@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{le_du_new_2023,

title = {A New Option for Pain Prevention Using a Therapeutic Virtual Reality Solution for Bone Marrow Biopsy (REVEH Trial): Open-Label, Randomized, Multicenter, Phase 3 Study},

author = {K. Le Du and A. -L. Septans and F. Maloisel and H. Vanquaethem and A. Schmitt and M. Le Goff and A. Clavert and M. Zinger and H. Bourgeois and O. Dupuis and F. Denis and S. Bouchard},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85148250546&doi=10.2196%2f38619&partnerID=40&md5=e27bfbd3d4c42f8850daf70bdf60b384},

doi = {10.2196/38619},

issn = {14388871 (ISSN)},

year  = {2023},

date = {2023-01-01},

journal = {Journal of Medical Internet Research},

volume = {25},

publisher = {JMIR Publications Inc.},

abstract = {Background: Evidence regarding the analgesic effect of distraction through immersion in virtual reality (VR) for care-induced pain has been documented in several phase 2 trials, but comparison with standard treatments in large, randomized studies is needed. Objective: In this open-label, multicenter, randomized, phase 3 trial, we evaluated the safety and efficacy of a novel VR therapy solution for distraction in the context of bone marrow biopsy. Methods: Bliss is a VR software with 4 imaginary interactive environments in 3 dimensions with binaural sound (head-mounted display). Efficacy regarding pain intensity was evaluated using a visual analog scale (VAS; score from 0 to 10) immediately after the biopsy. Secondary end points were anxiety and tolerance. Modified intention-to-treat analysis was performed. Results: Overall, 126 patients with previously documented untreated or suspected malignant hemopathy between September 6, 2018, and May 18, 2020, were randomly assigned in a 1:1 ratio to receive pain prevention with a mixture of nitrous oxide/oxygen (MEOPA; n=63) or VR (n=63) before and during the bone marrow biopsy. We excluded 8 patients from the final analysis (3 in the MEOPA group and 5 in the VR group). All patients received local anesthesia (lidocaine) before biopsy. Follow-up was limited to 1 month after the biopsy. Participants' median age was 65.5 (range 18-87) years, and 54.2% (64/118) of patients were male. The average pain intensity was 3.5 (SD 2.6, 95% CI -1.6 to 8.6) for the MEOPA group and 3.0 (SD 2.4, 95% CI -1.7 to 7.7) for the VR group, without any significant differences in age, sex, center, and hemopathy (P=.26). Concerning anxiety, 67.5% (79/117; fear of pain questionnaire) of the patients were afraid before the biopsy, and anxiety scores were moderate to very high in 26.3% (30/114; revised Spielberger State-Trait Anxiety Inventory questionnaire) of the patients before the biopsy and 9.0% (10/114) after the biopsy for all patients, without a significant difference between the 2 groups (P=.83). Immersion in VR was well tolerated by the majority (54/57, 95%) of patients in the VR group. Conclusions: The intensity of pain did not significantly differ between both arms. VR was well tolerated, and the satisfaction of patients, nurses, and physicians was very high. VR could be an alternative treatment in case of contraindication or intolerance to MEOPA. © 2023 Journal of Medical Internet Research. All rights reserved.},

note = {Publisher: JMIR Publications Inc.},

keywords = {80 and over, Adolescent, adult, aged, alprazolam, Anxiety, article, Biopsy, blood pressure measurement, Bone Marrow, bone marrow biopsy, clinical trial, controlled study, demographics, digital health, digital therapeutics, Distraction, Effectiveness, efficacy, eHealth, female, follow up, head-mounted display, hematologic disease, human, human tissue, Humans, hypertension, imagery, imaginary, imagination, Immersive environment, Intention to Treat Analysis, interactive environment, leukemia, lidocaine, local anesthesia, lymphoma, major clinical study, male, medical procedure, Meopa, Middle Aged, monoclonal immunoglobulinemia, multicenter study, myelodysplastic syndrome, myeloma, myeloproliferative disorder, myeloproliferative neoplasm, nitrous oxide plus oxygen, open study, Pain, pain intensity, pain measurement, paracetamol, phase 3 clinical trial, prospective study, questionnaire, randomized controlled trial, RCT, relaxation training, safety, satisfaction, solid malignant neoplasm, State Trait Anxiety Inventory, very elderly, virtual reality, visual analog scale, VR, Young Adult},

pubstate = {published},

tppubtype = {article}

}

@article{jeanningros_validation_2023,

title = {Validation of a Virtual Environment to Induce State Social Physique Anxiety in Women with Obesity and Social Physique Anxiety},

author = {A. Jeanningros and A. Baillot and G. Corno and M. -C. Rivard and A. Aimé and S. Bouchard},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85172809066&doi=10.3390%2fjcm12186065&partnerID=40&md5=27989e0e8e959a373732f11758e997b5},

doi = {10.3390/jcm12186065},

issn = {20770383},

year  = {2023},

date = {2023-01-01},

journal = {Journal of Clinical Medicine},

volume = {12},

number = {18},

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

abstract = {State Social Physique Anxiety (SPA), in contrast to Trait SPA, is triggered by specific situations that elicit SPA. To date, no research has used virtual reality (VR) to recreate a situation that may elicit State SPA. The purpose of this study is to validate a virtual environment (VE) that simulates an anxiogenic situation to induce State SPA in women with obesity and high SPA. The high SPA group consisted of 25 self-identified women living with obesity and high Trait SPA. The low SPA group consisted of 20 self-identified women with low SPA. All participants were immersed in a virtual swimming pool environment for 10 min using a virtual reality headset. After the immersion, State SPA and fear of being negatively judged felt during immersion were measured with self-report questionnaires. A questionnaire assessing unwanted negative side effects was administered before and after the immersion. Using an ANCOVA with Trait SPA as covariate, State SPA was found to be significantly higher in the high SPA group. Fear of being judged negatively was also significantly higher in the high SPA group. Unwanted negative side effects scores did not increase post-immersion in either group. This study documents the validity of a novel VE for inducing State SPA in women with obesity and high SPA. © 2023 by the authors.},

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

keywords = {adult, analysis of covariance, article, clinical article, controlled study, disease simulation, Fear, female, human, immersion, obesity, questionnaire, self report, social anxiety, swimming pool, validation process, virtual reality, visual analog scale},

pubstate = {published},

tppubtype = {article}

}