@article{jeanningros_exposure-based_2025,

title = {Exposure-Based Intervention in Virtual Reality to Address Kinesiophobia in Parkinson’s Disease: A Narrative Review},

author = {A. Jeanningros and S. Bouchard and A. Potvin-Desrochers},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-105025999269&doi=10.3390%2Fjcm14248837&partnerID=40&md5=9c874cbaf8739d404c31fff42aca15db},

doi = {10.3390/jcm14248837},

issn = {20770383 (ISSN)},

year  = {2025},

date = {2025-01-01},

journal = {Journal of Clinical Medicine},

volume = {14},

number = {24},

abstract = {Background/Objectives: Physical activity alleviates symptoms and may slow Parkinson’s disease (PD) progression, yet many individuals with PD remain sedentary. Kinesiophobia, the fear of movement, may represent a significant but underexplored psychological barrier to physical activity in this population. Virtual reality (VR), already effective in phobias, may represent a promising approach to address this challenge. This review initially aimed to systematically examine exposure-based interventions in VR (E-IVR) directly targeting kinesiophobia in PD. Methods: Database searches using keywords such as “kinesiophobia,” “fear of movement,” and “VR” combined with “PD” yielded no eligible studies. Consequently, the scope was broadened to include populations with neurological or musculoskeletal conditions, and a narrative review format was adopted to synthesize the available evidence. Furthermore, relevant studies of interventions in VR applied in PD, although not specifically addressing kinesiophobia, are detailed to provide evidence of efficacy and feasibility of VR interventions in PD. Finally, directions are offered to support the creation of E-IVR targeting kinesiophobia in individuals with PD. Results: Meta-analyses in neurological and musculoskeletal populations demonstrate moderate to large reductions in kinesiophobia following VR interventions, although effects vary depending on assessment tools, degree of immersion, and exposure design. In PD, VR has been applied to rehabilitation, anxiety reduction, and quality of life enhancement. These interventions achieved high adherence (≥90%), were well tolerated, and reported no major adverse events. Conclusions: Kinesiophobia is prevalent in PD and could contribute to physical inactivity. E-IVR appears feasible, safe, and innovative for addressing kinesiophobia in people living with PD. © 2025 by the authors.},

keywords = {avoidance behavior, chronic pain, Depression, disease exacerbation, exposure-based intervention, human, in vivo study, kinesiophobia, low back pain, Medline, musculoskeletal pain, outcome expectation, Parkinson disease, Parkinson’s disease, physical activity, quality of life, rehabilitation care, review, Scopus, Self Concept, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{bouchard_conducting_2025,

title = {Conducting exposure in virtual reality for the treatment of social phobia does lead to change in dysfunctional beliefs},

author = {S. Bouchard and H. Forget},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-105023856314&partnerID=40&md5=db4c4e86d7c32b544fe28c7fb6f9172b},

issn = {15548716 (ISSN)},

year  = {2025},

date = {2025-01-01},

journal = {Annual Review of CyberTherapy and Telemedicine},

volume = {23},

pages = {258–264},

abstract = {This study used data from a randomized control trial on cognitive behavior therapy for social phobia testing the effectiveness of exposure conducted in virtual reality. Measures of cognitive mechanisms had been collected but never analyzed. The study was motivated by a recent publication mentioning that potential aversive outcomes of being judged in virtual reality and by virtual characters have no objective negative consequence in daily life. A sample of 51 adults completed outcome and cognitive mechanism measures at a pretreatment, after 14 weeks of treatment or being on a waiting list, and at a 6-month follow-up. Results demonstrate that conducting exposure in virtual reality led to reductions in dysfunctional beliefs about the perceived consequences of feared social threats, about the likelihood of these feared threats occurring, as well as an increase in perceived self-efficacy to face social situations. These changes were statistically significant when compared to the waiting list condition, remained stable at the 6-month follow-up, and were no less important than when exposure was conducted in vivo. All predictors significantly correlated (p < .001) with the two measures of treatment outcome. Further analyses of cognitive mechanism measures predicting treatment outcomes revealed that, when controlling for shared variance, changes in perceived likelihood and in self-efficacy contributed significantly to patients’ improvement, whereas the role of perceived consequences was only a predictor of self-efficacy. © 2025, Interactive Media Institute. All rights reserved.},

keywords = {adult, article, clinical article, cognitive behavioral therapy, controlled study, exposure, female, follow up, hospital admission, human, in vivo study, Liebowitz Social Anxiety Scale, male, multiple regression, predictors of outcome, randomized controlled trial, social anxiety disorder, social phobia, Social Phobia Scale, threat, treatment duration, Treatment mechanisms, treatment outcome, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{ansado_how_2021,

title = {How brain imaging provides predictive biomarkers for therapeutic success in the context of virtual reality cognitive training},

author = {J. Ansado and C. Chasen and S. Bouchard and G. Northoff},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85089070480&doi=10.1016%2fj.neubiorev.2020.05.018&partnerID=40&md5=8e5ea676958e050b32a893830dbc2a93},

doi = {10.1016/j.neubiorev.2020.05.018},

issn = {01497634},

year  = {2021},

date = {2021-01-01},

journal = {Neuroscience and Biobehavioral Reviews},

volume = {120},

pages = {583–594},

publisher = {Elsevier Ltd},

abstract = {As Virtual reality (VR) is increasingly used in neurological disorders such as stroke, traumatic brain injury, or attention deficit disorder, the question of how it impacts the brain's neuronal activity and function becomes essential. VR can be combined with neuroimaging to offer invaluable insight into how the targeted brain areas respond to stimulation during neurorehabilitation training. That, in turn, could eventually serve as a predictive marker for therapeutic success. Functional magnetic resonance imaging (fMRI) identified neuronal activity related to blood flow to reveal with a high spatial resolution how activation patterns change, and restructuring occurs after VR training. Portable and quiet, electroencephalography (EEG) conveniently allows the clinician to track spontaneous electrical brain activity in high temporal resolution. Then, functional near-infrared spectroscopy (fNIRS) combines the spatial precision level of fMRIs with the portability and high temporal resolution of EEG to constitute an ideal measuring tool in virtual environments (VEs). This narrative review explores the role of VR and concurrent neuroimaging in cognitive rehabilitation. © 2020 Elsevier Ltd},

note = {Publisher: Elsevier Ltd},

keywords = {accuracy, attention deficit disorder, biological monitoring, brain depth stimulation, brain electrophysiology, brain radiography, brain region, cell function, cerebrovascular accident, clinician, cognition, Cognitive rehabilitation, disease marker, electroencephalogram, Electroencephalography, functional magnetic resonance imaging, functional near-infrared spectroscopy, human, image quality, in vivo study, nerve cell, neuroimaging, neurologic disease, neuropsychological test, neuropsychology, neurorehabilitation, nonhuman, prediction, priority journal, review, therapy effect, training, traumatic brain injury, virtual reality, virtual reality cognitive training},

pubstate = {published},

tppubtype = {article}

}

@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}

}

@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}

}

@article{robillard_development_2011-1,

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-s2.0-83455179431&partnerID=40&md5=c2fde1fc8ce186d921450fe0909cee56},

issn = {15548716},

year  = {2011},

date = {2011-01-01},

journal = {Annual Review of CyberTherapy and Telemedicine},

volume = {9},

number = {1},

pages = {85–89},

abstract = {For decades, empirical studies have shown the effectiveness of exposure techniques when used in cognitivebehavioral 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 = {article, clinical effectiveness, controlled study, cost benefit analysis, exposure, human, in vivo study, psychologist, questionnaire, reliability, specific work for exposure applied in therapy questionnaire, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@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}

}