@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{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{quintana_engaging_2023,

title = {Engaging in Awkward Social Interactions in a Virtual Environment Designed for Exposure-Based Psychotherapy for People with Generalized Social Anxiety Disorder: An International Multisite Study},

author = {P. Quintana and S. Bouchard and C. Botella and G. Robillard and B. Serrano and A. Rodriguez-Ortega and M. Torp Ernst and B. Rey and M. Berthiaume and G. Corno},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85165033932&doi=10.3390%2fjcm12134525&partnerID=40&md5=7b0f59b46ff7680611d5a64e18909651},

doi = {10.3390/jcm12134525},

issn = {20770383 (ISSN)},

year  = {2023},

date = {2023-01-01},

journal = {Journal of Clinical Medicine},

volume = {12},

number = {13},

publisher = {Multidisciplinary Digital Publishing Institute (MDPI)},

abstract = {The effectiveness of in virtuo exposure-based treatment of performance-only social anxiety disorder (SAD) has been demonstrated in several studies. However, few studies have validated virtual environments with participants suffering from generalized SAD. The goal of this study is to confirm the potential of a virtual environment in inducing anxiety in adults suffering from generalized SAD, compared to adults without SAD, when engaged in awkward social interactions. Differences between participants from two different countries were also explored. The sample consisted of 15 participants with SAD from Canada, 17 participants without SAD from Canada, 16 participants with SAD from Spain, and 21 participants without SAD from Spain. All participants were immersed in a control virtual environment and in an experimental virtual environment considered potentially anxiety-inducing for individuals with generalized SAD. As hypothesized, results showed that the experimental virtual environment induced a higher level of anxiety than the control environment among participants with SAD compared to those without SAD. The impact on anxiety of each socially threatening task performed during the experimental immersion was statistically significant. In terms of anxiety responses, no significant differences were found between participants from Canada and Spain. However, spatial presence and ecological validity were higher in Canadians than in Spaniards. Unwanted negative side effects induced by immersions in virtual reality were higher in the SAD group. This study highlights the importance for therapists to engage people with SAD in clinically relevant tasks while immersed in VR psychotherapeutic applications. © 2023 by the authors.},

note = {Publisher: Multidisciplinary Digital Publishing Institute (MDPI)},

keywords = {adult, anxiety assessment, article, Canada, clinical article, controlled study, cultural differences, ecological validity, exposure, female, generalized social anxiety, human, immersion, male, multicenter study, psychotherapy, self report, social anxiety, social interaction, social phobia, Spain, virtual reality, virtual reality exposure therapy},

pubstate = {published},

tppubtype = {article}

}

@article{benbouriche_self-regulation_2016,

title = {Self-regulation and virtual reality in forensic psychiatry: An emphasis on theoretical underpinnings [Applications de la réalité virtuelle en psychiatrie légale : la perspective de l'autorégulation comme cadre théorique]},

author = {M. Benbouriche and P. Renaud and J. -F. Pelletier and P. De Loor},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84954287281&doi=10.1016%2fj.encep.2015.12.001&partnerID=40&md5=3ce15162ac13e345f99c3cbdad987cf2},

doi = {10.1016/j.encep.2015.12.001},

issn = {00137006},

year  = {2016},

date = {2016-01-01},

journal = {Encephale},

volume = {42},

number = {6},

pages = {540–546},

publisher = {Elsevier Masson SAS},

abstract = {Introduction Forensic psychiatry is the field whose expertise is the assessment and treatment of offending behaviours, in particular when offenses are related to mental illness. An underlying question for all etiological models concerns the manner in which an individual's behaviours are organized. Specifically, it becomes crucial to understand how certain individuals come to display maladaptive behaviours in a given environment, especially when considering issues such as offenders’ responsibility and their ability to change their behaviours. Virtual reality Thanks to its ability to generate specific environments, associated with a high experimental control on generated simulations, virtual reality is gaining recognition in forensic psychiatry. Virtual reality has generated promising research data and may turn out to be a remarkable clinical tool in the near future. While research has increased, a conceptual work about its theoretical underpinnings is still lacking. However, no important benefit should be expected from the introduction of a new tool (as innovative as virtual reality) without an explicit and heuristic theoretical framework capable of clarifying its benefits in forensic psychiatry. Objectives Our paper introduces self-regulation perspective as the most suitable theoretical framework for virtual reality in forensic psychiatry. It will be argued that virtual reality does not solely help to increase ecological validity. However, it does allow one to grant access to an improved understanding of violent offending behaviours by probing into the underlying mechanisms involved in the self-regulation of behaviours in a dynamical environment. Illustrations are given as well as a discussion regarding perspectives in the use of virtual reality in forensic psychiatry. © 2015 L'Encéphale, Paris},

note = {Publisher: Elsevier Masson SAS},

keywords = {autoregulation, behavior, Computer Graphics, computer interface, Computer Simulation, conceptual framework, Crime, ecological validity, Environment, Expert Testimony, expert witness, Forensic psychiatry, human, human experiment, Humans, Mental Disorders, procedures, psychology, recognition, theoretical model, User-Computer Interface, Violence, virtual reality},

pubstate = {published},

tppubtype = {article}

}