@article{quintana_engaging_2023,

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

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

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

doi = {10.3390/jcm12134525},

issn = {20770383 (ISSN)},

year  = {2023},

date = {2023-01-01},

journal = {Journal of Clinical Medicine},

volume = {12},

number = {13},

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

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

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

pubstate = {published},

tppubtype = {article}

}

@article{orskov_cognitive_2022,

title = {Cognitive behavioral therapy with adaptive virtual reality exposure vs. cognitive behavioral therapy with in vivo exposure in the treatment of social anxiety disorder: A study protocol for a randomized controlled trial},

author = {P. T. Ørskov and M. B. Lichtenstein and M. T. Ernst and I. Fasterholdt and A. F. Matthiesen and M. Scirea and S. Bouchard and T. E. Andersen},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85140322564&doi=10.3389%2ffpsyt.2022.991755&partnerID=40&md5=1dacd4e05081f4790ccd5e0d7224e0ca},

doi = {10.3389/fpsyt.2022.991755},

issn = {16640640 (ISSN)},

year  = {2022},

date = {2022-01-01},

journal = {Frontiers in Psychiatry},

volume = {13},

abstract = {Background: Social anxiety disorder (SAD) has a high prevalence and an early onset with recovery taking decades to occur. Current evidence supports the efficacy of cognitive behavioral therapy (CBT) with virtual reality (VR) exposure. However, the evidence is based on a sparse number of studies with predominantly small sample sizes. There is a need for more trials investigating the optimal way of applying VR based exposure for SAD. In this trial, we will test the efficacy of CBT with adaptive VR exposure allowing adjustment of the exposure based on real-time monitoring of the participants's anxiety level. Methods: The trial is a randomized controlled, assessor-blinded, parallel-group superiority trail. The study has two arms: (1) CBT including exposure in vivo (CBT-Exp), (2) CBT including exposure therapy using individually tailored VR-content and a system to track anxiety levels (CBT-ExpVR). Treatment is individual, manual-based and consists of 10 weekly sessions with a duration of 60 min. The study includes 90 participants diagnosed with SAD. Assessments are carried out pre-treatment, mid-treatment and at follow-up (6 and 12 months). The primary outcome is the mean score on the Social Interaction Anxiety Scale (SIAS) with the primary endpoint being post-treatment. Discussion: The study adds to the existing knowledge by assessing the efficacy of CBT with adaptive VR exposure. The study has high methodological rigor using a randomized controlled trial with a large sample size that includes follow-up data and validated measures for social anxiety outcomes. Clinical trial registration: ClinicalTrials.gov, identifier: NCT05302518. Copyright © 2022 Ørskov, Lichtenstein, Ernst, Fasterholdt, Matthiesen, Scirea, Bouchard and Andersen.},

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

keywords = {adult, aged, Alcohol Use Disorders Identification Test, anxiety assessment, Anxiety disorder, article, behavior disorder assessment, cognitive behavioral therapy, comparative effectiveness, controlled study, Depression, Drug Use Disorders Identification Test, electrodermal activity, exposure, Fear of Negative Evaluation, follow up, health economics, Heart Rate, human, Leibowitz Anxiety Scale, Machine learning, major clinical study, psychological distress assessment, psychophysiological measurements, randomized controlled trial, Simulator Sickness Questionnaire, social anxiety, Social Interaction Anxiety Scale, social phobia, Subjective Units of Distress Scale, therapy effect, treatment duration, treatment outcome, virtual reality, virtual reality exposure therapy, Working Alliance Inventory},

pubstate = {published},

tppubtype = {article}

}

@article{silva_childrens_2022,

title = {Children's perception of phobogenic stimuli in virtual reality},

author = {C. Silva and S. Bouchard and C. Bélanger},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85117586475&doi=10.1016%2fj.ijcci.2021.100417&partnerID=40&md5=d853c1851b4b9574a7c67f2bce83b8e1},

doi = {10.1016/j.ijcci.2021.100417},

issn = {22128689 (ISSN)},

year  = {2022},

date = {2022-01-01},

journal = {International Journal of Child-Computer Interaction},

volume = {32},

abstract = {Background: There has been a growing interest in treatments involving exposure in virtual reality (VR) for a number of anxiety disorders and phobias. Contrary to expectations, this technique has proven less popular with phobic children and is less appealing to them than to adults. The hypothesis is that children may be more apprehensive about virtual aversive stimuli than adults. Methods: In Study 1, the perception of virtual phobogenic stimuli was assessed in 523 participants between the ages of 7 and 60. To analyze to what extent anxiety and phobic fear predict apprehension, 38 school-aged children took part in Study 2. Results: The results show that children apprehend phobic virtual stimulus more than adults and that apprehension is associated with specific phobic fear rather than a general anxiety state. Conclusion: Results are discussed in terms of clinical interest, children's cognitive development, and a priori fear of virtual reality stimuli. © 2021},

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

keywords = {Age-differences, Anxiety, Apprehension, Children, exposure, Spider phobia, virtual reality},

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{quintana_effect_2019,

title = {The effect of exposure to fear-related body odorants on anxiety and interpersonal trust toward a virtual character},

author = {P. Quintana and K. Nolet and O. Baus and S. Bouchard},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85074305238&doi=10.1093%2fchemse%2fbjz063&partnerID=40&md5=50ec319370e1688498abfa845c7ec343},

doi = {10.1093/chemse/bjz063},

issn = {0379864X},

year  = {2019},

date = {2019-01-01},

journal = {Chemical Senses},

volume = {44},

number = {9},

pages = {683–692},

abstract = {A growing body of literature documents how exposure to another person's fear-related body odorants can increase one's own anxiety and interfere with processing of social information, such as facial expression and impression formation. Building on these results, we aimed to 1) test the hypothesis that exposure to fear-related odorant would affect impression formation through fear contagion and 2) verify whether these effects can be observed in an ecologically valid (i.e., virtual) environment. We proposed that exposure to fear-related odorant would cause receivers to feel more anxious, which in turn would lead them to report less trust toward an unknown virtual character. This study had 2 distinct phases. First, we collected perspiration odorants from the armpits of 12 male senders (i.e., the source of the odorant) during the viewing of either fear or joy inducing film clips. In the second phase, 53 women receivers were exposed to either a fear, joy, or neutral odorant (i.e., between-subjects design) by breathing through a gauze attached to a disposable respirator mask while immersed in a virtual bar. As expected, receivers exposed to fear odorants felt significantly more stressed. Mediation analysis also revealed an indirect effect of exposure on trust through anxiety. More specifically, the more anxious the receiver felt, the less she trusted the virtual character. Our results show for the first time that the impact of exposure to fear-related body odorants on negative interpersonal impression formation is mediated by the anxiety induced in the receiver. © 2019 The Author(s) 2019. Published by Oxford University Press. All rights reserved.},

note = {Publisher: Oxford University Press},

keywords = {adult, Anxiety, article, body odor, body odorant, chemistry, controlled study, emotion, Emotions, exposure, Fear, female, fragrance, happiness, human, human experiment, Humans, male, metabolism, Middle Aged, odor, Odorants, pathology, Pleasure, priority journal, Sweat, sweating, Trust, unclassified drug, virtual reality, Young Adult},

pubstate = {published},

tppubtype = {article}

}

@article{laforest_effectiveness_2016,

title = {Effectiveness of in virtuo exposure and response prevention treatment using cognitive-behavioral therapy for obsessive-compulsive disorder: A study based on a single-case study protocol},

author = {M. Laforest and S. Bouchard and J. Bossé and O. Mesly},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84977551825&doi=10.3389%2ffpsyt.2016.00099&partnerID=40&md5=8aaf926230112d06a0c1e629e49b51c6},

doi = {10.3389/fpsyt.2016.00099},

issn = {16640640 (ISSN)},

year  = {2016},

date = {2016-01-01},

journal = {Frontiers in Psychiatry},

volume = {7},

number = {JUN},

abstract = {Obsessive-compulsive disorder (OCD) is characterized by the presence of distressing, recurrent and intrusive thoughts, impulses, or doubts as well as behavioral or mental rituals. OCD has various subtypes, including the fear of contamination in which individuals fear bacteria, germs, disease, or bodily secretions, and engage in clinically significant cleaning and avoidance rituals. Cognitive-behavioral therapy (CBT) is an effective treatment for OCD and involves, among other therapeutic strategies, exposing patients to feared stimuli while preventing them to engage in compulsive behaviors. In recent years, virtual reality (VR) has shown the potential of in virtuo exposure with people suffering from anxiety disorders and OCD. The objective of this pilotstudy is to examine the effectiveness of a CBT program where exposure in conducted in virtuo. Three adults suffering from OCD with a dominant subtype of contamination were enrolled in a single-case design with multiple baselines across participants. The presence and intensity of obsessions and compulsions were assessed daily during baselines of 3-, 4-, or 5-week, and a 12-session treatment. Follow-up information was gathered after 4 and 8 months. Treatment outcome is assessed with visual inspection of the graphs and ARMA time-series analyses. Clinical information, self-reports, and details of the treatment are provided for each patient. Statistical analyses for the time-series data revealed a statistically significant improvement in all three participants, but global improvement is considered positive for only two. This study innovates in proving preliminary support for the usefulness of VR in the CBT of OCD with contamination features. © 2016 Laforest, Bouchard, Bossé and Mesly.},

note = {Publisher: Frontiers Research Foundation},

keywords = {adult, aged, article, CBT, clinical effectiveness, cognitive behavioral therapy, disease severity, exposure, female, generalized anxiety disorder, human, hypnosis, male, obsessive compulsive disorder, Obsessive-Compulsive Disorder, pilot study, psychologic assessment, Response prevention, self report, treatment duration, treatment outcome, treatment response, virtual reality, Yale Brown Obsessive Compulsive Scale},

pubstate = {published},

tppubtype = {article}

}

@article{grenier_using_2015,

title = {Using virtual reality to improve the efficacy of cognitive-behavioral therapy (CBT) in the treatment of late-life anxiety: Preliminary recommendations for future research},

author = {S. Grenier and H. Forget and S. Bouchard and S. Isere and S. Belleville and O. Potvin and M. -È. Rioux and M. Talbot and N. A. Pachana and R. C. Oude Voshaar},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84931830085&doi=10.1017%2fS1041610214002300&partnerID=40&md5=6a937a7a7f13fca31c84fc7859b365d0},

doi = {10.1017/S1041610214002300},

issn = {10416102},

year  = {2015},

date = {2015-01-01},

journal = {International Psychogeriatrics},

volume = {27},

number = {7},

pages = {1217–1225},

abstract = {Cognitive-behavioral therapy (CBT) using traditional exposure techniques (i.e. imaginal and in vivo) seems less effective to treat anxiety in older adults than in younger ones. This is particularly true when imaginal exposure is used to confront the older patient to inaccessible (e.g. fear of flying) or less tangible/controllable anxiety triggers (e.g. fear of illness). Indeed, imaginal exposure may become less effective as the person gets older since normal aging is characterized by the decline in cognitive functions involved in the creation of vivid/detailed mental images. One way to circumvent this difficulty is to expose the older patient to a virtual environment that does not require the ability to imagine the frightening situation. In virtuo exposure has proven to be efficient to treat anxiety in working-age people. In virtuo exposure could be employed to improve the efficacy of CBT with exposure sessions in the treatment of late-life anxiety? The current paper explores this question and suggests new research avenues. Copyright © International Psychogeriatric Association 2014.},

note = {Publisher: Cambridge University Press},

keywords = {adult, aged, aging, Anxiety, Anxiety disorder, Anxiety Disorders, clinical effectiveness, cognition, cognitive defect, cognitive therapy, Depression, disease association, exposure, Fear, generalized anxiety disorder, gerontopsychiatry, human, Humans, late life anxiety disorder, panic, patient counseling, posttraumatic stress disorder, procedures, psychology, randomized controlled trial (topic), relaxation training, Research, review, Social Support, treatment outcome, trends, virtual reality, virtual reality exposure therapy},

pubstate = {published},

tppubtype = {article}

}

@article{robillard_development_2011-1,

title = {The development of the SWEAT questionnaire: A scale measuring costs and efforts inherent to conducting exposure sessions},

author = {G. Robillard and S. Bouchard and S. Dumoulin and T. Guitard},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-83455179431&partnerID=40&md5=c2fde1fc8ce186d921450fe0909cee56},

issn = {15548716},

year  = {2011},

date = {2011-01-01},

journal = {Annual Review of CyberTherapy and Telemedicine},

volume = {9},

number = {1},

pages = {85–89},

abstract = {For decades, empirical studies have shown the effectiveness of exposure techniques when used in cognitivebehavioral therapy (CBT) treatment for anxiety disorders. A few studies are now suggesting that using Virtual Reality (VR) may be an effective way to conduct exposure and overcome some of the limitations of in vivo exposure. The aim of this study is to validate the Specific Work for Exposure Applied in Therapy (SWEAT) questionnaire that measures costs and efforts required to conduct in vivo and in virtuo exposure. A total of 265 exposure sessions (in vivo = 140; in virtuo = 125) were rated by experienced psychologists. Reliability analysis revealed three main factors in the construct of the SWEAT questionnaire. Results also showed that conducting exposure in VR is less of a burden and more readily adapted to the patients' needs than in vivo.},

keywords = {article, clinical effectiveness, controlled study, cost benefit analysis, exposure, human, in vivo study, psychologist, questionnaire, reliability, specific work for exposure applied in therapy questionnaire, virtual reality},

pubstate = {published},

tppubtype = {article}

}

@article{robillard_development_2011,

title = {The development of the SWEAT questionnaire: a scale measuring costs and efforts inherent to conducting exposure sessions.},

author = {G. Robillard and S. Bouchard and S. Dumoulin and T. Guitard},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-80054121010&partnerID=40&md5=10bd1de5d9c38b5a975dab3b477c1d4d},

issn = {09269630},

year  = {2011},

date = {2011-01-01},

journal = {Studies in health technology and informatics},

volume = {167},

pages = {105–110},

abstract = {For decades, empirical studies have shown the effectiveness of exposure techniques when used in cognitive-behavioral therapy (CBT) treatment for anxiety disorders. A few studies are now suggesting that using Virtual Reality (VR) may be an effective way to conduct exposure and overcome some of the limitations of in vivo exposure. The aim of this study is to validate the Specific Work for Exposure Applied in Therapy (SWEAT) questionnaire that measures costs and efforts required to conduct in vivo and in virtuo exposure. A total of 265 exposure sessions (in vivo = 140; in virtuo = 125) were rated by experienced psychologists. Reliability analysis revealed three main factors in the construct of the SWEAT questionnaire. Results also showed that conducting exposure in VR is less of a burden and more readily adapted to the patients' needs than in vivo.},

keywords = {adult, Anxiety disorder, Anxiety Disorders, article, behavior therapy, clinical effectiveness, computer assisted therapy, computer interface, Computer Simulation, Computer-Assisted, controlled study, cost benefit analysis, economics, exposure, female, human, Humans, Implosive Therapy, in vivo study, male, methodology, psychologist, Psychometrics, psychometry, questionnaire, Questionnaires, reliability, reproducibility, Reproducibility of Results, specific work for exposure applied in therapy questionnaire, Therapy, User-Computer Interface, virtual reality},

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}

}