Humans, hypertension, Immersive virtual reality, mental stress, Middle Aged, Narration, pathophysiology, physiology, Pilot Projects, pilot study, procedures, Psychological, psychology, Pulmonary, pulmonary arterial hypertension, pulmonary hypertension, randomized controlled trial, rehabilitation, relaxation, Relaxation Therapy, relaxation training, Stress, Therapy, verbal communication, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{onita_virtual_2025,

title = {Virtual Reality Trier Social Stress and Virtual Supermarket Exposure: Electrocardiogram Correlates of Food Craving and Eating Traits in Adolescents},

author = {C. A. Onita and D. -V. Matei and E. Chelarasu and R. G. Lupu and D. Petrescu-Miron and A. Visnevschi and S. Vudu and C. Corciova and R. Fuior and N. Tupita and S. Bouchard and V. Mocanu},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-105026068857&doi=10.3390%2Fnu17243924&partnerID=40&md5=fde16e892b1a18284dc51ac869ba8ee9},

doi = {10.3390/nu17243924},

issn = {20726643 (ISSN)},

year  = {2025},

date = {2025-01-01},

journal = {Nutrients},

volume = {17},

number = {24},

abstract = {Background/Objectives: Acute stress is known to influence food-related motivation and decision-making, often promoting a preference for energy-dense, palatable foods. However, traditional laboratory paradigms have limited ecological validity. This study examined the relationship between stress-induced physiological changes, eating behavior traits, and food cravings using a virtual reality (VR) adaptation of the Trier Social Stress Test (VR-TSST) followed by a VR supermarket task in adolescents. Methods: Thirty-eight adolescents (mean age 15.8 ± 0.6 years) participated in the study. Physiological parameters (HR, QT, PQ intervals) were recorded pre- and post-stress using a portable ECG device (WIWE). Perceived stress and eating behavior traits were evaluated with the Perceived Stress Scale (PSS) and the Three-Factor Eating Questionnaire (TFEQ-R21C), respectively. Immediately after the VR-TSST, participants performed a VR supermarket task in which they rated cravings for sweet, fatty, and healthy foods using visual analog scales (VAS). Paired-samples t-tests examined pre–post changes in physiological parameters, partial correlations explored associations between ECG responses and eating traits, and a 2 × 3 mixed-model Repeated Measures ANOVA assessed the effects of food type (sweet, fatty, healthy) and uncontrolled eating (UE) group (low vs. high) on post-stress cravings. Results: Acute stress induced significant increases in HR and QTc intervals (p < 0.01), confirming a robust physiological stress response. The ANOVA revealed a strong main effect of food type (F(1.93, 435.41) = 168.98, p < 0.001, η2p = 0.43), indicating that stress-induced cravings differed across food categories, with sweet foods rated highest. A significant food type × UE group interaction (F(1.93, 435.41) = 16.49, p < 0.001, η2p = 0.07) showed that adolescents with high UE exhibited greater cravings for sweet and fatty foods than those with low UE. Overall, craving levels did not differ significantly between groups. Conclusions: The findings demonstrate that acute stress selectively enhances cravings for high-reward foods, and that this effect is modulated by baseline uncontrolled eating tendencies. The combined use of VR-based stress induction and VR supermarket simulation offers an innovative, ecologically valid framework for studying stress-related eating behavior in adolescents, with potential implications for personalized nutrition and the prevention of stress-induced overeating. © 2025 by the authors.},

keywords = {acute stress, Adolescent, Adolescents, adult, article, controlled study, craving, decision making, Eating, eating behavior, ecological validity, electrocardiogram, electrocardiogram (ECG) parameters, Electrocardiography, feeding behavior, female, food craving, food preference, Food Preferences, Heart Rate, human, Humans, hyperphagia, male, mental stress, motivation, normal human, overnutrition, pathophysiology, Perceived Stress Scale, personalized nutrition, physiological stress, physiology, PQ interval, Psychological, psychology, QTc interval, questionnaire, reward, simulation, social stress, Stress, supermarket, Surveys and Questionnaires, three-factor eating questionnaire (TFEQ), Three-Factor-Eating-Questionnaire, Trier Social Stress Test, virtual reality, virtual supermarket, visual analog scale},

pubstate = {published},

tppubtype = {article}

}

@article{antonio_posttraumatic_2025,

title = {Posttraumatic stress disorder and Physiological Response in First Responders During Virtual Reality Exposure},

author = {H. António and C. Barros and M. Vieira de Castro and J. Oliveira and P. Gamito and S. Bouchard and R. J. Pinto},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-105023876769&doi=10.1177%2F21522715251394917&partnerID=40&md5=c3c071b02ee24bd37789dfd06a936fbd},

doi = {10.1177/21522715251394917},

issn = {21522715 (ISSN)},

year  = {2025},

date = {2025-01-01},

journal = {Cyberpsychology, Behavior, and Social Networking},

abstract = {First responders (FRs) are routinely exposed to traumatic events, increasing risk for posttraumatic stress disorder (PTSD). This study compared heart rate variability (HRV) and skin conductance level (SCL) between FRs with and without probable PTSD at baseline and during a virtual reality (VR) task. Eighty-four FRs completed questionnaires and physiological assessments. Participants with probable PTSD showed significantly lower baseline HRV, indicating reduced parasympathetic modulation. No group differences emerged for HRV during VR or for SCL at either point. The results confirm reduced HRV at rest in PTSD, but further work is needed to clarify why this difference was not observed during the task and why SCL showed no group effects. To advance understanding of these results, future studies should include larger samples, longer baselines, recovery phases, and clinical interviews. © 2025 Mary Ann Liebert, (NY) LLC.},

keywords = {adult, electrodermal response, Emergency Responders, female, first responders, Galvanic Skin Response, Heart Rate, human, Humans, male, Middle Aged, pathophysiology, physiological response, physiology, Post-Traumatic, posttraumatic stress disorder, posttraumatic stress disorder (PTSD), psychology, questionnaire, rescue personnel, skin conductance, Stress Disorders, Surveys and Questionnaires, virtual reality, virtual reality exposure therapy, Young Adult},

pubstate = {published},

tppubtype = {article}

}

@article{onita_autonomic_2025,

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

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

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

doi = {10.3390/nu17152492},

issn = {20726643 (ISSN)},

year  = {2025},

date = {2025-01-01},

journal = {Nutrients},

volume = {17},

number = {15},

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

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

pubstate = {published},

tppubtype = {article}

}

@article{petrin_maternal_2024,

title = {Maternal childhood emotional abuse increases cardiovascular responses to children’s emotional facial expressions},

author = {R. Pétrin and A. Bérubé and É. St-Pierre and C. Blais},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85192637581&doi=10.1371%2fjournal.pone.0302782&partnerID=40&md5=c464b30fe7cc5b7b0baaf865fdf1f6de},

doi = {10.1371/journal.pone.0302782},

issn = {19326203 (ISSN)},

year  = {2024},

date = {2024-01-01},

journal = {PLoS ONE},

volume = {19},

number = {5 May},

publisher = {Public Library of Science},

abstract = {Parents with a history of childhood maltreatment may be more likely to respond inadequately to their child’s emotional cues, such as crying or screaming, due to previous exposure to prolonged stress. While studies have investigated parents’ physiological reactions to their children’s vocal expressions of emotions, less attention has been given to their responses when perceiving children’s facial expressions of emotions. The present study aimed to determine if viewing facial expressions of emotions in children induces cardiovascular changes in mothers (hypo- or hyper-arousal) and whether these differ as a function of childhood maltreatment. A total of 104 mothers took part in this study. Their experiences of childhood maltreatment were measured using the Childhood Trauma Questionnaire (CTQ). Participants’ electrocardiogram signals were recorded during a task in which they viewed a landscape video (baseline) and images of children’s faces expressing different intensities of emotion. Heart rate variability (HRV) was extracted from the recordings as an indicator of parasympathetic reactivity. Participants presented two profiles: one group of mothers had a decreased HRV when presented with images of children’s facial expressions of emotions, while the other group’s HRV increased. However, HRV change was not significantly different between the two groups. The interaction between HRV groups and the severity of maltreatment experienced was marginal. Results suggested that experiences of childhood emotional abuse were more common in mothers whose HRV increased during the task. Therefore, more severe childhood experiences of emotional abuse could be associated with mothers’ cardiovascular hyperreactivity. Maladaptive cardiovascular responses could have a ripple effect, influencing how mothers react to their children’s facial expressions of emotions. That reaction could affect the quality of their interaction with their child. Providing interventions that help parents regulate their physiological and behavioral responses to stress might be helpful, especially if they have experienced childhood maltreatment. © 2024 Public Library of Science. All rights reserved.},

note = {Publisher: Public Library of Science},

keywords = {adult, alcohol consumption, analysis of variance, article, blood pressure, cardiovascular response, Child, Child Abuse, Childhood, Childhood Trauma Questionnaire, demographics, electrocardiogram, Electrocardiography, emotion, Emotional Abuse, Emotions, Ethnicity, Facial Expression, female, Heart Rate, heart rate variability, human, human experiment, Humans, Likert scale, male, mother, mother child relation, Mother-Child Relations, Mothers, parasympathetic tone, physical activity, physiology, post hoc analysis, psychology, questionnaire, sexual abuse, Surveys and Questionnaires},

pubstate = {published},

tppubtype = {article}

}

@article{orskov_cognitive_2022,

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

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

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

doi = {10.3389/fpsyt.2022.991755},

issn = {16640640 (ISSN)},

year  = {2022},

date = {2022-01-01},

journal = {Frontiers in Psychiatry},

volume = {13},

publisher = {Frontiers Media S.A.},

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

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

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

pubstate = {published},

tppubtype = {article}

}

@article{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}

}

@article{bouchard_using_2012,

title = {Using biofeedback while immersed in a stressful videogame increases the effectiveness of stress management skills in soldiers},

author = {S. Bouchard and F. Bernier and E. Boivin and B. Morin and G. Robillard},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84860485827&doi=10.1371%2fjournal.pone.0036169&partnerID=40&md5=4b29a984169d2fe12d54f4c562344723},

doi = {10.1371/journal.pone.0036169},

issn = {19326203},

year  = {2012},

date = {2012-01-01},

journal = {PLoS ONE},

volume = {7},

number = {4},

abstract = {This study assessed the efficacy of using visual and auditory biofeedback while immersed in a tridimensional videogame to practice a stress management skill (tactical breathing). All 41 participants were soldiers who had previously received basic stress management training and first aid training in combat. On the first day, they received a 15-minute refresher briefing and were randomly assigned to either: (a) no additional stress management training (SMT) for three days, or (b) 30-minute sessions (one per day for three days) of biofeedback-assisted SMT while immersed in a horror/first-person shooter game. The training was performed in a dark and enclosed environment using a 50-inch television with active stereoscopic display and loudspeakers. On the last day, all participants underwent a live simulated ambush with an improvised explosive device, where they had to provide first aid to a wounded soldier. Stress levels were measured with salivary cortisol collected when waking-up, before and after the live simulation. Stress was also measured with heart rate at baseline, during an apprehension phase, and during the live simulation. Repeated-measure ANOVAs and ANCOVAs confirmed that practicing SMT was effective in reducing stress. Results are discussed in terms of the advantages of the proposed program for military personnel and the need to practice SMT. © 2012 Bouchard et al.},

keywords = {adult, Arousal, article, Biofeedback, clinical trial, controlled clinical trial, controlled study, explosion, feedback system, first aid, Heart Rate, human, human experiment, Humans, Hydrocortisone, male, mental stress, metabolism, methodology, Military Personnel, military phenomena, normal human, pathophysiology, Psychological, psychological aspect, psychology, Psychophysiology, randomized controlled trial, recreation, Saliva, saliva level, simulation, soldier, Stress, Stress management, Video Games},

pubstate = {published},

tppubtype = {article}

}

@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}

}