@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},

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{dugas_behavioral_2022,

title = {Behavioral Experiments for Intolerance of Uncertainty: A Randomized Clinical Trial for Adults With Generalized Anxiety Disorder},

author = {M. J. Dugas and K. A. Sexton and E. A. Hebert and S. Bouchard and J. -P. Gouin and R. Shafran},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85133178888&doi=10.1016%2fj.beth.2022.05.003&partnerID=40&md5=4dd15547cbef29c5f1adc84169176c53},

doi = {10.1016/j.beth.2022.05.003},

issn = {00057894 (ISSN)},

year  = {2022},

date = {2022-01-01},

journal = {Behavior Therapy},

volume = {53},

number = {6},

pages = {1147–1160},

abstract = {Sophisticated multicomponent treatments for adults with generalized anxiety disorder (GAD) have been developed over the past three decades. Although these comprehensive treatments have produced encouraging results, they appear to be less efficacious than treatments for other anxiety disorders. The goal of this randomized controlled trial is to test a newly developed, highly focused treatment for adults with GAD: Behavioral Experiments for Intolerance of Uncertainty. Sixty (60) participants (51 women, 9 men), with a mean age of 34.60 years (range: 19 to 67 years), were randomized to either treatment (n = 30) or wait-list control (n = 30). Treatment consisted of 12 weekly 1-hour sessions in which participants learned to use behavioral experiments to test their catastrophic beliefs about uncertainty. Assessments were conducted at pre-, mid- and postcondition, and at 6- and 12-month follow-up. The primary outcome was the severity of GAD, and secondary outcomes were worry, depression, somatic anxiety, and intolerance of uncertainty. Using growth curve modeling, we found that (1) the treatment group was superior to the wait-list group in terms of change from pre- to posttest on all outcomes; (2) the combined sample (once wait-listed participants received treatment) evidenced large and significant decreases on all outcomes; and (3) treatment gains were either maintained or increased over the 12-month follow-up period of the study. The new treatment is a promising treatment option for adults with GAD considering that it may be as efficacious as more comprehensive evidence-based psychological treatments for GAD. © 2022},

note = {Publisher: Elsevier Inc.},

keywords = {adult, aged, antidepressant agent, Anxiety, Anxiety disorder, Anxiety Disorders, anxiolytic agent, article, behavior assessment, behavioral experiments, benzodiazepine, cognitive behavioral therapy, cognitive vulnerability, Cognitive-behavioral treatment, confusion (uncertainty), controlled study, dependent variable, Depression, disease severity, female, follow up, generalized anxiety disorder, growth curve, human, Humans, intolerance of uncertainty, major clinical study, male, mental disease, outcome assessment, patient worry, procedures, psychology, randomized controlled trial, uncertainty},

pubstate = {published},

tppubtype = {article}

}

@article{marcotte-beaumier_role_2021,

title = {The role of intolerance of uncertainty and working alliance in the outcome of cognitive behavioral therapy for generalized anxiety disorder delivered by videoconference: Mediation analysis},

author = {G. Marcotte-Beaumier and S. Bouchard and P. Gosselin and F. Langlois and G. Belleville and A. Marchand and M. J. Dugas},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85103169307&doi=10.2196%2f24541&partnerID=40&md5=6d4abe613d27257552970428c3a84bb4},

doi = {10.2196/24541},

issn = {23687959},

year  = {2021},

date = {2021-01-01},

journal = {JMIR Mental Health},

volume = {8},

number = {3},

abstract = {Background: Previous meta-analyses have shown a significant relationship between working alliance and treatment outcome in general. Some studies have examined the relationship between working alliance and treatment outcome during telepsychotherapy, but to the best of our knowledge, no study has examined the mediating role of individual components of the working alliance. Objective: As part of a clinical trial of cognitive behavioral therapy (CBT) for generalized anxiety disorder (GAD) delivered by videoconference (VC), the aim of this study is to examine the mediating role of intolerance of uncertainty on the relationship between the components of the working alliance and treatment outcome. Methods: A sample of 46 adults with primary GAD received 15 sessions of CBT for GAD delivered over VC. Participants completed the measure of working alliance immediately after the fifth therapy session. The degree of change in intolerance of uncertainty (a key psychological process) was assessed from pre- to posttreatment. Treatment outcome was assessed via changes in GAD symptoms from pretreatment to the 6-month follow-up. Results: The results revealed that the therapeutic bond did not predict treatment outcome (r=-0.23; P=.12). However, agreement on therapeutic goals and tasks did predict treatment outcome (r=-0.42; P=.004 and r=-0.37; P=.01, respectively). In addition, the relationship between consensus on therapeutic tasks and treatment outcome was completely mediated by changes in intolerance of uncertainty (unstandardized β=-0.03; r2=0.12), whereas consensus relative to treatment goals had a direct impact on treatment outcome. Conclusions: These results provide a better understanding of the differential role of the components of the working alliance in telepsychotherapy as a facilitative factor for changes in key cognitive processes, leading to therapeutic change. © 2021 JMIR Publications Inc. All Rights Reserved.},

note = {Publisher: JMIR Publications Inc.},

keywords = {adult, article, clinical article, cognitive behavioral therapy, consensus, controlled study, female, follow up, generalized anxiety disorder, human, male, mediation analysis, outcome assessment, randomized controlled trial, telehealth, therapeutic alliance, treatment outcome, uncertainty, videoconferencing},

pubstate = {published},

tppubtype = {article}

}

@article{savard_efficacy_2021,

title = {Efficacy of a stepped care approach to deliver cognitive-behavioral therapy for insomnia in cancer patients: A noninferiority randomized controlled trial},

author = {J. Savard and H. Ivers and M. -H. Savard and C. M. Morin and A. Caplette-Gingras and S. Bouchard and G. Lacroix},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85121217599&doi=10.1093%2fsleep%2fzsab166&partnerID=40&md5=8c3390082d345b725c47465f96bb8e44},

doi = {10.1093/sleep/zsab166},

issn = {01618105 (ISSN)},

year  = {2021},

date = {2021-01-01},

journal = {Sleep},

volume = {44},

number = {11},

abstract = {Study Objectives: Cognitive-behavioral therapy for insomnia (CBT-I) is the recommended first-line treatment for cancer-related insomnia, but its accessibility is very limited in routine care. A stepped care approach has been recommended as a cost-effective way to make CBT-I more widely accessible. However, no controlled study has yet been published about the efficacy of this approach. The goal of this noninferiority randomized controlled trial (RCT) was to compare the short and long-term efficacy of a stepped care CBT-I (StepCBT-I) to a standard face-to-face CBT-I (StanCBT-I). Methods: A total of 177 cancer patients were randomized to: (1) StanCBT-I (6 face-to-face CBT-I sessions; n = 59) or (2) StepCBT-I (n = 118). In the StepCBT-I group, patients with less severe insomnia first received a web-based CBT-I (n = 65), while those with more severe insomnia received 6 face-to-face CBT-I sessions (n = 53). In both cases, patients could receive up to three booster sessions of CBT-I if they still had insomnia symptoms following this first step. Results: Results indicated that the Step-CBT-I group showed an Insomnia Severity Index score reduction and a sleep efficiency (on a sleep diary) increase that was not significantly inferior to that of StanCBT-I at all post-treatment time points. Analyses of secondary outcomes indicated significant time effects (ps <. 001) and no significant group-by-time interactions (ps from. 07 to. 91) on other sleep diary parameters, sleep medication use, depression, anxiety, fatigue, and quality of life scores. Conclusion(s): The efficacy of stepped care CBT-I is not inferior to that of a standard face-to-face intervention and is a valuable approach to making this treatment more widely accessible to cancer patients. Trial registration: ClinicalTrials.gov Identifier: NCT01864720 (https://clinicaltrials.gov/ct2/show/NCT01864720?term=Savard&draw=2&rank=6; Stepped Care Model for the Wider Dissemination of Cognitive-Behavioural Therapy for Insomnia Among Cancer Patients). © 2021 Sleep Research Society 2021. Published by Oxford University Press on behalf of the Sleep Research Society.},

note = {Publisher: Oxford University Press},

keywords = {adult, Anxiety, Anxiety disorder, cancer, cancer diagnosis, cancer patient, cognitive behavioral therapy, Cognitive-behavioral therapy, comparative study, complication, controlled study, cost effectiveness analysis, Depression, disease severity, drug use, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, fatigue, female, Hospital Anxiety and Depression Scale, human, Humans, insomnia, Insomnia Severity Index, long term care, major clinical study, male, malignant neoplasm, Middle Aged, Montreal cognitive assessment, neoplasm, Neoplasms, outcome assessment, procedures, psychotropic agent, quality of life, randomized controlled trial, remission, review, Self Care, short course therapy, sleep, sleep efficiency, Sleep Initiation and Maintenance Disorders, sleep pattern, stepped care, stepped care approach, Structured Clinical Interview for DSM Disorders, therapy effect, treatment outcome, web-based intervention},

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},

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{fernandez-alvarez_deterioration_2019,

title = {Deterioration rates in Virtual Reality Therapy: An individual patient data level meta-analysis},

author = {J. Fernández-Álvarez and A. Rozental and P. Carlbring and D. Colombo and G. Riva and P. L. Anderson and R. M. Baños and A. A. Benbow and S. Bouchard and J. M. Bretón-López and G. Cárdenas and J. Difede and P. Emmelkamp and A. García-Palacios and V. Guillén and H. Hoffman and I. Kampann and R. Moldovan and A. Mühlberger and M. North and P. Pauli and W. Peñate Castro and S. Quero and M. Tortella-Feliu and K. Wyka and C. Botella},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85050381788&doi=10.1016%2fj.janxdis.2018.06.005&partnerID=40&md5=012fdcaa9b8676314cbf22c52c91135b},

doi = {10.1016/j.janxdis.2018.06.005},

issn = {08876185 (ISSN)},

year  = {2019},

date = {2019-01-01},

journal = {Journal of Anxiety Disorders},

volume = {61},

pages = {3–17},

abstract = {Ample evidence supports the use of Virtual Reality (VR) for anxiety disorders. Nonetheless, currently there is no evidence about moderators or potential negative effects of VR treatment strategies. An Individual Patient Data (IPD) approach was employed with 15 retrieved datasets. The current study sample was composed of 810 patients. Randomized control trials (RCTs) for each primary outcome measure were performed, in addition to moderator analyses of the socio-demographic variables. Deterioration rates were 14 patients (4.0%) in VR, 8 (2.8%) in active control conditions, and 27 (15%) in the WL condition. With regard to receiving treatment, patients in a waiting list control condition had greater odds of deteriorating than in the two active conditions, odds ratios (ORs) 4.87, 95% confidence interval (CI) [0.05, 0.67]. In the case of the socio-demographic variables, none of them were associated with higher or lower odds of deterioration, with the exception of marital status in the WL condition; married people presented a significantly lower probability of deterioration, OR 0.19, 95% CI [0.05, 0.67]. Finally, when comparing pooled effects of VR versus all control conditions, the OR was 0.61 (95% CI 0.31–1.23) in favor of VR, although this result was not statistically significant. This study provides evidence about the deterioration rates of a therapeutic VR approach, showing that the number of deteriorated patients coincides with other therapeutic approaches, and that deterioration is less likely to occur, compared to patients in WL control groups. © 2018 Elsevier Ltd},

note = {Publisher: Elsevier Ltd},

keywords = {Adolescent, adult, aged, Anxiety disorder, Anxiety Disorders, article, demography, deterioration, Deterioration rates, disease association, female, human, Humans, Individual patient data analysis, male, marriage, meta analysis, Middle Aged, Odds Ratio, outcome assessment, Probability, psychology, randomized controlled trial (topic), social status, virtual reality, virtual reality exposure therapy, Young Adult},

pubstate = {published},

tppubtype = {article}

}

@article{du_sert_virtual_2018,

title = {Virtual reality therapy for refractory auditory verbal hallucinations in schizophrenia: A pilot clinical trial},

author = {O. P. Sert and S. Potvin and O. Lipp and L. Dellazizzo and M. Laurelli and R. Breton and P. Lalonde and K. Phraxayavong and K. O'Connor and J. -F. Pelletier and T. Boukhalfi and P. Renaud and A. Dumais},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85042420594&doi=10.1016%2fj.schres.2018.02.031&partnerID=40&md5=fe98669ecfdfb69d05cc9ebb58fecdcc},

doi = {10.1016/j.schres.2018.02.031},

issn = {09209964},

year  = {2018},

date = {2018-01-01},

journal = {Schizophrenia Research},

volume = {197},

pages = {176–181},

abstract = {Schizophrenia is a chronic and severe mental illness that poses significant challenges. While many pharmacological and psychosocial interventions are available, many treatment-resistant schizophrenia patients continue to suffer from persistent psychotic symptoms, notably auditory verbal hallucinations (AVH), which are highly disabling. This unmet clinical need requires new innovative treatment options. Recently, a psychological therapy using computerized technology has shown large therapeutic effects on AVH severity by enabling patients to engage in a dialogue with a computerized representation of their voices. These very promising results have been extended by our team using immersive virtual reality (VR). Our study was a 7-week phase-II, randomized, partial cross-over trial. Nineteen schizophrenia patients with refractory AVH were recruited and randomly allocated to either VR-assisted therapy (VRT) or treatment-as-usual (TAU). The group allocated to TAU consisted of antipsychotic treatment and usual meetings with clinicians. The TAU group then received a delayed 7 weeks of VRT. A follow-up was ensured 3 months after the last VRT therapy session. Changes in psychiatric symptoms, before and after TAU or VRT, were assessed using a linear mixed-effects model. Our findings showed that VRT produced significant improvements in AVH severity, depressive symptoms and quality of life that lasted at the 3-month follow-up period. Consistent with previous research, our results suggest that VRT might be efficacious in reducing AVH related distress. The therapeutic effects of VRT on the distress associated with the voices were particularly prominent (d = 1.2). VRT is a highly novel and promising intervention for refractory AVH in schizophrenia. © 2018},

note = {Publisher: Elsevier B.V.},

keywords = {adult, article, auditory hallucination, auditory verbal hallucination, clinical article, clinical effectiveness, computer assisted therapy, Computer-Assisted, controlled study, Cross-Over Studies, crossover procedure, disease severity, distress syndrome, female, follow up, Follow-Up Studies, hallucination, Hallucinations, human, Humans, male, Middle Aged, neuroleptic agent, outcome assessment, Outcome Assessment (Health Care), phase 2 clinical trial, physiology, Pilot Projects, pilot study, priority journal, procedures, psychotherapy, quality of life, randomized controlled trial, schizophrenia, Speech Perception, symptom, Therapy, therapy delay, therapy effect, treatment duration, treatment response, virtual reality, virtual reality exposure therapy},

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},

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}

}

@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},

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{st-jacques_is_2010,

title = {Is virtual reality effective to motivate and raise interest in phobic children toward therapy? A clinical trial study of in vivo with in virtuo versus in vivo only treatment exposure},

author = {J. St-Jacques and S. Bouchard and C. Bélanger},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-77955295979&doi=10.4088%2fJCP.08m04822blu&partnerID=40&md5=d542122407b00dcaecc8c51dcaf40610},

doi = {10.4088/JCP.08m04822blu},

issn = {01606689},

year  = {2010},

date = {2010-01-01},

journal = {Journal of Clinical Psychiatry},

volume = {71},

number = {7},

pages = {924–931},

abstract = {Objective: The first objective of this study was to assess if a combined treatment with mostly virtual reality-based (in virtuo) exposure increases phobic children's motivation toward therapy compared to children who only receive in vivo exposure. Another objective was the assessment of motivation as a predictor of treatment outcome. Method: Thirty-one DSM-IV-diagnosed arachnophobic participants aged from 8 to 15 years were randomly assigned to 1 of 2 treatment conditions: in vivo exposure alone or in virtuo plus in vivo exposure. Measures of motivation were taken at pretest and at the end of each part of the treatment; some other measures were taken at each session. The "Why Are You in Therapy?" questionnaire for children was the target measure of motivation and the main variable in the study. Outcome measures were taken at pretest, at the end of each part of the treatment, and at the 6-month follow-up. This study was conducted between September 2006 and March 2007. Results: The results showed that children who received in virtuo exposure did not show a higher level of motivation toward their treatment than those who received in vivo exposure, but statistically significant interactions were found for both parts of the treatment. Multiple regression analysis confirmed that motivation was a significant predictor of outcome (P < .01), especially extrinsic integrated motivation. Participants in the combined treatment were significantly more phobic before beginning treatment, but both treatments appeared successful (P < .001). Conclusions: In this study, the use of virtual reality did not increase motivation toward psychotherapy. At the end of the second part of therapy, all participants were comparably efficient in facing a live tarantula. These results bear important clinical implications concerning how to use virtual reality with children and concerning motivation of children toward therapy in general. They are discussed in the light of how to present in virtuo therapy to children. Trial Registration: controlled-trials.com Identifier: ISRCTN87716831. © Copyright 2010 Physicians Postgraduate Press, Inc.},

keywords = {Adolescent, Animals, article, Child, clinical article, clinical trial, cognitive therapy, Combined Modality Therapy, Computer-Assisted, controlled clinical trial, controlled study, exposure, female, follow up, human, Humans, Implosive Therapy, Internal-External Control, male, motivation, outcome assessment, phobia, Phobic Disorders, predictor variable, priority journal, psychotherapy, randomized controlled trial, school child, Spiders, Therapy, treatment outcome, User-Computer Interface, virtual reality},

pubstate = {published},

tppubtype = {article}

}