@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},

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{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{dugas_behavioral_2022,

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

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

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

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

issn = {00057894 (ISSN)},

year  = {2022},

date = {2022-01-01},

journal = {Behavior Therapy},

volume = {53},

number = {6},

pages = {1147–1160},

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

note = {Publisher: Elsevier Inc.},

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

pubstate = {published},

tppubtype = {article}

}

@article{bouchard_multisite_2022,

title = {A Multisite Non-Inferiority Randomized Controlled Trial of the Efficacy of Cognitive-Behavior Therapy for Generalized Anxiety Disorder Delivered by Videoconference},

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

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85139777758&doi=10.3390%2fjcm11195924&partnerID=40&md5=52cbc697b3a9705b2f7fb87b7bfdc3eb},

doi = {10.3390/jcm11195924},

issn = {20770383 (ISSN)},

year  = {2022},

date = {2022-01-01},

journal = {Journal of Clinical Medicine},

volume = {11},

number = {19},

abstract = {Delivering psychotherapy by videoconference has been studied in a number of clinical trials, but no large controlled trial has involved generalized anxiety disorder (GAD). This multicenter randomized controlled non-inferiority trial was conducted to test if cognitive-behavior psychotherapy delivered by videoconference (VCP) is as effective as cognitive-behavior psychotherapy delivered face-to-face, using a strict margin of tolerance for non-inferiority. A total of 148 adults received a 15-session weekly manualized program. The treatment was based on the intolerance of uncertainty model of GAD. The impact of treatment was assessed using primary (GAD severity), secondary (worry, anxiety, and intolerance of uncertainty) and tertiary (general functioning) variables measured before and after treatment and at 6-month and 12-month follow-ups. Results showed that: (a) the treatment was effective; (b) VCP for GAD was statistically non-inferior to face-to-face psychotherapy on primary, secondary and tertiary measures at all assessment points; (c) change in intolerance of uncertainty significantly predicted change in the primary outcome measure over and above important clinical factors common to all psychotherapies (motivation, working alliance, perceived therapist competence, and client satisfaction). These findings support the use of VCP as a promising treatment option for adults with GAD. Clinical trial registry: ISRCTN#12662027. © 2022 by the authors.},

note = {Publisher: MDPI},

keywords = {adult, Anxiety, article, Beck Depression Inventory, cognitive behavioral therapy, Cognitive-behavior therapy, competence, controlled study, female, follow up, generalized anxiety disorder, Generalized Anxiety Disorder Scale, human, Likert scale, major clinical study, male, motivation, multicenter study, non-inferiority, patient worry, penn state worry questionnaire, predictors of outcome, psychotherapist, quality of life, randomized controlled trial, Structured Clinical Interview for DSM Disorders, treatment outcome, videoconferencing, videoconferencing psychotherapy, World Health Organization},

pubstate = {published},

tppubtype = {article}

}

@article{marcotte-beaumier_role_2021,

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

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

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

doi = {10.2196/24541},

issn = {23687959},

year  = {2021},

date = {2021-01-01},

journal = {JMIR Mental Health},

volume = {8},

number = {3},

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

note = {Publisher: JMIR Publications Inc.},

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

pubstate = {published},

tppubtype = {article}

}

@article{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{baus_exposure_2019,

title = {Exposure to a pleasant odour may increase the sense of reality, but not the sense of presence or realism},

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

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85062948876&doi=10.1080%2f0144929X.2019.1590458&partnerID=40&md5=b9a2badea1774db4c07a5d9b256614d3},

doi = {10.1080/0144929X.2019.1590458},

issn = {0144929X (ISSN)},

year  = {2019},

date = {2019-01-01},

journal = {Behaviour and Information Technology},

volume = {38},

number = {12},

pages = {1369–1378},

abstract = {Smell can increase the sense of presence, reality, and realism when exposed in a virtual environment. This effect has been found to be increased when the nature of the odour is concordant visually with the scene, i.e. exposure to an unpleasant odour in a filthy virtual kitchen. The objective of this project was to verify whether this effect could be generalised to pleasant odours. Participants were immersed in a virtual apartment with a kitchen where the visual scene suggested that cinnamon apple pies had recently been baked. Participants were randomly and blindly assigned to three conditions: exposition to the ambient air, to a pleasant odour of cinnamon apple pie, or an unpleasant odour of urine. The results indicated that while exposure to the visually concordant pleasant odour did increase the sense of reality in a statistically significant manner, it did not affect the sense of presence or realism. Results also suggested that the visual/olfactory concordance may have facilitated the detection of the pleasant odour. The potential implications of the results, potential explanations for the lack of effect on the sense of presence, as well as potential follow-up research projects are discussed. © 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.},

note = {Publisher: Taylor and Francis Ltd.},

keywords = {adult, Ambient air, apple, article, cinnamon, female, follow up, Fruits, human, human experiment, human tissue, male, nonhuman, odor, Odors, Odours, Olfaction, Presence, Realism, Reality, Sense of presences, urine, virtual reality, Visual scene},

pubstate = {published},

tppubtype = {article}

}

@article{du_sert_virtual_2018,

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

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

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

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

issn = {09209964},

year  = {2018},

date = {2018-01-01},

journal = {Schizophrenia Research},

volume = {197},

pages = {176–181},

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

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

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

pubstate = {published},

tppubtype = {article}

}

@article{ikic_reduction_2017,

title = {Reduction in costs after treating comorbid panic disorder with agoraphobia and generalized anxiety disorder},

author = {V. Ikic and C. Bélanger and S. Bouchard and P. Gosselin and F. Langlois and J. Labrecque and M. J. Dugas and A. Marchand},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85018690998&partnerID=40&md5=0d0600e6dd4e2a381f733ac063d639dc},

issn = {10914358},

year  = {2017},

date = {2017-01-01},

journal = {Journal of Mental Health Policy and Economics},

volume = {20},

number = {1},

pages = {11–20},

abstract = {Background: Panic disorder with agoraphobia (PDA) and generalized anxiety disorder (GAD) are impairing and costly disorders that are often misdiagnosed and left untreated despite multiple consultations. These disorders frequently co-occur, but little is known about the costs associated with their comorbidity and the impact of cognitive-behavioral therapy (CBT) on cost reduction. Aims of the Study: The first objective of this study was to assess the mental health-related costs associated with the specific concomitance of PDA and GAD. The second aim was to determine whether there is a reduction in direct and indirect mental healthrelated costs following conventional CBT for the primary disorder only (PDA or GAD) or combined CBT adapted to the comorbidity (PDA and GAD). Methods: A total of 123 participants with a double diagnosis of PDA and GAD participated in this study. Direct and indirect mental health-related costs were assessed and calculated from a societal perspective at the pre-Test, the post-Test, and the three-month, sixmonth and one-year follow-ups. Results: At the pre-Test, PDA-GAD comorbidity was found to generate a mean total cost of CAD2,000.48 (SD = 2,069.62) per participant over a three-month period. The indirect costs were much higher than the direct costs. Both treatment modalities led to significant and similar decreases in all cost categories from the pretest to the post-Test. This reduction was maintained until the oneyear follow-up. Discussion: Methodological choices may have underestimated cost evaluations. Nonetheless, this study supports the cost offset effects of both conventional CBT for primary PDA or GAD and combined CBT for PDA-GAD comorbidity. Implications for Healthcare Provision and Use: Treatment of comorbid and costly disorders with evidence-based treatments such as CBT may lead to considerable economic benefits for society. Implications for Health Policies: Considering the limited resources of healthcare systems, it is important to make choices that will lead to better accessibility of quality services. The application of CBT for PDA, GAD or both disorders and training mental health professionals in this therapeutic approach should be encouraged. Additionally, it would be favorable for insurance plans to reimburse employees for expenses associated with psychological treatment for anxiety disorders. Implications for Further Research: In addition to symptom reduction, it would be of great pertinence to explore which factors can contribute to reducing direct and indirect mental health-related costs. © 2017 ICMPE.},

note = {Publisher: ICMPE},

keywords = {adult, agoraphobia, Anxiety disorder, Anxiety Disorders, article, cognitive behavioral therapy, cognitive therapy, comorbidity, controlled study, dysthymia, economics, female, follow up, generalized anxiety disorder, health care cost, Health Care Costs, human, Humans, major clinical study, major depression, male, Mental health, obsessive compulsive disorder, panic, Panic Disorder, phobia, posttraumatic stress disorder, procedures, Quebec, social phobia, statistics and numerical data},

pubstate = {published},

tppubtype = {article}

}

@article{yuen_acceptance_2013,

title = {Acceptance based behavior therapy for social anxiety disorder through videoconferencing},

author = {E. K. Yuen and J. D. Herbert and E. M. Forman and E. M. Goetter and A. S. Juarascio and S. Rabin and C. Goodwin and S. Bouchard},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84879799248&doi=10.1016%2fj.janxdis.2013.03.002&partnerID=40&md5=a280b967176db691df32f37d15cb52a1},

doi = {10.1016/j.janxdis.2013.03.002},

issn = {18737897 (ISSN)},

year  = {2013},

date = {2013-01-01},

journal = {Journal of Anxiety Disorders},

volume = {27},

number = {4},

pages = {389–397},

abstract = {Most individuals with social anxiety disorder (SAD) do not receive any type of treatment. Reasons include logistical barriers (e.g., geographic location, travel time), fear of stigmatization, and fear of the social interactions associated with seeking treatment. Videoconferencing technology holds great promise in the widespread delivery of evidence-based treatments to those who would otherwise not receive treatment. This pilot study assessed the feasibility, acceptability, and initial efficacy of an acceptance-based behavioral intervention using Skype videoconferencing to treat adults with generalized SAD. Twenty-four participants received 12 sessions of weekly therapy and were assessed at pre-treatment, mid-treatment, post-treatment, and 3-month follow-up. Participants and therapists rated the intervention as acceptable and feasible. Analyses revealed significant pre-treatment to follow-up improvements in social anxiety, depression, disability, quality of life, and experiential avoidance, with effect sizes comparable to or larger than previously published results of studies delivering in-person CBT for SAD. Implications and future directions are discussed. © 2013 Elsevier Ltd.},

keywords = {acceptance based behavior therapy, adult, agoraphobia, alcoholism, article, avoidance behavior, Beck Depression Inventory, behavior therapy, Behavioral Assessment Test, Brief Version of the Fear of Negative Evaluation Scale, clinical article, clinical trial, comorbidity, disability, effect size, Feasibility Studies, feasibility study, female, follow up, Follow-Up Studies, generalized anxiety disorder, human, Humans, interview, Liebowitz Social Anxiety Scale, major depression, male, named inventories, panic, patient attitude, Patient Satisfaction, phobia, Phobic Disorders, Pilot Projects, pilot study, procedures, Psychiatric Status Rating Scales, psychologic test, Psychological, psychological rating scale, psychotherapist attitude, quality of life, questionnaires and rating scales, Skype, social anxiety, social phobia, Social Phobia and Anxiety Inventory, Structured Clinical Interview for DSM Disorders, telehealth, Telemedicine, Telemental health, Telepsychology, treatment outcome, videoconferencing},

pubstate = {published},

tppubtype = {article}

}