Slide
Centre Interdisciplinaire
de Recherche et d’Innovation
en Cybersécurité et Société
de Recherche et d’Innovation
en Cybersécurité et Société
1.
Delangle, M.; Moïse-Richard, A.; Leclercq, A. -L.; Labbé, D.; Bouchard, S.; Andrews, S.; Ménard, L.
Speaking face-to-face with a virtual avatar to reduce anxiety in students who stutter: Tool development and pilot study results Article de journal
Dans: Journal of Fluency Disorders, vol. 87, 2026, ISSN: 0094730X (ISSN).
Résumé | Liens | BibTeX | Étiquettes: 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
@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}
}
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.
2.
Delangle, M.; Moïse-Richard, A.; Leclercq, A. -L.; Labbé, D.; Bouchard, S.; Andrews, S.; Ménard, L.
Speaking face-to-face with a virtual avatar to reduce anxiety in students who stutter: Tool development and pilot study results Article de journal
Dans: Journal of Fluency Disorders, vol. 87, 2026, ISSN: 0094730X (ISSN).
Résumé | Liens | BibTeX | Étiquettes: 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
@article{delangleSpeakingFacetofaceVirtual2026,
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/pages/publications/105028302364?origin=resultslist},
doi = {10.1016/j.jfludis.2026.106194},
issn = {0094730X (ISSN)},
year = {2026},
date = {2026-01-01},
journal = {Journal of Fluency Disorders},
volume = {87},
publisher = {Elsevier Inc.},
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}
}
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.
3.
Delangle, M.; Moïse-Richard, A.; Leclercq, A. -L.; Labbé, D.; Bouchard, S.; Andrews, S.; Ménard, L.
Speaking face-to-face with a virtual avatar to reduce anxiety in students who stutter: Tool development and pilot study results Article de journal
Dans: Journal of Fluency Disorders, vol. 87, 2026, ISSN: 0094730X (ISSN).
Résumé | Liens | BibTeX | Étiquettes: 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
@article{delangleSpeakingFacetofaceVirtual2026a,
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}
}
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.
4.
Jeanningros, A.; Bouchard, S.; Potvin-Desrochers, A.
Exposure-Based Intervention in Virtual Reality to Address Kinesiophobia in Parkinson’s Disease: A Narrative Review Article de journal
Dans: Journal of Clinical Medicine, vol. 14, no 24, 2025, ISSN: 20770383 (ISSN).
Résumé | Liens | BibTeX | Étiquettes: 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
@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}
}
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.
5.
Jeanningros, A.; Bouchard, S.; Potvin-Desrochers, A.
Exposure-Based Intervention in Virtual Reality to Address Kinesiophobia in Parkinson’s Disease: A Narrative Review Article de journal
Dans: Journal of Clinical Medicine, vol. 14, no 24, 2025, ISSN: 20770383 (ISSN).
Résumé | Liens | BibTeX | Étiquettes: 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
@article{jeanningrosExposureBasedInterventionVirtual2025,
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/pages/publications/105025999269?origin=resultslist},
doi = {10.3390/jcm14248837},
issn = {20770383 (ISSN)},
year = {2025},
date = {2025-01-01},
journal = {Journal of Clinical Medicine},
volume = {14},
number = {24},
publisher = {Multidisciplinary Digital Publishing Institute (MDPI)},
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}
}
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.
6.
Jeanningros, A.; Bouchard, S.; Potvin-Desrochers, A.
Exposure-Based Intervention in Virtual Reality to Address Kinesiophobia in Parkinson’s Disease: A Narrative Review Article de journal
Dans: Journal of Clinical Medicine, vol. 14, no 24, 2025, ISSN: 20770383 (ISSN).
Résumé | Liens | BibTeX | Étiquettes: 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
@article{jeanningrosExposureBasedInterventionVirtual2025a,
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}
}
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.
7.
Guitard, T.; Bouchard, S.; Bélanger, C.; Berthiaume, M.
Exposure to a standardized catastrophic scenario in virtual reality or a personalized scenario in imagination for Generalized Anxiety Disorder Article de journal
Dans: Journal of Clinical Medicine, vol. 8, no 3, 2019, ISSN: 20770383 (ISSN), (Publisher: MDPI).
Résumé | Liens | BibTeX | Étiquettes: adult, anxiety assessment, article, avoidance behavior, clinical article, cognitive avoidance questionnaire, cognitive behavioral therapy, Cognitive exposure, disease severity, DSM-IV, Exposure in virtual reality, fatigue, female, gatineau presence questionnaire, generalized anxiety disorder, Generalized Anxiety Disorder (GAD), human, human experiment, imagination, immersive tendencies questionnaire, Likert scale, male, Middle Aged, mini international neuropsychiatric interview, penn state worry questionnaire, Personalized scenario, Positive and Negative Affect Schedule, Positive and Negative Syndrome Scale, Presence Questionnaire, psychotherapy, questionnaire, Simulator Sickness Questionnaire, Standardized scenario, task performance, test retest reliability, time series analysis, virtual reality
@article{guitard_exposure_2019,
title = {Exposure to a standardized catastrophic scenario in virtual reality or a personalized scenario in imagination for Generalized Anxiety Disorder},
author = {T. Guitard and S. Bouchard and C. Bélanger and M. Berthiaume},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85073896961&doi=10.3390%2fjcm8030309&partnerID=40&md5=b80f2e6602416c35dd8e36fd8b19c803},
doi = {10.3390/jcm8030309},
issn = {20770383 (ISSN)},
year = {2019},
date = {2019-01-01},
journal = {Journal of Clinical Medicine},
volume = {8},
number = {3},
publisher = {MDPI},
abstract = {The cognitive behavioral treatment of generalized anxiety disorder (GAD) often involves exposing patients to a catastrophic scenario depicting their most feared worry. The aim of this study was to examine whether a standardized scenario recreated in virtual reality (VR) would elicit anxiety and negative affect and how it compared to the traditional method of imagining a personalized catastrophic scenario. A sample of 28 participants were first exposed to a neutral non-catastrophic scenario and then to a personalized scenario in imagination or a standardized virtual scenario presented in a counterbalanced order. The participants completed questionnaires before and after each immersion. The results suggest that the standardized virtual scenario induced significant anxiety. No difference was found when comparing exposure to the standardized scenario in VR and exposure to the personalized scenario in imagination. These findings were specific to anxiety and not to the broader measure of negative affect. Individual differences in susceptibility to feel present in VR was a significant predictor of increase in anxiety and negative affect. Future research could use these scenarios to conduct a randomized control trial to test the efficacy and cost/benefits of using VR in the treatment of GAD. © 2019 by the authors. Licensee MDPI, Basel, Switzerland.},
note = {Publisher: MDPI},
keywords = {adult, anxiety assessment, article, avoidance behavior, clinical article, cognitive avoidance questionnaire, cognitive behavioral therapy, Cognitive exposure, disease severity, DSM-IV, Exposure in virtual reality, fatigue, female, gatineau presence questionnaire, generalized anxiety disorder, Generalized Anxiety Disorder (GAD), human, human experiment, imagination, immersive tendencies questionnaire, Likert scale, male, Middle Aged, mini international neuropsychiatric interview, penn state worry questionnaire, Personalized scenario, Positive and Negative Affect Schedule, Positive and Negative Syndrome Scale, Presence Questionnaire, psychotherapy, questionnaire, Simulator Sickness Questionnaire, Standardized scenario, task performance, test retest reliability, time series analysis, virtual reality},
pubstate = {published},
tppubtype = {article}
}
The cognitive behavioral treatment of generalized anxiety disorder (GAD) often involves exposing patients to a catastrophic scenario depicting their most feared worry. The aim of this study was to examine whether a standardized scenario recreated in virtual reality (VR) would elicit anxiety and negative affect and how it compared to the traditional method of imagining a personalized catastrophic scenario. A sample of 28 participants were first exposed to a neutral non-catastrophic scenario and then to a personalized scenario in imagination or a standardized virtual scenario presented in a counterbalanced order. The participants completed questionnaires before and after each immersion. The results suggest that the standardized virtual scenario induced significant anxiety. No difference was found when comparing exposure to the standardized scenario in VR and exposure to the personalized scenario in imagination. These findings were specific to anxiety and not to the broader measure of negative affect. Individual differences in susceptibility to feel present in VR was a significant predictor of increase in anxiety and negative affect. Future research could use these scenarios to conduct a randomized control trial to test the efficacy and cost/benefits of using VR in the treatment of GAD. © 2019 by the authors. Licensee MDPI, Basel, Switzerland.
8.
Guitard, T.; Bouchard, S.; Bélanger, C.; Berthiaume, M.
Exposure to a standardized catastrophic scenario in virtual reality or a personalized scenario in imagination for Generalized Anxiety Disorder Article de journal
Dans: Journal of Clinical Medicine, vol. 8, no 3, 2019, ISSN: 20770383 (ISSN).
Résumé | Liens | BibTeX | Étiquettes: adult, anxiety assessment, article, avoidance behavior, clinical article, cognitive avoidance questionnaire, cognitive behavioral therapy, Cognitive exposure, disease severity, DSM-IV, Exposure in virtual reality, fatigue, female, gatineau presence questionnaire, generalized anxiety disorder, Generalized Anxiety Disorder (GAD), human, human experiment, imagination, immersive tendencies questionnaire, Likert scale, male, Middle Aged, mini international neuropsychiatric interview, penn state worry questionnaire, Personalized scenario, Positive and Negative Affect Schedule, Positive and Negative Syndrome Scale, Presence Questionnaire, psychotherapy, questionnaire, Simulator Sickness Questionnaire, Standardized scenario, task performance, test retest reliability, time series analysis, virtual reality
@article{guitardExposureStandardizedCatastrophic2019,
title = {Exposure to a standardized catastrophic scenario in virtual reality or a personalized scenario in imagination for Generalized Anxiety Disorder},
author = {T. Guitard and S. Bouchard and C. Bélanger and M. Berthiaume},
url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85073896961&doi=10.3390%2fjcm8030309&partnerID=40&md5=b80f2e6602416c35dd8e36fd8b19c803},
doi = {10.3390/jcm8030309},
issn = {20770383 (ISSN)},
year = {2019},
date = {2019-01-01},
journal = {Journal of Clinical Medicine},
volume = {8},
number = {3},
publisher = {MDPI},
abstract = {The cognitive behavioral treatment of generalized anxiety disorder (GAD) often involves exposing patients to a catastrophic scenario depicting their most feared worry. The aim of this study was to examine whether a standardized scenario recreated in virtual reality (VR) would elicit anxiety and negative affect and how it compared to the traditional method of imagining a personalized catastrophic scenario. A sample of 28 participants were first exposed to a neutral non-catastrophic scenario and then to a personalized scenario in imagination or a standardized virtual scenario presented in a counterbalanced order. The participants completed questionnaires before and after each immersion. The results suggest that the standardized virtual scenario induced significant anxiety. No difference was found when comparing exposure to the standardized scenario in VR and exposure to the personalized scenario in imagination. These findings were specific to anxiety and not to the broader measure of negative affect. Individual differences in susceptibility to feel present in VR was a significant predictor of increase in anxiety and negative affect. Future research could use these scenarios to conduct a randomized control trial to test the efficacy and cost/benefits of using VR in the treatment of GAD. © 2019 by the authors. Licensee MDPI, Basel, Switzerland.},
keywords = {adult, anxiety assessment, article, avoidance behavior, clinical article, cognitive avoidance questionnaire, cognitive behavioral therapy, Cognitive exposure, disease severity, DSM-IV, Exposure in virtual reality, fatigue, female, gatineau presence questionnaire, generalized anxiety disorder, Generalized Anxiety Disorder (GAD), human, human experiment, imagination, immersive tendencies questionnaire, Likert scale, male, Middle Aged, mini international neuropsychiatric interview, penn state worry questionnaire, Personalized scenario, Positive and Negative Affect Schedule, Positive and Negative Syndrome Scale, Presence Questionnaire, psychotherapy, questionnaire, Simulator Sickness Questionnaire, Standardized scenario, task performance, test retest reliability, time series analysis, virtual reality},
pubstate = {published},
tppubtype = {article}
}
The cognitive behavioral treatment of generalized anxiety disorder (GAD) often involves exposing patients to a catastrophic scenario depicting their most feared worry. The aim of this study was to examine whether a standardized scenario recreated in virtual reality (VR) would elicit anxiety and negative affect and how it compared to the traditional method of imagining a personalized catastrophic scenario. A sample of 28 participants were first exposed to a neutral non-catastrophic scenario and then to a personalized scenario in imagination or a standardized virtual scenario presented in a counterbalanced order. The participants completed questionnaires before and after each immersion. The results suggest that the standardized virtual scenario induced significant anxiety. No difference was found when comparing exposure to the standardized scenario in VR and exposure to the personalized scenario in imagination. These findings were specific to anxiety and not to the broader measure of negative affect. Individual differences in susceptibility to feel present in VR was a significant predictor of increase in anxiety and negative affect. Future research could use these scenarios to conduct a randomized control trial to test the efficacy and cost/benefits of using VR in the treatment of GAD. © 2019 by the authors. Licensee MDPI, Basel, Switzerland.
9.
Bouchard, S.; Dumoulin, S.; Robillard, G.; Guitard, T.; Klinger, E.; Forget, H.; Loranger, C.; Roucaut, F. X.
Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: A three-arm randomised controlled trial Article de journal
Dans: British Journal of Psychiatry, vol. 210, no 4, p. 276–283, 2017, ISSN: 00071250, (Publisher: Royal College of Psychiatrists).
Résumé | Liens | BibTeX | Étiquettes: 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
@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}
}
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.
10.
Bouchard, S.; Dumoulin, S.; Robillard, G.; Guitard, T.; Klinger, E.; Forget, H.; Loranger, C.; Roucaut, F. X.
Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: A three-arm randomised controlled trial Article de journal
Dans: British Journal of Psychiatry, vol. 210, no 4, p. 276–283, 2017, ISSN: 00071250.
Résumé | Liens | BibTeX | Étiquettes: 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
@article{bouchardVirtualRealityCompared2017,
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.},
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}
}
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.