@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{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{simon_assessing_2022,

title = {Assessing attentional bias for alcohol-related cues using eye tracking in a virtual reality environment},

author = {J. Simon and D. Grogna and M. -C. Rivard and M. Heck and S. Bouchard and E. Quertemont},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85139027341&doi=10.3389%2ffrvir.2022.849840&partnerID=40&md5=22d08446b9b6bf184867d77efa11932a},

doi = {10.3389/frvir.2022.849840},

issn = {26734192 (ISSN)},

year  = {2022},

date = {2022-01-01},

journal = {Frontiers in Virtual Reality},

volume = {3},

publisher = {Frontiers Media S.A.},

abstract = {Several experimental paradigms were developed to measure attentional biases towards alcohol-related cues. However, most of them are based on reaction times to two-dimensional stimuli displayed on a computer screen, such that their ecological validity has been questioned. To address this, we integrated an eye tracking system into a virtual reality headset (ET-VR) and measured attentional biases in a subclinical population of alcohol users. In this exploratory study, forty social drinkers were recruited and immersed in a virtual bar including alcohol-related stimuli. Attentional focus was assessed using dwell time and number of fixations for these alcohol-related stimuli as well as for neutral stimuli unrelated to alcohol consumption. The results show that the number of fixations and, to a lesser extent, the dwell time for alcohol-related cues were positively correlated with the drinking motivation of the participants. In contrast, no significant correlation was found for neutral stimuli. In conclusion, the present study shows that alcohol-induced attentional biases can be studied using an ET-VR device in a subclinical population of alcohol users. Copyright © 2022 Simon, Grogna, Rivard, Heck, Bouchard and Quertemont.},

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

keywords = {craving, cue exposure, eye tracking, immersion, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{simon_alcohol_2020,

title = {Alcohol Craving in Heavy and Occasional Alcohol Drinkers After Cue Exposure in a Virtual Environment: The Role of the Sense of Presence},

author = {J. Simon and A. -M. Etienne and S. Bouchard and E. Quertemont},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85083289867&doi=10.3389%2ffnhum.2020.00124&partnerID=40&md5=3ea6b9154dfcdcb4b4de0accc4ca0126},

doi = {10.3389/fnhum.2020.00124},

issn = {16625161 (ISSN)},

year  = {2020},

date = {2020-01-01},

journal = {Frontiers in Human Neuroscience},

volume = {14},

publisher = {Frontiers Media S.A.},

abstract = {The development of new technologies, and more specifically the opportunity to immerse participants in virtual controlled environments, provides a new ecological framework for researchers to study complex behaviors. This experiment aimed to compare post-immersion craving in occasional and heavy alcohol drinkers. Twenty-two occasional drinkers and eighteen heavy drinkers were recruited and immersed in a virtual bar, including alcoholic beverages. After the exposure, heavy drinkers reported a significantly higher craving than occasional drinkers. Post-immersion alcohol craving was significantly related to the levels of perceived ecological validity of the virtual environment. Finally, a moderation analysis suggested that the levels of craving more strongly increased with perceived ecological validity in heavy drinkers than in occasional drinkers. Therefore, the perceived ecological validity was an important experimental parameter to study craving in a virtual environment. These results further suggested that virtual reality might be a useful tool for both the scientific study of alcohol addiction and the treatment of alcohol dependence and relapse. © Copyright © 2020 Simon, Etienne, Bouchard and Quertemont.},

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

keywords = {adult, alcohol withdrawal syndrome, alcoholic beverage, article, association, clinical article, controlled study, craving, cue exposure, environmental exposure, female, heavy drinking, human, immersion, male, people by drinking status, Sensation, sense of presence, social drinker, validity, virtual reality, Young Adult},

pubstate = {published},

tppubtype = {article}

}

@article{canale_probing_2019,

title = {Probing gambling urge as a state construct: Evidence from a sample of community gamblers},

author = {N. Canale and A. Cornil and I. Giroux and S. Bouchard and J. Billieux},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85059626617&doi=10.1037%2fadb0000438&partnerID=40&md5=7d3a08b0815d09db467360f3a385f57d},

doi = {10.1037/adb0000438},

issn = {0893164X},

year  = {2019},

date = {2019-01-01},

journal = {Psychology of Addictive Behaviors},

volume = {33},

number = {2},

pages = {154–161},

publisher = {Educational Publishing Foundation},

abstract = {Little effort has been made to systematically test the psychometric properties of the Gambling Craving Scale (GACS; Young & Wohl, 2009). The GACS is adapted from the Questionnaire on Smoking Urges (Tiffany & Drobes, 1991) and thus measures gambling-related urge. Crucially, the validation of scales assessing gambling urge is complex because this construct is better conceptualized as a state (a transient and contextdetermined phenomenon). In the present study, we tested the psychometric properties of the French version of the GACS with 2 independent samples of community gamblers following an induction procedure delivered through an audio-guided imagery sequence aimed at promoting gambling urge. This procedure was specifically used to ensure the assessment of gambling urge as a state variable. Participants also completed measures of gambling severity, gambling cognitions and motives, impulsivity, and affect. Confirmatory factor analysis showed that the original 3-factor solution (anticipation, desire, relief) did not fit the data well. Additional exploratory factor analysis suggested instead a 2-factor solution: An intention and desire to gamble dimension and a relief dimension. The factorial structure resulting from the exploratory factor analysis was tested with confirmatory factor analysis in a second independent sample, resulting in an acceptable fit. The 2 dimensions presented good internal reliability and correlated differentially with the other study's variables. The current study showed that, similar to what has been reported for substance-related urges, gambling urges are adequately probed with a bidimensional model. The findings suggest that the French GACS has good psychometric properties, legitimizing its use in research and clinical practice. © 2019 American Psychological Association.},

note = {Publisher: Educational Publishing Foundation},

keywords = {Adolescent, adult, aged, anticipation, article, case report, clinical article, clinical practice, confirmatory factor analysis, craving, Cross-Sectional Studies, cross-sectional study, devices, Diagnosis, exploratory factor analysis, Factor Analysis, female, Gambling, guided imagery, human, Humans, impulsiveness, male, Middle Aged, procedures, Psychiatric Status Rating Scales, psychological rating scale, Psychometrics, psychometry, reliability, reproducibility, Reproducibility of Results, Statistical, Young Adult},

pubstate = {published},

tppubtype = {article}

}

@article{bouchard_using_2017,

title = {Using virtual reality in the treatment of gambling disorder: The development of a new tool for cognitive behavior therapy},

author = {S. Bouchard and G. Robillard and I. Giroux and C. Jacques and C. Loranger and M. St-Pierre and M. Chrétien and A. Goulet},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85014229849&doi=10.3389%2ffpsyt.2017.00027&partnerID=40&md5=27df5ef448fec9e2ac3498cd76632899},

doi = {10.3389/fpsyt.2017.00027},

issn = {16640640},

year  = {2017},

date = {2017-01-01},

journal = {Frontiers in Psychiatry},

volume = {8},

number = {FEB},

publisher = {Frontiers Research Foundation},

abstract = {Virtual reality (VR) can be used in the treatment of gambling disorder to provide emotionally charged contexts (e.g., induce cravings) where patients can practice cognitive behavior therapy (CBT) techniques in the safety of the therapist's office. This raises practical questions, such as whether the cravings are sufficient to be clinically useful but also manageable enough to remain clinically safe. Pilot data are also needed to test the development of a treatment manual and prepare large randomized control trials. This paper reports on three studies describing (a) cravings induced in VR compared to real gambling and a control game of skill with no money involved (N = 28 frequent gamblers and 36 infrequent gamblers); (b) the usefulness of a treatment protocol with only two CBT sessions using VR (N = 34 pathological gamblers); and (c) the safety of a four-session treatment program of CBT in VR (N = 25 pathological gamblers). Study 1 reveals that immersions in VR can elicit desire and a positive anticipation to gamble in frequent gamblers that are (a) significantly stronger than for infrequent gamblers and for playing a control game of skill and (b) as strong as for gambling on a real video lottery terminal. Study 2 documents the feasibility of integrating VR in CBT, its usefulness in identifying more high-risk situations and dysfunctional thoughts, how inducing cravings during relapse prevention exercises significantly relates to treatment outcome, and the safety of the procedure in terms of cybersickness. Results from Study 3 confirm that, compared to inducing urges to gamble in imagination, using VR does not lead to urges that are stronger, last longer, or feel more out of control. Outcome data and effect sizes are reported for both randomized control pilot trials conducted in inpatient settings. Suggestions for future research are provided, including on increasing the number of VR sessions in the treatment program. © 2017 Bouchard, Robillard, Giroux, Jacques, Loranger, St-Pierre, Chrétien and Goulet.},

note = {Publisher: Frontiers Research Foundation},

keywords = {adult, age distribution, article, clinical effectiveness, cognitive behavioral therapy, controlled study, craving, DSM-5, ethnic difference, female, high risk population, human, major clinical study, male, outcome assessment, pathological gambling, pilot study, program feasibility, safety, sex difference, treatment duration, treatment outcome, virtual reality exposure therapy},

pubstate = {published},

tppubtype = {article}

}