JCR 4(2) - Virtual Reality Medical Institute

Transcription

Volume 4, Issue 2, Summer 2011
Abstracts from the 16th Annual
CyberPsychology & CyberTherapy Conference
June 20-22, 2011 – Gatineau, Canada
Journal of CyberTherapy
&
rehabiliTaTion
Volume 4, Issue 2, Summer 2011
Brussels, Belgium
–
San Diego, California
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J CR
133
Journal of
CyberTherapy
& Rehabilitation
ediTor-in-Chief
managing ediTor
Brenda K. Wiederhold, Ph.D., MBA,
BCIA
Virtual Reality Medical Institute
Brussels, Belgium
Virtual Reality Medical Center
Emily Butcher
Interactive Media Institute
ediTorial board
Mariano Luis Alcañiz Raya, Ph.D.
Universidad Politécnica
de Valencia
Valencia, Spain
Rosa M. Baños, Ph.D.
University of Valencia
Valencia, Spain
Susan Baumgartner, M.A.
University of Amsterdam
The Netherlands
Willem-Paul Brinkman, Ph.D.
Delft University of Technology
The Netherlands
A.L. Brooks, Ph.D.
Aalborg University
Esbjerg, Denmark
Yang Cai, Ph.D.
Carnegie Mellon University
Pittsburgh, Pennsylvania
Julian Dooley, Ph.D.
Edith Cowan University
Mount Lawley, Australia
Paul M.G. Emmelkamp, Ph.D.
Amsterdam, Netherlands
Uri Feintuch, Ph.D.
Hadassah-Hebrew University
Medical Center
Jerusalem, Israel
Stéphane Bouchard, Ph.D.
Université du Québec en Outaouais
Gatineau, Québec, Canada
assoCiaTe ediTors
Luciano Gamberini, Ph.D.
University of Padova
Padova, Italy
Cristina Botella, Ph.D.
Jaume I University
Castelló de la Plana, Spain
Giuseppe Riva, Ph.D., M.S., M.A.
Istituto Auxologico Italiano
Verbania, Italy
Joshua Fogel, Ph.D.
Brooklyn College
Brooklyn, New York
John K. Miller, Ph.D., LMFT
Nova Southeastern University
Fort Lauderdale, Florida
Tom Furness, Ph.D.
University of Washington
Seattle, Washington
José Luis Mosso, M.D.
Regional Hospital No. 25 of the
IMSS
Mexico City, Mexico
Charles Hughes, Ph.D.
University of Central Florida
Orlando, Florida
Paul Pauli, Ph.D.
University of Würzburg
Würzburg, Germany
Wijnand IJsselsteijn, Ph.D.
Eindhoven University of
Technology
Eindhoven, Netherlands
Richard M. Satava, M.D., F.A.C.S.
University of Washington
Seattle, Washington
Linda A. Jackson, Ph.D.
Michigan State University
East Lansing, Michigan
Dick Schoech, Ph.D.
University of Texas
Arlington, Texas
Sun. I. Kim, Ph.D.
Hanyang University
Seoul, South Korea
Birgit U. Stetina, Ph.D.
Webster University
Vienna, Austria
Paul Kizakevich, Ph.D.
RTI International
Research Triangle Park,
North Carolina
Heidi Sveistrup, Ph.D.
University of Ottawa
Ottawa, Ontario, Canada
Dragica Kozaric-Kovacic, Ph.D.
University Hospital Dubrava
Zagreb, Croatia
Jang-Han Lee, Ph.D.
Chung-Ang University
Seoul, South Korea
José Gutiérrez Maldonado, Ph.D.
University of Barcelona
Barcelona, Spain
Chia-Wen Tsai, Ph.D.
Ming Chuan University
Taipei, Taiwan
Sy-Chyi Kiky Wang, MFA, D.Ed.
National Chiayi University
Taiwan
XiaoXiang Zheng
Zhejiang University
Zhejiang Province, P.R. China
9565 Waples Street - Suite 200
San Diego, CA 92121
Phone: (858) 642-0267
E-mail: frontoffice@vrphobia.com
Journal of CyberTherapy & Rehabilitation
S u m m e r 2 0 11
Vo l u m e 4 , I s s u e 2
137
editorial
B. Wiederhold
oral presentation abstracts from the 16th annual Cyberpsychology &
CyberTherapy Conference
145
Virtual Reality and Pain: Mechanisms for Analgesia and Exploring Empathy
155
Using Technologies for Cognitive Training in the Elderly
163
Exposure for Anxiety Disorders with Virtual and Augmented Realities
174
Applications for Cognitive Neurosciences
179
Cybertherapy for Anxiety Disorders: A Challenge for the Future
187
Developing New Tools and Technologies
194
Outcome Trials for Anxiety Disorders
202
Paradigms and Phenomenology of Cyberspaces
207
Posttraumatic Stress Disorder: Prevention and New Treatment Tools
218
Applications of Telehealth: Outcomes and Psychological Processes
227
Addictions, Urges and Cravings: Towards Better Understanding and Treatments
236
Human Dimensions in Online Social Networks
245
3-D Environments for Eating Disorders and Schizophrenia
251
Virtual Humans: the Next Generation of Personal Coaches
259
poster presentation abstracts from the 16th annual Cyberpsychology &
CyberTherapy Conference
309
Cyberprojects
G. Riva
310
Cyberfocus
D. Pizzioli
322
author index
JCR
137
S u m m e r 2 0 1 1 , Vo l u m e 4 , I s s u e 2
© Vi r t u a l R e a l i t y M e d i c a l I n s t i t u t e
ediTorial
Welcome to the Summer 2011 issue of the Journal of CyberTherapy & Rehabilitation (JCR). As you know, JCR
is one of the two official journals of the International Association of CyberPsychology, Training & Rehabilitation
(iACToR). Now in its 16th year, the annual international
CyberPsychology & CyberTherapy Conference (CT16)
agreed, in 2009, to become the official conference of
iACToR. So, along with CyberPsychology, Behavior, &
Social Networking Journal (CYBER), CyberTherapy &
Rehabilitation (C&R) Magazine, and JCR, we celebrate
our Combined Communications Platform. The journals,
conference, magazine, and association combine into one
powerful platform to address previous information
deficits in the utilization of advanced technologies in
healthcare. We will strive to speak with a united voice
to inform and educate stakeholders about the uses of
technologies in healthcare, as well as how technologies
are impacting behavior and society.
This year we are proud to be holding CT in Canada. Organized by the Interactive Media Institute (IMI), a
501c3 nonprofit organization, in cooperation with Université du Québec en Outoauais (UQO), CT16 is being
held June 19-22, 2011 in Gatineau, Canada. This venue
speaks to the continued growth and collaboration, not
just amongst Europe and the U.S., but also amongst researchers and scholars worldwide. This year’s conference theme is two-fold: First, CT16 will explore
technologies as enabling tools. This will include the uses
of advanced technologies such as Virtual Reality (VR)
simulations, videogames, telehealth, video-conferencing, the Internet, robotics, brain computer interfaces,
wearable computing, non-invasive physiological monitoring devices, in diagnosis, assessment, and prevention
of mental and physical disorders. In addition, we will
look at interactive media in training, education, rehabilitation, and therapeutic interventions. Second, CT16 will
explore the impact of new technologies. CT16 will investigate how new technologies are influencing behav-
JCR
ior and society, for example, through healthy ageing initiatives, positive and negative effects of social networking tools, and online gaming.
I would like to take this opportunity to thank all those
who are helping to make this year’s conference possible
through their tireless energy and drive – the Co-Organizer and Conference Co-Chair Professor Stéphane
Bouchard; this year’s Scientific Chairs, Professors Paul
Emmelkamp, Wijnand Ijsselsteijn and Giuseppe Riva;
Exhibit Chair Professor Sun Kim; Workshop Chair Professor Heidi Sveistrup; Cyberarium Chair Geneviève
Robillard; and Website Chair Professor Andrea Gaggioli. Many thanks also to the Scientific Committee, made
up of prominent researchers from around the world, and
the Local Advisory Committee in Gatineau, as well as
all of the presenters and attendees. Finally, my gratitude
to Geneviève Robillard, Emily Butcher and Jocel Rivera
for overseeing the Conference Coordination, to
Christina Valenti for editing related materials, and to the
teams at Université du Québec en Outaouais, Interactive
Media Institute, Virtual Reality Medical Center, and Virtual Realty Medical Institute for their time and contributions to all facets of the conference.
To our sponsors, who continue to support our vision and
help make it a reality, a warm and heartfelt thank you –
3dVia, Assemblée Nationale du Québec, Canada Research Chair in Clinical Cyberpsychology, Casino LacLeamy, the European Commission Information Society
and Media, Gouvernement du Québec, Interactive
Media Institute (IMI), International Association of CyberPsychology, Training & Rehabilitation (iACToR),
INTERSTRESS, In Virtuo, Istituto Auxologico Italiano,
Mary Ann Liebert, Inc. Publishers, National Institute on
Drug Abuse (NIDA), Université du Québec en
Outaouais (UQO), Ville de Gatineau, the Virtual Reality
Medical Center (VRMC), the Virtual Reality Medical
Institute (VRMI) and WorldViz.
138
As integral parts of our Combined Communications Platform, the CT Conference series will continue to work together with iACToR, JCR, and C&R to inform and
educate industry, academia, and government officials and
the general public on the explosive growth of advanced
technologies for therapy, training, education, prevention
and rehabilitation.
As in previous conferences, this year’s conference will
be hosting an interactive exhibit area, the Cyberarium,
which allows conference attendees and members of the
press to try new technologies firsthand. To recognize
outstanding achievements by students and new researchers, as well as lifetime achievement for a senior
researcher, we will also be hosting awards during the
conference and announcing the 2011-2012 iACToR officers during the General Assembly. Pre-conference
workshops will focus on advanced topics including psy-
chotherapeutic applications, brain computer interface devices, and rehabilitation, and there will also be an introduction to VR workshop for those newer to the area.
As we approach CT16 with excitement, we begin too to
look toward next year’s conference, CyberPsychology &
CyberTherapy 17, to be held in Brussels, Belgium September 12-15, 2012. Thank you again for your commitment to the evolution of healthcare!
Brenda K. Wiederhold, Ph.D., MBA, BCIA
Editor-in-Chief,
JCR
In-depth Co
Coverage
verage of the Psychological Aspects of the Internet,
Multimedia, and Social Networks on Behavior and Society
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The 16th annual Cyberpsychology
& CyberTherapy Conference
would like to thank the following sponsors:
Assemblée Nationale
du Québec
Canada Research Chair in
Clinical Cyberpsychology
Casino Lac-Leamy
European Commission
Information Society
and Media
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Interactive Media
Institute
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CyberPsychology, Training
& Rehabilitation
INTERSTRESS
In Virtuo
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National Institute on
Drug Abuse
Université du Québec
en Outaouais
Virtual Reality
Medical Institute
Ville de Gatineau
3dVia
(Silver Sponsor)
Virtual Reality
Medical Center
WorldViz
(Platinum Sponsor)
S u m m e r 2 0 1 1 , Vo l u m e 4 , I s s u e 2
© Vi r t u a l R e a l i t y M e d i c a l I n s t i t u t e
abstracts from
the 16th annual Cyberpsychology
& CyberTherapy Conference
June 20-22, 2011
Gatineau, Canada
143
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145
VirTual realiTy and pain: meChanisms for
analgesia and exploring empaThy
Control over the Virtual environment influences
the presence and efficacy of a Virtual reality
intervention on pain
Olga Gutiérrez-Martíneza,1, José Gutiérrez-Maldonadoa
and Desirée Loreto-Quijadaa
University of Barcelona, Spain
a
Corresponding author:
Olga Gutiérrez-Martínez
Department of Personality, Assessment and
Psychological Treatments
Paseo Valle de Hebrón, 171
08035, Barcelona
Spain
E-mail: olgagutierrez@ub.edu
1
abstract
This study investigates whether the control a user has
over a virtual environment influences their sense of presence, as well as how effectively a Virtual Reality (VR)
intervention increases pain tolerance during a cold-pressor experience. Ninety-four participants underwent two
consecutive cold-pressor trials, one without VR exposure
and the other providing a VR stereoscopic figure used as
a symbolic representation of the sensation of pain. Participants were randomly assigned to an interactive condition, which enabled users to actively manipulate the VR
figure to achieve a pleasant and quiet environment (analogous to a situation of no pain) or to a passive intervention, which led participants to passively contemplate the
changes of the VR figure. Results showed that participants had higher pain tolerance during both VR conditions relative to no-VR trials, with a higher magnitude of
change in the interactive condition. The amount of VR
presence reported was significantly higher in the interactive condition and correlated positively with pain tolerance scores. Here we discuss the importance of VR
interaction and control over the VR environments used
in VR pain interventions aimed to gain an increased cognitive control over pain.
Keywords: Virtual Reality, Presence,
Interaction, Pain Tolerance
introduction
One aspect of Virtual Reality (VR) analgesia that has been
hypothesized to contribute to its effectiveness is the degree
to which the individual feels ‘‘present’’ in the virtual environment (VE) [1, 2]. In VR literature, the concept of presence is broad and has a variety of definitions and meanings.
From a pragmatic point of view, several characteristics of
VR have been proposed to enhance presence, such as the
vividness of the VE, rate of update in the VE, field of view,
amount of control the individual has over the VE, head
tracking, localized sound and the extent to which the users
can experience emotions similar to those felt in a comparable real world setting [3, 4, 5]. In the field of VR for pain
management, the study of the degree of control that the
user has over the VE seems particularly relevant because
enhancing a sense of pain control may help explain the effectiveness of VR for pain management [6].
This study evaluated the effects of two different VR interventions that were hypothesized to affect the degree to
which participants felt control over the virtual environment. The first, an interactive intervention, enabled users
to actively search correspondence between the experienced pain during a cold-pressor trial and a VR stereoscopic figure that could be gradually manipulated by the
participant to achieve a pleasant and quiet environment
(analogous to a situation of no pain). The second was a
passive intervention, which led participants to passively
imagine the correspondence between the experienced pain
and the changes of the VR figure. Based on VR literature,
both VR conditions were expected to result in greater
cold-pressor pain tolerance than a non-VR condition.
However, the interactive condition was expected to result
in higher presence ratings and concomitantly higher paintolerance scores than the passive condition.
method
participants
The sample consisted of 94 students (84 women, 10 men)
aged 19 to 31 years (mean age 22.38, SD = 2.27). All par-
JCR
146
ticipants provided written informed consent prior to enrollment in the study. This study was approved by the
Ethics Committee of the University of Barcelona.
apparatus and measures
The cold-pressor apparatus consisted of a plastic tank (34
x 34 x 16 cm) filled with cold water that was used as the
pain stimulus by the submergence of the hand. The water
temperature was maintained at 6 °C.
The stereoscopic environment was displayed with two
BARCO ID R600 projectors onto a 2.43 x 1.82 meters.
Maxwell polarized screen. StereoGraphics Corp polarized
3-D glasses were also used. The distance between the subject and the screen was two meters. Auditory effects were
delivered through a multi-channel system of five speakers.
Two measures were registered for the purposes of this
study: the total duration of cold-water exposure in seconds
was recorded as pain tolerance, and the Igroup Presence
Questionnaire (IPQ) [7] was used to measure the degree
of presence elicited by the virtual environment used in the
experiment. The total score was used to enable analysis of
presence as a single construct.
Vr intervention, design and experimental Conditions
A mixed between-within-subjects experimental design
was used. All subjects participated in two consecutive
cold-pressor trials, one with VR and one without. The
order of the trials was counterbalanced. The VE consisted
of a stereoscopic figure that appeared in the centre of the
screen with a black background. The environment was designed to be an experience that was analogous to the pain
felt during the cold-pressor task. The initial appearance of
the figure was modeled according to certain sensory descriptors (e.g. burning, cutting, sharp, stabbing, stinging)
from the McGill Pain Questionnaire [8]. Following these
descriptors the initial appearance of the figure was constructed as an irregular sharp-edged polygon, mainly in
hot colors (i.e. yellow and red). This figure was presented
together with an unpleasant sound (a tone of 600 Hz at 80
dB). In the non-VR condition, the VR environment was
substituted by a black screen.
Participants were randomly assigned to one of two VR experimental conditions: interactive VR condition or passive
VR condition. In the interactive VR condition, participants
were told they could gradually manipulate the initial environment to achieve a pleasant and quiet environment
(analogous to a situation of no pain) using the mouse. This
CT16 Oral Presentations
pleasant environment contained a spherical shape composed mainly of cold colors (blue and white) combined
with a quiet sound produced by a generative music engine.
Participants in the passive VR condition were told they
could contemplate how the initial environment could
change into a pleasant and quiet environment. Thus, they
were exposed to the changes in the VR figure generated
simultaneously by the participant assigned to the active
condition. Both participants were separated by a folding
screen, so they could not see each other.
results
As expected, participants were able to tolerate cold-pressor
pain longer during VR trials than during trials without VR
(ts (46) > -1.8, ps < .06). Specifically, 57.4% of the participants in the interactive VR condition increased tolerance,
whereas the same effect was registered in 48.9% of the participants in the passive VR condition. According to prediction, the magnitude of change from non-VR trial to VR
trial was significantly higher in the interactive condition.
Overall, the ratings of presence (as measured by the IPQ)
were medium (M = 2.9, SD = 1.2, range of scores 0-6).
As predicted, participants reported a greater sense of presence when they actively manipulated the VR figure (M =
3.3, SD = 1.1), as compared with the passive contemplation of the VR (M = 2.6, SD = 1.2, t (92) = -3.1, p < .005).
Finally, the relationship between presence and tolerance
in the VR conditions was assessed using Pearson productmoment correlation coefficients. The amount of presence
reported correlated significantly and positively with paintolerance scores (r (94) = .3, p < .01).
discussion
These results are consistent with other laboratory pain
studies that show that VR technology can improve pain
tolerance in healthy adults undergoing experimentally induced pain [9, 10]. More importantly, these findings extend to the VR field the established idea that active coping
strategies and greater perceived control over pain are associated with improved pain-related outcomes [11].
As predicted, participants reported a greater sense of presence when they actively manipulated the VR figure, as
compared to the passive condition. These data provide further evidence that VR interaction can enhance the sense
of presence [3, 4, 5]. However, these results contrast with
a recent study where the effects of a VR-distraction intervention consisting of playing an auto racing videogame
from either a first-person or a third-person point of view
JCR
147
were explored [12]. Although participants in the study reported a greater sense of presence during the first-person
condition than in the third-person condition, presence ratings were not significantly related to cold-pressor pain-tolerance. This inconsistency may in part be due to the
different kinds of coping strategies that can be taught using
VR technology. Inducing a strong sense of presence may
be more important when the VR application involves the
individual gaining an increased cognitive control over pain.
references
[1] H.G. Hoffman, E.J. Seibel, T.L. Richards, T.A. Furness, D.R. Patterson, S.R. Sharar, Virtual reality helmet
display quality influences the magnitude of virtual reality
analgesia. The Journal of Pain 7 (2006), 843-850.
[2] H.G. Hoffman, S.R. Sharar, B. Coda, J.J. Everett, M.
Ciol, T. Richards, D.R. Patterson, Manipulating presence
influences the magnitude of virtual reality analgesia. Pain
11 (2004), 162-168.
[10] C.E. Rutter, L.M. Dahlquist, K. Weiss, Sustained efficacy of virtual reality distraction. The Journal of Pain 10
(2009) 391-397.
[11] M.P. Jensen, J.A. Turner, J.M. Romano, Changes in
beliefs, catastrophizing, and coping are associated with improvement in multidisciplinary pain treatment. Journal of
Consulting and Clinical Psychology, 69 (2001) 655-662.
[12] L.M. Dahlquist, L.J. Herbert, K.E. Weiss, M. Jimeno,
Virtual-Reality distraction and cold-pressor pain tolerance:
does avatar point of view matter? Cyberpsychology, Behavior and Social Networking 13 (2010) 587-591.
––––––––––––––––––––––––––––––––––––––––––––––
interactive and passive Virtual reality distraction:
effects on presence and pain intensity
José Gutiérrez-Maldonadoa,1, Olga Gutiérrez-Martíneza
and Katia Cabas-Hoyosa
[3] G. Riva, Is presence a technology issue? Some insights
from cognitive sciences. Virtual Reality 13 (2009), 159-169.
a
José Gutiérrez-Maldonado
08035, Barcelona
Spain
E-mail: jgutierrezm@ub.edu
1
[4] M. Slater, B. Lotto, M.M. Arnold, M.V. SanchezVives, How we experience immersive virtual environments: the concept of presence and its measurement.
Anuario de Psicología 40 (2009), 193-210.
[5] M.D. Wiederhold, B.K. Wiederhold, Virtual reality and
interactive simulation for pain distraction. Pain Medicine
6 (2007), S182–S188.
[6] J. Gutierrez-Maldonado, O. Gutierrez-Martinez, D.
Loreto, C. Penazola, R. Nieto, Presence, involvement and
efficacy of a virtual reality intervention on pain. Studies
in Health Technology and Informatics 154 (2010), 97-101.
[7] T. Schubert, F. Friedmann, H. Regenbrecht, The experience of presence: Factor analytic insights. Presence: Teleoperators & Virtual Environments 10 (2001), 266–281.
[8] R. Melzack, The McGill Pain Questionnaire: major
properties and scoring methods. Pain, 1 (1975) 277–299.
[9] L.M. Dahlquist, K.D. McKenna, K.K. Jones, L.
Dillinger, K.E. Weiss, C.S. Ackerman, Active and passive
distraction using a head-mounted display helmet: Effects
on cold pressor pain in children. Health Psychology 26
(2007), 794-801
JCR
abstract
The current study explores the effects of interactive versus passive Virtual Reality (VR) distraction on the sense
of presence and pain intensity. Sixty-eight healthy students underwent two consecutive cold-pressor trials, one
without VR and another providing a VR distraction "Surreal World." Participants were randomly assigned to an
interactive VR distraction condition, where a number of
interactions with the environment was possible, or to a
passive VR distraction condition, where they were also
exposed to the surreal world, but instead of interacting
with the virtual environment (VE), they watched the navigation generated by another participant assigned to the
interactive condition. After the VR cold-pressor trial, each
subject provided ratings of pain intensity and rated the
degree to which they had felt “present” in the VE. Results
showed that participants in the interactive VR condition
148
reported a greater reduction in pain intensity. Also, the
amount of presence reported was significantly higher during the interactive VR distraction and correlated negatively with pain intensity scores.
Keywords: Virtual Reality Distraction, Presence,
Interaction, Pain Intensity
introduction
Several studies have shown that Virtual Reality (VR) distraction may be a useful tool for clinicians who work with
a variety of pain problems [1]. Furthermore, emerging laboratory research has tried to systematically isolate and examine the active ingredients of effective VR-assisted
distraction interventions. For example, some controlled
studies suggest that the magnitude of VR analgesia is related to VR presence levels [2, 3, 4]. Another relevant variable that has been studied is the active or passive character
of technology-assisted distraction. The available literature
suggests that patients are likely to benefit more from interactive rather than passive distraction [5, 6].
In the present study, some participants manipulated an interactive VR distraction environment ("Surreal World")
while performing a cold-pressor task. Others were exposed to the same environment, but they were unable to
interact with it (passive observation condition). We predicted that the interactive VR distraction condition would
result in higher presence ratings and concomitantly lower
pain intensity than the passive VR distraction condition.
Also, the amount of VR presence reported was expected
to be negatively and significantly correlated with the
amount of pain reduction in VR.
method
participants
The sample consisted of 68 students (52 women, 16 men)
between the ages of 19-36 years old (mean age 21.8, SD
= 4.3). All participants provided written informed consent
prior to enrolment in the study. The study was approved
by the Ethics Committee of the University of Barcelona.
apparatus and measures
The cold-pressor apparatus consisted of a plastic tank (34
x 34 x 16 cm) filled with cold water that was used as the
pain stimulus by submerging the hand. The water temperature was maintained at 6 °C.
The stereoscopic environment was displayed with two
BARCO ID R600 projectors onto a 2.43 x 1.82 m.
Maxwell polarized screen. StereoGraphics Corp polarized
3-D glasses were also used. The distance between the subject and the screen was 2 m. Auditory effects were delivered through a multi-channel system of five speakers.
Two measures were taken for the purposes of this study.
Pain intensity was measured with a 0-10 visual analogue
scale (VAS) where the participant was asked to rate pain
intensity when the hand was removed from the cold water.
The Igroup Presence Questionnaire (IPQ) [7] was used to
measure the degree of presence elicited by the virtual environment (VE) used in the experiment. The total score
was used to enable analyses of presence as a single construct.
Vr intervention, design and experimental Conditions
A mixed between-within-subjects experimental design
was used. All subjects participated in two consecutive
cold-pressor trials, one using VR and one without. The
order of the trials was counterbalanced. The VE consisted
of a “Surreal World” with auditory and visual stimuli
based on art images designed to surprise the participant
with unreal objects that challenge the laws of physics.
Participants were randomly assigned to one of two experimental VR conditions: interactive VR distraction or passive VR distraction. In the interactive VR condition, a
number of interactions with the objects in the VE were
possible.
In the passive condition participants were exposed to the
same environments, but instead of interacting with the VE,
they watched the navigation simultaneously generated by
another participant assigned to the interactive distraction
condition.
results
Most of the participants (73.5%) who experienced the interactive VR distraction reported less pain intensity relative to the no-VR trial, X2 (1, N = 34) = 7.5, p < .01.
However, in the passive VR condition, only 5.9% of participants showed a decreased level of pain intensity and
the change did not reach statistical significance, X2 (1, N
= 34) = .47, p = .49.
Overall, the ratings of presence (as measured by the IPQ)
were medium (M = 3.1, SD = 1.1, range of scores 0-6).
As predicted, participants reported a greater sense of presence during interactive VR distraction, M = 3.5, SD = 1.0,
compared with the passive VR condition, M = 2.7, SD =
1.2, t (66) = 3.0, p < .005.
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Finally, the relationship between presence and pain intensity in VR conditions was assessed using Pearson
product-moment correlation coefficients. The amount of
VR presence reported correlated significantly and negatively with pain intensity, r (68) = -.29, p < .05.
[5] L.M. Dahlquist, K.D. McKenna, K.K. Jones, L.
Dillinger, K.E. Weiss, C.S. Ackerman, Active and passive
distraction using a head-mounted display helmet: effects
on cold pressor pain in children. Health Psychology 26
(2007), 794-801.
discussion
These findings offer additional support to previous research that suggest that multisensory and interactive distraction is more likely to be effective in allocating
attention away from pain sensations than passive methods of distraction [5, 8, 9].
[6] L.M. Dahlquist, K.E. Weiss, L.D. Clendaniel, E.F.
Law, C.S. Ackerman, K.D. McKenna, Effects of
Videogame Distraction using a Virtual Reality Type HeadMounted Display Helmet on Cold Pressor Pain in Children. Journal of Pediatric Psychology 34 (2009), 574–584.
Recent studies focused on the critical components of effective VR distraction have evaluated whether using a
VR head-mounted display helmet enhanced the effectiveness of videogame distraction for children experiencing cold-pressor pain [6, 10]. The results of these studies
indicate that simply adding ‘‘high tech’’ equipment to a
distraction task does not necessarily make the intervention more effective. Data from the current study show
that the degree of interactivity may significantly improve
the impact of a VR distraction intervention. Together,
these results suggest that efforts to improve the effectiveness of VR distraction interventions must not solely
focus on immersive technology, since there are other
variables like interaction that could be also relevant. Additional research on this topic is needed.
references
[1] K.M. Malloy, L.S. Milling, The effectiveness of virtual reality distraction for pain reduction: A systematic
review. Clinical Psychology Review 30 (2010), 10111018.
[2] O. Gutiérrez-Martínez, J. Gutiérrez-Maldonado, K.
Cabas-Hoyos, K., D. Loreto, The illusion of presence influences VR distraction: effects on cold-pressor pain.
Studies in Health Technology and Informatics 154
(2010), 155-159.
[3] H.G. Hoffman, E.J. Seibel, T.L. Richards, T.A. Furness, D.R. Patterson, S.R. Sharar, Virtual reality helmet
display quality influences the magnitude of virtual reality
analgesia. The Journal of Pain 7 (2006), 843-850.
[4] H.G. Hoffman, S.R. Sharar, B. Coda, J.J. Everett, M.
Ciol, T. Richards, D.R. Patterson, Manipulating presence
influences the magnitude of virtual reality analgesia.
Pain 11 (2004), 162-168.
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[7] T. Schubert, F. Friedmann, H. Regenbrecht. The experience of presence: Factor analytic insights. Presence:
Teleoperators & Virtual Environments 10 (2001), 266–
281.
[8] H.G. Hoffman, A. Garcia-Palacios, D.R. Patterson, M.
Jensen, T. Furness, W.F. Ammons, The effectiveness of
virtual reality for dental pain control: a case study. Cyberpsychology & Behavior 4 (2001), 527-535.
[9] B. van Twillert, M. Bremer, A.W. Faber, Computergenerated virtual reality to control pain and anxiety in pediatric and adult burn patients during wound dressing
changes. Journal of Burn Care & Research 28 (2007) 694702.
[10] L.M. Dahlquist, K.E. Weiss, E.F. Law, S. Sil, L.J.
Herbert, S.B. Horn, K. Wohlheiter, C.S. Ackerman, Effects
of Videogame Distraction and a Virtual Reality Type
Head-Mounted Display Helmet on Cold Pressor Pain in
Young Elementary School-Aged Children. Journal of Pediatric Psychology 35 (2010) 617–625.
––––––––––––––––––––––––––––––––––––––––––––––
The importance of Cognitive Charge Versus attention focus in the effect of Virtual reality analgesia
Stéphanie Dumoulina, Stéphane Bouchardb, Claudie
Lorangerb, Véronique Gougeonb and Kim Lavoiea
Université du Québec à Montréal, Québec, Canada
Université du Québec en Outaouais, Québec, Canada
a
b
1
Stéphanie Dumoulin
Laboratoire de Cyberpsychologie de l’Université du
Québec en Outaouais
283 Alexandre-Taché, CP 1250, Succursale Hull
150
Gatineau, QC, J8X 3X7 Canada
E-mail : stephanie.dumoulin@uqo.ca
abstract
The theory of Leventhal et al. (1979) suggests that the
treatment of painful stimuli includes its encoding and the
simultaneous treatment of the feelings and sensations
connected to the experience. As suggested by Leventhal,
attention seems to play an important role in the perception
of painful stimuli. When managing sudden painful stimuli, the individual’s attention will go to the source or the
location of the harmful stimulation, causing a decrease or
a complete cessation of the current task. As for distraction, it involves a process by which an individual diverts
his attention away from painful stimuli towards thoughts
or activities that the individual can either focus attention
on (thoughts) or remain engaged in (activities). Distraction involves a divergence of the attention, which otherwise would be centered on the painful stimulus, towards
another activity or task, with the aim of coping with the
pain. Virtual Reality (VR) combines both a distractive potential and attention-grabbing environment, which makes
it a perfect tool in pain management. But which variable
is more important? To test the influence of attention and
distraction on pain, 30 participants were subjected to a
cold pressor test while being distracted in VR. Repeated
measures of pain were taken in order to confirm or infirm
our hypothesis.
Keywords: Virtual Reality, Attention, Distraction,
Acute Pain, Cold Pressor Test
introduction
Pain is a highly subjective phenomenon which can be influenced by many psychological and physiological variables [1]. According to Leventhal and colleagues’ model
(1979) [2], attention seems to play an important role in the
perception of painful stimuli. When managing sudden
painful stimuli the individuals’ attention will go to the
source or the location of the harmful stimulation, causing
a decrease or a complete cessation of the current task [3].
The pain becomes the main focus, since the stimulus is the
most attention grabbing among the environmental and internal stimuli. When attention and pain are coupled, it becomes difficult to separate them [3] and the intensity of the
pain increases [4]. According to Melzack and Wall (1983)
[4], any tasks or activities that have the potential to divert
attention away from the pain and to act as a distractor have
the potential to inhibit the pain. Several researchers agree
that the difference of attention towards a stimulus other
than the pain itself could have the effect of reducing the
subjective experience of the pain, in terms of intensity and
uncomfortable sensations [3, 5, 6]. Therefore, a large
amount of studies have targeted a variety of methods of
distraction [7].
Distraction involves a process by which an individual diverts his attention away from painful stimuli towards
thoughts or activities that the individual can either maintain
attention towards (i.e., in the case of thoughts) or remain
engaged in (i.e., in the case of activities) [8, 9]. In the case
of painful stimuli, distraction involves a divergence of the
attention, which otherwise would be centered on the
painful stimulus, towards another activity or task [10, 11],
with the aim of coping with the pain [12]. This is considered adaptation because it involves more than a simple
avoidance of the pain. Indeed, it allows the individual to
actively engage in a task or a cognitive and/or behavioral
activity.
According to Hines and Martin (1988) [8] and Sylvestre
(2000) [9], Virtual Reality (VR) has the necessary criteria
to be qualified as a distractor [13]. Indeed, it possesses the
capacity to distract the attention of a potentially harmful
stimulus towards a neutral or pleasant stimulus. The efficacy of the method may be due to its immersive nature and
the large amount of attentional resources it attracts. Also,
the use of the head-mounted display (HMD) blocks the
view of the “real world” and uses multi-sensory resources
such as visual, auditory and sometimes, tactile stimulation.
However, the question remains whether VR is an efficient
distractor because it draws attention away from the pain,
or because it increases the cognitive load of attention.
The aim of the present study is to differentiate whether it
is the cognitive load or the focus of attention that is the central process behind distraction and the analgesic effect of
VR during a cold-pressor test (CPT).
method
Thirty healthy adults (15 men and 15 women) are being
recruited. Subjects presenting predispositions to cybersickness or Reynaud’s Syndrome were excluded. They
were asked to perform five cold-pressor tests (a baseline,
with no task combined and four immersions). A VR training immersion was performed without inducing pain to
allow participants to learn how to navigate in the virtual
environment (VE) and manipulate the equipment. Then,
the four immersions were conducted while participants
had their forearm immersed in cold water (5°C) while at-
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tention was manipulated. Participants were told they
could take their arm out of the water at any time, although
they should try to tolerate the pain as long as possible.
The VE was divided into two levels of manipulating attention (with a higher or lower cognitive load involvement) and two levels manipulating distraction (with or
without visual recall of the hand immersed in cold water).
The cognitive load was manipulated asking the participant to aim and shoot at flies in an environment with either a low or high number of flies. The following
measures were administered after baseline and post-immersion: Visual Analogue Scale, Pain Catastrophizing
Scale [14], McGill Pain Questionnaire [15], Fear of Pain
Questionnaire [16] and a pain management self-efficacy
questionnaire designed for the study. The time participants left their hand immersed in cold water and number
of flies shot were also measured.
results
Preliminary results obtained with multiple regression
analyses confirm our main hypothesis that distraction and
attention were mainly involved in pain management in VR.
Indeed, it seems that a complex task that involves a larger
cognitive charge is better to distract the participant from
pain. Further analysis will be reported.
references
[1] S.A. Janssen, Negative affect and sensitization to pain,
Scandinavian Journal of Psychology 43 (2002), 131-137.
151
[7] J.E. MacLaren & L.L. Cohen, A comparison of distraction strategies for venipuncture distress in children, Journal
of Pediatric Psychology 30 (2005), 387-396.
[8] P.S. Hines & J. Martin, Hopefulness and the self-substaining process in adolescents with cancer, Nursing Research 37 (1988), 336- 340.
[9] J.C. Sylvestre, A process-oriented approach to the study
of coping by disengagement and distraction, Document inédit, Guelph, University of Guelph, 2000.
[10] M. Davis, J. Vasterling, D. Bransfield & T.G. Burish,
Behavioral interventions in coping with cancer-related
pain, British Journal of Guidance and Counseling 15
(1987), 17-29.
[11] K.D. McCaul & J.M. Malott, Distraction and coping
with pain, Psychological Bulletin 95 (1987), 516-533.
[12] M. McCaffrey, Nursing approaches to non-pharmacological pain control, International Journal of Nursing
Studies 27 (1990), 1-5.
[13] S.M. Schneider & M.L. Workman, Effects of virtual reality on symptom distress in children receiving chemotherapy, Cyberpsychology & Behavior 2 (1999), 125-134.
[14] M.J.L Sullivan, S.R. Bishop & J. Pivik, The pain catastrophizing scale: Development and validation, Psychological Assessment 7 (1995), 524-532.
[2] H. Leventhal, D. Brown, S. Shacham, & G. Engquist,
Effects of preparatory information about sensations, threat
of pain and attention on cold pressor distress, Journal of
Personality and Social Psychology 37 (1999), 688-714.
[15] R. Melzack, The short-form McGill Pain Questionnaire, Pain 30 (1987), 191-197.
[3] C. Ecclestone, & G. Crombez, Pain demands attention:
A cognitive-affective model of the interruptive function of
pain, Psychological Bulletin 125 (1999), 356-366.
[16] D.W. McNeil & A.J. Rainwater, Development of the
Fear of Pain Questionnaire – III, Journal of Behavioral
Medicine 21 (1998), 389-410.
[4] R. Melzack & P.D. Wall, The challenge of pain, New
York, Basic Books, 1983.
–––––––––––––––––––––––––––––––––––––––––––––
a Comparison of guided imagery modalities
for pain distraction
[5] G.W. Farthing, M. Venturino & S.W. Brown, Suggestion and distraction in the control of pain: Test of two hypotheses, Journal of Abnormal Psychology 93 (1984),
266-276.
Melba C. Stetza, Richard I. Riesa,
Kathleen S. Browna and Raymond A. Folena
Department of Psychology, Tripler Army Medical Center
a
[6] S. Villemure & C. Bushnell, Cognitive modulation of
pain: How do attention and emotion influence pain processing? Pain 95 (2002), 195-199.
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Melba C. Stetz
1
152
Department of Psychology
Tripler Army Medical Center
Honolulu, HI 96819, U.S.A.
E-mail: melba.stetz@us.army.mil
Figures 1-3. Screen
shots of the VR
zones displayed during the audiorecorded guided
imagery with VR.
abstract
Preliminary data from an ongoing study examining pain
distraction, from none to some technological assistance,
suggests that technology can be an effective addition to
relaxation sessions. That is, when compared with standard
face-to-face relaxing sessions, participants reported experiencing a decrease in pain levels when being distracted
with the help of technology (e.g., relaxing audio and Virtual Reality zones).
Keywords: Pain, Distraction, Imagery,
Technology, Depression
introduction/problem
Even when healthcare providers support the use of analgesics, many times, the best pain treatments involve a combination of these with alternative (non-drug) medicine. For
mild to moderate pain, non-drug approaches alone may
provide relief [1]. The use of mental imagery [2], biofeedback [3], and hypnosis [4], has been shown to be an effective moderator of pain levels. This study aims to examine
whether technological enhancements to a relaxation session can meaningfully contribute to decreased pain.
method/Tools
Thirty-one randomly-assigned individuals (civilian and military), suffering from chronic pain, participated in three painreducing mental imagery modalities. One modality involved
a relaxation script being read by a mental health professional.
Another one involved listening to a recorded audio script.
The third modality involved listening to the same audio
script while also navigating through a Virtual Reality (VR)
beach (see Figures 1-3). Participants rated their pain levels
from “0” to “10” (before and after each session) on an item
taken from the Brief Pain Inventory (BPI, by [5]).
results
Paired-sample t-tests were conducted to compare the pre
and post administrations of the pain item. Out of the three,
there were only significant differences in the scores for
the audio (M=1.06, SD=2.28), t(31)=5.02, p = .000 and
the VR (M=.84, SD=1.96), t(31)=3.610, p=.001 modalities. These results suggest that pain levels could significantly drop with either an audio or a VR script
enhancement to the relaxation session.
references
[1] McCaffrey, M. & Pasero, C. (1999). Overview of three
groups of analgesics. In. Pain Clinical Manual (2nd, pp.
103-128), St. Louis: MO, Mosby.
[2] Patterson, D.R., Everett, J.J., Burns, G.L., & Marvin,
J.A. (1992). Hypnosis for the treatment of burn pain. Journal of Consulting Clinical Psychology, 60, 713-717.
[3] Knudson-Cooper, M.S. (1981). Relaxation and biofeedback training in the treatment of severely burned children.
Journal of Burn Care and Rehabilitation, 2, 102-110.
[4] Patterson, D.R., Questad, K.A., & Boltwood, M.
(1987). Hypnosis applied to pain control in burn patients:
a review.Journal of Burn Care and Rehabilitation, 8, 262268.
[5] Cleeland, C.S., Gonin, R., Hatfield, A.K. (1994). Pain
and its treatment in outpatients with metastatic cancer.
New England Journal of Medicine, 330, 592-596.
–––––––––––––––––––––––––––––––––––––––––––––
empathy Toward Virtual humans depicting a
Known or unknown person expressing pain
Johana Monthuy-Blanca,b, Stéphane Boucharda,b,
François Bernierc, Stéphanie Dumoulina,b, Mylène
Laforesta,b, Tanya Guitarda,b, Éric Boivinc, Geneviève
Robillarda,b and Patrice Renauda,b
Université du Québec en Outaouais,
b
Laboratoire de Cyberpsychologie de l’UQO,
a
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153
c
Defence Research and Development Canada - ValCartier,
ValCartier, Québec, Canada
an unknown person; and (b) the role of social presence in
users’ empathy toward the avatar’s pain.
Johana Monthuy-Blanc
Laboratoire de Cyberpsychologie, 283, Boulevard
Alexandre-Taché, Bureau C2501
C.P. 1250, Succursale Hull
Gatineau (Québec)
Canada J8X 3X7
E-mail: montjo02@uqo.ca
method
The sample is composed of 42 adults (18 to 60 years old,
26 females and 16 males) who were familiar with Stéphane
Bouchard. Participants were randomly assigned to two
avatar conditions: (a) Known Avatar First (KAF; i.e., the
immersion with the known avatar preceded the immersion
with the unknown avatar, n = 22); or (b) Unknown Avatar
First (UAF; i.e., the immersion with the unknown avatar
preceded the immersion with the known avatar, n = 20).
Each participant completed: (a) two items rated on a one
to seven scale measuring empathy toward the pain of the
avatar (“I was empathic to the pain of the virtual person”
and “the pain of the virtual character was credible”); and
(b) the French-Canadian translation and adaptation of the
Gerhard’s social presence questionnaire [4].
1
abstract
This study tested both (a) empathy toward the pain of an
avatar when the avatar was a realistic representation of a
known versus unknown person, and (b) the role of social
presence in users’ empathy toward the avatar’s pain.
Forty-two participants were immersed in a virtual environment where they could interact in real-time with
avatars. The participants had to converse with an avatar,
that experienced acute and very strong pain, depicting a
familiar person and an unknown avatar. The sequence
was randomized and both avatars expressed identical pain
reactions. Repeated measures analyses of variance revealed that participants were empathic toward both
avatars, yet more empathic to the known avatar. Participants’ feeling of social presence (impression that known
avatar was really there, with them) was a significant predictor of empathy.
Keywords: Empathy, Pain, Virtual Reality,
Emotion, Virtual Human
All immersions were performed in the CAVE-like system
at the Laboratoire de Cyberpsychologie de l’Université du
Québec en Outaouais. A control/reference immersion was
first conducted where participants interacted with a virtual
cat. Then, in a virtual bar, the avatar invited participants to
tell the story of the best thing that had ever happened to
them. While talking with the avatar, the avatar had an acute
and painful stomach cramp.
The main set of analyses was conducted to document the
impact of observing pain in the known and the unknown
avatars using repeated measures ANOVAs. Multivariate
regression analyses were conducted to assess the role of
social presence.
introduction
Results have consistently shown that avatars (3-D representation of a person) in pain can elicit reactions in the user.
Concerning empathy reaction, using avatars may not be
straightforward because, despite that facial expression of
pain can elicit empathy [1], empathy is also affected by
other complex processes including how pain is interpreted
and perceived, the fact that avatars are not real, or that the
observer has a personal connection with the person in pain
(e.g., a friend or a relative) [2]. Moreover, the interactions
with avatars in Virtual Reality (VR) are influenced by social presence [3]. Social presence reflects how users immersed in VR feel that avatars are really there with them.
results
Participants’ reactions were quite different in the immersions, as documented by the statistically significant interaction main effect. Those who met the known avatar first were
significantly less empathic towards the pain of the unknown
avatar, and those who met the unknown avatar first were significantly more empathic to the pain of the known avatar in
the second immersion. When looking at social presence, results were relatively stable from the control immersion to
the first experimental immersion with an avatar. The interaction between the first and the second immersions revealed
a clear impact of knowing or not knowing the avatars.
This study tested both: (a) whether people felt more empathy toward the pain of an avatar when the avatar was a
realistic representation of a person known as opposed to
The standard regression predicting empathy toward the
known avatar revealed social presence as a main significant
predictor [F(3, 41) = 20.57, p < .001].
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154
Conclusion
Despite the fact that the expression of pain was identical
in terms of facial and verbal expressions as well as nonverbal behaviors, the users reported significantly more
empathy toward the known avatar. Participants also related more strongly to the known avatar than the unknown
avatar. Moreover, the social presence – the extent to which
the participants felt the avatar was really there, in the room
with them – was stronger with the known avatar than the
unknown avatar. Finally, if social presence is an important
factor in the suspension of disbelief toward 3-D characters
and the illusion that the virtual experience is real, researchers should consider using more frequently immersive technologies than simply displaying avatars on
computer monitors when studying pain.
references
[1] A.P. Botvinick et al. Viewing facial expressions of pain
engages cortical areas involved in the direct experience of
pain, Neuroimage 25 (2005), 312–319.
[2] L. Goubert et al. Facing others in pain: The effects of
empathy,Pain118 (2005), 285-288.
[3] J.N. Bailenson et al.The independent and interactive
effects of embodied-agent appearance and behavior on
self-report, cognitive, and behavioral markers of copresence in immersive virtual environments. Presence14
(2005), 379-393.
[4] M. Gerhard, D. Moore & D. Hobbs, D. Continuous
presence in collaborative virtual environments: Towards
the evaluation of a hybrid avatar-agent model for user representation. In A. de Antonio, R. Aylett, & D. Ballin (Eds.):
Proc of the International Conference on Intelligent Virtual
Agents, pp. 137-153, Madrid, Spain, 2001
–––––––––––––––––––––––––––––––––––––––––––––
night Vision and Cybertherapy for
ambulatory surgery
José Luis Mossoa,1, Brenda K. Wiederholdb, Mark D.
Wiederholdb, Gregorio Tomás Obradora, Melba Stetzc,
Maripaz Palestinoa and Dejanira Mossoa
School of Medicine, Universidad Panamericana,
HGR 25 IMSS
b
The Virtual Reality Medical Center,
San Diego, CA, USA
c
The Tripler Army Medical Center, HI, USA
a
José Luis Mosso
School of Medicine, Universidad Panamericana
HGR 25 IMSS
Mexico
E-mail: jmosso@up.edu.mx
1
abstract
Five cases of ambulatory surgery were successfully performed under total darkness and immersion. Patients navigated through intraoperative Virtual Reality (VR)
scenarios to reduce pain. Two wireless microcameras and
goggles were used to facilitate performance of night-vision
surgeries. Five ambulatory surgeries were performed on
humans in total darkness; a right inguinal hernia repair and
four large lipomas resections were performed without complications. Pain and anxiety was reduced considerably in
the intraoperative period. Night vision is a cybertherapy alternative to reduce pain and anxiety in ambulatory surgery.
Keywords: Night Vision, Cybertherapy,
Ambulatory Surgery
introduction
For many years, physicians have worked in medicine with
black and white and color to make diagnoses, perform invasive medical procedures, plan medical procedures and
surgeries, for example, using x-ray, sonographs, scanners,
cardiac catheterizations, common bile duct cannulation in
cholangiography, etc. We performed ambulatory surgery,
aided by Cybertherapy, under natural light to reduce anxiety
and pain until July 2010; 110 surgeries were performed (56
cases with Laptop, 25 cases with Nokia N95, 24 cases with
PSP2) in the Hospital General y Regional No. 25 of the Instituto Mexicano del Seguro Social in Mexico City. We also
tried to perform surgeries under partial darkness using
lamps on the head of the surgeon and first assistant [1]. But,
the idea of providing total immersion to patients began
when the lights turned off during a storm in an indigenous
region on the top of a mountain when we were performing
a short recovery surgery [2]. We used a commercial goggle
to perform a small incision in the skin – two centimeters
large with three stitches. Night vision in the military has
been used for advanced life support skills by emergency
personnel [3], including cricothyroidotomy [4], and orotracheal intubation in darkness using night vision goggles [5].
methodology
At the General Hospital No. 25 of the IMSS, in five males
with authorized consent, we performed a non-compli-
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cated right inguinal hernia repair with mesh application
and four large lipomas on their arms and legs were removed. We turned off the lights of the operating room
after we cleaned and covered the surgical field. Also, before the surgeries, we set up goggles with a microcamera
attached to the top of the goggles. We had performed the
same surgeries in five males with natural lights without
complications. The virtual scenario used to distract patient was the Enchanted Forest developed by Drs. Brenda
and Mark Wiederhold at the Virtual Reality Medical Center in San Diego California, USA.
results
During surgery, we could manipulate surgical tools, sutures (with more difficulty in recognizing catgut chromic
00), and discovered it was easier to recognize veins than
arteries. With this equipment it was possible to recognize
tissues at a short distance, but at no more than 50 cm. The
surgical time in the problem group was longer than the
control group. The reduction of pain and relaxation was
higher in the problem group than the control group.
Conclusions
Previous night vision surgeries performed at the School
of Medicine at the Universidad Panamericana in Mexico
City on rabbits include one appendectomy, two nefrectomies, one laparotomy, one right thoracotomy, one
splenectomy and one left thoracotomy. Using successful
preliminary results on animals, we performed ambulatory
surgeries on humans with no problems during recovery.
The technical problems we encountered were the cables
on the back of the surgeon disconnected many times and
resulted in limitations on his movement. We can suggest
this technique to the patient candidates under total darkness, but with natural light controlled. We also need
155
higher resolution in the microcamera to recognize sutures,
such as catgut chromic, because it is transparent. In future
work we will make subclavian venipuncture catheter installation and perform leg amputations. This technique
could be performed by a surgeon with experience in open
surgery, because much of the skill needed is in the propioception to manipulate tissues and surgical tools. To resolve black and white issues, it may be possible to add
color to night vision in augmented reality to recognize organs and tissues with colors.
references
[1] Jose Louis Mosso, Mark Wiederhold, Brenda Wiederhold, Skip Rizzo, et al., Cybertherapy and open surgery.
Cybertherapy 12th conference, p.p. 82.
[2] Alessandra Gorini, Jose´ Luis Mosso, Dejanira
Mosso, Erika Pineda, Norma Leticia Ruíz, Miriam
Ramíıez, and Giuseppe Riva, Emotional Response to Virtual Reality Exposure across different Cultures: The Role
of the Attribution Process. Cyberpsychology & Behavior,
Volume 12, Number 6, 2009.
[3] Brummer S, Dickinson ET, Shofer FS, McCans JP,
Mechem CC. Effect of night vision goggles on performance of advanced life support skills by emergency personnel. Mil Med. 2006 Apr;171(4):280-2.
[4] MacIntyre A, Markarian MK, Carrison D, Coates J,
Kuhls D, Fildes JJ. Three-step emergency cricothyroidotomy. Mil Med. 2007 Dec;172(12):1228-30.
[5] Schwartz RB, Gillis WL, Miles RJ. Orotrachial intubation in darkness using night vision goggles. Mil Med.
2001 Nov;166(11):984-6.
using TeChnologies for
CogniTiVe Training in The elderly
Towards a Web 2.0 based software for the design
and animation of Cognitive stimulation Workshops
Evelyne Klingera,1, Elise Martineta and David Perreta
Arts et Metiers ParisTech, LAMPA-EA 1427,
Angers-Laval, France
Arts et Metiers ParisTech
LAMPA-EA 1427
Angers-Laval
France
E-mail: evelyne.klinger@ensam.eu
a
Evelyne Klinger
1
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abstract
Cognitive Stimulation Workshops (CSW) are recommended for elderly people with a decline in cognitive
functions, for example, mild cognitive impairment. Infor-
156
mation and Communication Technology (ICT) has the
potential to enrich and facilitate preparation, animation
and assessment of CSW interventions. We present the
first steps of our co-design approach towards a Web 2.0
based software for the design and the animation of CSW.
Keywords: Cognitive Stimulation Workshop,
Elderly People, Mild Cognitive Impairment,
Web 2.0, Information and
Communication Technology
introduction
In France, 16.7% of the general population are elderly
people (aged 65 or more); this number will reach 26.5%
in 2050 [1]. Aging is often accompanied by a decline in
cognitive functions, especially in the case of dementia
and Alzheimer’s disease. The incidence of dementia is
19.4 for 1000 people per year and the rate increases with
age [2]. Cognitive impairment related to aging and dementia has an immense social impact on elderly people,
caregivers and family members due to the loss of memory
and communication of the elderly people [3].
Cognitive stimulation aims to apply strategies of rehabilitation for people with dementia by capitalizing on preserved skills and cerebral plasticity to stimulate encoding,
consolidation and retrieval of information [4, 5]. Recent
studies showed the beneficial impact of such interventions
for elderly people with mild cognitive impairment (MCI)
[6] and mild-to-moderate dementia [7]. They are carried
out during Cognitive Stimulation Workshops (CSW) that
include about ten structured sessions and that are directed
by an animator, who may be a therapist.
Interactive multimedia and Web-based technologies have
been used to develop tools in the case of reminiscence
therapy. The Computer Interactive Reminiscence and
Conversation Aid (CIRCA) [8] employs generic and nonpersonalized media to stimulate conversation in reminiscent therapy sessions. Networked Reminiscence Therapy
was designed for individuals with dementia by using
photo and video sharing [9]. These studies confirm the
benefits of Information and Communication Technology
(ICT) in the enrichment and the facilitation of cognitive
stimulation approaches.
The aim of this paper is to present the first steps of our codesign approach towards a Web 2.0 based software for the
design and the animation of CSW. This work is carried out
during the STIMULEE project which is funded in France
by the General Directorate for Competitiveness, Industry
and Services (DGCIS).
method
In the context of our collaboration with STIMULEE partners and end users, we conducted observations of traditional CSW in Laval Hospital and Ernée Hospital, in
France. Our objective was to understand the unfolding of
CSW and the habits of their animators, as well as their
needs, in order to provide guidelines for the design of the
STIMULEE service.
Two observers (partners’ members) participated in five
various CSW in-care units in order to collect information
about the unfolding of the CSW and about the participants,
who were five animators (two female, three male) with a
long history of practice in CSW and five groups of elderly
people. They led qualitative interviews based on questionnaires in order to collect habits, preferences and needs of
both kinds of end users.
An analysis of the data was performed to synthesize the
needs and to extract recommendations for the design of
the STIMULEE tool.
results
According to our observations, CSW are often recommended by neuropsychologists for people with MCI. They
are proposed to a homogeneous group of about 12 participants and they focus on specific objectives, like memory
retrieval. CSW include 10 weekly 90-minute sessions. The
sessions are scheduled at the same time and the same place
to preserve the participants’ habits. The makeup and order
of the sessions is unchanging: welcoming the participants
with a hot drink and some questions about the date; sharing good news; correcting homework if prescribed; training using different kinds of exercises (semantic or episodic
memory, attention, planning, orientation or concentration);
ending the session by delivering homework.
As often as possible, the CSW is delivered by the same
animator throughout the sessions. Group leaders require
skills to animate the CSW, like flexibility, capacity to
adapt the content to the needs, and efficacy. Our study
highlights their need in: multimedia contents and tools
for the preparation of the CSW; appropriate functionalities and exercises during the unfolding of the CSW; and
tools for the assessment of the participants and the sessions. More details about the results will be provided in
the full paper.
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Co-design of Web 2.0 based CsW
Due to the study we were able to elaborate on recommendations for the design of the STIMULEE service that is a
Web 2.0 based software for the preparation and the animation of CSW. In a co-design user-centered approach,
we identified the features and the scenario for use; they
are currently implemented.
STIMULEE is an online tool for cognitive stimulation intended to improve the wellbeing and the communication
capacities of the elderly, as well as people with
Alzheimer‘s disease. Connected to the memOree.fr Web
site, STIMULEE uses previously stored memory contents
to currently propose tools for two kinds of end-users: the
elderly and their caregivers. It allows caregivers to prepare
the content of all the sessions of the CSW, to manage their
groups of participants, to visualize the contents in an interactive way during the CSW and finally, to assess the
participants and the intervention. More details about the
tool will be provided in the full paper.
A study of feasibility and utilisability will be carried out
until the end of the project which is scheduled for the end
of June 2011.
Conclusion and novelty
We reported preliminary steps towards the design of a tool
dedicated to facilitate CSW. STIMULEE will allow end
users easy insertion of new multimedia data in the memory database and their indexing; and generation of cognitive stimulation scenarii which will contribute to propose
innovating workshops. The achievement of these developments will provide novel therapeutic practices to our
clinical partners.
Acknowledgments
We thank all STIMULEE partners (SAFRAN Morpho,
ARTS, Ergonomica, Xedix, and Sovame) for their contribution to this work. We thank STIMULEE end-users
(Mayenne Alzheimer Foundation, Laval Hospital and Ernée
Hospital) for their participation in our co-design approach.
references
[1] I. Robert-Bobée, Projections de population 2005-2050:
Vieillissement de la population en France métropolitaine,
Economie et Statistique (2007), 95-109.
157
[3] A. Rodriguez-Rodriguez, L. Martel-Monagas and A.
Lopez-Rodriguez, Enhancing the communication flow between Alzheimer patients, caregivers, and neuropsychologists, Adv Exp Med Biol (2010), 601-607.
[4] Véronique Breuil, Jocelyne De Rotrou, Françoise
Forette, Daniele Tortrat, Annie Ganansia-Ganem, Anne
Frambourt, Florence Moulin and Fraņcois Boller, Cognitive stimulation of patients with dementia: Preliminary results, International journal of Geriatric Psychiatry 3
(1994), 211-217.
[5] E. Wenisch, I. Cantegreil-Kallen, F. Moulin, F. Batouche, A. Richard, A. S. Rigaud and J. De Rotrou, Intérêt
d’un programme de stimulation cognitive pour des sujets
âgés présentant un “mild cognitive impairment”, NPG
Neurologie - Psychiatrie - Gériatrie (2006), 41-44.
[6] E. Wenisch, I. Cantegreil-Kallen, J. De Rotrou, P. Garrigue, F. Moulin, F. Batouche, A. Richard, M. De Sant'Anna and A. S. Rigaud, Cognitive stimulation
intervention for elders with mild cognitive impairment
compared with normal aged subjects: preliminary results,
Aging Clin Exp Res 4 (2007), 316-322.
[7] A. Spector, B. Woods and M. Orrell, Cognitive stimulation for the treatment of Alzheimer's disease, Expert Rev
Neurother 5 (2008), 751-757.
[8] G. Gowans, J. Campbell, N. Alm, R. Dye, A. Astell
and M. Ellis, Designing a multimedia conversation aid for
reminiscence therapy in dementia care environments, in:
Proceedings of the CHI '04 extended abstracts on Human
factors in computing systems, ACM, Vienna, Austria,
2004, pp. 825-836.
[9] N. Kuwahara, S. Abe, K. Yasuda and K. Kuwabara, Networked reminiscence therapy for individuals with dementia
by using photo and video sharing, Proceedings of the 8th
international ACM SIGACCESS conference on Computers
and accessibility, Portland, Oregon, USA, 2006.
––––––––––––––––––––––––––––––––––––––––––––––
The use of Text and Technology-based Training
Tools to improve Cognitive skills in older adults
Kevin Powera, Grainne Kirwana,1 and Marion Palmera
[2] J. Ankri, Prévalence, incidence et facteurs de risque de
la maladie d’Alzheimer, Gérontologie et Société (2009),
129-141.
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Institute of Art, Design and Technology, Dun
Laoghaire, Ireland
a
158
Grainne Kirwan
School of Creative Technologies
Dun Laoghaire Institute of Art, Design and Technology
Kill Avenue, Dun Laoghaire
Co Dublin, Ireland
E-mail: grainne.kirwan@iadt.ie
1
abstract
Research has indicated that the use of cognitive skills training tools can produce positive benefits with older adults.
However, little research has compared the efficacy of technology-based interventions and more traditional, text-based
interventions which are also available, nor has it been determined which method older people derive most satisfaction from. This study aimed to investigate cognitive skills
improvements experienced by 40 older adults using cognitive skills training tools. A Solomon four group design
was employed to determine which intervention demonstrated the greatest improvement. Participants were asked
to use the interventions for 5-10 minutes per day, over a
period of 60 days. Pre and post-tests consisted of measures
of numerical ability, memory and intelligence. Following
training older adults indicated significant improvements on
numerical ability and intelligence regardless of intervention
type. This research provides a critical appraisal of brain
training tools and can help point the way for future improvements in the area. Brain training improvements could
lead to improved quality of life, and perhaps have financial
and independent living ramifications for older adults.
Keywords: Cognitive Training, Gerontology, Brain Training, Cognitive Decline, Human-computer Interaction
introduction
Declines in cognitive function over the adult life span have
been found in both cross-sectional and longitudinal studies
for a variety of tasks, abilities, and processes (Kramer &
Willis, 2002). If these cognitive declines can be prevented
or avoided, a greater proportion of elderly individuals may
be able to live independently for a longer period of time,
thus reducing pressure on family and state resources. Bell
et al. (2002) found that when older adults aged 65-94 years
were provided with cognitive skills training (memory, reasoning, and speed of processing) the effects could be seen
even at a two-year follow up. Bell et al. also suggest that
these improvements may reduce the eventual decline of
cognitively demanding everyday functioning across these
groups. Other researchers (such as Hooyman & Kiyak,
2010; Langbaum, Rebok, Bandeen-Roche & Carolson,
2009) have demonstrated that older adults can respond
well to cognitive training interventions.
Various “brain-training” games have become available in
recent years, with one of the most popular being “Dr
Kawashima's Brain Training” for the Nintendo DS Lite
console. However, there has been little research to date
comparing the efficacy of such technologically based interventions with more traditional, text-based interventions
which are also available.
method/Tools
This study aimed to investigate cognitive skills improvements experienced by forty older adults using cognitive
skills training tools. A Solomon four group design was employed to determine which intervention demonstrated the
greatest improvement among older adults while controlling for the effects of pre-testing. Participants were recruited from a number of social organizations for older
people, and were screened for prior use of the interventions and for serious cognitive decline. Eligible participants were randomly allocated to either the technological
or text-based intervention. Those assigned to the technological intervention were provided with a Nintendo DS
Lite console and a copy of the game “Dr Kawashima’s
Brain Training.” Participants assigned to the text-based intervention were provided with a copy of a cognitive training workbook also developed by Kawashima (2007),
which uses similar techniques to the technological intervention. Participants were instructed on the use of the interventions, and were then asked to use the intervention
tool for 5-10 minutes per day for a period of 60 days. Pre
and post-tests examined self-reported memory (using the
MAC-S), intelligence (using the WASI) and numerical
ability. Participants also completed a satisfaction questionnaire at the end of the study.
results
Following training older adults demonstrated significant
improvements on both intelligence and numerical ability
regardless of intervention type. There was no significant
improvement in self-reported memory. There was no significant difference in improvement between the two types
of intervention. Participants using the technological intervention had a significantly higher satisfaction rating with
the tool than those who used the text-based intervention.
Conclusion
This research provides a critical appraisal of the brain training tools and can help point the way for future improve-
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ments in the area. Brain training improvements could lead
to improved quality of life, and perhaps have financial and
independent living ramifications for older adults.
––––––––––––––––––––––––––––––––––––––––––––––
Cognitive Training with nintendo Wii® for the
elderly: an evaluation
Stefano Cardulloa, Bruno Seragliaa, Adalberto Bordinb
and Luciano Gamberinia,1
Università degli Studi di Padova,
Dipartimento di Psicologia
b
Anni Sereni, Scorzè, Venezia
a
Luciano Gamberini
Department of Psychology, Italy
E-mail: luciano.gamberini@unipd.it
1
abstract
Two groups of elderly people were monitored during a
period of three months: one group followed an experimental training program with games developed for the
Nintendo Wii® console, while the other group performed
a regular training program offered by the elderly care center. Classic neuropsychological tests were administered
before and after this period to both groups. The results
show better cognitive performances of the experimental
group in several tests.
Keywords: Cognitive Training, Elderly,
Videogames, Evaluation
159
a cognitive training for elderly users, based on Nintendo
Wii®. Twenty-one subjects were recruited in an Italian
elderly care center, according to their score at the Mini
Mental State Examination (>21; MMSE) and their willingness to participate in the experimental program. They
were randomly divided in two groups, an experimental
group and a control group. The experimental group (n =
10) replaced part of the daily activities planned by the institution with game sessions with the Nintendo Wii®,
plaid twice a week for a period of three months; two experimenters followed the participants during the gaming
sessions. The control group (n = 11) during the same period performed the regular activities planned by the institution. The games were the same as in [3], and were
designed to train attention, memory and motor control.
At the beginning and the end of the three months, both
groups were administered the Brief Neuropsychological
Examination (BNE; a battery of tests to assess memory,
attention and motor skills), the MMSE (to assess cognitive decline) and some scales of motor and functional autonomy used by the hosting institution (Barthel Index, to
assess disability; AIADL and IADL to assess daily activities impairment). The experimental design included a between-subjects factor (control group vs. experimental
group), and a within-subjects factor (first and second test
administration, t1 and t2). The analysis of variance
showed a significant effect in four specific tests; by comparing the second administration with the first administration through the t test, it turned out that in the Digit
span and Story Recall Test the control group remained
stable while the experimental group achieved a higher
score; in the Memory with interference test, the control
group gained a lower score while the experimental group
remained stable; in the MMSE, the control group
achieved a lower score while the experimental group had
a higher score.
introduction
The rapid increase of the aging population, especially in
North America and Europe, requires reliable, engaging
and low-cost solutions to counter the decline in the cognitive abilities of elderly people [1]. Computer games are
one solution to train cognitive and physical abilities [2].
Following the encouraging results obtained by a previous
research on cognitive training with Nintendo Wii® games
[3], we present here an evaluation of the effectiveness of
the same game program.
Acknowledgements
The authors would like to thank ‘Anni Sereni’ Elderly
Care Center at Scorzè (Venice, Italy) and Nintendo Italia.
The study
The aim of this study was to evaluate the effectiveness of
the games that were developed by some of the authors as
references
[1] L. Gamberini, M. Alcaniz, G. Barresi, M. Fabregat, L.
Prontu, B. Seraglia, Playing for a Real Bonus:
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Conclusion
Further research is needed but the current results suggest
that the training program can lead to satisfactory results
in memory skills and to an overall improvement in cognitive skills, as was revealed by the MMSE.
160
Videogames to Empower Elderly People. Journal of CyberTherapy & Rehabilitation, 1(1) (2008), 37-48.
ent SOCIABLE and to describe the SOCIABLE social
activation tool in more detail: The Book of Life.
[2] C. Basak , W.R. Boot, M.W. Voss, A.F. Kramer, Can
training in a real-time strategy video game attenuate cognitive decline in older adults? Psychology and Aging,
23(4) 2008, 765-77.
Keywords: Elderly, Cognitive Impairment, Social
Activation, Quality of Life, Information Communication
Technology, Surface Computing
[3] L. Gamberini, S. Cardullo, B. Seraglia, A. Bordin,
Neuropsychological testing through a Nintendo Wii.
Studies in Health Technology and Informatics, 154
(2010), 29-33.
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soCiable: improving Cognitive skills and social
activation through surface Computing Technology
Reyes Molinera,b, Irene Zaragozac, Milagros Burgueraa,
Veronica Guillend and Azucena Garcia-Palaciose
Centro Clinico PREVI
Universidad Catolica de Valencia San Vicente Martir
c
Labhuman. Universidad Politecnica de Valencia
d
Universidad de Valencia
e
Universitat Jaume I
a
b
Azucena Garcia-Palacios
Universitat Jaume I
Dpt. Psicologia Basica, Clinica y Psicobiologia. Avda
Vicent Sos Baynat s/n 12071
Castellon, Spain
E-mail: azucena@psb.uji.es
1
abstract
Aging is associated with cognitive and social impairment.
There is a growing interest in the development of procedures to delay cognitive impairment and to improve
mood, social life and quality of life in the elderly. Information Communication Technology (ICT) can help to
support such procedures. SOCIABLE is an EU-funded
project whose aim is to develop and test ICT procedures
for the promotion of wellbeing in the elderly. Four European countries participate in this project. SOCIABLE introduces and pilots a novel approach for ICT assisted
cognitive training and social activation using a surface
computing platform for a wide range of senior citizens,
including cognitive intact elderly, older adults with Mild
Cognitive Impairment, as well as patients suffering from
mild Alzheimer’s disease. The aim of this work is to pres-
introduction
Dementia is one the most common conditions seen in
older adults, being also the leading cause of institutionalization among the elderly. As life expectancy increases,
the worldwide number of demented patients is projected
to grow and reach 81.1 million in 2040 [1]. In the last
decade it has been a growing interest in the development
of procedures that help to delay cognitive impairment and
increase quality of life in the elderly. Several studies have
demonstrated the value of cognitive training with ICT systems and services with the potential of improving the cognitive, emotional and social status of these patients.
SOCIABLE is a project funded by the EU involving experts
from different European countries (Norway, Greece, Italy
and Spain) with the common aim of developing ICT procedures for the promotion of wellbeing among the elderly.
SOCIABLE introduces and pilots a novel approach for
ICT assisted cognitive training and social activation for a
wide range of senior citizens, including cognitive intact
elderly, older adults with Mild Cognitive Impairment, as
well as patients suffering from mild Alzheimer’s disease.
The aim of this work is to present SOCIABLE and the
work done so far and to describe in more detail one of the
SOCIABLE applications: the Book of Life.
method
The study to validate SOCIABLE will include 350 users
from four different European countries: Greece, Italy, Norway and Spain. Participants will use SOCIABLE in two
different settings: 278 in nursing homes or day hospitals
and 72 will use the tool at home. Caregivers will also be
trained and will support the elderly in the use of the system. Participants will belong to three different groups regarding cognitive impairment: normal users (without any
cognitive impairment), and users with mild cognitive impairment and users with mild Alzheimer’s disease.
In addition to many elderly end-users, SOCIABLE pilots
will involve several health professionals, including medical experts and caregivers. Moreover, family members
may also be involved in the scope of in-home pilots.
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SOCIABLE pilots will take place in seven pilot sites of
different types/nature including private hospitals, public
hospitals, municipalities and care centers.
The SOCIABLE pilot process involves a set of disciplined
standard procedures, which ensure the project’s clinical
background along with the credible scientific evaluation
of the project’s results.
The SOCIABLE pilots will be supported by a non-trivial
ICT infrastructure, including a surface platform and the
SOCIABLE software/middleware libraries. During the
pilot operations, special provisions should be made towards enhancing the SOCIABLE surface computing infrastructure and related applications.
After an evaluation targeting cognitive impairment, mood
and social impairment (pre-intervention assessment), participants will be randomly assigned to one of two experimental conditions:
1. Intervention condition
2. Waiting list
Participants in the intervention condition will use SOCIABLE twice a week during three months (24 sessions) supported by a caregiver. Some sessions will be performed in
groups of three users and other sessions will be performed
individually. After the intervention period there will be a
post-intervention assessment in order to determine if the
intervention has produced significant changes in cognitive
impairment, social impairment and mood. There will be
also an assessment of usability and acceptability of the
system.
Participants in the waiting list condition will be assessed
at pre-test and will be reassessed after three months (posttest). After the post-test assessment participants will be offered the SOCIABLE intervention.
The project consortium has developed a series of tools:
1. A set of services enabling the hosting of multiple applications and cognitive training games, along with their
combination in the scope of cognitive training programs.
2. A rich set of cognitive games covering the needs of normal elderly, older adults with Mild Cognitive Impairment,
as well as patients suffering from mild Alzheimer’s disease.
3. A Social Activation module supporting distinct applications facilitating the social interaction of the elderly,
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161
namely the “Book of Life,” as well as elderly communication services.
4. A back-office application facilitating health professionals Electronic Health Record (EHR) management.
We anticipate that surface platforms will provide added
value over conventional games, in terms of usability, ergonomics and ease of use. We also hypothesize that users
in the intervention condition compared to users in the
waiting list condition will present improvements in mood,
social impairment and cognitive impairment. Figure 1
shows an image of an elderly user interacting with SOCIABLE in the surface display.
The present work focuses in the description of the third
application, the Social Activation module, developed by
a team of psychologists and engineers (PREVI and Labhuman) aimed to decrease social isolation and to improve
mood and quality of life.
Figure 1. An
elderly user
interacting
with the
SOCIABLE
Book of Life
The Book of Life is an intervention that promotes reminiscence: “the progressive return to consciousness of prior experiences which can be re-evaluated with the intention of
resolving past conflict giving new significance to one’s
life” [2]. Reminiscence of life review therapy has demonstrated positive psychological effects in elderly people [3].
Reminiscence therapy involves the review of life stages,
childhood, adolescence, adulthood, and maturity. The
process is guided by the therapist who asks questions to
the elderly user concerning events occurred in those different stages. This work makes possible to remember positive events and resolve past conflicts, resulting in a process
of giving meaning to one’s life. In SOCIABLE a reminiscence protocol has been developed supported by ICTs. In
the surface the user can use a virtual book with different
chapters corresponding to different life stages. In each
chapter, the caregiver has at his/her disposal different questions in order to work in reminiscence. The Book of Life
offers the possibility of working, not only with texts and
narratives about the memories of the user, but also audio
162
as well. In the book it is possible to include songs or music
that were meaningful for the user in a certain life stage, as
well as images (pictures). For example, the application
presents a set of photos related to the stage of the life selected. The user can select the most meaningful photos and
can write or record (voice) a short statement explaining the
photo. The user can provide his/her personal photos to the
career in order to include them in the application.
Once the reminiscence work has been completed it is possible to review the different chapters and share it with
other users or family members.
references
[1] Alzheimer’s Association. Alzheimer’s Diseasease
Facts and Figures, Alzheimer’s & Dementia, 5: 3 (2009).
[2] Buechel, H. Reminiscence: a review and prospectus.
Physical and Occupational Therapy in Geriatrics, 5,
(1986), 25-37.
[3] Haight, B., Michel, Y. & Hendrix, S. The extended effects of the life review in nursing home residents. International Journal of Aging and Human Development, 50
(2000), 151-168.
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active Video gaming to improve
balance in the elderly
Claudine J.C. Lamotha, Simone R. Caljouwa
and Klaas Postemab
Center for Human Movement Sciences, University
Medical Centre Groningen, University of Groningen,
The Netherlands
b
Department for Rehabilitation Medicine, University
Medical Centre Groningen, The Netherlands
a
Claudine J.C. Lamoth
Center for Human Movement Sciences
University Medical Centre Groningen
University of Groningen
The Netherlands
E-mail: c.j.c.lamoth@med.umcg.nl
1
abstract
The combination of active video gaming and exercise
(exergaming) is suggested as a means to improve elderly
people’s balance, thereby decreasing fall risk. Exergaming has been shown to increase motivation during exercise therapy due to the enjoyable and challenging nature,
which could support long-term adherence for exercising
balance. However, scarce evidence is available for the direct effects of exergaming on postural control. Therefore,
the aim of the study was to assess the effect of a six-week
videogame-based exercise program aimed at improving
balance in elderly people. Task performance and postural
control were examined using an interrupted time series
design. Results of multilevel analyses showed that performance on the dot task improved within the first two
weeks of training. Postural control improved during the
intervention. After the intervention period, task performance and balance were better than before the intervention.
Results of this study show that healthy elderly people can
benefit from a videogame-based exercise program to improve balance and that all subjects were highly motivated
to exercise balance because they found gaming challenging and enjoyable.
Keywords: Active Video Gaming, Exergaming,
Balance Training, Elderly
introduction
The expanding aging population has ignited a growing interest in the prevention of balance problems to reduce the
risk of falling, since falling can result in loss of independence, significant morbidity or death. New technology-based
techniques, such as interactive (video) games appear quite
promising for (home-based) balance training in the elderly
population. The advantage of serious gaming devices is that
people do not pay attention to the exercise and their own
movements, but on the outcome of their movements in the
projected environment. This is important because in most
daily-life settings, balance control is not an aim by itself,
but postural adjustments of the whole body are continuously
needed for many goal-directed movements within a specific
environment. Another benefit is that serious gaming systems motivate people to practice and because they are becoming more and more cost-effective, portable and
user-friendly, people can also exercise at home.
However scarce, some evidence is available for the direct
beneficial effect of playing an active video game with a
balance board as a peripheral on postural control [1-3].
Therefore, the objective of the study was to assess the effect of a six-week videogame-based balance training program on balance performance in a group of elderly
community dwelling persons. Balance control, as well as
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163
pleasure participating in and motivation for, the gamebased training, were assessed.
methods
Nine healthy, elderly subjects participated in this study
(age > 65 years). A balance training device was used
which integrates video gaming with balance control on a
moveable platform (SensBalance Fitness Board; Sensamove®, the Netherlands). When the platform is perfectly balanced the maze is horizontal and the ball lies still.
By subtly shifting weight on the balance board people can
learn to move the ball through the maze or to a target. The
game has different levels of difficulty which can be adjusted to the performance level of the individual subject.
An interrupted time series design was used with a threeweek baseline period preceding the intervention and a
three-week baseline period following the six-week intervention. Before, after and during the intervention, performance was tested three times a week by using a
dot-circle gaming task. Balance was assessed using general clinical balance assessment instruments, during which
trunk accelerations were registered with an ambulant accelerometer device (DynaPort®; McRoberts). Intervention effects were examined using multilevel modeling
statistics. Outcome measures were:
• Task related measures, the percent error, the number of
samples outside the circle and the root mean square error
(RMSE) of the dot with respect to zero point.
(smaller RMSE’s and percent of errors) in the first two
training weeks and remained unaltered thereafter (p <
0.05). Postural control measured with accelerometry improved significantly during the training (p < 0.05) and was
significantly better after training than before the training,
as indicated by lower RMS values, and a more stable and
regular trunk acceleration pattern. However, the time-scale
of improvement was slower than that of the dot-test. Multilevel modeling revealed that participants with low scores
at the start of the program improved more over time than
the highest scoring participants. All subjects reported
being highly motivated to exercise because they found the
games challenging and enjoyable.
discussion/Conclusion
Elderly people without a specific pathology can benefit
from a videogame-based exercise program aimed at improving balance, where people had to move a platform in
response to stimulation from a game that was challenging
and fun to play. Balance measurements indicate that although performance on the game might improve quickly,
it takes a longer period of training to improve postural control. Future studies will be aimed at studying not only balance, but the ability to orient oneself in space, using
serious gaming with motion-tracking devices to capture
whole body movements.
references
[1] CJC Lamoth CJC, W Berend, A Schmid, SR Caljouw,
S. Gait Posture 30 (2009), 30, S144-S145
• Medio-lateral and anterior-posterior variability, regularity, and stability of trunk, and the acceleration patterns
recorded during the balance assessment tests.
[2] D. Fitzgerald, NTrakarnratanakul, B. Smyth and B.
Caulfield. J.Orthop.Sports Phys.Ther. 40 (2010) 11-
results
Performance on the dot task showed a quick improvement
[3] AL Betker, T. Szturm, ZK Moussavi and C Nett. 87
(2006) 1141-9
exposure for anxieTy disorders WiTh
VirTual and augmenTed realiTies
The development of the
sWeaT Questionnaire: a scale measuring
Costs and efforts inherent to Conducting
exposure sessions
Geneviève Robillarda, Stéphane Boucharda,
Stéphanie Dumoulinb and Tanya Guitardb
Université du Québec en Outaouais (Canada)
b
Université du Québec à Montréal (Canada)
a
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Geneviève Robillard
CP1250 Succ Hull
Gatineau J8X 3X7 Canada
E-mail: genevieve.robillard@uqo.ca
1
abstract
For decades, empirical studies have shown the effectiveness of exposure techniques when used in Cognitive Be-
164
havioral Therapy (CBT) treatment for anxiety disorder.
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 268 exposure sessions
(in vivo = 136; in virtuo = 132) 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: Virtual Reality, Exposure, Psychometric
Measure, Social Anxiety, Cognitive Behavioral Therapy
introduction
For decades, empirical studies have shown the effectiveness of exposure techniques when used in a Cognitive
Behavioral Treatment (CBT) for anxiety disorder [1-6].
A few studies are now suggesting that using Virtual Reality (VR) may be an effective way to conduct exposure
(also called in virtuo exposure) and overcome some of
the limitations of in vivo exposure [7, 8]. For example,
one significant limitation of the traditional in vivo exposure is the challenge for therapists to recreate adequate
and controlled social exposure situations (e.g., audience
to conduct the exposure, control on people’s reactions,
appropriate situations for exposure). VR overcomes these
barriers, in addition to providing a treatment that is more
enticing and allows the client to interact with a phobic
scenario in the safety and confidentiality of the office. A
recent study also suggests that the advantages of using in
virtuo exposure may not only be to provide a more effective treatment (as least, given the currently available virtual environments), but to provide a treatment that is more
flexible and cost-effective for therapists [9].
The aim of this study is to validate an instrument that
measures specific costs and efforts required to conduct
exposure sessions called the Specific Work for Exposure
Applied in Therapy (SWEAT) questionnaire. The Cyberpsychology Lab of the Université du Québec en
Outaouais (Canada) developed and used this instrument,
rated by therapists after each exposure session, in order
to systematically assess the costs (e.g., the salary of the
confederate audience used for exposure) and practical effort (e.g., time spent going to the cafeteria with the pa-
tient, finding appropriate stimuli) required to conduct exposure in the treatment of social anxiety.
method
A total of 265 individual exposure sessions (in vivo = 140
and in virtuo = 125) were rated by four experienced therapists immediately after the exposure session during a 16week CBT treatment. A total of 39 adults receiving a
DSM-IV-TR principal diagnosis of social anxiety (mean
age = 37.9; 71.8% female) participated in this study and
were randomized in three treatment conditions (this study
is part of a broader project): (1) CBT with in vivo only
exposure (n=16); (2) CBT with in virtuo only exposure
(n=14); (3) CBT with combined exposure techniques
(both in vivo and in virtuo) (n=9).
results
The internal reliability coefficient of the SWEAT was
good, with a Chronbach’s alpha of .83. Also, an exploratory factor analysis was performed on the SWEAT
questionnaire and a three-factor solution was found. Factor loadings were interpreted after a varimax rotation.
Factor 1 explains the burden imposed on the therapist to
prepare and conduct the exposure session. Factor 2 expresses the challenge of fine-tuning the exposure exercise
and Factor 3 captures the notion of time required to plan
and conduct the exposure.
ANOVAs comparing in vivo versus in virtuo exposure
sessions revealed that in virtuo exposure sessions were
significantly less expensive than in vivo exposure sessions. Results on the total score and the subscales of the
SWEAT were compared with Student t-tests for sessions
involving in vivo and in virtuo exposure. This analysis
revealed that in virtuo exposure sessions required less effort to surpass burden constraints (e.g., confidentiality issues, schedule constraints, etc.) [SWEAT total score,
t(199) = 11.01, p<.001]. Refining our understanding by
looking at the subscales revealed that the significant difference is specific to how cumbersome exposure is in
vivo [Factor 1, t(170) = 15.04, p<.001].
Conclusion
The SWEAT is proposed as a new measure to document
the efforts, burden, costs, time and constraints inherent to
conducting exposure in therapy sessions. The original
group of items was developed during discussions with
clinicians and, after being put to the test, the number of
items was reduced and some of the rating scales (e.g.,
exact time spent to search for stimuli and prepare the ex-
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posure, exact cost of each exposure session) modified to
produce categories allowing the possibility to sum each
item and report a total score.
The final instrument uses three factors describing how
difficult it may be for a therapist to set up and conduct
exposure sessions: the burden for the therapist, the difficulties in fine-tuning the exposure, and time constraints.
The scale was developed with the hope of being used
with any type of exposure stimuli, but the comparison
between the different modalities of exposure revealed
clear advantages for therapists using VR over real life
situations involving elements such as a mock audience,
going to washrooms wearing a silly hat, or going out to
a restaurant.
references
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165
[8] G. Robillard, S. Bouchard, S. Dumoulin, T. Guitard,
G., & É. Klinger. Using virtual humans to alleviate social
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Conference 2010, Seoul (Korea), June 13-15.
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G. Comparing the costs and efforts required to conduct
exposure in vivo or in virtual reality during CBT for social
phobia. Poster presented at the 44th Annual Conference
of the Association for Behavioral and Cognitive Therapy,
San Francisco (CA), November 18-21.
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differences in hpa axis activation secondary to
individual CbT session using either in Vivo or in
Virtuo exposure in sad patients
François-Xavier Roucauta,b,1, Stéphane Bouchardb
and Hélène Forgetb
a
CHRU Montpellier (France)
Université du Québec en Outaouais (Canada)
b
1
François-Xavier Roucaut
CHRU Montpellier
1 route de Champagne
Ecully 69130, France
E-mail: roucautfrancois@live.fr
abstract
We wanted to investigate whether differences in the hypothalamus-pituitary-adrenal (HPA) axis activation could
be observed between different types of exposure (in vivo
and in virtuo) embedded in an individual format of Cognitive Behavioral Therapy (CBT) for social anxiety disorder (SAD). Twenty-two SAD patients underwent an
individual CBT session using either in vivo, in virtuo or
combined in vivo/in virtuo exposure. Each time an exposure session occurred during the treatment, salivary cortisol samples were taken at time of arrival in the
laboratory and before and after each CBT session. Differences between groups concerning salivary cortisol
variations before and after CBT sessions will be analyzed.
Analyses are still in progress and results will be presented
and discussed at the time of the oral presentation.
Keywords: Virtual Reality, Exposure, Cognitive
Behavioral Therapy, Social Anxiety, Salivary Cortisol
166
introduction
Social anxiety disorder (SAD) is a common (lifetime
prevalence of 12.1% in the general population), yet underestimated disorder characterized by a marked fear and
avoidance of social interactions [1]. As for several neuropsychiatric disorders, the hypothalamus-pituitaryadrenal (HPA) axis is implied in SAD physiopathology.
The HPA axis is a major neuroendocrine system linked to
stress activation, in which stimulation results in the release
of cortisol in the serum and saliva. HPA axis activation is
studied in many fields of mental disorders including depressive disorder [2], dementia [3] and several anxiety disorders, such as Posttraumatic Stress Disorder [4] and
general anxiety disorder [5]. Concerning social anxiety,
increased HPA axis activity has been associated with increased social avoidance and freezing reaction in healthy
subjects [6-8]. Research on rodents and primates has also
shown that socially avoidant behaviors were correlated
with HPA activation [9-12]. In the SAD population, several studies showed an alteration of HPA axis activation
when confronted with social stimuli [13]. Activation of
the HPA axis can be experimentally induced using tasks
like delivering a speech in front of an audience, even using
a virtual one [14, 15].
Our study aimed to investigate whether differences exist
concerning anxiety experienced during exposure to social
situations in vivo and in virtuo. For this purpose, we studied HPA axis variation during in vivo or in virtuo exposure
sessions with salivary cortisol. Salivary cortisol is a good
marker of HPA axis activity with a practical and minimally
intrusive way to collect samples. For social phobics involved in exposure, it allows a less cumbersome way to
assess reactions to stress than heart rate or skin conductance monitoring. Besides, some studies showed that subjects find in virtuo exposure safer and less frightening than
in vivo exposure [16]. We therefore hypothesized that
HPA axis activation will be less important during in virtuo
exposure compared to in vivo exposure.
method
A total of 22 adults receiving a DSM-IV-TR diagnosis of
SAD participated in this study and were randomized in
three treatment conditions (this study is a part of a broader
project): (1) individual CBT with in vivo exposure (n=7);
(2) individual CBT with in virtuo exposure (n=9); individual CBT with combined in vivo/in virtuo exposure
(n=6). Patients underwent 14 weekly 60-minute sessions
of individual CBT sessions based on the model and approach of Clark and Well [17]. Salivary samples were
taken upon arrival to the laboratory, and before and after
each CBT session to study HPA activation due to CBT sessions. To control for patient’s cortisol circadian rhythm in
the two days before exposure, samples were collected at
awakening, 30 minutes after awakening, at 4 p.m. and at
bedtime. Samples from patients included in the combined
in vivo/in virtuo exposure group were allocated according
to the type of exposure performed during the CBT session
(i.e., either in vivo or in virtuo). Thus, a total of 679 samples of salivary cortisol were collected. To assess free cortisol levels, salivary samples were obtained with
Salivette© collection devices (Sarstedt, Rommelsdorf,
Germany). The samples were stored at -20°C before assaying. Biochemical analysis of free cortisol in saliva was
performed with a competitive immunosorbent assay (Salimetrics™ cortisol kit, LLC, State College, United States
of America). Comparison between groups concerning salivary cortisol levels before and after each CBT session will
be done with controlling for patient’s cortisol circadian
rhythm and cortisol levels upon arrival to the laboratory.
results
The data are still being analyzed.
discussion
Our results will be relevant when considering the optimal
level of anxiety during exposure. Several authors put forward that mild exposure sessions could be more effective
than exposure sessions eliciting a higher level of anxiety,
because this would allow the patient a less emotional experience and better cognitive treatment of the anxiogenic
stimuli. Results will be discussed according to these considerations.
references
[1] R.C. Kessler, P. Berglund, O. Demler, R. Jin, K.R.
Merikangas, et E.E. Walters, Lifetime prevalence and ageof-onset distributions of DSM-IV disorders in the National
Comorbidity Survey Replication, Archives of General
Psychiatry 62 (2005), 593-602.
[2] R.M. Sapolsky, Glucocorticoids and hippocampal atrophy in neuropsychiatric disorders, Archives of General
Psychiatry 57 (2000), 925-935.
[3] F. Magri, L. Cravello, L. Barili, S. Sarra, W. Cinchetti,
F. Salmoiraghi, G. Micale, et E. Ferrari, Stress and dementia: the role of the hypothalamicpituitary-adrenal
axis, Aging Clinical and Experimental Research 18
(2006),167-170.
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[4] E.D. Kanter, C.W. Wilkinson, A.D. Radant, E.C.
Petrie, D.J. Dobie, M.E. McFall, E.R. Peskind, et M.A.
Raskind, Glucocorticoid feedback sensitivity and adrenocortical responsiveness in posttraumatic stress disorder,
Biological Psychiatry 50 (2001), 238-245.
[5] R.C. Mantella, M.A. Butters, J.A. Amico, S. Mazumdar, B.L. Rollman, A.E. Begley, C.F. Reynolds, et E.J.
Lenze, Salivary cortisol is associated with diagnosis and
severity of late-life generalized anxiety disorder, Psychoneuroendocrinology 33 (2008) 773-781.
[6] J. van Honk, A. Tuiten, M. van den Hout, H.
Koppeschaar, J. Thijssen, E. de Haan, et R. Verbaten, Conscious and preconscious selective attention to social threat:
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of stress-induced cortisol responses on approach-avoidance
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[8] K. Roelofs, P. Bakvis, E.J. Hermans, J. van Pelt, et J.
van Honk, The effects of social stress and cortisol responses on the preconscious selective attention to social
threat, Biological Psychology 75 (2007), 1-7.
[9] R.M. Sapolsky, A. E. Bennett Award paper. Adrenocortical function, social rank, and personality among wild
baboons, Biological Psychiatry 28 (1990), 862-878.
[10] N.H. Kalin, S.E. Shelton, M. Rickman, et R.J. Davidson, Individual differences in freezing and cortisol in infant and mother rhesus monkeys, Behavioral
Neuroscience, 112 (1998), 251-254.
[11] J.F. Núñez, P. Ferré, R.M. Escorihuela, A. Tobeña, et
A. Fernández-Teruel, Effects of postnatal handling of rats
on emotional, HPA-axis, and prolactin reactivity to novelty and conflict, Physiology & Behavior 60 (1996), 13551359.
[12] S.A. Cavigelli, M.M. Stine, C. Kovacsics, A. Jefferson, M.N. Diep, et C.E. Barrett, Behavioral inhibition and
glucocorticoid dynamics in a rodent model, Physiology &
Behavior 92 (2007), 897-905.
[13] K. Roelofs, J. van Peer, E. Berretty, P.D. Jong, P.
Spinhoven, et B.M. Elzinga, Hypothalamus-pituitaryadrenal axis hyperresponsiveness is associated with in-
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creased social avoidance behavior in social phobia, Biological Psychiatry 65 (2009), 336-343.
[14] O. Kelly, K. Matheson, A. Martinez, Z. Merali, et H.
Anisman, Psychosocial stress evoked by a virtual audience: relation to neuroendocrine activity, Cyberpsychology & Behavior: The Impact of the Internet, Multimedia
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[15] P. Jönsson, M. Wallergård, K. Osterberg, A.M.
Hansen, G. Johansson, et B. Karlson, Cardiovascular and
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[16] A. Garcia-Palacios, C. Botella, H. Hoffman, et S. Fabregat, Comparing acceptance and refusal rates of virtual
reality exposure vs. in vivo exposure by patients with specific phobias, Cyberpsychology & Behavior: The Impact
of the Internet, Multimedia and Virtual Reality on Behavior and Society 10 (2007), 722-724.
[17] D.M. Clark, A. Wells, Social Phobia: Diagnosis, Assessment and Treatment, Guilford Press, New York, 1995.
––––––––––––––––––––––––––––––––––––––––––––––
you better Control for Video gaming experience
because Video gamers are more difficult to
scare in Virtual reality
Erik Geslina,1, Stéphane Bouchardb and Simon Richira
Arts et MetiersParisTech, LAMPA, 2 Bd du
Ronceray, 49000 Angers – France
b
Université du Québec en Outaouais – Canada
a
1
Erik Geslin
Arts et MetiersParisTech
LAMPA, 2 Bd du Ronceray
49000 Angers, France
E-mail: erik.geslin@gmail.com
abstract
Few studies have examined the impact of prior video
gaming experience on the stress experienced while immersed in a virtual environment (VE). Our hypothesis
was that prior experience with immersive video games
could reduce the stressful impact of a VE. We compared
168
emotions in gamers and non-video gamers. Our results
show that the level of fear in people who consider themselves non-gamers is higher than in gamers.
Keywords: Emotions, Virtual Environment,
Video Game, Video Gamer, Head Mounted
Display, Presence
introduction
Understanding emotional reactions is crucial for researchers working on topics such as Virtual Reality (VR),
presence or cybertherapy [1-4]. The relationship between
emotions and presence has been less extensively studied.
It seems important to document the impact of playing
video games regularly on the sensitivity to environments
designed to induce emotions.
Context
Emotions were later categorized and even reduced to
basic ones using the classifications system. Many theories and definitions of emotions have been successfully
implemented. It is now accepted that emotions arise from
continuous appraisal and information processing of situations. Contemporary cognitive models introduce the
idea of two parallel models of information processing.
Emotions play a significant role in the sense of presence
in VR. For example, studies show that depending on the
valence of the emotions induced, the presence significantly increases [5-6]. This suggests that more experience
with games would be associated with decreases in spatial
presence. Smith and Du’Mont [7] also found a significant
correlation between the level of activity in first person
shooter (FPS) video games and performance in the navigation task based on virtual environment (VE) time.
method
device
One hundred forty-one adults of both sexes participated
in our study (81 people defining themselves as video
game players, and 60 people defining themselves as “not
video gamers”). They were immersed with a head
mounted display (HMD) 180 ° focal in the VE, inducing
fear in real-time 3-D. The viewpoint is first. The trackers
consisted of eight Vicon cameras located around the subject and were also used to track the HMD. Movements in
the VE were achieved through the use of a PAD type
Xbox 360 connected via USB.
equipment and Virtual environments
The HMD used was the HEWDD-1080 manufactured by
Crescent, Inc. which relied on LCOS rear projection,
providing a definition of 12.2 megapixels (R + G + B) *
(Left Eye + Right Eye) a resolution of 1920 * 1080, a
Horizontal FOV of 140 degrees and 90 degrees vertical,
with overlap of 90 degrees. The application ran on two
2 HP xw9400 workstation with two Quadro graphics
cards 5800 (one for each eye). The pixel dimensions of
images were conventionally of the type 28, 29, 210, and
211. Shaders were programmed in HLSL.
procedure
The experiment lasted between 8-10 minutes. Participants were asked to make a virtual journey through dark
alleys. The liberty of the subject was constrained by the
topology of the site. After the experiment each user completed a semantic differential questionnaire based on
three emotional responses [8]. The three questions were:
Are you afraid? Were you anxious? Were you surprised?
Participants had to answer using a scale ranging from 0
to 21. All information collected were analyzed with oneway ANOVAs.
results
The sample consisted of participants from both genders
(27% female in the gamers condition and 34% in the nongamers condition, X2(1) = 4.02, p < .05) and their age
varied between 12-50 years old. The gamers were
younger than the non gamers (X²(2) =15.47, p < .001). A
Bonferroni correction was applied to the critical p values
in order to control the error rate. The one-way ANOVAs
for fear and surprise were both statistically significant
[F(1,139) = 7.81, p < .01 and F(1,139) = 8.22, p < .01,
respectively], which is significantly lower that the corrected significance level.The ANOVA for the measure of
anguish did not reach significance [F(1,139) = 0.53, ns].
The eta-squared of .004 showed that the effect size of the
difference between the two conditions was very small.
discussion
The objective was to determine whether being an experienced video game player or not influences sensitivity
to the emotion of fear in VEs. The results regarding fear
and surprise are significant. They show that subjects considering themselves as video gamers have less fear and
less surprise in VEs that subjects considering themselves
as non-video gamers.
One consequence of these results is that it is likely that,
for designers of video games or VEs, the task of inducing
emotion will become more complex with the growing
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number of people who have played video games, given
the increasing number of players and time consumed interacting with the medium. Similarly, cognitive behavioral therapy using VR to induce emotions may also be
affected by this challenge if patients (more video game
consumers) are less sensitive to VEs.
In this sense, it seems that even partial knowledge of the
mediation system created a habit that can partially inhibit
emotional response during immersion. If this is the case,
then researchers working on VR applications for mental
disorders should control for video gaming experience,
and even purposely include video gamers in their samples, since gamers are more difficult to scare in VR. The
frightening VE used in this experiment relied on stressors
typically used in horror video games [9], such as gloomy
ambiance and the element of surprise.
The stimuli used to elicit emotions in clinical applications are tailored to emotionally relevant cues that are
specific to each disorder (e.g., a shopping mall, for the
treatment of agoraphobia) and do not trigger the same
response in people who are not afflicted by that disorder
[10]. A potential indirect support for the hypothesis of
habituation to specific stimuli is the study from Gamito
et al. [11] (2010) showing that presence increases with
experience in VE.
The results observed during the experiment show a lesser
awareness of emotions in VEs, according to the amount
of exposure to video games. Given our research, these
results can only be explained by a lower psychological
investment, and smaller amount of involvement of people with experience in mediation systems. These topics
are de facto as related to using mediation systems of VR.
references
[1] Bouchard, S., Côté, S., & Richard, D. C. S. (2006).
"Virtual reality applications for exposure. In D. C. S."
Richard (Éd.) Handbook of exposure347-388.
169
ments." Philosophical transactions of the Royal Society of
London. Series B, Biological sciences364(1535): 3549-57.
[5] Bouchard, S., & Labonté-Chartrand, G. (2011). Emotions and the emotional valence afforded by the virtual environments. In J.-J. Kim (Ed.) Virtual Reality (pp.
513-526). Croatia: InTech.
[6] Riva, G., F. Mantovani, et al. (2007). "Affective interactions using virtual reality: the link between presence and
emotions." 10(1): 45-56.
[7] Smith, S. P. and S. Du’Mont (2009). "Measuring the Effect of Gaming Experience on Virtual Environment. Navigation Tasks." IEEE Symposium on 3D User Interfaces.
[8] Osgood (1975). The measurement of meaning, Ninth
printing.
[9] Perron, B. (2005). A Cognitive Psychological Approach to Gameplay Emotions. . DIGRA 2005 International Conference. Vancouver, Canada.
[10] Robillard, G.Robillard, G., Bouchard, S., Fournier,
T., & Renaud, P. (2003). Anxiety and presence during VR
immersion: A comparative study of the reactions of phobic
and non-phobic participants in therapeutic virtual environments derived from computer games. CyberPsychology
and Behavior, 6(5), 467-476.
[11] Gamito, P. Oliveira, J., Morais, D., Baptista, A., Santos, N. et al. (2010).Training presence: the importance of
virtual reality experience on the "sense of being there".
Annual review of Cybertherapy and Telemedecine 2010,
154, 128-133.
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Towards immersive and adaptive augmented
reality exposure Treatment
Andreas Dünsera,1 and Raphaël Grasseta
[2] Freeman, D. (2008). "Virtual reality study of paranoid
thinking in the general population." The British Journal
of Psychiatry(192): 258-263.
The HIT Lab NZ, University of Canterbury
a
Andreas Dünser
The HIT Lab NZ
University of Canterbury
New Zealand
E-mail: andreas.duenser@hitlabnz.org
1
[3] Mair, G. M. (2007). "Towards Transparent Telepresence." Ergonomics, 300-309.
[4] Slater, M. (2009). "Place illusion and plausibility can
lead to realistic behaviour in immersive virtual environ-
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170
abstract
We are proposing a new type of augmented reality (AR)
based exposure therapy system to treat specific phobias.
This research testbed allows patients not only to see virtual fear stimuli overlaid onto the real world, but to fully
interact with them in real time. Extending on previous
work, we focus on creating a visually realistic context
and supporting interactivity (through gesture recognition
and physiological sensors). We aim at developing a very
life-like system that allows full control over stimulus intensity and other parameters necessary for an effective
exposure therapy system.
Keywords: Augmented Reality, Exposure
Therapy, Interactive Augmented Reality
introduction
Exposure therapy is a very effective treatment choice for
specific phobias [1]. However, since it entails being confronted with intense fear-inducing situations, many people never seek or refuse treatment, and it can be
challenging and expensive to provide appropriate therapeutic stimuli. Immersive Virtual Reality (VR) systems
address some of these concerns and have been shown to
be very effective in the treatment of phobias [2], but they
separate users from the real world. More recently, augmented reality (AR), a technology that overlays virtual
content on the real world, has gained interest from researchers in clinical psychology. AR systems have great
potential for treating specific phobias and in some cases
may be more efficient and cost effective than VR. However, current AR systems are rather limited in their capabilities for displaying and interacting with virtual
stimuli.
related Work
An AR environment seems to be especially suitable for exposure treatment because it enables displaying and interacting with virtual fear stimuli in the real world (including
“mediated” perception of the real environment, real artifacts and our own bodies). Juan et al. argue that one benefit
of treatment with an AR system is that it allows patients to
use real objects or their hands (and feet) to interact with
the stimuli [3]. However, this type of interactivity has so
far not been implemented in AR-based exposure therapy
systems. AR systems have been developed for exposing
patients to spiders [3] or cockroaches [4-5].
These systems use basic hardware and software setups
with clients wearing a head mounted display with an at-
tached USB camera to track visual markers. Fear stimuli
are (virtually) overlaid on top of these markers and animated with predefined basic motions. In a later study [6]
a special ink was used to make the tracking marker invisible, avoiding the visual disruption induced by the
presence of the markers.
Although interaction in these systems was rather limited,
studies found that they are capable of inducing high levels of anxiety which is a necessary prerequisite for such
a system to be effective [5]. The main element that
elicited the highest anxiety levels was “giving movement” to the virtual fear stimuli. Considering that a virtual stimulus is not just moving but also reacting and
adapting to the client’s presence or actions (i.e., body
posture, gestures, gaze or emotional state) might make
them appear even more realistic.
results and Conclusion
In this context, we are currently developing an advanced
interactive AR exposure therapy system that will provide
a high quality experimental test-bed and allow us to study
the potential of using non-disruptive and interactive AR
as a tool for exposure therapy. The novelty of our system
lies on using user actions/behavior as a control input to
the system and creating a naturalistic environment.
We have implemented a first prototype that allows users
to see and interact with virtual stimuli in their real surroundings. Our AR system uses a planar Natural Feature
Tracking technique which allows us to display virtual
stimuli on any natural textured surface of the environment
(no need for additional visual markers or tags). Interaction
is supported through hand interaction above this surface,
using a basic gesture recognition technique and a visionbased hand tracking algorithm. We can detect hand movements (e.g., static, shaking, moving forward) and use
these as input for controlling the system and having the
virtual stimulus react to it.
We aim to create an application that allows the therapist
to have full control over various parameters in real
time. In addition, the system automatically triggers
changes in stimulus intensity depending on the client’s
reactions. In the future we envision integrating more
input control such as physiological sensors (galvanic
skin response or heart rate sensors). By directly integrating such sensors, stimulus intensity can be adapted
automatically according to sensor output, making the
system more interactive.
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references
[1] Y. Choy, et al., "Treatment of specific phobia in
adults," Clinical Psychology Review, vol. 27, pp. 266286, 2007.
[2] S. Cote and S. Bouchard, "Virtual reality exposure for
phobias: a critical review," Journal of CyberTherapy &
Rehabilitation, vol. 1, pp. 75-81, 2008.
[3] M. C. Juan, et al., "Using augmented reality to treat
phobias," IEEE computer graphics and applications, vol.
25, pp. 31-37, 2005.
[4] M. C. Juan, et al., "An augmented reality system for
treating psychological disorders: Application to phobia to
cockroaches," Proceedings of the 3rd IEEE/ACM International Symposium on Mixed and Augmented Reality,
pp. 256-257, 2004.
[5] J. Breton-Lopez, et al., "An Augmented Reality System Validation for the Treatment of Cockroach Phobia,"
Cyberpsychology, Behavior, and Social Networking,
2010.
[6] M. C. Juan, et al., "A markerless augmented reality
system for the treatment of phobia to small animals," Proceedings of the 9th Annual International Workshop on
Presence, Cleveland, Ohio, 2006.
––––––––––––––––––––––––––––––––––––––––––––––
Comparison of anxiety in response to Virtual
spiders While immersed in augmented reality,
head-mounted display, or CaVe-like system
Oliver Bausa,1, Stéphane Bouchardb,
Véronique Gougeonb and François-Xavier Roucautc
University of Ottawa, Ottawa, Ontario, Canada
b
Université du Québec en Outaouais,
c
Centre Hospitalier Régional Universitaire
de Montpellier, Montpellier, France
a
Oliver Baus
98 rue du Meridien
Gatineau
J9A3A8 Canada
E-mail: obaus@yahoo.ca
1
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abstract
During in virtuo exposure therapy, the virtual environment may be completely virtual (Virtual Reality; VR)
and projected via a head mounted display (HMD), or
projected via a Computer Automated Virtual Environment (CAVE). However, the virtual stimuli may also be
synthetic but presented as an overlay to a live video
stream (augmented reality; AR) projected in the HMD.
The objective of this study is to compare the levels of
anxiety induced by a standardized arachnophobia scenario displayed either in a HMD, in a 6-wall CAVE-Like
system, or in AR. The final sample will be comprised of
60 non-phobic participants exposed, in random order, to
each of the three systems. The level of anxiety is quantified through physiological measures (skin conductance
and heart rate), behavioral measures (changes in distance
from the user’s head to the spider and hand to the spider),
and self-reported measures (during immersion verbal and
post-immersion written questionnaires). Preliminary
analysis of the data (with 40% of the participants tested
so far) suggests that the hypothesis could be verified with
sufficient power when the sample size reaches 60 participants, but currently shows no significant difference between the three virtual environment systems, for any of
the measures.
Keywords: Anxiety, Virtual Reality, Augmented Reality,
Head Mounted Display, Computer Automated
Virtual Environment
introduction
According to various studies, in virtuo exposure therapy
is efficacious in treating anxiety disorders [1]. More precisely, in the domain of specific phobias, it seems efficacious against acrophobiac [2, 3], arachnophobiac [4],
aviophobiac [5-8], claustrophobia [9, 10], and driving
phobia [11]. According to a meta-analysis by Powers and
Emmelkamp [12], in the treatment of phobias and anxiety
disorders, in virtuo exposure therapy is slightly, but significantly more efficacious, than in vivo exposure therapy.
While the clinical applications of Virtual Reality (VR) are
well established, it is not yet the case for augmented reality
(AR) [13]. As exposure therapy depends on the ability of
the environment to induce anxiety, some authors have investigated whether a particular system is superior at this
task. For example, Juan and Perez [14] found that an acrophobia environment induced more anxiety in a Computer
Automated Virtual Environment (CAVE) than in a head
mounted display (HMD). In the domain of AR, Juan and
colleagues [15], as well as Bretón-López and colleagues
172
[16], confirmed that AR does induce anxiety in individuals
suffering from spider or cockroach phobia. However, Juan
and Pérez [17] were unable to find a difference in the anxiety-inducing abilities of AR and VR.
In sum, the induction of anxiety is a major issue in exposure therapies; virtual environments have demonstrated
this ability, both in clinical and non-clinical samples. However, it seems that no study has endeavoured a direct comparison between the levels of anxiety induced by a VR
system utilizing a HMD, a VR system utilizing a 6-walls
CAVE-Like system, and an AR system. This project will
carry out such a comparison, with the hypothesis that the
AR system will induce the highest level of anxiety.
methods
protocol
The protocol will include a final sample of 60 non-phobic
participants exposed, in random order, to each of the three
systems. At the beginning of the experimental scenario, the
participant sits at a virtual table (a real table in the case of
AR). As virtual spiders begin to appear at the far end, a prerecorded verbal instruction invites the participant to place
the dominant hand on the near end of the table. About a
dozen virtual spiders end up walking around on the table,
without approaching closer than the mid-point of the table.
After about one minute, a larger virtual spider heads directly towards the hand of the participant and stops short
by about 15 cm. A pre-recorded verbal instruction then invites the participant to place his hand as close as possible
to this spider, to hold it in that position for about five seconds, and to then put it back in the original position on the
table. At that point, the spiders begin to head to, and disappear from, the far end of the table. The spiders and the scenario are identical for each of the three systems.
measures
The data collected prior to the first immersion include: (1)
basic socio-demographic information; (2) the immersive
tendencies (via a French-Canadian validated version of
the Immersive Tendencies Questionnaire[18]); (3) the
level of cybersickness (via a French-Canadian validated
version of the Simulator Sickness Questionnaire[19]; (4)
the level of state anxiety (via the French-Canadian validated State-Trait Anxiety Inventory[20]); and (5) the level
of sensitivity to spiders (via a French-Canadian version of
the Sensitivity to Spiders Questionnaire[21]).
Skin conductance and heart rate baseline measures are
taken prior to each immersion and prior to the launch of
the scenario. These same physiological measures, as well
as the distance of the head relative to the center of the
table, are also taken throughout the scenario. Hand-to-spider distance is measured when the participant places his
hand closer to the spider.
Measures of anxiety are taken verbally: (1) prior to the appearance of the spiders; (2) just before the participant has
to approach the hand to the spider; and (3) once the spiders
have all left the table. A measure of disgust towards the
spiders is taken verbally when the large spider is stationary
in front of the participant.
The measures taken after each immersion include: (1) a
measure of reality judgement (via a French-Canadian
version of the Reality Judgement Questionnaire[22]); (2)
a measure of disgust via a French-Canadian translation
of the Short Version of Ekel-State-Fragebogen[23]); (3)
a measure of the level of cybersickness (via a FrenchCanadian validated version of the Simulator Sickness
Questionnaire[24]); and (4) the level of state anxiety (via
the French-Canadian validated State-Trait Anxiety Inventory[25]). After completing the post-immersion questionnaires, the participant completes a distraction task
intended to bring his emotional state back to its baseline.
results
Preliminary analysis of the data (with 40% of the participants tested so far) shows several effects. Regarding the
physiological measures, the heart rate was significantly
affected by Time (F(1.9, 22.8) = 12.32, p < .001; η2 partial
= .51), but not by the Type of virtual environment system
(F(2, 12) = .96, p = .41; η2 partial = .14); the interaction
Time X Type of system was not significant either (F(3.8,
22.8) = 1.28, p = .31; η2 partial = .18). The contrasts indicate a significant increase in heart rate between pre-immersion and immersion 1 (F(1,12) = 10.80, p < .001; η2
partial = .47). The skin conductance was not significantly
affected by either the Time (F(1.7,20.5) = 1.05, p = .36;
η2 partial = .08), the Type of system (F(2,12) = .83, p =
.46; η2 partial = .12), or their interaction (F(3.4,20.5) =
.92, p = .46; η2 partial = .13).
Regarding the subjective measures taken verbally, the
level of self-reported anxiety was not significantly affected
by either the Time (F(3,60) = .61, p = .61; η2 partial = .03),
the Type of system (F(2,20) = .22, p = .80; η2 partial =
.02), or their interaction (F(6,60) = .54, p = .78; η2 partial
= .05). The self-reported disgust was not significantly affected by either the Time (F(2,42) = .26, p = .77; η2 partial
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= .01), the Type of system (F(2,21) = .08, p = .93; η2 partial = .01), or their interaction (F(4,42) = .79, p = .54; η2
partial = .07).
Regarding the subjective measures taken post-immersion,
the level of self-reported anxiety was significantly affected
by the Time (F(3,63) = 3.13, p < .05; η2 partial = .13), but
not by the Type of system (F(2,21) = .95, p = .40; η2 partial = .08), or their interaction (F(6,63) = .89, p = .51; η2
partial = .08). The contrasts indicate a significant decrease
in anxiety between pre-immersion and immersion 3
(F(1,21) = 10.35, p < .01; η2 partial = .33). The self-reported disgust was not significantly affected by either the
Time (F(2,42) = 2.66, p = .08; η2 partial = .11), the Type
of system (F(2,21) = .53, p = .60; η2 partial = .05), or their
interaction (F(4,42) = .60, p = .67; η2 partial = .05).
In sum, this project is ongoing and the preliminary data
suggests that the hypothesis could be tested with sufficient
power when the sample size reaches 60 participants. Its
results could prove valuable in the process of selecting the
type of system to favor in the future.
references
[1] C. Botella, H. Villa, A. García-Palacios, R.M. Baños,
C. Perpiñá, & M. Alcañiz, Clinically significant virtual
environments for the treatment of panic disorder and agoraphobia, CyberPsychology & Behavior, 7 (2004), 527535.
[2] P.M. Emmelkamp, M. Bruynzeel, L. Drost, & C.A.
van der Mast, Virtual reality treatment in acrophobia: A
comparison with exposure in vivo, Cyberpsychology &
Behavior, 4 (2001), 335-339.
[3] P.M. Emmelkamp, M. Krijn, A.M. Hulsbosch, S. de
Vries, M.J. Schuemie, & C.A. van der Mast, Virtual reality
treatment versus exposure in vivo: A comparative evaluation in acrophobia, Behaviour Research and Therapy, 40
(2002), 509-516.
[4] A. García-Palacios, H. Hoffman, A. Carlin, T.A. Furness III, & C. Botella, Virtual reality in the treatment of
spider phobia: A controlled study, Behaviour Research and
Therapy, 40 (2002), 983-993.
[5] B.O. Rothbaum, L. Hodges, S. Smith, J.H. Lee, & L.
Price, A controlled study of virtual reality exposure therapy for the fear of flying, Journal of Consulting and Clinical Psychology, 68 (2000) 1020-1026.
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173
[6] B.O. Rothbaum, L. Hodges, P.L. Anderson, L. Price,
& S. Smith, Twelve-month follow-up of virtual reality and
standard exposure therapies for the fear of flying, Journal
of Consulting and Clinical Psychology, 70 (2002), 428432.
[7] N. Maltby, I. Kirsch, M. Mayers, & G.J. Allen, Virtual
reality exposure therapy for the treatment of fear of flying:
A controlled investigation, Journal of Consulting and Clinical Psychology, 70 (2002), 1112-1118.
[8] B.K. Wiederhold, D.P. Jang, R.G. Gevirtz, S.I. Kim,
I.Y. Kim, & M.D. Wiederhold, The treatment of fear of
flying: A controlled study of imaginal and virtual reality
graded exposure therapy, IEEE Transactions on Information Technology in Biomedicine, 6 (2002), 218-223.
[9] C. Botella, H. Villa, R. Baños, C. Perpiñá, & A. García-Palacios, The treatment of claustrophobia with virtual
reality: Changes in other phobic behaviors not specifically
treated, CyberPsychology & Behavior, 2 (1999), 143-148.
[10] C. Botella, R.M. Baños, H. Villa, C. Perpiñá, &
A.García-Palacios, Virtual reality in the treatment of claustrophobic fear: A controlled, multiple-baseline design, Behavior Therapy, 31 (2000), 583-595.
[11] J. Wald, & S. Taylor, Preliminary research on the efficacy of virtual reality exposure therapy to treat driving
phobia, Cyberpsychology and Behavior, 6 (2003), 459465.
[12] M.B. Powers, & P.M.G. Emmelkamp, Virtual reality
exposure therapy for anxiety disorders: A meta-analysis,
Journal of Anxiety Disorders, 22 (2008), 561-569.
[13] C. Botella, M.C. Juan, R. Baños, M. Alcañiz, V. Guillén, & B. Rey, Mixing realities? An application of augmented reality for the treatment of cockroach phobia,
CyberPsychology & Behavior, 8 (2005), 162-171.
[14] M.C. Juan, & D. Pérez, Comparison of the levels of
presence and anxiety in an acrophobic environment
viewed via HMD or CAVE, Presence, 18 (2009), 232-248.
[15] J. Bretón-López, S. Quero, C. Botella, A. García-Palacios, R.M. Baños, & M. Alcañiz, An augmented reality system validation for the treatment of cockroach phobia,
Cyberpsychology, Behavior, and Social Networking. Advance online publication. doi:10.1089/cyber.2009. 0170.
174
[16] M.C. Juan, M. Alcañiz, C. Monserrat, C. Botella, R.
Baños, & B. Guerrero, Using augmented reality to treat
phobias, IEEE Computer Graphics and Applications, 25
(2005), 31-37.
[17] C. Juan, & D. Pérez, Using augmented and virtual reality for the development of acrophobic scenarios. Comparison of the levels of presence and anxiety, Computers
& Graphics, 34 (2010), 756-766.
[21] J.M. Armfield, & J.K. Mattiske, Vulnerability representation: The role of perceived dangerousness, uncontrollability unpredictability and disgustingness in spider
fear, Behaviour Research and Therapy, 34 (1996), 899909.
[22] R.M. Baños, C. Botella, A. Garcia-Palacios, H. Villa,
C. Perpiña, & M. Alcañiz, Presence and Reality Judgment
in Virtual Environments: A Unitary Construct? Cyberpsychology & Behavior, 3 (2000), 327-335.
[18] B.G. Witmer, & M.J. Singer, Measuring Presence in
virtual environments: A presence questionnaire, PresenceTeleoperators and Virtual Environments, 7 (1998), 225240.
[23] J.M. Ihme, & K. Mitte, Measuring state disgust: Evaluation of a German state disgust scale, European Journal
of Psychological Assessment, 25 (2009), 150-156.
[19] R.S. Kennedy, N.E. Lane, K.S. Berbaum, & M.G.
Lilienthal, Simulator Sickness Questionnaire: An enhanced method for quantifying simulator sickness, International Journal of Aviation Psychology,3 (1993),
203–220.
[24] R.S. Kennedy, N.E. Lane, K.S. Berbaum, & M.G.
Lilienthal, Simulator Sickness Questionnaire: An enhanced method for quantifying simulator sickness, International Journal of Aviation Psychology,3 (1993),
203–220.
[20] J. Gauthier, & S. Bouchard, Adaptation canadiennefrançaise de la version révisée du State-Trait Anxiety Inventory de Spielberger, Canadian Journal of Behavioral
Sciences, 25 (1993) 559-589.
[25] J. Gauthier, & S. Bouchard, Adaptation canadiennefrançaise de la version révisée du State-Trait Anxiety Inventory de Spielberger, Canadian Journal of Behavioral
Sciences, 25 (1993) 559-589.
appliCaTions for CogniTiVe neurosCienCes
Validation of a neuro Vr-based Version of the
multiple errands Test for the assessment of
executive functions: preliminary results
Simona Raspellia,1, Federica Pallavicinia, Laura Carellia,b,
Francesca Morgantib, Barbara Polettid, Barbara Corrad,
Vincenzo Silanid and Giuseppe Rivaa,c
Applied Technology for Neuro-Psychology Lab,
Istituto Auxologico Italiano, Milan, Italy
b
Department of Human Sciences, University of
Bergamo, Bergamo, Italy
c
Department of Psychology, Catholic University of
Milan , Milan, Italy
d
Department of Neurology and Laboratory of
Neuroscience, “Dino Ferrari” Center, University of
Milan, IRCCS Istituto Auxologico Italiano,
Milan, Italy
a
Simona Raspelli
1
Via Pelizza da Volpedo 41
Milan, Italy 20149
E-mail: s.raspelli@gmail.com
abstract
The purpose of this study was to establish ecological validity and initial construct validity of the Virtual Reality
(VR) version of the Multiple Errands Test (MET) [1,2],
based on the NeuroVR software as an assessment tool
for executive functions. In particular, the MET is an assessment of executive functions in daily life which consists of tasks that abide by certain rules, and is performed
in a shopping mall-like setting where there are items to
be bought and information to be obtained. The study
population included three groups: post-stroke participants (n = 5); healthy young participants (n = 5); and
healthy older participants (n = 5). Specific objectives
were (1) to examine the relationships between the performance of the three groups of participants in the Virtual
Multiple Errands Test (VMET) and at the traditional neu-
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ropsychological tests employed to assess executive functions, and (2) to compare the performance of post-stroke
participants to those of healthy young and older controls
in the VMET and at the traditional neuropsychological
tests employed to assess executive functions.
Keywords: Virtual Reality, Executive Functions,
Multiple Errands Test, Daily Life Tasks,
NeuroVR
introduction and methods
The goal of the present study was to establish ecological
validity and initial construct validity of the Virtual Reality
(VR) version of the Multiple Errands Test (MET) [1,2].
The virtual environment employed in this study is a supermarket developed via the NeuroVR software and is
displayed on a desktop monitor where users are requested
to select and buy various products presented on shelves.
The original procedure of the MET was modified to be
adapted to the virtual scenario of the supermarket and
consists of some tasks that abide by certain rules. Besides
the Virtual Multiple Errands Test (VMET), participants
also went under an exhaustive neuropsychological assessment with the aim to obtain an accurate overview of
their cognitive functioning in order to be compared with
the performance on the experimental test.
expected results
A total of 15 participants in three groups were included
in the study, five post-stroke individuals and 10 healthy
people in two age groups. The five post-stroke participants ranged in age from 50 to 70 years. In addition, 10
healthy participants volunteered to participate in this
study, including five young participants with an age range
between 20 and 30 years, and five older participants with
an age range between 50 and 70 years. All groups were
fully independent in activities of daily living and instrumental activities of daily living.
Ongoing data analysis is carried out using SPSS for Windows, Version 17.0. Due to the small group sample size,
non-parametric statistics are used. Pearson correlation coefficients are used to examine the relationships between
the various scores of the neuropsychological tests employed to assess executive functions and the scores of the
VMET for each group separately, while the comparison
of the scores of the same tests between the post-stroke
participants and both groups of healthy controls is performed using the Kruskal-Wallis procedure.
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175
We expect that ecological validity of the VMET will be
demonstrated by significant correlations among the
VMET and different tests employed for the measurement
of executive functions within the groups of patients and
healthy subjects such as the Test of Everyday Attention,
the Dysexecutive Questionnaire (DEX), the Stroop Test
and the Iowa Gambling Task. We also expect significant
differences among the three groups on different measures
of the VMET and the other tests traditionally employed
for the assessment of executive functions. More specifically, we expect that post-stroke patients make the greatest number of errors, inefficiencies and rule breaks,
employ fewer strategies and take the longest time executing the VMET, followed by adult and young control
subjects.
Acknowledgments
The work in preparing this paper was supported by the
funded project "Immersive Virtual Telepresence (IVT) for
Experiential Assessment and Rehabilitation,” IVT2010,
RBIN04BC5C.
references
[1] T. Shallice, & P. W. Burgess, Deficits in strategy application following frontal lobe damage in man, Brain 114
(1991), 727-741.
[2] S. Fortin, L. Godbout, & C. M. J. Braun, Cognitive
structure of executive deficits in frontal lesioned head
trauma patients performing activities of daily living, Cortex 39 (2003), 273-291.
––––––––––––––––––––––––––––––––––––––––––––––
sensitivity of the ClinicaVr: apartment stroop
Mylène Henrya,1, Pierre Nolina, Anne Drouin-Germaina
and Christian C. Joyala
Laboratoire de Recherche Interdisciplinaire en Réalité
Virtuelle (LARI-RV) Université du Québec à
Trois-Rivières, Québec, Canada
a
Mylène Henry
Laboratoire de Recherche Interdisciplinaire
en Réalité Virtuelle (LARI-RV)
Université du Québec à Trois-Rivières
Trois-Rivières, Québec
G9A 5H7 Canada
E-mail: Mylene.Henry@uqtr.ca
1
176
abstract
This study aimed to see if the ClinicaVR: Apartment,
used for research purposes, could also yield some clinical
outputs. Thirty-five adults were evaluated with the CPTII, the Stroop (D-KEFS) and the virtual Stroop from the
ClinicaVR: Apartment. Results show that the virtual
Stroop is more sensitive to attention components than the
traditional Stroop. These results are very promising for
the ClinicaVR: Apartment, but further participants are
needed to replicate these results.
Keywords: ClinicaVR, Classroom, Adults, CPT-II,
Attention, Virtual Apartment
introduction
Neuropsychological assessments are sometimes criticized
for their weak ecological validity [1]. The ClinicaVR: Appartment is a new virtual environment developed by Digital MediaWorks (http://www.dmw.ca/), in collaboration
with our team, to assess impulsivity in a more ecological
way. This study aimed to see if the ClinicaVR: Apartment
Stroop, used for research purposes, could also yield some
clinical outputs.
method
Thirty-five normal adults (10 men, 25 women; average
age = 25.89 years, SD=9.14 years) were administered the
CPT-II, Stroop (D-KEFS) and ClincaVR: Apartment
Stroop. The bimodal virtual Stroop is divided in two conditions: condition one consists of colored blocks and is
comparable to card 1 of the traditional Stroop, and condition two is composed of colored words written in a different ink color (i.e., blue written in green ink) and could
be compared to card 3 of the traditional Stroop. This test
is presented on a TV screen in an apartment filled with
visual and auditory distracters (cell phone ringing, cars
passing, etc.).
results
Correlation tests showed that there are no relationships
between the Non-Clinical ADHD probability from the
CPT-II and the Stroop (D-KEFS) for both time completion and number of errors. No significant correlations
were found for reaction time in the virtual task (ClinicaVR: Apartment), but number of errors yielded significant relationships for both conditions.
Conclusion
Results showed that the number of errors factor from the
virtual Stroop (ClinicaVR: Apartment) is more sensitive
to attention difficulties than other variables, from both virtual and traditional Stroop. These results support virtual
reality as a sensitive clinical assessment of impulsivity
amongst normal adults, but further participants are needed
to better support these observations.
references
[1] Tupper, D., and Cicerone, K. Introduction to the neuropsychology of everyday life. In: Tupper, D., and Cicerone, K. (eds.). The Neuropsychology of Everyday Life:
Assessment and Basic Competencies. Kluwer Academic,
Boston, MA, 1990.
––––––––––––––––––––––––––––––––––––––––––––––
affective reactions to Visually masked stimuli
within a Virtual environment
Jason Drummonda,1, Nadia Berthouzea
and Anthony Steeda
University College London
a
Jason Drummond
University College London
UCL Computer Science Department
Gower Street, London
WC1E 6BT, U.K.
E-mail: j.drummond@cs.ucl.ac.uk
1
abstract
Within perceptual psychology, visual masking describes
a process whereby the presentation of one image, the
mask, effects the conscious perception of another, the
target. Given the right conditions the target can effectively be rendered invisible. There is a dearth of research
into the effects of visually masked stimuli within virtual
environments, particularly with regard to affect psychology. There are two studies presented here. The first study
was used to establish the efficacy of visual masking
using three dimensional (3-D), masked objects. Usually,
mask and target stimuli are co-planar, with no internal
depth disparity. This study found that visual masking is
possible within a virtual space using target objects with
internal depth disparity. The second study investigated
affect driven, choice reactions to 3-D, masked facial expressions. This study also found an effect, specifically, a
difference in reaction between angry and smiling
masked, virtual faces. Participants were unconscious of
their response. These two studies form a foundation for
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a wider project: using visual masking within a virtual environment for mood induction, primarily as a cybertherapeutic aid.
Keywords: Visual Masking, Affect Psychology,
Virtual Environments, Cybertherapy
introduction
Under certain conditions the rapid, repeated presentation
of a “masking” image can be used to prevent conscious
perception of a “target” image [1]. In visual masking research both targets and masks are usually planar and coplanar. Prior research has shown that perceived external
depth disparity between target and mask can result in an
inhibition of masking [2]. There is a lack of work which
uses targets with internal depth disparity such as those
found within a virtual environment (VE). The first study
addresses this.
Where facial expressions are used as targets, reactions
occur both in preference behavior [3] and facial muscles
[4]. It can be argued that such non-conscious, affective
processing occupies the same functional domain as psychotherapy. There is a lack of research into masked facial
expressions within a VE. The second study here looks at
this. It builds on the first study’s conclusion that non-planar, polyhedral structures with internal depth disparity
can be used as targets by using virtual faces with such a
structure. Choice behavior reactions to the imperceptible,
virtual facial expressions were measured and an effect
found.
A further possibility is raised of positive mood induction
using visual masking techniques. Harnessing such effects
may prove useful for future, cybertherapeutic interventions, perhaps running in conjunction with more conventional therapies.
methods
Both studies were within-participants, in the first study
n=22, the second n=21. In both, participants navigated a
series of virtual rooms, each with a pair of doors at one
end. They chose which door to enter, left or right, to proceed into the next room.
study 1. procedures
The first study used domestic objects as masked targets.
For each pair of doors, one was blocked by an object. A
questionnaire recorded a series of forced choice answers
regarding object visibility. The number of correct door
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177
choices per participant, ie., doorways entered containing
masked objects, provided the main measurement.
study 2. procedures
The second study contained masked virtual faces with
three expressions: happy, angry and neutral. A different
expression was placed in each doorway for each door
pair. Door choice was thought to indicate non-conscious
preference for one expression over another. The measure
was formed from participant choice scores for each expression. A conflict/non-conflict condition was also introduced to look at modulating any effect.
The first study experimental mean was 7.9 ± 2.1 SD, the
control mean was 6.2 ± 1.7 SD. P was found to be 0.008
(two tailed). This strongly suggests that the objects' positions were known despite being imperceptible and that
the masking effect worked.
The second study overall score means were: happy 8.5
± 2.0 SD, angry 7.2 ± 1.5 SD and neutral 8.4 ± 1.9 SD
with p=0.0034. Contrasts showed the angry score to be
significantly lower than the others. The conflict/non conflict condition showed no significant effect. Order effects
were controlled for on both studies.
Conclusion
The first study showed that it is possible to visually mask
non-planar virtual objects. The second study showed that
non-perceivable, masked virtual faces can produce affect-driven responses. This method opens up the possibility for cybertherapy to induce a positive mood by
disrupting non-conscious, negative affect processing.
references
[1] B. Breitmeyer and H. Öğmen, Visual Masking, Oxford University Press, New York, 2006.
[2] S. Lehmkuhle and R. Fox, Effect of Depth Separation on
Metacontrast Masking, Journal of Experimental Psychology:
Human Perception and Performance 6 (1980), 605–621.
[3] P. Winkielman and K.C. Berridge, Unconscious Emotion, Current Directions in Psychological Science 13
(2004), 120–123.
[4] U. Dimberg, M. Thunberg, and K. Elmehed, Unconscious Facial Reactions to Emotional Facial Expressions,
Psychological Science 1 (2000), 86–89.
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accuracy of a brain-Computer interface
(p300 spelling device) used by people with
motor impairments
Gunther Krausza, Rupert Ortnera and Eloy Opissob
g.tec – Guger Technologies, Sierningstr.
14, 4521 Schiedlberg, Austria
b
Fundació Privada Institut de Neurorehabilitació
Guttmann, Barcelona, Spain
a
Gunther Krausz
Guger Technologies
Sierningstr. 14
4521 Schiedlberg, Austria
E-mail: krausz@gtec.at
1
abstract
A Brain-Computer Interface (BCI) provides a completely
new output pathway and so, an additional possible way
a person can express himself if he/she suffers from disorders like amyotrophic lateral sclerosis (ALS), brainstem stroke, brain or spinal cord injury, or other diseases
which impair the function of the common output pathways which are responsible for the control of muscles or
impair muscle movement. Although most BCIs are
thought to help people with disabilities, they are mainly
tested on healthy, young subjects who may achieve better
results than people with impairments. In this study we
compare measurements, performed on 10 physically disabled people, to the results of a previous study involving
100 healthy participants. We prove that, under certain
constraints, most patients are able to control a P300based spelling device with almost the same accuracy as
the healthy subjects. Tuning parameters are discussed,
as well as criteria for people who are not able to use this
device.
Keywords: Brain-Computer Interface, P300,
Visual Evoked Potentials, Locked-in Syndrome
introduction
It is of special interest to test the performance of the
P300-spelling device for people with motor impairments
and compare these results to those taken from tests on
healthy subjects to prove if the current settings are working properly, and under which constraints the device is
working. In a previous study [1] we examined the overall
accuracy of our P300 speller for healthy subjects. After
five minutes of training the subjects were asked to spell
five characters. It was up to the subjects to choose between a row/column (RC) speller or a single character
(SC) speller. Of the subjects, 72.8% (N=81) were able to
spell with 100% accuracy in the RC paradigm and 55.3
% (N=38) spelled with 100% accuracy in the SC paradigm. Less than 3% of the subjects did not spell any
character correctly. Following this first study, we examined the same paradigm with exactly the same settings
on people with motor impairments. Only the RC speller
was used in this study, as it resulted in better accuracy in
the former study.
method
A total of 10 subjects (six male, four female, age: 35.6
± 11.96) participated in this study. Inclusion criteria
were: Cervical Spinal Cord Injury (between C2 and C6)
and massive subcortical stroke patients with preserved
cognitive function. The subjects sat in front of a laptop
computer and were instructed to relax and remain as still
as possible. The EEG data were acquired using eight active electrodes at positions Fz, Cz, P3, Pz, P4, PO7, Pz
and PO8. The “intendiX” Spelling System (g.tec medical engineering GmbH, Austria) was used for the study.
For comparability, the paradigm was performed in the
same way as in the former study [1]. The number of
flashes of each row and column for classification was
15. The characters for the training procedure were
WATER, hence, it took about five minutes to set up the
classifier. After training, the subject was asked to write
the word LUKAS, one character at a time, also taking
about five minutes. The spelling accuracy of each person was calculated by looking at the number of correctly
spelled characters of the word LUKAS. For example,
when one person misspelled one character (e.g., LUFAS
instead of LUKAS) then there were four out of five
characters spelled correctly, and the accuracy was lowered to 80%.
main result
Three subjects (S3, S7, S8) achieved an accuracy of
100%. The two patients suffering LIS (S2 and S10) did
not get any control with the predefined settings. These
results were included in the table for comparison of accuracy. Nevertheless, afterwards, another measurement
was performed applying different settings (flashing time:
150 ms, dark time: 100 ms). Here, the subjects reached
an accuracy of 40% and 20%, respectively. Subjects S1,
S3, S5, S7, S8, S9 reached accuracy levels between
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100% and 80% with a mean of 90%. This proves that
their control of the speller is comparable to the 81
healthy subjects (accuracy: 91%) in the previous study.
references
[1] C. Guger, S. Daban, E. Sellers, C. Holzner, G.
Krausz, R. Carabalona, F. Gramatica and G. Edlinger,
“How Many People Are Able to Control a P300-based
Brain-Computer Interface (BCI)?” Neursocience Letters
462 (1) (2009), 94-98.
––––––––––––––––––––––––––––––––––––––––––––––
The Critical importance of immersive displays for
studying human performance: evidence from
different populations and paradigms
Jocelyn Fauberta,1
Université de Montréal, Canada
a
Jocelyn Faubert
Université de Montréal
3744 Jean Brillant
1
179
Bureau 210-40
Montreal
H3T 1B8 Canada
E-mail: Jocelyn.Faubert@umontreal.ca
abstract
For over a decade now we have been using immersive
displays to understand human behavior and performance.
We will demonstrate why such environments are critical
for the full understanding of human processing of dynamic visual scenes. A number of studies from our laboratory with different tasks and involving observers of
different age groups, and performance levels (e.g., highlevel athletes) will be discussed to highlight this fact.
Specifically, the studies will discuss research on optic
flow, biological motion, and perceptual-cognitive processing in dynamic visual displays. It will be demonstrated that some critical conclusions about human
behavior and performance could not have been reached
if the studies would not have been conducted in immersive Virtual Reality environments.
Keywords: Human Behavior, Immersion, Aging,
Sports, Perceptual-cognitive
CyberTherapy for anxieTy disorders:
a Challenge for The fuTure
effectiveness of Cybertherapy in mental
health: a Critical appraisal
reasons for the lack of dissemination are discussed and
challenges are pointed out.
Paul M.G. Emmelkampa,1
Keywords: Virtual Reality Exposure Therapy,
Internet-based Therapy, Second Life
Department of Clinical Psychology,
a
Paul M.G. Emmelkamp
Department of Clinical Psychology
The Netherlands
E-mail: p.m.g.emmelkampr@uva.nl
1
abstract
Although Virtual Reality (VR) treatment and Internetbased cognitive behavior therapy (CBT) have been found
to be effective, dissemination of these therapies in the
community at large is still in its infancy. A number of
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introduction
In the last decade numerous studies have investigated
Virtual Reality exposure therapy (VRET) and Internetbased psychotherapy for anxiety, depression and eating
disorders. The effectiveness of VRET has now been
firmly established for a few specific phobias such as fear
of heights and fear of flying [1, 2], but very few wellcontrolled studies have been clinically conducted in
more disabling anxiety disorders such as panic disorder,
agoraphobia, social anxiety disorder and obsessive-compulsive disorder.
Since 2000, a number of controlled clinical studies have
shown that Internet-based cognitive behavior therapy
180
(CBT) is more effective than no-treatment control and
may be as effective as face-to-face therapy in treating
anxiety disorders and depressive disorders [3]. However,
dissemination of VRET and Internet-based therapies in
the community at large is still in its infancy.
future applications: What needs to be done
Some of the barriers for the clinicians’ resistance are fear
of being replaced by the computer, lack of knowledge
about the application of new technologies in the field of
clinical psychology, and a lack of training on how to use
VRET and Internet-based treatment programs. Clinicians
worry about the influence that such technology-driven
treatments could have on the development of a productive
participant-clinician relationship. In addition, there is
some concern that Internet-based cognitive and behavioral treatments for anxiety and depression are characterized by poor adherence. Each limitation is a challenge
that researchers have to try to surpass in future studies before broad scale implementation will be feasible. For example, research has already shown that the role of the
therapeutic alliance might be as important in technology
driven treatment as in face-to-face therapy [4, 5].
Another challenge for the future is to make the patients
participating in these programs more representative of
the community. Generally, samples in the studies into
the effects of Internet-based treatments in anxiety disorders and depression are characterized by highly-educated females with an age range from 30-45 years of age
[3]. Further, it should be noted that in most currently
available programs, patients themselves chose a computer-based treatment rather than face-to-face treatment
and are often self-referred. Thus, it is questionable how
representative the participants are. Another challenge
for Internet treatment is how to best tailor them to the
individual participant needs. Comorbidity is very common in a clinical setting, for instance, the combination
of mood disorders and anxiety disorders is not infrequent. An Internet treatment should have modules to
deal with co-current problems in order to provide participants adequate treatment.
As to the implementation of VRET, there is a clear need
of the development of more Virtual Reality (VR) worlds
in the public domain for a variety of anxiety disorders.
Further, as a clinician it is astonishing to see how few
controlled clinical studies have been conducted on social anxiety disorder, panic disorder and agoraphobia,
obsessive-compulsive disorder and posttraumatic stress
disorder – the clinically most prevalent anxiety disorders. Further, there is a clear need of studies investigating the possibilities of integrating VRET in
Internet-based treatments.
Finally, the use of Second Life for conducting CBT has
hardly been studied. In a series of studies we found no
difference for any of the five subscales of the Big 5 personality scale (extraversion, friendliness, conscientiousness, neuroticism, development) between the pencil and
paper and a virtual version, suggesting that users of virtual realities do not create a “virtual” personality for their
avatar [6]. This suggest that these personal avatars may
be used for treatment purposes.
Conclusions
Although VRET and Internet-based psychotherapy has
shown some promise, large-scale clinical implementation
has not yet been achieved. VRET is typically applied in
a few academically oriented institutions and the evidence
of its effectiveness is primarily limited to the treatment
of fear of flying and acrophobia. Internet-based CBT may
be as effective as face-to-face therapy for anxiety disorders and depression [3], but results are limited to volunteers who applied for psychological treatment through the
Internet.
references
[1] Meyerbröker, K. & Emmelkamp, P.M.G. (2010). Virtual reality exposure therapy in anxiety disorders: A systematic review of process-and outcome studies.
Depression and Anxiety, 27(10), 933-944.
[2] Powers, M.B., Emmelkamp, P.M.G. (2008. Virtual reality exposure therapy for anxiety disorders: A metaanalysis. Journal of Anxiety Disorders, 22 (3), 561-569.
[3] Gallego, M.J. & Emmelkamp, P.M.G. Effectiveness
of Internet psychological treatments in emotional disorders and eating disorder. In L’Abate, L. & Kaiser, D.A.
(Eds.). Handbook of technology in psychology, psychiatry, and neurology: Theory, research, and practice, (in
press).
[4] Lange, A., Rietdijk, D., Hudcovicova, M., van de Ven,
J. P., Schrieken, B. & Emmelkamp, P. M. (2003). Interapy: a controlled randomized trial of the standardized
treatment of posttraumatic stress through the internet.
Journal of Counsulting & Clinical Psychology, 71, 901912.
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[5] Meyerbröker, K. & Emmelkamp, P.M.G. (2008).
Therapeutic processes in virtual reality exposure therapy:
The role of cognitions and the therapeutic alliance. Journal
of CyberTherapy & Rehabilitation, 1, 247-257.
[6] Aas, B., Meyerbröker, K. & Emmelkamp, P.M.G.
(2010).Who am I - and if so, where? An experiment on
personality in online virtual realities. Journal of Virtual
Worlds Research,2(5), 3-15.
––––––––––––––––––––––––––––––––––––––––––––––
Treatment of agoraphobia in Virtual reality: level
of presence and outcome of head-mounted display
and Computer automatic Virtual environment
Katharina Meyerbrökera,1, Nexhmedin Morinaa, Gerard
Kerkhofa and Paul M.G. Emmelkampa
University of Amsterdam, Department of Psychology,
Amsterdam, the Netherlands
a
Katharina Meyerbröker
Department of Clinical Psychology
The Netherlands
E-mail: K.Meyerbroker@uva.nl
1
abstract
In this study the effects of Virtual Reality Exposure Therapy (VRET) were investigated in patients with panic disorder and agoraphobia. A head-mounted display (HMD)
and a computer automatic virtual environment (CAVE)
were compared with a waiting list control condition. Results indicate that there was no relationship between the
level of experienced presence and treatment outcome.
VRET in general was more effective than no treatment.
No differences were found in effectiveness between
VRET using an HMD or CAVE.
Keywords: Virtual Reality Exposure Therapy,
Presence, Panic Disorder, Agoraphobia
introduction
Research concerning Virtual Reality Exposure Therapy
(VRET) and the level of experienced presence is often
done with non-phobic populations, and is limited to specific phobias. Hardly any research has been conducted
in more complex anxiety disorders such as panic disorder
and agoraphobia [1]. Research suggests that a computer
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181
animated virtual environment (CAVE) produces a higher
sense of presence [2, 3]. However, research with clinical
samples concerning the level of experienced presence
and anxiety has been inconclusive. Research concerning
the relationship between the experienced amount of presence and treatment outcome indicates that more presence
does not necessarily lead to a better treatment outcome
[4]. In this quasi-experimental study, patients were assigned to either receive VRET via an HMD or a CAVE,
or were assigned to a waiting list control condition.
method
All patients had to meet current diagnostic and statistical
manual of mental disorders (DSM-IV-TR) criteria for panic
disorder and agoraphobia [5]. Patients (ages 18-65) were
assigned to cognitive behavior therapy (CBT) followed by
two variants of VRET – CAVE versus HMD. The first
module (CBT) consisted of four sessions of psycho-education, cognitive restructuring and interoceptive exposure.
The second module consisted of six sessions of VRET. At
pre and post treatment, panic and agoraphobia were assessed with self-report measures. Presence was assessed
after each VRET session with the Igroup presence questionnaire [6]. The same virtual environments were used in
both conditions. In the CAVE, virtual environments were
projected on the floor and three sides of the cubicle. The
participants wore CrystalEyes active stereo glasses; Ascension Flock of Birds was used for the head tracking. The
projection was accomplished by eight projectors, each with
a resolution of 1400x1050 pixels and 60 Hz refresh rate.
VRET with HMD was given using a Dell Precision T3500
and a Dell Optilex 760, collaborating with a NVIDIA FX
1400 low-end card with drivers, which was used to generate the virtual environments. The worlds were displayed
using the nVisor SX. Projection was stereographic. Tracking was done with the WorldViz PPT tracking system including four cameras and the NVIS dual channel SX
control unit.
results
Results indicate that there was no significant correlation between the level of presence experienced during VRET and
treatment outcome. To investigate whether VRET was more
effective than no treatment, the data of the HMD (n=5) and
CAVE (n=6) subjects were pooled. These analyses indicate
that VRET was more effective than no treatment. Both
CAVE and HMD conditions resulted in significant improvements on panic and agoraphobia measures. No differences were found in effectiveness between VRET using an
HMD or CAVE.
182
Conclusion
This is the first study in which clinically distressed patients
with panic disorder and agoraphobia underwent VRET in
different conditions (CAVE versus HMD). VRET was superior to no treatment on panic and agoraphobia measures.
No differences in effect were found between VRET by
means of CAVE or HMD. Presence often resulted in a
moderately successful outcome in VR treatment; Schubert
et al.’s study [6] did not have any effect on treatment effectiveness in this study.
references
[1] Meyerbröker, K. & Emmelkamp, P.M.G. Virtual reality exposure therapy in anxiety disorders: A systematic review of process-and outcome studies. Depression and
Anxiety, 27 (2010), 933-944.
[2] Krijn, M., Emmelkamp, P.M.G., Biemond, R., de
Wilde de Ligny, C., Schuemie, M.J. & van der Mast,
C.A.P.G. Treatment of acrophobia in virtual reality: The
role of immersion and presence. Behaviour Research and
Therapy, 42, (2004) 229-239.
[3] Juan, M.C. & Perez, D. Comparison of the levels of
presence and anxiety in a acrophobic environment viewed
via HMD or CAVE. Presence, 18, (2009) 232-248.
[4] Price, M. & Anderson, P. The role of presence in virtual
reality exposure therapy. Journal of Anxiety Disorders, 21,
(2007) 742-751.
[5] American Psychiatric Association. Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition
Text Revision (DSM-IV-TR). Washington D.C.: Author,
2000.
[6] Schubert, T., Friedmann, F., & Regenbrecht, H. Embodied presence in virtual environments. In R. Paton, &
I. Neilson (Eds.), Visual representations and interpretations (pp. 268–278). London: Springer-Verlag, 1999.
––––––––––––––––––––––––––––––––––––––––––––––
Virtual hoarding: development of a Virtual
environment for Compulsive accumulation
Kieron O’Connora,b,1, Manon Bertranda,b, Étienne St.
Pierrea and Marie-Eve Delormeb
Department Psychoeducation and Psychology, University of Quebec in Outaouais, Gatineau, Canada
a
Fernand-Seguin Research Center, Louis-H. Lafontaine
Hospital, Montréal, Canada
b
Kieron O’Connor
University of Quebec in Outaouais
Quebec, Canada
E-mail: Kieron.oconnor@uqo.ca
1
abstract
Virtual Reality (VR) is already established as a tool for
facilitating exposure in the treatment of anxiety. Its advantages are: an access to personalized stimulus control;
control of the environment; and non-threatening immersion in an anxiogenic environment. Compulsive accumulation is extremely difficult to treat due to the lack of
ability to sustain motivation in the hoarding environment
to discard objects. Success rates for cognitive behavior
therapy (CBT) are barely 40%. The present study explored the possibility of building a VR space in which the
person could simulate a personal hoarding space to manipulate and store objects as if at home. The VR hoarding
space was constructed using NEURO-VR and the VR
room was filled with objects photo-scanned from the participants’ personal stock. Three behaviors specific to
hoarding were assessed: accumulation of new objects;
arrangement of objects; and elimination of objects. Cognitive, behavioral and symptom measures were recorded
quantitatively and qualitatively during each of the three
behaviors in both home and VR environments. Five participants diagnosed with compulsive accumulation were
recruited from referrals to a community support group.
Results showed the feasibility of employing VR in hoarding and indentified parameters important in ensuring immersion in a hoarding environment. There were
implications for the integration of VR into the behavioral
treatment of compulsive accumulation.
Keywords: Compulsive Accumulation,
Virtual Hoarding, Virtual Space
problem
Hoarding is recognized as a particularly treatment resistant
form of obsessive compulsive disorder (OCD) [1]. Frequently, the person is unable to throw out objects which
to common sense seem useless and of no value [2]. In severe cases, the person can end up with severe clutter, impeding normal living conditions. The hoarded items may
literary occupy all available space and leave no room for
basic needs and impede normal social functioning. Fur-
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thermore, the objects hoarded may pose health or fire risks
[3]. Hoarders typically are more likely to be unmarried,
unemployed and isolated than normal [4]. Frequently, the
problem is associated with compulsive buying which exacerbates the hoarding. Other psychiatric comorbidities
include depression, social phobia, personality disorders
and pathological perfection [4]. Over 80% of hoarders suffer from another type of OCD (usually rumination and
checking).
Visibility and hoarding
Like other OCD subtypes, the causes of hoarding are unclear. Research, however, has identified early attachment
issues as possible targets, but there is also some evidence
that cognitive factors involving visuo-spatial processing
and organization may be affected in hoarders, compared
to other OCD subtypes [4]. The visibility of objects and
visual feedback form a clear reinforcer in hoarding where
the person will often organize objects in an idiosyncratic
manner, ordering to maximize visual impact rather than
efficient storage and retrieval.
Cognitive behavior Therapy
One important aspect of cognitive behavioral therapy
(CBT) is helping the person to learn skills of organizing,
categorizing and discarding objects. Typically, this takes
the form of constructing a hierarchy of objects, separating
out valuable from invaluable and embarking on a program
of cumulative discarding, working up a difficulty ladder.
The sight of the hoarding pile itself may have become an
aversive stimulus generating complex and effective avoidance. Effectively, a series of metacognitive beliefs often
impede the person working on hoarding, in real time in
the real space [5, 6].
183
cially tailored VR program mimicking real life hoarding.
The VR program is an adaptation of an existing program
NEURO-VR developed by Guiseppe Riva. The program
permits selection and storing of individually selected items
from a bank of images of everyday objects. The person
enters a storage space and then begins to build up their
own stock of items by clicking and transporting the items
from elsewhere. The space and items were idiosyncratically tailored to the hoarder. The person had degree of control over the items, where they were placed and whether
to discard them.
Three specific hoarding behaviors were tested with the
program: (1) accumulating the person’s specific objects in
the virtual space; (2) sorting the person’s specific objects
in the virtual space; and (3) discarding items from the virtual space.
Five participants were recruited from a local hoarding support group. Each paradigm was repeated both in the person’s natural environment and in VR. The order of
presentation was randomized both for task and for
home/VR environment across participants. The person
was assessed on: degree of presence; anxiety; emotions;
and ability to carry out behavioral tasks.
Conclusion
Equivalence of the two environments was assessed by
auto-observation, measures of clutter, and similarity in reactions during the three specific hoarding tasks. The results enabled us to establish: the feasibility of a virtual
hoarding space; the equivalence of cognitive and emotive
reactivity; subjective reactions to improve the task; and
generalizability of findings.
Virtual reality
Virtual Reality (VR) has already to be proved an important
tool for facilitating exposure in anxiety disorders. The advantages in summary are: VR permits access to a personalized stimulus control; VR can effectively immerse the
person in an anxiogenic environment in which the immersion does not rely exclusively on the resolution of the display; VR permits fine tuning of the aversiveness of the
virtual scene; permits synchronization of stimuli and response sequences; and can measure dynamic physiological and other response variables within a physically static
environment.
[3] Tolin DF, Fitch KE, Frost RO, & Steketee G. Family
informant’s perception of insight in compulsive hoarding.
Cognitive Therapy and Research 2010; 34: 69-81.
methods and results
The aim of the project was to compare reactions to a spe-
[4] Gilliam CM, & Tolin DF. Compulsive Hoarding. Bulletin of The Meninger Clinic 2010; 74(2): 93-121.
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references
[1] Hartl TL, Frost RO. A cognitive behavioural model of
compulsive hoarding. Behaviour Research and Therapy
1996; 34(4): 341-350.
[2] Frost RO,Tolin DF,& Maltby N. Insight-related challenges in the treatment of hoarding. Cognitive and Behavioral Practice 2010; 17: 404-413.
184
[5] Steketee G, Frost RO & Kyrios M. Cognitive aspects
of compulsive hoarding. Cognitive Research and Therapy
2003; 27(4): 463-479.
[6] Pertusa A, Fullana MA, Singh S, Alonso P, Menchon
JM, & Mataix-Cols D. Compulsive hoarding: OCD symptom, distinct clinical syndrome, or both. Amercian Journal
of Psychiatry 2008; 165 (10): 1289-1298.
––––––––––––––––––––––––––––––––––––––––––––––
The Contribution of perception and information
on the fear experience in Claustrophobia:
a Virtual reality study
Andreas Mühlbergera,1, Henrik Peperkorna,
Paul Paulia and Georg Alpersb
Institute of Psychology, University of Würzburg
b
Department of Clinical Psychology and
Psychotherapy, University of Mannheim
a
Andreas Mühlberger
Institute of Psychology
University of Würzburg
Würzburg, Germany 97070
E-mail: muehlberger@psychologie.uni-wuerzburg.de
1
abstract
In order to investigate whether the perception of phobic
cues or information about the presence of a phobic situation differently activate fear networks, we established
a Virtual Reality (VR) claustrophobia test situation.
Claustrophobic participants were randomly assigned to
a group that perceived the phobic situation, a group that
was informed about the real presence of the phobic situation, or to both components. The first analyses indicate that the information about, as well as the
perception of the phobic situation, induced a fear experience, but that perception induced more fear than information. These results clearly indicate that VR is
useful for inducing phobic fear and that perception is
more important than cognitive knowledge about the
real situation.
Keywords: Virtual Reality, Claustrophobia
introduction
Although there is great evidence that Virtual Reality
(VR) has the power to induce phobic fear [1,2], as well
as evidence that in-vivo and VR exposure can be used
for the effective treatment of specific phobias (e.g.,
aviophobia [3-5]), studies focusing on the mechanisms
by which VR is able to induce anxiety are rare. One investigated issue is the association of fear and presence
in VR [6]. However, to date there have been no studies
that have attempted to differentiate the power of perceptual cues to induce fear responses in contrast to real phobic situations or in contrast to situations in which
patients only knew about the phobic situations.
description of methods
In order to investigate whether the perception of phobic
cues or information about the presence of a phobic situation differently activate fear networks, we applied VR
to disentangle these two components of real phobic situations. Claustrophobic participants were randomly assigned to a) virtual phobic stimuli, b) information about
a real phobic situation (but with no perception of the situation), or c) both. Participants were exposed to the according situation, e.g., sitting in a small virtual box with
the door virtually closed, really closed, or both virtually
and really closed. Trials lasted five minutes and were
repeated five times.
results
The first analyses indicate that information about the
phobic situation, as well as the perception of the phobic
situation, induce fear as assessed by fear ratings on a
scale from zero (no fear) to 100 (extreme fear). Most
importantly, the perception of the phobic situation induced more fear than knowledge about the real phobic
situation, and the difference between the perception and
the combination of perception and knowledge about the
phobic situation was small.
Conclusions
These results clearly indicate that VR is useful for inducing phobic fear and for activating fear networks. Furthermore, perception is more important than cognitive
knowledge about the real situation. Further research
should focus on the mechanism of action of fear activation and processing, and the potential impact on therapy
for phobias.
references
[1] Mühlberger, A., Bülthoff, H. H., Wiedemann, G. &
Pauli, P. (2007). Virtual reality for psychophysiological
assessment of phobic fear: responses during virtual tunnel drives. Psychological Assessment. 19. 340-346.
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[2] Mühlberger, A., Sperber, M., Wieser, M. J. & Pauli, P.
(2008). A virtual reality behaviour avoidance test (VRBAT) for the assessment of spider phobia. Journal of CyberTherapy & Rehabilitation, 1, 147-158.
[3] Wiederhold, B.K., & Wiederhold, M.D. (2003). Threeyear follow-up for virtual reality exposure for fear of flying. CyberPsychology & Behavior, 6, 441-445.
[4] Mühlberger, A., Herrmann, M. J., Wiedemann, G., Ellgring, H. & Pauli, P. (2001). Repeated exposure of flight
phobics to flights in virtual reality. Behaviour Research
and Therapy, 39, 1033-1050.
[5] Mühlberger, A., Weik, A., Pauli, P. & Wiedemann, G.
(2006). One-session virtual reality exposure treatment for
fear of flying: one year follow-up and graduation flight accompaniment effects. Psychotherapy Research. 16, 26-40.
[6] Bouchard, S., St-Jacques, J., Robillard, G., & Renaud,
P. (2008). Anxiety increases the feeling of presence in virtual reality. Presence-Teleoperators and Virtual Environments. 17, 376-391.
––––––––––––––––––––––––––––––––––––––––––––––
efficacy and effectiveness of online Cognitive behavioral Treatment: a decade of interapy research
Jeroen Ruwaarda,1, Alfred Langea, Bart Schriekenb
and Paul Emmelkampa
University of Amsterdam, Department of
Psychology, Amsterdam, the Netherlands
b
Interapy PLC, Amsterdam, the Netherlands
a
Jeroen Ruwaard
Interapy PLC, P.O. Box 3884
1001 AR Amsterdam
The Netherlands
E-mail: research@interapy.nl
185
tive to face-to-face treatment. Treatment adherence was
82%, and reductions in psychopathology represented a
large between-group effect size of SMD = 0.9 (95% CI:
0.7 to 1.1), which were maintained over long periods. The
research culminated in the foundation of the Interapy
clinic, which received Dutch health regulatory body approval in 2005. Since then, costs of online CBT are reimbursed through public health insurance. A large study of
treatment outcome of 1,500 patients of the Interapy clinic
showed that effects in clinical practice are similar to those
observed in the controlled trials, and comparable to selected benchmarks of naturalistic studies of face-to-face
CBT. The accumulated evidence provides compelling
support for the efficacy and effectiveness of online CBT.
Keywords: Cognitive Behavior Therapy,
Internet, Computer Assisted Protocol Directed Therapy,
Effectiveness Studies, Internet Intervention,
Randomized Controlled Trial
introduction
In 1996, researchers of the University of Amsterdam conducted a small feasibility study of Internet-based psychotherapy. Although the World Wide Web was still in its
infancy at that time, they created a website through which
they treated 20 students with posttraumatic stress. To the
surprise of the research team, the results of what they
called “Interapy” were very encouraging. Despite the lack
of face-to-face contact, stress symptoms of 19 of the 20
students had reduced to normal levels after treatment. This
study was seminal. It was followed by over a decade of
research which resulted in full integration of Internetbased treatment in the Dutch public health system. In this
presentation, we briefly summarize this research from a
meta-analytical perspective.
1
abstract
Since 1996, researchers of the Interapy research group of
the University of Amsterdam have been examining the
effects of online cognitive behavioral treatment (online
CBT). Over the years, the group has conducted nine controlled trials of online CBT of a variety of mental health
disorders, among a total of 840 participants. These studies
suggest that online CBT is a viable and effective alterna-
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methods
Over the years, online CBT has been evaluated in nine
controlled trials, among a total of 840 participants, across
a variety of mental health disorders such as depression,
posttraumatic stress, bereavement, work-related stress,
panic disorder and bulimia nervosa [2-10]. Most studies
were randomized controlled trials, in which participants
were randomly assigned to the Interapy treatment condition, or to a waiting list control condition. Outcome was
assessed through validated self-report measures, such as
the Beck Depression Inventory and the Depression Anxiety Stress Scales, which were administered at pretest,
posttest and one to three years after treatment. In 2001,
the Interapy research team founded the Interapy clinic,
186
with the aim of implementing online CBT in the public
health system. In 2008, the team examined treatment outcome of 1,500 consecutive patients of this clinic, to determine the effectiveness of Interapy during routine clinical
practice.
[2] A. Lange, J.P. van de Ven, B. Schrieken, and P.M.
Emmelkamp, Interapy, treatment of posttraumatic stress
through the Internet: a controlled trial. Journal of Behavior Therapy and Experimental Psychiatry 32 (2001):
73-90.
results
In each study, online CBT induced strong reductions in
primary and secondary symptom severities, which were
maintained in the long term. Despite the lack of face-toface contact, treatment adherence was good (82% completed the full treatment), and client satisfaction was high.
Consistently, effects of online CBT were superior to those
of control conditions. Conservative intention-to-treat estimates of the standardized mean difference (SMD) between the groups ranged from SMD = 0.5 to SMD = 1.3,
with an overall SMD of 0.9. In the clinical practice study,
dropout was 29%, and symptom reductions represented a
large pooled (uncontrolled) effect size of SMD = 1.4
(range: 0.7 ≤ SMD ≤ 1.9). Among treatment completers,
71% reliably improved and 52% experienced a clinically
significant change (i.e., recovery). Symptoms were more
severe in the real world sample in comparison to trial participants, but this had no negative impact on the outcome.
Benchmarks against RCT data revealed that effects in the
clinic were better, because patients of the clinic had more
to gain from treatment.
[3] A. Lange, D. Rietdijk, M. Hudcovicova, J.P. van de
Ven, B. Schrieken, and P.M. Emmelkamp, Interapy: a
controlled randomized trial of the standardized treatment
of posttraumatic stress through the internet. Journal of
Consulting and Clinical Psychology 71 (2003): 901-9.
Conclusion
A decade of Interapy research has provided compelling
support for the efficacy and effectiveness of online CBT.
Research findings identify online CBT as a viable alternative to current treatment options. Despite the lack of
face-to-face contact, treatment adherence is high, effects
are comparable to those of face-to-face treatment, and
method and outcome generalize well to routine clinical
practice. Dutch regulatory health bodies have recognized
the potential of online CBT. In 2005, these bodies endorsed the services of the Interapy clinic as a valid alternative to regular, face-to-face treatment. Since then, costs
of online treatment are reimbursed through public health
insurance to all Dutch citizens with a GP-referral for psychotherapy. The implementation and dissemination of online treatment has started.
references
[1] A. Lange, J.P. van de Ven, B.A. Schrieken, B. Bredeweg, and P.M. Emmelkamp, Internet-mediated, protocol-driven treatment of psychological dysfunction. Journal
of Telemedicine and Telecare 6 (2000): 15-21.
[4] B. Wagner, C. Knaevelsrud, and A. Maercker, Internet-based cognitive-behavioral therapy for complicated
grief: a randomized controlled trial. Death Studies 30
(2006): 429-53.
[5] C. Knaevelsrud and A. Maercker, Internet-based
treatment for PTSD reduces distress and facilitates the
development of a strong therapeutic alliance: a randomized controlled clinical trial. BMC Psychiatry 7
(2007): 13.
[6] J. Ruwaard, A. Lange, M. Bouwman, J. Broeksteeg,
and B. Schrieken, E-Mailed standardized cognitive behavioural treatment of work-related stress: a randomized
controlled trial. Cognitive Behaviour Therapy 36 (2007):
179-192.
[7] J. Ruwaard, B. Schrieken, M. Schrijver, J. Broeksteeg, J. Dekker, H. Vermeulen, and A. Lange, Standardized web-based cognitive behavioural therapy of mild to
moderate depression: a randomized controlled trial with
a long-term follow-up. Cognitive Behaviour Therapy 38
(2009): 206-221.
[8] A. Lange and J. Ruwaard, Ethical dilemmas in online
research and treatment of sexually abused adolescents.
Journal of Medical Internet Research 12 (2010): e58.
[9] J. Ruwaard, J. Broeksteeg, B. Schrieken, P. Emmelkamp, and A. Lange, Web-based therapist-assisted
cognitive behavioral treatment of panic symptoms: A
randomized controlled trial with a three-year follow-up.
Journal of Anxiety Disorders 24 (2010): 387-396.
[10] J. Ruwaard, A. Lange, J. Broeksteeg, A. RenteriaAgirre, B. Schrieken, C. Dolan, and P. Emmelkamp, Online cognitive behavioral treatment of bulimic
symptoms: A randomized controlled trial, (submitted).
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187
deVeloping neW Tools and TeChnologies
psychlog: a personal data Collection Tool
for psychophysiological research
Andrea Gaggiolia,b,1, Giovanni Pioggiac,
Gennaro Tartariscoc, Pietro Cipressoa
and Giuseppe Rivaa,b
ATN-P Lab, Istituto Auxologico Italiano,
Milan, Italy
b
Department of Psychology, Catholic
University of Milan, Italy
c
Institute of Clinical Physiology,
National Research Council, Italy
a
Andrea Gaggioli
Milan, Italy 20149
E-mail: andrea.gaggioli@auxologico.it
1
abstract
In the following paper we introduce PsychLog
(http://www.psychlog.com), a mobile sampling platform that allows real-time collection of psychological,
behavioral and physiological data for research and clinical applications. The mobile platform allows administering self-report surveys to capture in-the-moment
user’s experience in natural contexts. The researcher
schedules the administration of self-reports by setting
a trigger at specific times of interest, or randomly during a day. A wireless electrocardiogram sensor module
equipped with an accelerometer (Shimmer Research™)
allows monitoring activity and hearth rate information.
In this way, it is possible to study the relationship between self-reported psychological variables, physical
activity and physiological arousal, as well as to monitor
their dynamic fluctuations over time. PsychLog is
freely available for Windows mobile and its opensource code can be configured to meet specific experimental design requirements. In this paper, we provide
an overview of the system and describe its future developments.
Keywords: Ecological Momentary Assessment, Selftracking, Wearable Sensors, Electrocardiogram,
Accelerometer, Smartphones
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introduction
Recently, there has been growing interest in the use of
experience sampling procedures in research and in the
clinic. Experience sampling method (ESM), also known
as ecological momentary assessment (EMA), is a naturalistic observation technique that allows capturing subjects' experience and activities in real-life contexts [1].
Thanks to its flexibility and the possibility of adapting
the questions to the goals and motivations of the researcher, ESM has been used with adolescent and adult
populations for decades to understand areas such as
mood, social interactions and time use. This approach
has also proven to be helpful in the clinical context, i.e.,
to define therapeutic interventions that are optimally
suited for an individual patient.
In the past, ESM-based studies have been mainly done
via paper and pencil measures. However, in the last
decade computerized versions of this technique have
been developed, which allows for collecting data using
handheld electronic devices. Computerized procedures
have several advantages over pen-and-paper approaches.
For example, they allow the researcher to precisely control the timing of self-report administration, to analyze
compliance rates and to reduce the chance of human
error when managing the data [2]. Further, computerized
experience sampling procedures can take advantage of
recent advances in computational perception and sensing
technologies to automatically detect events that can trigger data collection [3].
system overview
PsychLog is a mobile sampling platform that allows for
the collection of psychological, physiological and contextual information in naturalistic settings. The PsychLog application allows administering self-report questionnaires to
gather participants' feedback on his/her quality of experience in its various cognitive, affective and motivational dimensions. The researcher schedules the administration of
the questionnaires by setting a trigger, which can be
launched at specific times or randomly during the day.
When the participant is prompted by a notification, he/she
can answer the survey questions by selecting a response or
entering a text (for open-ended questions).
The PsychLog platform supports a wireless electrocardiogram (ECG) equipped with a three-axis accelerom-
188
eter that allows monitoring of heart rate and activity.
The wireless sensor platform (Shimmer Research™) includes a low-power serial bluetooth communication,
transduction, amplification and signal pre-processing
modules. The unit is mounted on a soft-textile chest
strap designed to seamlessly adapt to the user's body
shape, allowing full freedom of movement. Sampling
intervals (epoch) can be tailored to the specific experimental design. For example, an epoch can be set to 15
minutes before and after the launch of each notification
trigger, for a total ECG recording time of 30 minutes.
This strategy reduces battery consumption by limiting
data collection to the events of interest.
During each epoch, ECG and accelerometer signals are
sampled at 100 Hz, filtered and analogue-to-digital
converted with 12-bit accuracy in the ±3 V range. The
two signals are wirelessly transmitted to the mobile
phone application, where rough data are stored and
processed for the extraction of relevant features. ECG
signal is pre-filtered using a moving average filter to
extract and subtract the baseline. The automatic algorithm developed by Pan-Tompkins for the detection of
QRS complex [4] is used to define heart rate (HR) and
heart rate variability (HRV). HRV is measured by the
variation in the beat-to-beat interval, obtaining time
series sequence of non-uniform RR intervals
(tachograms). This information can be correlated with
the movement information obtained from the accelerometer. In this way, it is possible to study the relationship between the user's physical activity,
self-reported psychological variables and physiological arousal, as well as to monitor their dynamic fluctuations.
The PsychLog application runs on Windows mobile 6.5
and was developed in Visual C# (an Android version is
under development). The software is freely available
for Windows mobile and its open-source code can be
configured to meet specific experimental or clinical requirements.
references
[1] R. Larson, M. Csikszentmihalyi, The experience sampling method, New Directions for Methodology of Social
and Behavioral Science 15 (1983) 41-56.
[2] L. F. Barrett, D. J. Barrett, An introduction to computerized experience sampling in psychology, Social Science
Computer Review, 19(2) (2001) 175–185.
[3] S. S. Intille, J. Rondoni, C. Kukla, I. Ancona, L. Bao,
A context-aware experience sampling tool. In CHI ’03:
CHI ’03 extended abstracts on Human factors in computing systems, NY, USA, 2003 ACM, 972–973.
[4] J. Pan, W.J. Tompkins, A Real-Time QRS Detection
Algorithm, IEEE Transactions of Biomedical Engineering,
32 (1985) 230-236.
––––––––––––––––––––––––––––––––––––––––––––––
an evidence-based Toolset to Capture,
measure and assess emotional health
Edward Hilla,b,1, Pierre Dumouchela,c
and Charles Moehsd
Génie Logiciel et des TI, École de Technologie
Supérieure, Université du Québec
b
Applied R&D Technology and Funding
Solutions Inc., Montréal
c
Centre de Recherche Informatique de Montréal (CRIM)
d
Occupational Medicine Associates,
Watertown, New York
a
Edward Hill
École de Technologie Supérieure
406-905 Ste. Croix. Saint Laurent
QC, H4L 5N9 Canada
E-mail: edward-arne.hill.1@ens.etsmtl.ca
1
abstract
We present (1) an automated telephone check-in system
(emotiondetect.com) to capture emotional health based
on automatic emotion classification, crowd-sourcing and
the experience sampling method; (2) a method that combines acoustic-based and perception-based emotion classifiers to maximize the likelihood of correctly identifying
the emotion in a speech recording; (3) an evidence-based
toolkit to measure and assess emotional health; and (4)
the results of three experimental trials held in 2010 and
2011: (a) English speaking members of Alcoholics
Anonymous, (b) French speaking general population, and
(c) English speaking Opioid addicts undergoing Suboxone maintenance treatment. Emotional health can be defined as the ability to express emotions, identify one’s
own emotions, relate to other people’s emotions and live
life with predominantly positive emotions. Emotional
health plays a major role in addiction treatment and Cognitive Behavioral Therapy (CBT).
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Keywords: Emotion Detection, Emotional Health,
Crowd-sourcing, Ecological Momentary Assessment
Method, Experience Sampling Method, Interactive
Voice Response, Cognitive Behavioral Therapy
introduction
A common Experience Sampling Method (ESM) in CBT
is for a patient to maintain a daily written journal of the
day’s events and associated feeling, emotions, and actions. This journal contributes to the therapist’s assessment of the patient’s cognitive and behavioral health.
Daily journaling is one component of homework assignments incorporated into CBT treatments [1]. Research has
recently commenced in evidence-based methods to capture and measure momentary emotional state using windows-form mobile devices [2] and Interactive Voice
Response (IVR) systems [3]. These systems cannot capture and measure all four aspects of emotional health: a
person’s ability to express emotions, identify their own
emotions, relate to other people’s emotions, and to live
life with predominantly positive emotions. In addition,
these methods suffer from busy bias, resulting in participation apathy and neglect.
Emotiondetect.com can automatically capture and measure all four aspects of emotional health. The capture phase
is performed either by inbound or outbound call and takes
less than 20 seconds (12 seconds on average), thereby
avoiding procrastination typically associated with lengthy
pen & paper journaling, form-based mobile device entry,
and multiple question IVR.
emotion detection in speech
What is the actual emotion in a speech recording? There
is no “ground truth” in emotion detection. People will listen to a speech recording and classify the emotion differently. Even with professional emotion transcribers, Steidl
et al. showed that normally only in a few cases do labelers
agree on one common emotion label. In most cases, only
three out of five labelers agreed on emotional content [4].
Contrast this to speech recognition where there is ground
truth: a speech recording is transcribed to text, and the
speech recognizer’s textual result can then be verified
against the transcription for accuracy.
A method has been devised to combine emotion classifiers to maximize the likelihood of correctly identifying
the emotion in a speech recording. This method is based
on the maximum likelihood of the combined scores from
self-assessment, crowd-sourced anonymous assess-
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189
ments, trained transcriber assessments, and acoustic classifiers [5, 6].
emotional health measurement
Measurements of the emotion captured in the speech
recording capture phase, emotional self-assessment and
emotional assessment of an anonymous speech recording
are analyzed to determine a person’s ability to express an
emotion, identify their own emotion and relate to other
people’s emotions. Call completion rates (answered calls,
unanswered calls) are also collected and time-stamped.
This aggregated data is then used to calculate trends over
time such as emotion predominance, emotional reaction
to event stimulus, positive versus negative emotions, and
multiple instances of an emotion or emotional subset (for
mood detection).
experimental Trials
Two trials have been held in 2010: (a) 33 members of English speaking members of Alcoholics Anonymous with 10
control participants during August and September of 2010;
and (b) 24 French speaking participants from the general
population. A trial is commencing late January 2011 with
50+ Opioid addicts undergoing Suboxone maintenance
treatment, along with a control group from the general
population.
references
[1] N. Kazantzis, F.D., K. Ronan, Homework Assignments
in Cognitive and Behavioral Therapy: A Meta-Analysis.
Clinical Psychology: Science and Practice, 2006. 7(2): p.
189-202.
[2] Vahabzadeh M., L.J.-L., Mezghanni M., Epstein
D.H., Preston K.L., Automation in an Addiction Treatment Research Clinic: Computerized Contingency Management, Ecological Momentary Assessment, and a
Protocol Workflow System, in Practice management
Conference, M.G.M. Associtiona, Editor. 2010: New Jersey. p. 3-11.
[3] Stritzke W., D.L., Durkin K., Houghton S., Use of interactive voice response (IVR) technology in health research with children. Behavior Research Methods, 2005.
37(1): p. 119-126.
[4] Steidl S. , L.M., Batliner A. , Noth E. ,Niemann H. .
"Of all things the measure is man" automatic classification
of emotions and inter-labeler consistency. in ICASSP.
2005.
190
[5] Ahn, L.v., reCAPTCHA. 2009.
[6] Pierre Dumouchel, N.D., Yazid Attabi1, Reda Dehak,
Narjes Boufaden Cepstral and Long-Term Features for
Emotion Recognition, in INTERSPEECH 2009. 2009.
–––––––––––––––––––––––––––––––––––––––––––––
use of robotics Kits for the enhancement of
metacognitive skills of mathematics:
a possible approach
Filippo La Pagliaa,1, Rosalinda Rizzob
and Daniele La Barberaa
a
Dipartimento di Biomedicina Sperimentale
e Neuroscienze Cliniche, Università degli Studi
di Palermo, Italy
b
Dipartimento di Scienze Pedagogiche e Psicologiche,
Università degli Studi di Messina, Italy
Filippo La Paglia
Dipartimento di Biomedicina
Sperimentale e Neuroscienze Cliniche
Università di Palermo
Italy
E-mail: filippolapaglia@gmail.com
1
abstract
The present study aims to analyze the process of building
and programming robots as a metacognitive tool of
mathematics. Quantitative data from research performed
on a sample of students in Italian secondary school are
described in this work. Results showed that robotics activities may be utilized as a new metacognitive environment that allows students to improve their attitude
towards mathematics, or increase their propensity to reflect on themselves and on their own learning, and
higher-level control components, such as forecasting,
planning, monitoring and evaluation exercises and problems related to implementation.
Keywords: Educational Robotics, Metacognition,
Learning, New Technology
introduction
Robotic kits are high tech toys that allow users to build
and program small mobile autonomous robots to interact
with the physical environment [1]. These kits allow users
to develop a game that consists of two steps; first partic-
ipants have to build a robot body and, subsequently, they
create a program in order to enable it with artificial intelligence (e.g., create a robot that is able to move and
change its behavior if it encounters an obstacle). Finally,
subjects test the robot’s performance in the physical environment in order to check its success/failure. The final
test is quite important because users can instantaneously
see what they have planned for the robot and verify if it
behaves as it was intended to do.
A large amount of theoretical studies and empirical research shows that playing with robots allows students
of different ages to improve their planning, reasoning
and problem-solving capabilities [2-4], as well as social
skills related to peer conflict resolution, group decisionmaking and so on [5]. Moreover, children with mental
retardation and autistic disorders seem to benefit from
rehabilitative activities based on robotics [6, 7]. Also,
there are studies, according to our knowledge, which analyzed the possibility of using robotics kits as metacognitive tools [8]. In general, metacognition consists of
two basic processes occurring simultaneously: the first
is monitoring the progress of learning; the second is
adapting learning strategies as subjects perceive there is
a need alter their behavior [9]. Specifically, metacognitive skills include monitoring the progress of learning,
correcting errors, and changing strategies when needed
[10]. From this perspective, the whole experience of
playing with robots may be considered as a metacognitive process that leads users to become more aware and
conscious of the way they think, learn, and organize the
game itself. In order to check the improvement of
metacognitive skills related to mathematics through the
use of robotic kits, we performed a study on a sample
of students attending secondary school involved in a robotics laboratory.
methods
Two groups of student, each composed of 15 subjects
(nine male and six female; mean age: 11 years; range:
10-12 years), were involved in the study. Students were
randomly selected from the first classes of a secondary
School of Palermo. The study consisted of three phases:
the first phase (pre-test) consisted of an assessment of
metacognitive skills and beliefs related to the acquisition of mathematical knowledge; in the second phase
(treatment) the experimental group was involved in a
robotics lab (described below); the third phase (posttest) provided a second measurement session of the two
groups’ metacognitive skills.
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The students’ metacognitive skills were evaluated individually during the pre-test and post-test assessment
using the following tests: Questionario di Matematica e
Metacognizione-MM, and Caponi et al.’s test (2006) [11]
encompassing three sections: attitudes, belief, and control processes influencing learning the subject of math.
The questionnaire allowed for several qualitative observations, such as exploring the presence of specific mathematics skills, and some aspects of metacognition in
mathematics.
According to previous studies [2-4], the experimental
group was provided with a robotics kit and was involved
in an extra-curricular laboratory based on robotics activities (10 meetings; three hours each, once a week).
After becoming familiar with the hardware and software
elements of the kit, all students were given various construction and programming tasks with an increasing level
of difficulty, evaluated by the number of bricks needed
to build the robot body and by the number of drives
which had to be linked to create a specific robot behavioral repertory (e.g., “create a robot able to move along
a linear route” – one command).
results and Conclusions
Results showed an increase in post-test performance for
the experimental group compared with the control group.
Specifically, it has been demonstrated that the use of
robot kits improves students’ attitude towards mathematics, or increases the propensity to reflect on themselves
and on their own learning, and higher-level control components, such as forecasting, planning, monitoring and
evaluation exercises and problems related to implementation. Also, it decreases the main beliefs in mathematics,
or the wider issues, such as the concept of intelligence
in relation to scholastic success, and those more specifically related to the solution of exercises and problems.
The present study is a first attempt to investigate the possibility of using robotics activities as a metacognitive
tool of mathematics.
191
and Human Interactive Communication, IEEE Roman
2002, September 25-27 2002, Berlin – Germany (2002).
[3] B. Caci, A. D’Amico, & M. Cardaci, Costruire e Programmare Robots, Tecnologie Didattiche, 27(3), (2002),
36-40.
[4] B. Caci, A. D’Amico, & M. Cardaci, New frontiers
for psychology and education: robotics, Psychological
Reports, 94, (2004), 1372-1374.
[5] M.A. Barfurth, Understanding the collaborative
learning process in a technology rich environment: the
case of children’s disagreements. In L. Schnase & E. L.
Cunnius (Eds.), Proceedings of CSCL95: computer support for collaborative learning. Mahwah, NJ: Erlbaum,
(1995), 8-13.
[6] K. Dautenhahn, Design issues on interactive environments for children with autism. Proceeding International
Conference on Disability, Virtual Reality and Associated
Technologies, ICDVRAT 2000, 23-25 September, Alghero, Sardinia, Italy (2000), 153-161.
[7] F. Michaud, C. & Théberge-Turmel, Mobile robotic
toys and autism. In K. Dautenhahn, A. Bond, L.
Canamero & B. Edmonds (Eds.) Socially Intelligent
Agents - Creating Relationships with Computers and Robots. London: Kluwer Academic (2002).
[8] F. La Paglia, B. Caci, D. La Barbera, M. Cardaci,
Using robotics construction kits as metacognitive tools.
A research in an Italian Primary School, Studies in
Health Technology and Informatics 154 (2010), 110114.
[9] W. Winn, & D. Snyder, Cognitive perspectives in
pyschology. In D.H. Jonassen, ed. Handbook of research for educational communications and technology,
New York: Simon & Schuster Macmillan (1996), 112142.
references
[1] O. Miglino, H.H. Lund, & M. Cardaci, Robotics as
an Educational Tool, Journal of Interactive Learning Research, 10 (1), (1999), 25-48.
[10] D.S Ridley, P.A. Schutz, R.S. Glanz, & C.E. Weinstein, Self-regulated learning: the interactive influence
of metacognitive awareness and goal-setting, Journal of
Experimental Education, 60 (4), (1992), 293-306.
[2] B. Caci, A. & D’Amico, Children’s Cognitive Abilities in Construction and Programming Robots. Proceeding of the 11th IEEE International Workshop on Robot
[11] B. Caponi, G. Falco, R. Focchiatti, C. Cornoldi, &
D. Lucangeli, Didattica metacognitiva della matematica,
Erickson, Trento, 2006.
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192
–––––––––––––––––––––––––––––––––––––––––––––
a lightweight augmented Virtuality system for
providing a faithful and spatially manipulable
Visual hand representation
Andreas Puscha,1, Olivier Martinb
and Sabine Coquillartb
b
a
IIHM – UJF – LIG, France
INRIA Grenoble Rhône-Alpes – LIG, France
Andreas Pusch
IIHM – UJF – LIG
110, av. de la Chimie – BP 53
38041 Grenoble Cedex 9
France
E-mail: andreas.pusch@imag.fr
1
abstract
This paper introduces the technical foundations of a system designed to embed a lightweight, faithful and spatially manipulable representation of the user's hand into
an otherwise virtual world – Augmented Virtuality (AV).
A highly intuitive control during pointing and space interaction can be provided to the user, as well as a very
flexible means to experimenters in a variety of non-medical and medical contexts. Our approach essentially relies
on stereoscopic video, see-through Augmented Reality
technology and a generic, extendible framework for
managing 3-D visual hand displacements. Previous
works from human-computer interaction, perception and
motor control have contributed to the elaboration of our
proposal which combines a) acting in co-location, b)
avoiding occlusion violations by assuring a correct scene
depth ordering and c) providing a convincing visual
feedback of the user's hand. We further present two cases
in which this system has already successfully been used
and then outline some other applications that we think
are promising, for instance, in the fields of neuromotor
rehabilitation and experimental neuroscience.
Keywords: Augmented Virtuality, Video See-through
Head-mounted Display, Co-location, Visuo-proprioceptive Sensory Conflict, Visual Hand Shift Framework
introduction
Experimental setups typically used to manipulate the
perceived location of one’s own hand are often very restrictive for subjects or patients who are forced to take
specific artificial fixed postures and have little space to
move the interacting limb around. Moreover, the visual
hand feedback is often reduced to ordinary cursors or
otherwise oversimplified, while it is known that the quality of representation of the hand can have a strong impact
on the feeling of limb ownership, self-action recognition,
and thus, on the reliability in the display and so, on the
performed actions. Different types, amounts and variations of visuo-proprioceptive conflicts (VPC) can rarely
be simulated by the same system.
Independent of the actual purpose or application context,
be it the investigation of human multimodal perception,
the study of certain symptoms of neuromotor disorders
or the development of novel rehabilitation methods for
motor skill recovery, it seems that the range of possibilities and the richness of the tools can, at a fairly low cost,
still be increased. To approach such a multipurpose solution is what we aim to address in this paper. We also
think that our system, which does not require complex
3-D hand reconstruction techniques, can be of great interest in the field of human-computer interaction.
method and results
The system is composed of four network-enabled building blocks: 1) The video see-through head-mounted display (HMD) with two built-in (stereo) cameras; 2) the
video acquisition and post processing unit also used for
image correction and background segmentation; 3) the
tracking system that tracks the head and hand at six degrees of freedom; and 4) the compositing unit performing real-time simulation, interaction and rendering. On
top of this infrastructure, our VPC generation and management framework provides a highly configurable interface to the top-level application layer. This framework
does all the work to dynamically control (i.e., increase
or reduce) visual hand shifts, perform feasibility tests and
store intermediate runtime data for post-hoc analyses.
The overall concept of visually displacing the hand in 3D space uses live video data captured in stereo by the
HMD's built-in cameras. The mixing approach generalized past work [1]. We provide an extendible framework
for creating and managing VPC that operates on the vertices of the carrier geometry mapped with the segmented
live video hand. Virtual objects in front occlude the hand
correctly as virtual objects behind the hand are correctly
occluded. A previous study was conducted on perceptual
illusions [1] using an earlier version of the presented
system. Subjects had to expose their hand (viewed
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through the video see-through HMD) to a virtual force
field that attracted the “visual hand” and shifted it progressively away from its real counterpart. The triggered
motor reaction in the pectoralis major produced the illusion of a flow that pushes the hand/arm to the side.
Conclusion and future Work
We have designed and implemented a novel, lightweight,
generalizing near space interaction system [1]. It is
meant to better exploit sensorimotor processes involved
in natural visuomotor coordination. The system includes
a generic, extendible framework capable of inducing
static and dynamic spatial VPC at hand level. We have
recently used this setup to study the effects of hand feedback fidelity on motor performance and user acceptance
in a virtual object touching task [2]. Other promising applications can be found in areas where controlled VPC
at hand level are needed while maintaining hand/finger
feedback and natural motion (e.g., studying multimodal
perception and online manipulation of visually perceived
actions or developing novel diagnostics and rehabilitation methods). We also wish to perform conformity evaluations in order to compare our system to
well-established, though mostly much less flexible, tools.
Additional work is required, for instance, to overcome
some technical limitations.
references
[1] A. Pusch, O. Martin, and S. Coquillart, HEMP –
Hand-Displacement-Based Pseudo-Haptics: A Study of
a Force Field Application, In Proc. of IEEE 3DUI, 2008.
[2] A. Pusch, O. Martin, and S. Coquillart, Effects of
Hand Feedback Fidelity on Near Space Pointing Performance and User Acceptance, to appear in Proc. of
ISVRI, 2011.
–––––––––––––––––––––––––––––––––––––––––––––
immersive Virtual environments for emotional
engineering: description and preliminary results
Alejandro Rodrígueza,1, Beatriz Reya
and Mariano Alañiza,b
a
Instituto en Bioingeniería y Tecnología
Orientada al Ser Humano, Universidad Politécnica de
Valencia, Camino de Vera s/n, 46022
Valencia (España)
b
Ciber Fisiopatología Obesidad y Nutrición (CB06/03)
Instituto Salud Carlos III
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193
Alejandro Rodríguez
Instituto en Bioingeniería y Tecnología
Orientada al Ser Humano
Universidad Politécnica de Valencia
Camino de Vera s/n, 46022
Valencia, Spain
E-mail: arodriguez@labhuman.i3bh.es
1
abstract
This work aims to identify the arousal and presence level
during an emotional engineering study. During the experimental sessions, a high-immersion Virtual Reality
(VR) system, a CAVE-like configuration, will be used.
Thirty-six volunteers will navigate in virtual houses that
can be customized and that have been designed for emotional induction. Emotional induction will be obtained
by stimulating the senses of sight, hearing and smell. For
this purpose, ambient lighting, music and scent will be
controlled by the researcher, who will create a comfortable environment for the subject. Several physiological
variables (Electrocardiogram (ECG), respiratory signal
and Galvanic Skin Response (GSR)) will be recorded
during the sessions. The results obtained will help furniture companies identify the senses that have more influence on the emotions and will be the basis for new
studies about user needs in the sector of furniture and interior decoration.
Keywords: Emotional Induction, Emotional
Engineering, Kansei, CAVE, Heart Rate Variability,
Respiration, Galvanic Skin Response
introduction
The application of immersive virtual environments
(VEs) for emotional engineering is a field that has not
been widely studied, despite its potential for providing
new useful information about human behavior. Nowadays, virtual technology used for emotional engineering
studies has been limited to obtaining custom prototypes
of objects [1].
In this work, we offer a new approach for the communication, marketing, design and manufacturing processes
applied to furniture and other habitat products. The goal
is to use VR to analyze the arousal and presence levels
while participants navigate in virtual houses.
method
Kansei Theory Type V [2] was applied in the study, com-
194
bined with VR. Three VEs were developed, each containing a different lifestyle house. A CAVE-like system
with head-tracking and stereoscopic vision will be used
to achieve a more immersive experience.
Thirty-six volunteers will be exposed to the VE and they
will have to freely decorate the house. Sensory stimulation (hearing, sight and smell) will be applied to the subjects while they freely navigate through the custom VE
in order to induce positive emotions. During the entire
study, physiological signals will be recorded. ECG, respiratory signal and GSR [3] will be analyzed (using Matlab) to obtain different parameters [4]. In addition,
questionnaires about presence and activation (SUS:
Slater, Usoh & Steed questionnaire [5]) will be completed by the subjects at the end of the experiment.
results
Arousal and presence level will be obtained through
questionnaires and will be correlated with physiological
parameters. This way, we will study the influence on
physiological signals of the emotional induction during
the navigation in the virtual house, with the different experimental conditions based on light, ambient sound and
scent customization. A file with all events of the subject
during the study will be generated by the system after
each test.
Conclusions
The results obtained will help furniture companies identify the senses that have more influence on the emotions
and will help them to design furniture more adapted to
users.
references
[1] Söderman, Mikael (2005); Virtual reality in product
evaluations with potential customers: An exploratory
study comparing virtual reality with conventional product representations; Journal of Engineering Design, Vol.
16, Nº 3, June 2005, 311-328.
[2] Nagamachi, Mitsuo (2003); “Innovations of Kansei
Engineering”. CRC Press Taylor & Francis Group,
2011. Published by JSA-Japanese Standards Association,
Tokyo, in 2003, in Japanese.
[3] Slater, M., Guger, C., Edlinger, G., Leeb, R.,
Pfurtscheller, G., Antley, A., Garau, M., Brogni, A.,
Friedman, D.: Analysis of physiological responses to a
social situation in an immersive virtual environment.
Presence: Teleoper. Virtual Environ. 15(5), 553–569
(2006).
[4] Jonghwa Kim; Elisabeth André; Emotion Recognition Based on Physiological Changes in Music Listening; IEEE Transactions on Pattern Analysis and
Machine Intelligence, Vol 30, Nº 12 December 2008:
2067-2083.
[5] Usoh, M., Catena, E., Arman, S., and Slater, M. 2000.
Using presence questionnaires in reality. Presence: Teleoperators and Virtual Environments 9: 497–503.
ouTCome Trials for anxieTy disorders
new Technologies to manage exam anxiety
Alessandra Grassia,b,1, Andrea Gaggiolia,b
and Giuseppe Rivaa,b
Istituto Auxologico Italiano, Milano, Italy
b
Centro Studi e Ricerche di Psicologia della
Comunicazione, Università Cattolica del
Sacro Cuore, Milano, Italy
a
Alessandra Grassi
Applied Technology for Neuro-Psychology Lab
1
Milano, Italy
E-mail: a.grassi@auxologico.it
abstract
The aim of this study is to create and to verify the effectiveness of a multimedia protocol developed to teach students to manage exam anxiety. Authors want to investigate
the capability of audio/video contents to induce emotional
changes. The protocol is based on the Stress Inoculation
Training procedure (SIT) and is made of six experimental
sessions where participants have to watch a multimedia
content and to perform different relaxation exercises. According to the type and mobility of the medium used, 75
JCR
university students were randomly divided into five
groups: 1) audio and video narrative on a mobile phone
(UMTS); 2) audio and video narrative on a DVD (DVD);
3) audio narrative on an MP3 player (M3); 4) audio narrative on a CD (CD); 5) control group (CTRL). Results
showed that audio/video contents induced a significant reduction in exam anxiety and an increase of relaxation in
students, compared to the audio-only content.
Keywords: Exam Anxiety, Stress Inoculation Training,
New Technologies, Mobile Phone, Video Clip
Exam anxiety in students reflects negative effects on
scholastic performances [1-3] and it could induce emotional (fear and panic), cognitive (loss of concentration)
and neurovegetative reactions (perspiration, heart rate
acceleration). Starting from these observations, it is important to consider in which way students could improve
their competencies to manage exam anxiety. A common
cognitive-behavioral approach is Stress Inoculation
Training, SIT [4-6], based on three phases of intervention:
1. Conceptualization phase: the patient is taught by the
therapist about the impact and effects of stress;
2. Skills acquisition and rehearsal: the therapist enhances
a pecific patient’s coping skills;
3. Application and follow through: the patient is “inoculated” into a stressful and controlled environment to verify the efficacy of the treatment.
The experimental protocol, based on the SIT procedure,
is aimed to teach students different relaxation exercises
and to enhance their coping strategies.
The project investigates the effectiveness of six audio
and video narratives (lasting five minutes each) in the
emotion induction process by using different media:
UMTS mobile phone, DVD, MP3 player and audio
CD. The protocol is composed by six sessions, students have to watch once a day from the selected multimedia content. A mood induction is expected in each
session:
- Sessions 1, 2: in a relaxing virtual environment, participants are presented with common psycho-physiological
reactions to a university exam;
- Sessions 3, 4: peculiar coping strategies are presented
in a relaxing virtual environment to teach students how
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195
to manage exam anxiety;
- Sessions 5, 6: a stressful virtual environment (VE) (a
classroom during an university exam) is presented in
order to evaluate the acquired competencies.
The intervention lasts six days. On the seventh day students take the real exam.
The sample is composed of 75 female university students
aged 20- 23 years old (M= 21,06 ± 1,25).
This study has a mixed design (5x2). The first independent variable refers to an experimental intervention and is
measured between subjects on five levels: video and
audio content on a mobile phone (UMTS); video and
audio content on a DVD (DVD); only audio content on
a MP3 player (M3); only audio content on an audio CD
(CD); a control group (Ctrl); and a non intervention
group. The second independent variable refers to time:
pre- and post-intervention. The dependent variables are
emotional state dimension and sense of presence. Each
participant took the the following questionnaires before
and after each multimedia experience:
state Questionnaires:
- STAI (State Trait Anxiety Inventory) [7];
- Vas (Visual Analogue Scale) [8].
results
Results show a significant decrease in anxiety level in
the audio/video condition (UMTSand DVD) from the
beginning to the end of treatment, as assessed by the Stai
State questionnaire [7].
Results show a significant increase in relaxation level in
the audio/video condition (UMTS and DVD) from the
beginning to the end of the treatment, as assessed by Vas
questionnaire [8]. These results suggest the effectiveness
of the Stress Inoculation Training protocol, implemented
through new media, to manage exam anxiety and to improve a relaxation level in users.
references
[1] Alexander K.L., Entwhistle D.R., Gabbani N.S. The
dropout process in life course perspective: early risk factors at home and school, Teachers College Record 103,
760-822, 2001.
[2] Hurrelmann K., Engel U., Weidman J. C. Impacts of
school pressure, conflict with parents and career uncer-
196
tainty on adolescent stress in the federal Republic of Germany, International Journal of Adolescence and Youth,
4, 33-50, 1992.
[3] Torsheim T., Aarø L.E. e Wold B. School-related
stress, social support, and distress: prospective analysis
of reciprocal and multi-level relationships. Scandinavian
Journal of Psychology, 44, 153-159, 2003.
[4] Meichenbaum, D., Cognitive-behavioral modification: An integrative approach. New York Plenum, 1977.
[5] Meichenbaum, D., Cognitive Modification of test
anxious college students. Journal of Consulting Clinical
Psychology, 39, 370-380, 1972.
[6] Hussian R. A. & Lawrence P. S., The reduction of
test, state and trait anxiety by test-specific and generalized stress, Cognitive Therapy and Research, 2, 25-37,
1978.
[7] Spielberger CD, Gorush RL, Lushene RE., State Trait
Anxiety Inventory manual, Palo Alto, CA: Consulting
Psychologists Press, 1970.
[8] Gross, J.J., & Levenson, R.W. Emotion elicitation
using films. Cognition and Emotion, 9, 1995.
–––––––––––––––––––––––––––––––––––––––––––––
Virtual homework for posttraumatic stress
disorder with driving phobia – a novel
approach to Virtual reality Therapy
David Walshea,1 and David R. Walsheb
a
St. Stephen’s Hospital Cork, Department
of Psychiatry, University College Cork
b
Virtual Reality Driving Clinic, Cork
David Walshe
St. Stephen’s Hospital
Glanmire, Cork
Ireland
E-mail: davidgmw@yahoo.com
1
abstract
Virtual Reality Exposure Therapy (VRET) provides a
safe and effective therapeutic alternative that is not dependent on real life situations or a person’s imagination.
Phobic subjects have been shown to readily immerse in
VR driving settings with subjective and physiological
arousal. Case reports and case series studies have supported the effectiveness of VR therapy with driving phobic patients with and without PTSD [2-6]. However,
exposure therapy has treatment failures. Some cases do
not readily respond to prolonged VR exposure with persistent heightened anxiety in VR driving settings, preventing progression along a graded hierarchy of driving
exposures. These resistant cases pose a therapeutic challenge. A new approach is outlined in three resistant cases
of driving phobia with PTSD post motor vehicle accident
(MVA).
Keywords: Virtual Reality Exposure Therapy, Driving
Phobia, Posttraumatic Stress Disorder, Virtual Reality
Homework, DVD Homework
method
Three cases of Posttraumatic Stress Disorder (PTSD)
with driving phobia that proved resistant to a combination of pharmacotherapy and six or more sessions of Virtual Reality (VR) driving were included in the study. The
therapeutic intervention involved the addition of graded
DVD/VR homework tasks to VR driving. The patient
was instructed to undertake a daily DVD exposure task
for at least 30 minutes, and record subjective ratings of
distress (SUD levels) during this task. The homework involved watching recorded video game driving/travel experiences of graded difficulty (variable car speed, traffic
density, accident scenarios). These scenes were recorded
on DVD from video games used in VR exposure. Patients were reviewed on a four to five weekly basis over
five or more sessions to review homework, reset tasks
based on performance and optionally undertake further
VR driving at reviews.
results
Following completion of five or more review sessions,
patients were re-interviewed to assess progress on the
exposure hierarchy, on VR driving and driving/vehicular
travel in everyday situations.
Conclusions
The positive therapeutic responses illustrate the benefit
of this novel approach.
novelty
A new component to VR therapy for resistant driving
phobia.
JCR
references
[1] Walshe, D.G., Lewis, E.J., O’Sullivan, K. et al
(2005). Virtually driving: are the driving environments
‘real enough’ for exposure therapy with accident victims? An explorative study. Cyber-Psychology & Behaviour, 8:532-537.
[2] Wald, J., Taylor, S. (2000) Efficacy of virtual reality
exposure therapy to treat driving phobia: a case report.
J Behaviour Therapy Experimental Psychiatry. SeptDec;31(3-4):249-57.
[3] Walshe, D.G., Lewis, E.J. Kim, S.I. et al (2003). Exploring the use of computer games and virtual reality in
exposure therapy for fear of driving following a motor
vehicle accident. Cyber-Psychology & Behaviour, 6:
329-334.
[4] Wald, J., Taylor, S. (2003) Preliminary research on
the efficacy of virtual reality exposure therapy to treat
driving phobia. Cyber-Psychology & Behaviour. Oct;
6(5):459-65.
[5] Beck, J.G., Palyo, S.A., Winer, E.H. et al (2007) Virtual Reality Exposure Therapy for PTSD symptoms after
a road accident: an uncontrolled case series Behaviour
Therapy. Mar;38(1):39-48.
[6] Essen, J., Walshe, D. (2010) A case of driving phobia
with agoraphobia responsive to VR therapy, Modern
Medicine Sept;22: 17-20.
–––––––––––––––––––––––––––––––––––––––––––––
a randomized Control Trial for the use of
In Virtuo exposure in the Treatment of
social phobia: final results
Stéphane Boucharda,1, Stéphanie Dumoulina,
Geneviève Robillarda, Tanya Guitarda, Évelyne
Klingerb, Hélène Forgeta and François Xavier Roucautc
b
Arts et Métiers ParisTech-LAMPA Angers-Lava
c
Université Montpellier I
a
Stéphane Bouchard
Canada
E-mail: Stephane.Bouchard@uqo.ca
1
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197
abstract
Social anxiety disorder (SAD) can be treated effectively
with multicomponent cognitive behavior therapy (CBT)
programs. However, patients rarely receive CBT and access to adequate exposure stimuli is sometimes a challenge for therapists. Previous trials on Virtual Reality
(VR) and SAD were promising but they did not address
the full spectrum of SAD symptoms or were preliminary.
In this study, 45 adults receiving a DSM-IV-TR diagnostic of SAD were randomly assigned to a waiting list
(WL) or multicomponent CBT treatments comprising either only in vivo (CBT-in vivo) or in virtuo (CBT – in
virtuo) exposure. Patients in the waiting list were later
treated with a multicomponent CBT treatment combining in vivo and in virtuo exposure (CBT – combined).
Traditional repeated-measures ANOVAs (pre/post/f-up)
and interaction-contrasts were conducted and confirmed
the superiority of the CBT– in vivo and CBT – in virtuo
over the WL. Non-inferiority testing confirmed that
treatments involving VR were not less effective than
standard CBT. However, results on the SWEAT measure
show that using VR is more practical for therapists.
Keywords: Social Anxiety, Virtual Reality,
Anxiety, Exposure
introduction
Social anxiety disorder (SAD) is characterized by a
marked and persistent fear of being negatively judged or
humiliated in social or performance situations and leads
to avoidance of social situations [1]. SAD is prevalent
[2,3] and often results in a diminished quality of life,
considerable emotional suffering, and significant impairment in personal, occupational and social experiences
[4]. Outcome studies over the past 20 years have consistently shown the effectiveness of a multicomponent cognitive-behavior intervention in the treatment of SAD
[4-9] based essentially on cognitive-restructuring and exposure to the feared situation(s).
One significant limitation of the traditional in vivo exposure is the difficulty for the therapist to get adequate
and controlled social interactions (e.g., audience to conduct the exposure, control on people’s reactions, variety
of social situations appropriate for exposure) in order to
make progress in a continuous and gradual way for the
participant. Virtual Reality (VR) overcomes many of the
shortcomings of in vivo exposure, in addition to providing a treatment that is more readily accepted by clients
[10, 11]. Outcome studies have been published on VR
198
and SAD, mostly with the fear a public speaking, a less
severe form of SAD [12, 13]. Klinger and colleagues
[14] published a very promising study but a more rigorous randomized control trial remains necessary before
reaching a firm conclusion on the efficacy of CBT using
VR-based exposure. The present study represents final
and complete results from a study introduced at the previous CyberTherapy conference [15].
method
Forty-five adults (mean age 34.9 years old; 71% female)
receiving a DSM-IV-TR diagnosis of social anxiety were
randomly assigned to one of these three conditions: (a)
traditional individual CBT treatment where exposure
was conducted only in vivo (CBT – in vivo; n=16); (b)
individual CBT where exposure was conducted in virtuo
(CBT – in virtuo; n=14); and (c) waiting list (WL; n=15).
Members of the WL group were measured “pre and post”
and were later treated with individual CBT where exposure combined in vivo and in virtuo. All treatments lasted
16 sessions. Exposure was performed in various public
speaking and social situations (virtual or not, depending
on the participant group condition). In virtuo exposure
was conducted with an e-Magin HMD and softwares created by Klinger [14] and Virtually Better [13]. Several
self-report were used (Liebowitz Scale, Social Phobia
Scale, Appraisal of Social Concerns, Fear of Negative
Evaluation, Beck Depression Inventory II, etc.), as well
as behavioral and physiological data gathered during behavioral avoidance tests. Salivary cortisol samples were
drawn to compare the anxiety induced by both forms of
exposure. The Subjective Work for Exposure and Therapy instrument was used with 269 exposure sessions to
compare the costs and efforts required by the therapists
to adequately plan each exposure exercise.
results
Outcome data were analyzed with three strategies: (a) traditional repeated-measures ANOVAs (pre/post/f-up) and
pre / post interaction-contrasts to compare CBT – in vivo
and CBT – in virtuo to the WL; (b) non-inferiority testing
was used to show if CBT – in virtuo was equivalent to CBT
– in vivo; and (c) CBT – combined was compared to the
other two treatment modalities. Results clearly show that
conducting exposure in virtuo is effective for the treatment
of social phobia, that it is as effective as in vivo, and that it
is more flexible and cost-effective than in vivo.
Conclusion
This is the first randomized controlled study that includes
a large sample of people suffering from severe social
anxiety (DSM-IV-TR criteria) using CBT treatment
combined with in virtuo exposure and compared to a
waiting list. Results are supporting the efficacy of VRbased exposure and suggest that it is more cost-effective
than traditional in vivo exposure. Additional process
variables have also been examined and will be discussed,
such as the therapeutic alliance, the sense of presence,
immersive tendency and cognitive change variables. The
discussion will also address two areas needing further
research: using augmented reality and exposing SAD patients to “extreme” social situations (e.g., being exposed
to socially inadequate behaviors) that go beyond what is
usually done in vivo.
references
[1] American Psychiatric Association, Diagnostic and
Statistical Manual of Mental Disorders Fourth Edition
Text Revision. Washington, DC: American Psychiatric
Association, 2000.
[2] Statistics Canada, Enquête sur la santé dans les collectivités canadiennes. Santé mentale et bien-être. 82617-XIF Retrieved August 25, 2004, from Statistics
Canada Website: http://www.statcan.ca/daily/francais/030903/q030903a.htm, 2003 (September).
[3] R.C. Kessler, K.A. McGonagle, S. Zhao, C.B. Nelson,
M. Hughes, S. Eshelman, et al. Lifetime and 12-month
prevalence of DSM-III-R psychiatric disorders in the United
States. Archives of General Psychiatry 51 (1994), 8-19.
[4] D.H. Barlow. Anxiety and its disorders: the nature
and treatment of anxiety and panic 2nd edition. New
York: Guilford Press, 2002.
[5] M. Stein. Evidence-based treatment of anxiety disorders. International Journal of Psychiatry in Clinical Practice 10 (2006), 16-21.
[6] U. Stangier, T. Heidenreich, M. Peitz, W. Lauterbach,
D.M. Clark. Cognitive therapy for social phobia: individual versus group treatment. Behaviour Research and
Therapy 41 (2003), 991–1007.
[7] D.M. Clark, A. Ehlers, A. Hackmann, F. McManus,
M. Fennell, N. Grey et al. Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized controlled trial. Journal of Consulting and
Clinical Psychology 74 (2006), 568-578.
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199
[8] S.G. Hofmann. Perception of control over anxiety
mediates the relation between catastrophic thinking and
social anxiety in social phobia. Behaviour Research and
Therapy, 2005, 885-895.
[9] J.K. Wilson, R.M. Rapee. The interpretation of negative social events in social phobia: changes during
treatment and relationship to outcome. Behaviour Research and Therapy 43 (2005), 373-389.
[10] A. Garcia-Palacios, C. Botella, H.G. Hoffman, H.
Villa, & S. Fabregat. Comparing the acceptance of VR
exposure vs. in vivo exposure in a clinical sample. Presented at CyberTherapy Conference 2004, January 10 –
12, San Diego, CA.
[11] A. Garcia-Palacio, H. Hoffman, S. See, A. Tsai, C.
Botella. Redefining therapeutic success with virtual reality exposure therapy. CyberPsychology and Behavior
4 (2001), 341-348.
[12] B.K. Wiederhold, M.D. Wiederhold. Virtual-reality
therapy for anxiety disorders: Advances in evaluation
and treatment. New York: American Psychological Association Press, 2004.
[13] M. North, S. North, J.R. Coble. Virtual reality therapy: An effective treatment for the fear of public speaking. International Journal of Virtual Reality 3 (1998),
2-6.
[14] E. Klinger, S. Bouchard, P. Légeron, S. Roy, F.
Lauer, I. Chemin, P. Nugues. Virtual reality therapy for
social phobia: A preliminary controlled study. Cyberpsychology and Behavior 8 (2005), 76-88.
[15] Robillard, G., Bouchard, S., Dumoulin, S., & Guitard, G., & Klinger, É. Using virtual humans to alleviate
social anxiety : preliminary report from a comparative
outcome study. Oral Presentation at the 15th Annual
CyberTherapy Conference 2010, Seoul (Korea), June
13-15.
–––––––––––––––––––––––––––––––––––––––––––––
isolating the effect of Virtual reality based
exposure Therapy for agoraphobia:
a Comparative Trial
Eric Malbosa,1, Ronald M. Rapeea
and Manolya Kavaklib
JCR
Department of Psychology, Macquarie
University, Sydney, Australia
b
Department of Computing, Macquarie
University, Sydney, Australia
a
1
Eric Malbos
Building C3A, Office 709
Macquarie University
Sydney, NSW 2109
Australia
E-mail: eric.malbos@mq.edu.au
abstract
The isolated effect of Virtual Reality Based Exposure
Therapy (VRBET) for agoraphobia was analyzed
through a comparative trial involving 18 agoraphobic
participants. All the required virtual environments (VEs)
were created with an inexpensive Game Level Editor
(GLE). Outcome measures supported the immersive effect of the VEs. Questionnaires, behavioral tests and
physiological measures indicated a positive effect of
VRBET alone. The addition of cognitive therapy did not
generate any significant difference. Consequences for
future research and practice are discussed.
Keywords: Virtual Reality, Exposure Therapy, Virtual
Environments, Agoraphobia, Cognitive Therapy,
Game Level Editors
introduction
Urban life inherently implies situations dealing with reduced and/or enclosed spaces (crowded places, subway,
lifts, skyline, etc.). A certain percentage of people suffering from a phobia entitled agoraphobia perceive those
situations as threatening or panic provoking [1]. The
subsequent avoidance behavior exhibited by agoraphobics can have disabling consequences. Recent research
involved the use of Virtual Reality (VR) for phobia exposure therapy, a process for obtaining fear extinction
[2]. During the exposure, reality is replaced by artificially created stimuli inside a computerized world. Past
clinical studies demonstrated the efficacy of Virtual Reality Based Exposure Therapy (VRBET) to treat participants suffering from agoraphobia [2]. However, these
studies employed a treatment that combined VRBET
with cognitive therapy or relaxation. Therefore, it is impossible to assess the efficacy and the role of the VR itself. Moreover, the virtual environments (VEs) in
200
previous studies were constructed with an exclusive in
house program or relatively expensive professional software. To reduce cost and improve access, several research teams have successfully employed VEs created
from inexpensive Game Level Editors (GLE) to treat
arachnophobia and claustrophobia [3,4]. Ipso facto, our
objectives are twofold. Firstly, the study measured the
isolated effect of VRBET when compared to a combined
treatment of VRBET and cognitive therapy. The efficacy
of the treatment was assessed using self-report questionnaires, behavioral tests as well as physiological measures. Our secondary objective focused on demonstrating
that affordable means, such as a GLE, allow the experimenter to construct various VEs realistic enough to induce a feeling of presence and to obtain therapeutic
efficacy.
methodology
Eighteen participants diagnosed with agoraphobia were
recruited for the clinical trial. They were randomly assigned to two therapeutic groups: one group receiving
VRBET only (VRO); and one group receiving VRBET
and cognitive therapy (VRC). The protocol included 10
weekly sessions of 90 minutes each for the two groups:
eight sessions of VRET for both groups; two neutral initial sessions for the VRO group; and two initial sessions
of cognitive therapy for the VRC group. The eight sessions of VRBET comprised an exposure to nine different
context graded VEs related to agoraphobia (airplane,
subway, driving, etc.) supplemented with interoceptive
cues (heartbeat sounds, tunnel vision, etc.) To explore
the VEs elaborated with a selected GLE, participants
donned a Head Mounted Display with a motion tracker.
Questionnaires, behavior tests and physiological measures were registered before and after the treatment procedure.
results
Means and ANOVA F values of the dependent variables
evidenced a significant time effect for all measures.
There was no significant interaction (time/group) for
these scores. PQ rating indicated that the patients felt immersed in the VEs.
Conclusion
The present clinical trial demonstrated the therapeutic
effectiveness and presence eliciting effect of VEs constructed with a GLE. Results also revealed the isolated
positive outcome of VRBET for agoraphobia. The addition of cognitive therapy did not generate any significant
difference. Future research should explore the use of
other components in addition to cognitive therapy and
VREBT (relaxation, mindfulness, etc.)
references
[1] American.Psychiatric.Association. Diagnostic and
statistical manual of mental disorders. American Psychiatric Association 2000.
[2] Powers MB and Emmelkamp PMG. Virtual reality
exposure therapy for anxiety disorders: A meta-amalysis,
Journal of Anxiety Disorders 22 (2008), 561-9.
[3] Bouchard S, Cote S and St-Jacques J. Effectiveness
of virtual reality exposure in the treatment of arachnophobia using 3D games, Technology and health care 14
(2006), 19-27.
[4] Malbos E, Mestre DR, Note ID, et al. Virtual Reality
and Claustrophobia: Multiple Components Therapy Involving Game Editor Virtual Environments Exposure,
Cyberpsychology and behavior 11 (2008), 695-7.
–––––––––––––––––––––––––––––––––––––––––––––
youths are more apprehensive and frightened
Than adults by a Virtual environment used to
Treat arachnophobia
Cidalia Silvaa,1, Stéphane Bouchardb
and Claude Bélangerc
Cyberpsychology Laboratory, Université
de Québec en Outaouais
b
Department of Psychoeducation and Psychology,
Université de Québec en Outaouais
c
Department of Psychology, Université de
Québec à Montréal
a
Cidalia Silva
Cyberpsychology Lab
Université de Québec en Outaouais
369 rue Darquise
Laval, QC H7P 5N1
Canada
E-mail: silva.cidalia@courrier.uqam.ca
1
abstract
To overcome their fear, phobic adults are more attracted to a Virtual Reality (VR) exposure-based treat-
JCR
ment than an in vivo exposure-based treatment. Even
if they are born in the technological era, anxious children don’t seem very enthusiastic with idea of using
VR to overcome their anxiety’s problem. For some
phobic children, VR exposure can be apprehended as
a frightening experience. This study examines the difference between children and adults’ perception toward
stimuli used in VR to treat arachnophobia. Expectations of 313 participants aged younger than 18, and
210 aged 18 and older were measured while immersed
in VR just before opening a door that would lead to
an environment used to treat arachnophobia. Results
show a significant difference between children and
adults’ perception toward how large, scary and dangerous the spider would be. Apprehension toward a virtual
rabbit was used as a control variable. The findings are
clinically very important as they suggest that before
using VR to expose a child in therapy, the therapist
should carefully describe the virtual stimuli, a precaution that is not necessary or routinely done with adults.
Keywords: Virtual Reality, Children, Virtual
Phobic Stimuli, Apprehension, Arachnophobia,
Virtual Reality Exposure
introduction
To overcome their fear, phobic adults are more attracted to a Virtual Reality (VR) exposure-based treatment than an in vivo exposure-based treatment. Even
if they are born in the technological era, anxious children don’t seem very enthusiastic with idea of using
VR to overcome their anxiety’s problem. For some
phobic children, VR exposure can be apprehended as
a frightening experience. This study examines the difference between children and adults’ perception toward
stimuli used in VR to treat arachnophobia. Expectations of 313 participants aged younger than 18, and
210 aged 18 and older were measured while immersed
in VR just before opening a door that would lead to
an environment used to treat arachnophobia.
Results show a significant difference between children
and adults’ perception toward how large, scary and
dangerous the spider would be. Apprehension toward
a virtual rabbit was used as a control variable. The
findings are clinically very important as they suggest
that before using VR to expose a child in therapy, the
therapist should carefully describe the virtual stimuli,
a precaution that is not necessary or routinely done
with adults.
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201
Conclusion/discussion
The approach to introducing children to exposure-based
interventions for childhood anxiety is much similar to
what is done with adults, including how to present VRbased treatments [4]. The results of this study show how
children’s perception toward phobic virtual stimuli is
quite different from adults. These results are clinically
important, especially for professionals who might use
VR exposure to treat children anxiety.
A key issue that emerges from this study is the importance of carefully preparing anxious children prior to
VR-based exposure. Knowing that children usually
have a very creative imagination and that anxious children have a greater tendency to anticipate future events
in a negative way [2], restructuring excessive apprehension toward what therapeutic 3-D stimuli entails becomes almost essential since children can be over
apprehensive.
references
[1] Garcia-Palacios, A., Hoffman, H., See, S., Tsai, A.,
& Botella, C. Redefining therapeutic success with virtual reality exposure therapy. CyberPsychology and
Behavior 4 (2001) 341-348.
[2] Muris, Meesters, Smulders, & Mayer, Threat perception distortions and psychopathological symptoms
in typically developing children, Infant and Child Development 14(3),273-285, 2005.
[3] Robillard, G., Bouchard, S. Fournier, T. & Renaud,
P., Anxiety and presence during VR immersion: A
comparative study of the reactions of phobic and nonphobic participants in therapeutic virtual environments
derived
from
computer
games.
CyberPsychology & Behavior 6(5) (2003) 467-476.
[4] St-Jacques, J., Bouchard, S. & Bélanger, C., 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, J Clin Psychiatry. 71(00) (2010), 13
pp.
[5] Vasey, M. & Maxleod, C., Information-processing
Factors in Chilhood Anxiety: A Review and Developmental Perspective in Mark R. Dadds & Michael W.
Vasey, The Developmental Psychopathology of Anxiety, Oxford University Press, New York, 2001.
202
paradigms and phenomenology
of CyberspaCes
interpretations of Virtual reality
Alexander Voiskounskya,1
Psychology Department, Moscow
State University, Russia
a
Alexander Voiskounsky
Psychology Department
Moscow State University
9/11 Mokhovaya St.
Moscow, Russia
E-mail: vae-msu@mail.ru
1
abstract
In this study, university students were surveyed to learn
what they know about Virtual Reality (VR) (N=42). Two
students provided correct explanations and the rest reported examples that were incorrect. All students were
asked what kinds of VR examples they could name. The
number of examples provided by the students differed
from two to eight (median 3.4). Most often the students
cited social networking and Massively Multiplayer Online (MMO) gaming; the least often mentioned examples
were TV, movies, and e-papers.
Keywords: Virtual Reality, Survey Study, University
Students, Interpretation
introduction
The technological and conceptual ideas underlying Virtual
Reality (VR) are not yet widely known, nor is the notion
of “Virtual Reality” universally and correctly comprehended. While this is clear to an observer, the full diversity
of existing interpretations is worth studying. These interpretations need to be collected by administering a survey
of ordinary people; experts are presumed to express less
diverse interpretations of the essence of VR. The latter presumption, though, should be tested as well, and if done,
many professionals are likely to be only minimally astonished to learn that the presumption is incorrect.
The media offers support for both correct interpretations
and misinterpretations. Popular movies are the champions in pushing human beings’ minds in both directions.
Movies, such as “The Matrix” (as well as the “Matrix
Reloaded”) and “Avatar,” are likely to provide both correct and false hints on the nature of VR. The difference
is that “The Matrix” was seen by many viewers who had
rather distant connections with information technologies,
while “Avatar” was seen by a population of viewers, the
majority of who participate in the widespread use of social networks. The role played by movies is not the goal
of the current paper; they are mentioned to note that the
media provides equally helpful support for quite different
views on VR.
The study of College students’
Views on Virtual realities
Popular media, electronic and printed, provides diverse
views on VR: alongside 3-D environments human beings
often tell of video gaming, chatting, sending/receiving
e-mail messages, web navigating, blogging, social networking, etc., as representing VR. The idea of the current
work is to find out what ordinary people believe to belong to the notion of VR. The investigation consists of
surveying university students. It was administered in late
spring, 2010. At that time, the majority of viewers had
had no experience with a purely 3-D environment as exemplified in the movie “Avatar.”
methodology
The participants were 42 university students – 23 females and 19 males, aged 17-24 years old (median 19.8).
Their areas of study include social sciences and humanities (N=24, 14 females and 10 males) or science – mathematics, biology, and geology (N=18, nine females and
nine males).
The participants were asked either one or two questions.
First, “Can you explain what a VR is?” Only two students (males, one mathematician and one biologist) provided a theoretically correct explanation mentioning
slightly differing computer-generated images projected
to either eye/ear, with trackers to trace the human beings’
movements and to pass the information related to movements to the computer to render and change the image.
These two students were then asked to provide examples.
Two more students (females, in humanities) refused to
give any explanation. They were given the second question, “Can you give examples of VR?” The rest, 38 stu-
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dents, started answering the first question by giving examples of VR. They were not asked to answer the second
question; instead, they were encouraged to provide as
many examples as they could. Thus, the second question
was presented to two participants.
results
Forty-two students provided examples of VR. The number of examples provided by participants differed from
two to eight (median=3.4).
–––––––––––––––––––––––––––––––––––––––––––––
Virtual space and human self problems and solutions for the self in
the Virtual space
Iva Georgievaa,1
Department of Philosophy and History of Science,
Graduate School of Arts and Sciences,
The University of Tokyo, Japan
a
Iva Georgieva
Department of Philosophy and History of Science
Graduate School of Arts and Sciences
The University of Tokyo
153-8002 Tokyo
3-8-1 Komaba, Meguro-ku
Japan
E-mail: cc097920@mail.ecc.u-tokyo.ac.jp
1
abstract
In the exploration of a person's self-image in the Internet it seems that there is one representing profile. But
is it actually coherent with the real self? Where do the
problematic cases and diseases start? Today we are
able to perform counseling and therapeutic practices,
we can affect and change the human self and mind set
in virtual spaces. Using the connection between neuroscience and philosophy, it is possible to show that
there are different forms of the self which people adopt
in cyber space. By showing how their disposition
changes online many questions can be answered. What
mind state provokes addictive impulses and at the
same time enables treatment therapy? How does the
sense and concept of reality change? Can we transfer
the experiences we have gained in the virtual space in
real life? By investigating how the virtual affects our
perceptions in a positive or negative way, support to a
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203
successful treatment application is possible. The goal
of this study is to find answers for the virtual space
usage as a treatment tool and to see what the future is
for such a therapeutic tendency.
Keywords: Virtual Space, Virtual Self, Therapy,
Counseling, Treatment, Addiction
introduction
This study uses a theoretical approach for investigating
the self in the virtual space and suggests this self-representation can be summarized in one term – the virtual
self. The virtual self itself presents some differences in
reality experiences in real life and the virtual space. I propose a hypothesis about the different types of the virtual
self: a self similar to the real self, a self different from
the real self, or an addicted person's self. From those distinct types many ethical issues arise (e.g., deviant behavior and crime). Moreover, the different and the addicted
self can show that the self experiences and uses the virtual space in a very unique way. I claim that the same situation enables the virtual space to become an application
tool for treatment. This is possible due to the perception
of easiness and freedom that is typical for that space and
more importantly, due to the specific process of transferring of experiences in real life.
method
With methods from the philosophy of neuroscience, I analyze the three types of the self and connect them with
empirical investigations of the effects of the virtual
space. The change occurring in online identity affects
both the virtual and the real self. I investigate the results
of counseling practices with technologies like fMRI and
BMI. The research starts from findings about self-identity and counseling [1] and explores cybertherapy works
[2, 3]. Summarizing those methods, an assumption is
made: the real selves change in real life due to experiences as virtual selves in the virtual space. This can help
to understand how reality is perceived so that the polar
cases can be explained.
results
Many problems connected to the self occur in the virtual
space – information overload, attention problems, addictive behavior, identity thefts and virtual rapes. They affect real life and the real persona. If the virtual identity
transforms in the virtual space, this affects the real self
(for example, in the form of crimes). Counseling and
therapeutic practices are enabled by the exact same prin-
204
ciple of self-change in both spaces. Theoretically, the
same issues that arise in the virtual space can be solved
in it. The exploration of the mind's works shows why
there is the "attachment" to the virtual realm. Experiences in the virtual space can affect our real life and this
grants the possibility of a positive effect on the self. The
perception of reality and mental states are investigated
in order to support the treatment application of the virtual
space. In conclusion, this happens because of the transfer
of the experience, a claim supporting the therapeutic possibilities in the different spaces.
future applications
The history of therapeutic tendency in virtual environments starts from online advice in self-support discussions. But seeking the necessity of professional medical
therapy and exploring how the mind works we can address not only the issues about multiple personalities or
dissociation [4] of the human self identity today but also
to prove that therapeutic result can be made in the virtual
space. By applying neuroscience and by creating the
model of the three types of the self in the virtual space,
an analysis of the treatment tool practices gives additional support for this. The possibility for positive results
in therapy can be multiplied by further research in the
same direction.
references
[1] S. Turkle, Life on the screen: Identity in the age of
the Internet, Simon & Schuster, New York, 1995.
[2] B. K. Wiederhold and M. D. Wiederhold, Virtual reality with fMRI: a breakthrough cognitive treatment tool,
Virtual Reality 12 (2008), 259–267.
[3] P. Mitchell, S. Parsons, and A. Leonard, Using virtual environments for teaching social understanding to
6 adolescents with autistic spectrum disorders, Journal
of Autism and Development Disorders 37 (2007), 589–
600.
[4] J. Kokswijk, Digital ego: Social and legal aspects of
virtual identity, Eburon Academic Publishers, Eindhoven, 2007.
–––––––––––––––––––––––––––––––––––––––––––––
presence, actions and emotions:
a Theoretical framework
Giuseppe Rivaa,b,1
b
Psychology Department, Catholic
University of Milan, Italy
a
Giuseppe Riva
Milan 20149
Italy
E-mail: giuseppe.riva@unicatt.it
1
abstract
As commented on by Biocca [1], and supported by most
researchers in the area, ‘‘While the design of Virtual Reality (VR) technology has brought the theoretical issue
of presence to the fore, few theorists argue that the experience of presence suddenly emerged with the arrival
of VR” (p. 121). So, what is presence? And what is its
possible impact in cybertherapy? For instance, does a
strong sense of presence cause patients to better engage
and modify emotions and cognitive processes they have
already developed in a real environment? Will the skills
and the competences acquired in the virtual world transfer to a corresponding real life experience? The following presentation will try to provide some answers to
these questions using the outcomes of different controlled studies, with both patients and VR users.
Keywords: Virtual Reality, Assessment, Therapy,
NeuroVR, Open Source
introduction
The term ‘‘presence’’ entered into the wide scientific debate in 1992 when Sheridan and Furness used it in the
title of a new journal dedicated to the study of Virtual
Reality (VR) systems and teleoperations: Presence, Teleoperators and Virtual Environments (VEs).
In the first issue, Sheridan [2] clearly refers to presence
as an experience elicited by technology: the effect felt
when controlling real world objects remotely, as well as
the effect people feel when they interact with and immerse themselves in VEs.
However, as commented on by Biocca [1], and supported
by most researchers in the area, ‘‘While the design of VR
technology has brought the theoretical issue of presence
to the fore, few theorists argue that the experience of
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205
presence suddenly emerged with the arrival of VR’’ (p.
121). So, what is presence? And what is its possible impact in cybertherapy?
[3] G. Riva, J.A. Waterworth, E.L. Waterworth, and F.
Mantovani, From intention to action: The role of presence, New Ideas in Psychology 29 (2011), 24-37.
presence as a Cognitive process
To address these questions, a growing group of researchers is considering presence as “Inner Presence,”
the feeling of being located in a perceived external world
around the self [3-6]. In this view, presence is a broad
psychological phenomenon, not necessarily linked to the
experience of a medium, whose goal is the control of the
individual and social activity. Specifically, in the following presentation we will try to justify and discuss the
broad statements, below, using the outcomes of different
experimental clinical and nonclinical studies [7-10]:
[4] G. Riva, Is presence a technology issue? Some insights from cognitive sciences Virtual Reality 13 (2009),
59-69.
• The content of consciousness is the content of a simulated world in our brain;
• Presence refers to the part of the contents of consciousness that relate to the current time and place in which the
body is located;
• The psychology of presence is related to human action
and its organization in the environment;
• The feeling of presence is not the same in all situations
(virtual or real), but can be different in relation to the
characteristics of the physical, social and cultural space
the subject is in;
• A circular interaction exists between presence and
emotions: on one side, the feeling of presence is greater
in “emotion-inducing” environments; on the other side,
the emotional state is influenced by the level of presence;
• Presence alone is not enough to guarantee a positive
clinical outcome in VR exposure therapy: the technology
behind the virtual stimuli has to be “transparent” enough
to enable the activation of the fear structure. Once this
threshold is passed, there is no direct effect of the level
of presence on the efficacy of desensitization.
references
[1] F. Biocca, The Cyborg's Dilemma: Progressive embodiment in virtual environments, in: Humane interfaces: questions of method and practice in cognitive
technology, J.P. Marsh, B. Gorayska, and J.L. Mey,
eds., Elsevier, Amsterdam, The Netherlands, 1999, pp.
113-142.
[2] T.B. Sheridan, Musing on telepresence and virtual
presence, Presence, Teleoperators, and Virtual Environments 1 (1992), 120-125.
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[5] J.A. Waterworth, E.L. Waterworth, F. Mantovani, and
G. Riva, On Feeling (the) Present: An evolutionary account of the sense of presence in physical and electronically-mediated environments, Journal of Consciousness
Studies 17 (2010), 167-178.
[6] A. Revonsuo, Inner Presence, Consciousness as a Biological Phenomenon, MIT Press, Cambridge, MA, 2006.
[7] S. Cote and S. Bouchard, Cognitive mechanisms underlying virtual reality exposure, Cyberpsychol Behav 12
(2009), 121-129.
[8] A. Gorini, E. Griez, A. Petrova, and G. Riva, Assessment of the emotional responses produced by exposure
to real food, virtual food and photographs of food in patients affected by eating disorders, Ann Gen Psychiatry 9
(2010), 30. Online: http://www.annals-general-psychiatry.com/content/39/31/30.
[9] A. Gorini, C.S. Capideville, G. De Leo, F. Mantovani,
and G. Riva, The Role of Immersion and Narrative in Mediated Presence: The Virtual Hospital Experience, Cyberpsychology, Behavior and Social Networks (2010),
DOI: 10.1089/cyber.2010.0100.
[10] G.M. Manzoni, F. Pagnini, A. Gorini, A. Preziosa,
G. Castelnuovo, E. Molinari, and G. Riva, Can relaxation
training reduce emotional eating in women with obesity?
An exploratory study with 3 months of follow-up, Journal
of American Dietetic Association 109 (2009), 1427-1432.
–––––––––––––––––––––––––––––––––––––––––––––
between Cyberplace and Cyberspace: The
researcher role in Virtual setting research
Carlo Galimbertia,1, Matteo Cantamessea
and Eleonora Brivioa
a
Università Cattolica del Sacro Cuore
Comunicazione, Milano, Italy
206
Carlo Galimberti
Comunicazione
via Nirone 15
Milan 20123
Italy
E-mail: carlo.galimberti@unicatt.it
1
abstract
Disciplines such as Internet Research, the Psychology of
Cyberspace and the Social Psychology of Cyberplaces
call for an epistemological reflection not merely on the
universe of objects they deal with, but also, and perhaps
especially, on the research settings used to investigate
them. With this work, we intend to make a contribution
to the debate on three issues: psychosocial interpretation
of the new environments, the “mediated” nature of the
researcher-setting-study object relationship, and cyberplaces as settings for mediated interaction research.
Keywords: Videogame, Interaction,
Social Network, Identity
introduction
Disciplines such as Internet Research, the Psychology of
Cyberspace [1] and the Social Psychology of Cyberplaces [2] call for an epistemological reflection not
merely on the universe of objects they deal with, but also,
and perhaps especially, on the research settings used to
investigate them. As pointed out by Blascovich et al.
back in 2002, virtual environments give social psychologists the opportunity to build a third place – besides the
“laboratory” and “field” – in which to conduct their research [3]. This third place is a very unusual research setting, characterized by particular elements and specific
issues. For example, this “new opportunity” has to come
to terms with the way in which the conventional approaches to the study of new media, within the theoretical horizon of CMC, used to represent the researcher,
considering him to be “external” to the media environments, and, similarly, with the role attributed to new
technologies, considered solely as tools for planning and
managing experimental situations that were strongly
characterized in terms of controlled artificiality.
More recently, with the consolidation of approaches akin
to ethnology and anthropology (such as netnography),
there has been a tendency to think of the researcher as
being hidden by these new technologies, thus, eliminating his potential meddling in the data production process.
methodological issues
Here, we consider some of the aspects that the assumption in critical terms of the new settings for mediated interaction research inevitably entails.
a) A more markedly psychosocial interpretation of the
new environments with varying degrees of virtuality requires a shift in emphasis: rather than cyberspace – intended as a set of tools that allows the Internet to function
– it urges us to consider them as cyberplaces, recognizing
in them the co-construction of meanings and management of the interactions between those who act inside
them, thus, considering them contexts in which the construction of intersubjectivity occurs partly in the same
way as in face-to-face social spaces [2], and partly according to processes that are yet to be explained.
b) We recognize the “mediated” nature of the researchersetting-study object relationship, which requires a reflection on the ways in which it “immerses” into the
medium. For example, one recent study focusing on user
dynamics in Massive Multiplayer Online Role Playing
Games (MMORPG) in school contexts, conducted by
one of the authors, highlighted how the researcher, in
order to observe, in order to understand and interpret the
alternating in-game/out-game processes or group dynamics, had to actively “immerse” himself in the environment, considered not merely as a setting useful to the
organization of a complex trial design, but rather as an
environment to “be inhabited” and that is anything but
easily controlled, in which the “here and now” of the
events could not be reduced to action tracking, the simple
recording of discursive, exploratory, competitive or play
activities.
c) Considering the settings for mediated interaction research such as cyberplaces leads us to reflect on two
questions. The first concerns the consequences the symbolic aspects of the new media will have on the research.
For instance, to what extent does the symbolic load of a
social network or a Virtual Reality (VR) environment
“weigh” on the narrations produced/co-produced by the
individuals and groups interviewed and on their mediated interactions? Secondly, we need to further explore
the network of relationships between the (cyber)places
investigated and unmediated reality, to grasp implications and mutual contaminations. Indeed, it is not un-
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usual for those who study these new settings to encounter
reluctance and refusal, based on questions “external” to
the environment forming the object of the study, or
“transverse” to numerous environments, for example, of
an organizational or institutional nature, as we saw in a
recent study on the integration of web 2.0 tools in the
banking and insurances sectors.
Conclusion
With this work, we intend to make a contribution to the
debate on the three areas outlined above, using our recent
experiences in mediated interaction research, along the
lines of thought that can be summarized by the following
three questions: a) Is it useful to analyze the psychosocial
dimension of mediated interaction research settings? If
so, on which variables is it worth concentrating our attention? b) What weight do the modalities of the researcher’s presence in the cyberplace(s) being studied
have on the data production and analysis processes? c)
What is the role of the symbolic dimension in the narra-
207
tions proposed by the subjects participating in the study
and of the pragmatic dimension on the assimilation
processes of the results obtained?
references
[1] A. Barak, J. Suler, “Reflections on the psychology
and social science of cyberspace.” In Psychological aspects of cyberspace: Theory, research, applications, edited by A Barak. Cambridge University Press, 2008.
[2] C. Galimberti, “Segui il coniglio bianco. Strategie
identitarie e costruzione della soggettività nelle interazioni mediate.” In Identità in relazione. Le sfide odierne
dell’essere adulto, edited by C. Regalia and E. Marta,
Milano: McGraw Hill, (2010), 73-127.
[3] J. Blascovich, J. Loomis, A. Beall, K. Swinth, C.
Hoyt, and J. N. Bailenson. “Immersive virtual environment technology as a methodological tool for social psychology.” Psychological Inquiry 13 (2002): 103-124.
posTTraumaTiC sTress disorder:
preVenTion and neW TreaTmenT Tools
startle reactivity in acute stress disorder and
posttraumatic stress disorder
Dragica Kozarić-Kovačića,1, Andrea Jambrošić
Sakomana and Tanja Jovanovicb
Referral Centre for Stress Related Disorders of the
Ministry of Health and Social Welfare of the Republic
of Croatia, Department of Psychiatry, University
Hospital Dubrava, Zagreb, Croatia
b
Department of Psychiatry and Behavioral Sciences,
Emory University School of Medicine,
Atlanta, GA, USA
a
Dragica Kozarić-Kovačić
University Hospital Dubrava
Avenija Gojka Suska 6
Zagreb, Croatia
E-mail: dkozaric_kovacic@yahoo.com
1
abstract
The study presents preliminary psychophysiological data
analyses from 16 individuals (10 women and six men)
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with acute stress disorder (ASD) within one month and
six months after trauma experience. Half of the participants met criteria for posttraumatic stress disorder
(PTSD) after six months. Psychophysiological parameters can provide better clarification between ASD and
PTSD patients. Heightened startle magnitude in the immediate aftermath of trauma may be a good predictor of
PTSD; moreover, a lack of startle habituation appears to
be a more stable marker of PTSD, which persists for six
months after trauma exposure.
Keywords: Acute Stress Disorder,
Posttraumatic Stress Disorder, Psychophysiology,
Startle Response, Electromyogram,
Electrodermal Activity, Electrocardiogram
Activity, Heart Rate
introduction
Exaggerated startle responses are among the diagnostic
criteria shared by acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). The acoustic startle reflex is one of the startle responses that is typically
measured in the laboratory with sudden, high-intensity
tones used as startle stimuli delivered through head-
208
phones. The startle reflex is considered to be a sensitive
measure of individual differences in emotional reactivity
[1]. Startle reactivity measures include the magnitude
of the orbicularis muscle electromyogram (EMG), heart
rate (HR) and skin conductance (SC) responses.
Startle reactivity in ASD patients has not been sufficiently investigated, while studies of startle reactivity in
PTSD patients have frequently reported exaggerated
startle reactions. For PTSD patients, findings of EMG
startle responses were less consistent than those of HR
and SC measures [2]. One study found elevated eye blink
EMG in patients suffering from PTSD, but not ASD [3].
Another study found that pre-trauma SC responses to
startle stimuli could support the biological models of the
acute arousal and its relation to development of PTSD
[4]. Some of the studies have found larger eye blink
EMG, SC response magnitudes, and slower habituation
rates to startle stimuli in PTSD patients [5, 6].
Some authors suggest that results of startle reactivity
shown by the studies of PTSD patients may serve as a
vulnerability marker for the development of anxiety disorders [7].
Studies of ASD add to our knowledge of PTSD and its
underlying neurobiology, as well as describe protective
factors in the aftermath of trauma.
aim
The aim of this study is to prospectively examine the
psychophysiological responses in patients diagnosed
with ASD after experiencing a traffic accident or violent
attack.
The first evaluation was done within the first month after
a traumatic experience, the second assessment was done
six months later, and the third assessment was done after
12 months.
(MINI) [9], Acute Stress Disorder Structured Interview
(ASDI) [10], and Clinician Administered PTSD Scale
(CAPS) [11]. Dissociative experiences were evaluated
using The Dissociative Experience Scale [12] and The
Peritraumatic Dissociative Experiences Questionnaire
[13]. The Biopac MP150 system (Biopac Systems, Inc.,
Aero Camino, CA.) was used for psychophysiology
recording.
results
Preliminary data analyses from 16 individuals (10
women and six men) immediately after trauma and six
months after trauma indicate that 50% met criteria for
PTSD after six months. Mean age of ASD participants
was 46.1± 11.35 years.
The eight participants who developed PTSD did not differ in age or gender from the eight that did not. However, when first tested for startle reactivity, those who
later developed PTSD had a significantly higher startle
magnitude (M=129.02, SE=27.00 µV) compared to
those whose condition improved (M=27.12, SE=8.24
µV), F (1, 14)=13.03, p=0.003. Moreover, only those
that improved showed significant startle habituation
over the seven startle probes, linear trend F (1, 7)=6.38,
p=0.04.
When re-tested after six months, average startle magnitude no longer differed between groups, F (1, 14)=0.66,
p>0.1, due to a reduction in the startle magnitude in
PTSD participants over time. However, a lack of habituation was still present in the PTSD subjects, as only
those who had improved after six months showed significant startle habituation at this time point as well, linear trend F (1, 7)=9.80, p=0.02.
EMG activity, electrodermal activity (EDA), electrocardiogram activity (ECG), and respiration were recorded
at baseline and during a startle procedure in follow-up
study design.
Conclusion
Psychophysiological parameters can provide better clarification between ASD and PTSD patients. Heightened
startle magnitude in the immediate aftermath of trauma
may be a good predictor of PTSD; moreover, a lack of
startle habituation appears to be a more stable marker
of PTSD, which persists for six months after trauma exposure.
methods and participants
We used the same battery of scales and diagnostic procedures as we have previously reported [8]. Psychiatric
disorders were assessed by administrating the Mini International Neuropsychiatric Interview, Croatian version
Acknowledgments
This research was supported by the Ministry of Science
and Technology of the Republic of Croatia, in the project: Psychophysiological diagnostics of the stress related
disorders (198-0982522-0075).
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209
references
[1] D. Cicchetti, D. J. Cohen, eds, Developmental psychopathology, 2nd edition, Wiley, 2006.
tered PTSD Scale (CAPS), National Center for PostTraumatic Stress Disorder, Behavioral Science Division,
Boston, 1990.
[2] N. Pole, The psychophysiology of posttraumatic
stress disorder: a meta-analysis. Psychol Bull, 133
(2007), 725-746.
[12] E.M Bernstein, F.W. Putnam, Development, reliability, and validity of a dissociation scale, J Nerv Ment
Dis, 174 (1986), 727-735.
[3] K. Elsesser, G. Sartory, A. Tackenberg, Attention,
heart Rate, and startle responce during exposure to
trauma relevant pictures: A comparison of recent trauma
victims and patients with Posttraumatic Stress Disorder,
J Abnorm Psychol, 113 (2004), 289-301.
[13] C. R. Marmar, D. S Weiss, T. J. Metzler, The peritraumatic dissociative experiences questionnaire. In: Assessing psychological trauma and PTSD, J. P. Wilson and
T. M. Keane, eds, Guilford Press, New York, 1997.
[4] R. M. Guthrie, R. A. Bryant, Auditory startle response in firefighters before and after trauma exposure,
Am J Psychiatry, 162 (2005), 283-290.
[5] A. Y. Shalev, T. Peri, D. Brandes, S. Freedman, S. P.
Orr, R. K. Pitman, Auditory startle response in trauma
survivors with posttraumatic stress disorder: a prospective study, Am J Psychiatry, 157 (2000), 255–261.
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enhancing stress management skills in military
personnel using biofeedback and immersion in a
stressful Videogame: a randomized Control Trial
François Berniera,1, Stéphane Bouchardb, Geneviève
Robillardb, Brian Morinc and Hélène Forgetb
Defence R&D Canada – Valcartier
c
Clinique de Psychologie Cognitive
a
b
[6] L. J. Metzger, S. P. Orr, N. J. Berry, C. E. Ahern, N.
B. Lasko, R. K. Pitman, Physiologic reactivity to startling tones in women with posttraumatic stress disorder,
J Abnorm Psychol, 108 (1999), 347–352.
[7] C. Grillon, Startle reactivity and anxiety disorders:
Aversive conditioning, Context, and Neurobiology, Biol
Psychiatry, 52 (2002), 958-975.
[8] D. Kozarić-Kovačić, A. Jambrošić Sakoman, T. Jovanovic, G. Milas. Psychophysiological indicators of
acute stress disorder. Stud Health Technol Inform, 154
(2010):185-189.
[9] Y. Lecrubier, E. Weiller, T. Hergueta, P. Amorim, L.
I. Bonora, J. P. Lépine, D. Sheehan, J. Janavs, R. Baker,
R. K. Sheehan, K. Knapp, M. Sheehan, Mini international neuropsychiatric Interview (MINI). Croatian version 5.0.0 /DSM-IV/ current, August 1998. Croatian
translation: N. Henigsberg, 2006.
[10] R. A. Bryant, M. L. Moulds, R. M. Guthrie, Acute
Stress Disorder scale: A self-report measure of Acute Stress
Disorder, Psychological Assessment, 12 (2000), 61-68.
[11] D. Blake, F. Weathers, L. Nagy, D. Kaloupek, G.
Klauminzer, D. Charney, T. Keane, Clinician-Adminis-
JCR
1
François Bernier
Defence R&D Canada – Valcartier
2459 boul. Pie-XI Nord
Québec G3J 1X5
Canada
E-mail: Francois.Bernier@drdc-rddc.gc.ca
abstract
This study assessed the efficacy of using visual and auditory biofeedback while immersed in a 3-D videogame
to practice a stress management skill (tactical breathing).
All 41 participants were soldiers who had previously received basic stress management training and first aid
training in combat. On the first day, they received a 15minute refresher briefing and were randomly assigned to
either: (a) no additional SMT training for three days; or
(b) 30-minute sessions (one per day for three days) of
biofeedback-assisted SMT while immersed in a
horror/first-person shooter game. The training was performed in a dark and enclosed environment using a 50inch TV with active stereoscopic display and
loudspeakers. On the last day, all participants underwent
a live simulated ambush with an improvised explosive
device, where they had to provide first aid to a wounded
210
soldier. Stress levels were measured with heart rate at
baseline, during an apprehension phase, and during the
live simulation. Stress was also measured with salivary
cortisol collected when waking-up, before and after the
live simulation. Repeated-measure ANOVAs and ANCOVAs confirmed that practicing SMT was effective in
reducing stress. Results are discussed in terms of a “buyin” factor facilitating the practice of SMT in soldiers.
Keywords: Stress Management Training,
Soldiers, 3-D Games, Biofeedback, Posttraumatic
Stress Disorder, Games for Health, Cortisol, Heart Rate
Author Note: The opinions expressed in the publication
reflect the opinion of the author and do not necessarily
represent the opinion of the Canadian Forces or the Department of National Defence.
introduction
Exposure to combat in theater of operations is associated with a high risk of developing posttraumatic stress
disorder. As a consequence, there is an increase in interest toward the development of emotion regulation
skills that foster resilience [1]. Stress management
training (SMT) has been shown to be effective to reduce stress [2] and tactical breathing [3] is frequently
taught to soldiers. Although preliminary data from the
few available programs are somewhat encouraging,
they are confronted with significant adherence problems. Practicing SMT is a challenge for people involved in a culture where virility and an “Army Strong”
mentality prevail. In addition, it requires the trainers to
stress the soldiers so they can practice the necessary
coping skills. The efficiency of horror/first-person
shooter games to induce enough stress to practice SMT
has been shown in a previous study [4]. The aim of the
current study was to confirm that practicing SMT
would increase the efficiency of “training as usual” offered to military personnel.
method
After a 15-minute refresher briefing on SMT and tactical
breathing, 41 soldiers were randomly assigned to either:
(a) a “training as usual” control (TAU-Control) condition
where no session of supervised practice was offered to
soldiers; or (b) a practice condition (Practice) where
three daily sessions were offered to practice SMT while
using biofeedback to inform the participant on current
level of arousal and while being immersed in a 3-D game
to induce stress.
The training program required participants to wear a ProComp Infinity system monitoring their heart rate and
skin conductance while playing a modified version of
the game Left 4 Dead for 30 minutes. By referring to a
two-minute baseline recorded while loading the game,
both physiological parameters were integrated to provide
visual (increasingly opaque red filter masking the visual
display) and audio (heart rate) feedback. A coach assisted
the participants in noticing their signs of stress, learning
to apply tactical breathing and mastering this skill while
being more involved in the 3-D game. The coach could
also adjust “on the fly” the sensitivity of the feedback
and the relative weight of the heart rate versus the skin
conductance, as well as modify the baseline level in
order to maximize the chances that participants could
benefit from the biofeedback. On day five, all participants were subjected to a simulated ambush with an improvised explosive device where they had to provide first
aid to a wounded soldier (live actor).
The dependent measures in this study were stress levels
measured using heart rate and salivary cortisol. Heart
rate was recorded continuously with a wireless ProComp
Infinity and a Polar belt during three phases: (a) baseline;(b) apprehension (i.e., when receiving their mission
and when waiting to move to the ambush situation); and
(c) during the simulation (i.e., when providing first aid
and when a second bomb exploded). Cortisol was measured when waking-up in the morning, at the baseline and
after the simulation. Two advantages of the cortisol
measure were that it was not influenced by the physical
efforts of performing first aid and it allowed using heart
rate during the simulation as a covariable.
results
Participants in both conditions did not differ significantly
on descriptive variables such as age, rank, previous exposure to combat, etc. A first repeated measure ANOVA
comparing heartrate during the baseline to the apprehension level revealed a statistically significant difference
between participants favoring the Practice condition over
the increase in the TAU-Control condition. The second
repeated measures ANOVA comparing heart rate levels
during the simulation and the baseline revealed a significant increase that was similar in both conditions. A 2
Times (pre/post) by 2 Conditions (TAU-Control/Practice) repeated measure ANCOVA for cortisol levels with
morning level and maximum heart rate during the simulation as covariables revealed a statistically significant
interaction. Participants who could practice SMT in the
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211
Katharine C. Searsa,1, Raymond C. Rosenb, Josef I.
Ruzeka, Donn W. Garverta, Lauren D. Smithb, Lisa D.
Marceaub, Mary Jo Larsenc and Brett Litzd
stressful immersions were less stressed by the live simulation than those who received the training as usual.
Conclusion
There is a growing interest in the military about resilience
and the development of emotion regulation skills. However, it is doubtful that limiting the training of military
personnel to teaching SMT in a classroom would be sufficient to result in significant mastery of the techniques.
Practice is essential; yet, it may be insufficient unless
there is objective information about the level of arousal
and the immediate impact of the technique. The immersion in a stressful game, coupled with biofeedback, has
the advantages of inducing enough stress to practice SMT
and enough feedback to allow soldiers to master the technique and increase their perceived self-efficacy. Therefore, the most significant advantage of the immersion
probably rests on the fact that playing videogames has a
strong “buy-in” value: it is more likely to be accepted by
soldiers than simply practicing techniques that may be
considered “too feminine for a real man” [5].
references
[1] Casey Jr., G. W. (2011). Comprehensive soldier fitness. A vision for psychological resilience in the U.S.
Army. American Psychologist, 66 (1), 1-3.
[2] Bouchard, S., Bernier, F., Boivin, E., & Robillard, G.
(submitted). Modes of immersion and stress induced by
commercial (off-the-shelf) 3D games.
[3] Grossman, D., & Christensen, L. W. (2008). On combat. The psychology and physiology of deadly conflict
in war and in peace, 3rd edition. Warrior Science Publications.
[4] Bouchard, S., Guitard, T., Bernier, F., Dumoulin, S.,
& Boulanger, J. (submitted). The potential of stress management training as a coping strategy for stressors experienced in theater of operation: A systematic review.
[5] Wexler, D. B. (2009). Men in therapy. New approaches for effective treatment. New York: W. W. Norton & Co.
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internet-based Cognitive behavioral Therapy
skills Training for Clinicians: Content
development, participant feedback
and future directions
JCR
United States Department of Veterans Affairs
National Center for PTSD, Dissemination &
Training Division, Menlo Park, CA
b
New England Research Institutes
c
The Heller School, Brandeis University
d
Department of Psychology, Boston University
a
Katharine C. Sears
VA National Center for PTSD
795 Willow Road, Menlo Park
California 94025
USA
E-mail: Katharine.sears@va.gov
1
abstract
In recent years, a wide range of new technologies (e.g.,
video teleconferencing, Virtual Reality, internet-based
interventions) have been applied to the field of mental
and behavioral health, with positive outcomes. The current study is a randomized controlled trial of web-based
clinical skills training for therapists and counselors (n
= 168) who treat Veterans with Posttraumatic Stress
Disorder (PTSD). Participants were randomized into
one of three arms: 1) control; 2) web training; or 3) web
training plus follow-up telephone consultation. Participants in the “web training” and “web plus” groups
were exposed to three 2 hour interactive online training
modules that teach core elements of Cognitive Behavioral Therapy (CBT). Participants were asked to login
during their free time to take the self-paced trainings
and had access to the site throughout the remainder of
the study period, except during assessment intervals.
Participants in the “web plus” condition then received
five weeks of post training telephone consultation. All
participants were evaluated on skill performance (via
simulated interview) and clinical knowledge at pre and
post. Data collection is complete and preliminary results will be presented along with a discussion of web
module development, strengths and weaknesses of the
interactive training, and special considerations regarding follow-up telephone consultation for web-trained
skills.
Keywords: Online, Training, Cognitive Behavioral
Therapy, Posttraumatic Stress Disorder
212
introduction
In recent years, a wide range of new technologies (e.g.,
video teleconferencing, Virtual Reality, internet-based
interventions) have been applied within the field of mental and behavioral health, with positive outcomes [1].
Also within these fields, the dissemination of evidencebased treatments has been identified as a high priority
area [2,3]. Web and other communications technologies
have the potential to revolutionize the way that we approach training and dissemination in the behavioral sciences. The current study is a randomized controlled trial
of web-based clinical skills training, for therapists and
counselors (n = 168) who treat Veterans with Posttraumatic Stress Disorder (PTSD).
method
We recruited psychologists, psychiatrists, clinical nurse
specialists, and rehabilitation counselors working in a
variety of treatment settings within the Veterans Affairs
(VA) system. Participants were randomized into one of
three arms: 1) control; 2) web training; or 3) web training
plus follow-up telephone consultation. Control participants were assessed at pre and post and did not receive
any online training intervention. Participants in training
groups were exposed to three 2-hour interactive online
training modules focused on three core CBT skills: motivational interviewing; goal setting; and behavioral task
assignment.
Modules were designed to be maximally interactive
within cost limitations. Each one included printable
handouts, audio examples, interactive exercises for each
skill, and figures/diagrams to supplement text and audio
descriptions. Modules were designed to be sequential
pages with “back” and “forward” capabilities. Participants were asked to login during their free time to take
the self-paced trainings anytime during the four week
training interval. Participants in the “web plus” condition
also received five weeks of post training telephone consultation, in which consultants adhered to a protocol developed directly from the online content.
results
Participants in all three arms were evaluated on skill performance, clinical knowledge, self-efficacy, self-delivery
of skills, and relevant covariates (e.g., organizational barriers, attitudes towards CBT) at pre and post. Knowledge, self-efficacy, attitudes, and covariates were
assessed via online questionnaires and clinical skills performance was evaluated via telephone-based simulated
patient interviews. A performance rating scale and coding manual were developed for the interviews, and research staff trained six expert raters to evaluate
transcripts of participant performance. Data also include
participant feedback about web module design and perceived efficacy of the trainings to meet learning objectives.
Conclusion
The current paper will discuss preliminary findings (e.g.,
knowledge changes) and feedback data about the
strengths and weaknesses of online training and telephone consultation, aiming to address the following
questions: how can course content and multimedia display be manipulated to maximize learning?; what are
some potential strengths and weaknesses of this method
for training mental health providers?; how can followup consultation be designed to best compliment online
learning?
references
[1] Cucciare, M.A. & Weingardt, K.R. Using technology
to support evidence-based behavioral health practices.
Routledge, New York, 2010.
[2] McHugh, R.D. & Barlow, D.H. The dissemination
and implementation of evidence-based psychological
treatments: A review of current efforts. American Psychologist 65 (2010), 73–84.
[3] Ruzek, J.I. & Rosen, R.C. Disseminating evidencebased treatments for PTSD in organizational settings: A
high priority focus area. Behavior Research and Therapy
47 (2009), 980–989.
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military motion-based memory desensitization
and reprocessing (3mdr): a novel Treatment for
posttraumatic stress disorder – proof of Concept
Agali Merta,1 and Eric Vermettenb
National Military Rehabilitation Center Aardenburg,
Doorn, The Netherlands
b
Military Mental Health Research, Utrecht,
The Netherlands
a
Agali Mert
Korte Molenweg 3, Postbus 185
1
JCR
3940 AD, Doorn
The Netherlands
E-mail: a.mert@mrcdoorn.nl
abstract
Introduction: The dual task processing in eye movement
desensitization and reprocessing (EMDR) has proven effective for the treatment of deployment related posttraumatic stress disorder (PTSD). The procedure is typically
performed in a sedentary condition with imaginary exposure conditions. Therapeutic adherence has been reported
as a problem in military populations, compromising treatment efficacy. We aimed at designing a treatment procedure that preserved the dual task processing principle, yet
introduced new engagement by performing the desensitization during motion, by walking on a treadmill. Moreover, we aimed at exposure to real high affect pictures of
deployment setting. Our objective was to design a modified EMDR procedure for deployment related PTSD
using motion-based memory reprocessing with Virtual
Reality (VR).
Method: We designed a treatment based on the 6-DoF motion base of the Computer Assisted Rehabilitation Environment (CAREN) facility. This added to regular therapy
physical (walking) elements, virtuality with visual (pictures/words with 180deg field of vision) and auditory
(Dolby surround). Subjects walked a repetitive cycle while
walking and viewing high affect pictures of deployment
scenes. Dual task processing was maintained by an oscillating ball. Aspects of presence were adhered to, in order
to maximize possible positive outcome.
Results/Conclusions: The proof of concept will be presented with preliminary results on efficacy and therapeutic
adherence.
Keywords: Eye Movement Desensitization and
Reprocessing, Posttraumatic Stress Disorder,
Virtual Reality, Military
introduction
Deployment related posttraumatic stress disorder
(PTSD) is a chronic disabling disorder, causing functional disability and mental suffering. Contemporary and
effective interventions for PTSD are cognitive behavioral
therapy (CBT) and eye movement desensitization and
reprocessing (EMDR) [1]. EMDR has seen a rapid
breakthrough in the last decade and has proven to be effective for its treatment and can result in the resolution
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213
of the condition. Both are based on exposure as a guiding
principle for therapeutic efficacy. Exposure can be offered with imagery, graded, prolonged and Virtual Reality (VR) procedures. Typically six to eight sessions
should be sufficient to achieve symptom improvement.
PTSD in military personnel is characterized by the frequent co-occurrence of other psychiatric problems and
physical complaints. Typically, military personnel present with complex PTSD, in part due to a delayed presentation. Therefore, additional assessments as well as
interventions that are beyond the scope of conventional
civilian PTSD are needed.
EMDR is a form of imaginal exposure accompanied by
typical saccadic eye movements. It is conducted by having the patient focus on a disturbing image with high affect or memory, while the therapist moves a finger across
the patient's visual field. The high affect picture will activate the memory network. Following the finger serves
as a distractor task that enables desensitization of the disturbing memory. The saccadic eye movements result
from the patient tracking the therapist's finger. It is a general thought that EMDR is based on the principle of dual
task processing – involvement in a high affect task
(viewing emotional pictures) while performing a distraction task (watching a finger/ball that moves in an oscillating way, either on a display or, in the case of a finger
from left to right in front of the patient’s eyes). Since its
inception, EMDR has been the focus of much controversy, but in the last decade it has resulted in a breakthrough in the treatment of PTSD. In some studies,
prolonged exposure and EMDR did not differ significantly for change from baseline to either posttreatment
or follow-up measurement for any quantitative scale.
EMDR is typically performed in a sedentary position, as
most psychotherapeutic treatments are.
While CBT and EMDR are the most effective treatments
currently available for PTSD, and phase orientation is
recognized as an important factor in therapy, there is still
a need to find interventions that are more efficient. Moreover, in our clinical setting we experience relatively low
therapeutic adherence by young adults because EMDR
and other psychotherapeutic interventions are performed
in a sedentary manner. Designing therapy in a VR
scenery in which the patient participates, by walking on
a treadmill, could offer new therapeutic possibilities to
challenge patients with. Walking could add a principle
of motion-based learning that could enhance memory
processes – either new learning or extinction processes.
214
We aimed at designing an invitational and challenging
form of PTSD therapy that built on the successful elements of regular PTSD/EMDR therapy, but transferred
to the realm of VR. We were able to conceptualize this
new procedure in a multisite effort together with the
Canadian Forces. The first conceptual proof of concept
phase has been finalized in the Netherlands.
method
A novel treatment of PTSD, called 3MDR, was designed
on the 6-DoF motion base of the Computer Assisted Rehabilitation Environment (CAREN, Motek Medical,
Amsterdam, Netherlands) facility at the Military Rehabilitation Center in Doorn, Netherlands. 3MDR adds to
regular therapy virtuality with visual (pictures/words
with 180deg field of vision), auditory (Dolby surround)
and physical (walking) elements. Prior to the start of the
therapy, subjects delivered personal pictures with high
emotional load. Therapeutic principles of EMDR in dual
task processing of emotional (emotional pictures, activating memory network) and irrelevant stimuli (moving
object, facilitating desensitization, new learning) have
been maintained. Aspects of presence were adhered to,
to maximize possible positive outcome.
The CAREN facility is a 6-DoF motion base on which a
single belt (max 18 km/h) treadmill is integrated. Directly underneath the treadmill are four force plates. A
six meter screen encircles the motion base enabling a 180
degree field of vision (average distance of eye to screen
was 2.5 m). Three LCD projectors, several meters above
the subject, project a virtual environment on the screen.
At the level of the LCD projectors, located in a square,
are nine Vicon 3-D motion capture cameras and three are
present at the level of the motion base.
At the start of a session, subjects first familiarized themselves with treadmill walking by music guided walking
for five minutes. A repetitive cycle is started in which a
deployment related photo with high affect is presented on
the screen. The visual distance to the picture is 50 m.
Each cycle contains three phases. The first is the maximizing affect in which the subject interacts with the picture, since walking will move the picture closer. Initially,
walking is in a fixed pace mode, but after five seconds
changes to a self-paced mode to allow control over speed
at which the picture is full screen. In the second phase,
desensitization, the picture freezes and the patient continues to walk. A virtual ball making a horizontal sinusoidal movement (one sine wave per second) is presented
on the screen for a duration of 24 seconds. This movement is augmented with typical “clicking” sounds. Subjects are instructed to follow the ball for the time duration,
and push a button on a device that is held in their hand to
sign that emotional arousal is maximal. The picture will
then dissipate. The third phase, cognitive and emotional
assessment, is when the scenery is changed to a tunnel.
Therapists will ask for associative words that come into
patients’ minds and these are then displayed in the tunnel.
Total time duration for these three phases last three minutes. Each phase will be repeated for a total of seven
times. The consecutive sequences will be facilitated by
discrete musical background. Communication between
patient and therapist is maintained through a headset.
results
The proof of concept will be presented and motivated as
well as preliminary results and conclusions about the efficacy and therapeutic adherence.
discussion/novelty
This is the first type of PTSD therapy that builds on the
successful elements of regular PTSD/EMDR therapy,
but transferred to the realm of VR using a 6-DoF motion base.
references
[1] Cukor, J.; Olden, M.; Lee, F., and Difede, J. Evidence-based treatments for PTSD, new directions, and
special challenges. Ann N Y Acad Sci. 2010 Oct;
1208:82-9.
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a Virtual reality serious game for Training older
patients for a Treated fire related posttraumatic
stress disorder in personal fire safety skills:
a Case report
Ioannis Tarnanasa,1 and Orestis Giotakosb
Hellenic Association for Alzheimer’s Disease,
Aristotle University of Thessaloniki
b
EPINOISI not for profit company
a
Ioannis Tarnana
Hellenic Association for Alzheimer’s Disease
Aristotle University of Thessaloniki
Greece
E-mail: i.tarnanas@vrethics.com
1
JCR
abstract
We present a case of a 74-year-old Greek male who has
suffered from fire-related Posttraumatic Stress Disorder
(PTSD), and memory and orientation problems. The patient was assessed with neuropsychometric tests, auditory event-related potentials and cerebrospinal fluid
proteins, and was diagnosed with mild cognitive impairment. The emphasis on the case is on the use of a Virtual
Reality (VR) serious game as a tool to treat personal fire
safety skills. First, we will provide motivations for adopting serious games in this domain, the mild cognitive impairment patients’ domain. Second, we will describe in
detail the game we have developed. Third, we will show
how data logged by the game can be used for players’
behavior analysis. Finally, we will discuss future work.
Keywords: Posttraumatic Stress Disorder,
Serious Games, Fire Safety, Training, Virtual Worlds,
Virtual Environments
introduction
A 74-year-old Greek male patient was referred to the
Memory Outpatients Clinic of the "G. Papanikolaou"
Hospital on October 17, 2010, due to treated fire-related Posttraumatic Stress Disorder (PTSD) and current
memory and orientation problems. The orientation
problems were reported to be worse at night. The patient was 1.76 m tall and 92 kg and had nine years of
education. His problems began five years before, with
initial symptoms of mood and behavioral changes. One
initiating factor that was mentioned was the loss of his
brother due to a fire.
A neuropsychological examination was performed. The
score in the Mini-Mental State Examination (MMSE)
[1, 2] scale was 27/30 and the Clinical Dementia Rating
(CDR) [3] scale was 0.5 suggesting that global cognitive
function was satisfactory. The score in the Geriatric Depression Scale (GDS) [4] was 0/15, excluding depression as a diagnosis.
Neuroimaging studies (MRI) revealed slight microdegenerative changes of arterial type and slight atrophy of
the right hippocampus. The patient was diagnosed as
having mild cognitive impairment (MCI). Auditory
event-related potentials (ERP) were performed to the patient, who was included in the study of Papaliagkas et al.
[5]. The P300 and SW latencies were found to be 591 ms
and 779 ms respectively. Compared to the mean values
of the latencies observed in a group of 91 MCI patients
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215
(mean ± SD value for P300: 406.4 ± 51.8 ms and for SW:
536.35 ± 62.11 ms) the patient's figures were higher by
more than three standard deviations for P300 and by
more than four for SW. On the contrary, the value of
N200 latency (260 ms) was approximately equal to the
respective mean value of the MCI patients (252 ms). A
CSF sample was also obtained with lumbar puncture.
The β-amyloid(1-42) and tau levels were determined,
using the sandwich ELISA INNOTEST β-amyloid(1-42)
and hTau-Antigen sandwich ELISA kits of Innogenetics,
Ghent, and Belgium. Both protein levels were within
normal levels according to the kit manufacturer (β-amyloid(1-42) = 911 pg/ml, tau = 194 pg/ml). A follow-up
examination was performed after 12 months. The MMSE
score was stable (27/30). P300 and SW latencies continued to be extremely high (P300 = 625 ms and SW = 751
ms), whereas N200 latency (268 ms) was still approximately equal to the mean value of the MCI patients (255
ms). Furthermore, CSF proteins continued to be within
normal levels (β-amyloid(1-42) = 791 pg/ml, tau = 109
pg/ml).
motivation
In general, analyzing how people navigate and interact
in a virtual environment (VE) can be interesting both
for psychological studies of users and for optimizing
VEs for rehabilitation and interaction. Stress during a
real emergency creates the so-called “tunnel vision”
phenomenon in which people’s attention narrows to
only a very limited number of details, usually at the
center of the field of view [6]. This phenomenon can
leave signs unnoticed by the occupant, and can be exacerbated by suboptimal visibility conditions (e.g., insufficient illumination or smoke), sign design or sign
placement.
From an affective neuroscience and cognitive point of
view, this approach would allow the patient to rehabilitate different types of procedural and spatial knowledge [7, 8]: landmark; route; and survey knowledge.
From this perspective, the serious game experience
could help patients build richer emotional responses
and cognitive maps. For example, as discussed by [9],
the frequent real world prohibition of using the alternate exits during non-emergency conditions limits the
formation of cognitive maps and inadvertently creates
negative associations and biases, highly limiting the
likelihood of their use in emergencies. The author explicitly proposes training and clinical rehabilitation to
reduce this problem.
216
We believe that a serious game engine should be provided with physiologically sound models of human activities, ideally with the possibility for the player to
personalize these models based on her personal data. It
could be also interesting to demonstrate the effect of the
personalization before starting to play scenarios, so that
players could familiarize with the differences their character will show with respect to typical recreational
games.
sessed using a single sample Lilliefors hypothesis test
of composite normality. Average data is expressed as
mean ± standard error of the mean in the text and the
figures, unless otherwise stated. For all statistical comparisons the significance level was set to 5% (p < .05).
All statistical analysis was performed using MATLAB
2008 (MathWorks Inc.) and SPSS 17.0 (SPSS Inc.,
USA).
Another topic of future work concerns how to make the
player more aware of the physiological state of her character (e.g., strength, injuries, etc.) and the environment
(e.g., heat, highly toxic smoke, etc.) in the game. This
requires a careful exploitation of visual and audio cues.
Cognitive auditory ERPs have been widely used in this
study to assess the mental processes, such as recognition, categorization of stimuli, and expectancy or shortterm memory, while there are many regions in the brain,
especially in the temporal lobe, the parietal lobe and the
hippocampus which are thought to be responsible for its
generation [10].
results
We quantitatively defined the relationship between fire
evacuation task difficulty and the game parameters, allowing the patient to autonomously adjust the properties
of the game to the abilities of the user with treated
PTSD. As expected, the patient reached dissimilar difficulty levels for emotionally demanding and non-emotionally demanding scenarios. A correct adaptive
procedure requires that the difficulty of the task is
changed, but the final score should be similar for both
emotionally demanding and non-emotionally demanding scenarios. Indeed, for the emotional scenarios score
we got a model fit (R2 = 0.3745, F(2.37) = 82.4866, p
< .001).
protocol
To be able to assess the relationship between game parameters and fire safety skills performance, the case patient performed 10 fire evacuation scenarios with
different fire sizes, location and span each time. For a
specific combination, each parameter could have one
of four predefined values: Fire Speed = [8, 14, 19, 25]
m/s; Interval = [.25, .50, 1.0, 1.5] s; Range = [.42, .69,
.83, .97] m; and Size = [.07, .14, .21, .28] m. We selected this set of parameters in order to cover the behaviorally relevant part of the parameter space while
keeping the number of trials within practical limits. We
varied the gaming parameters every 10 trials (i.e., 10
scenarios).
We identified specific properties of the fire evacuation
task by exploring the individual gaming parameters
(fire range, fire speed, and time interval between fire
movements). For low difficulty scenarios, we found no
significant differences between trials in fire range [ttest, t (9) = -.055, p = .957], fire movement interval [t
(9) = 1.199, p = .261] and fire speed [t-test, t (9) = .233,
p = .821]. On the other hand, for more difficult – emotionally demanding scenarios – we found significant
differences between trials for fire movement interval
[t-test, t (8) = -2.71, p = .027] and fire speed [z = -2.07,
p = .038].
data analysis
To assess the main and interaction effects of the game
parameters on the performance of the fire evacuation
task, we performed a four-way analysis of variance
(ANOVA) with the game score as the dependent variable and fire speed, interval, range and size as independent variables. Once we identified the main effects and
interaction effects between the parameters of the training scenario and the user's performance, we quantified
this relationship using a quadratic multiple regression
model, and extracted the parameters of the regression
for all trials. The normality of the distribution was as-
Comparing the performance of the individual between
trials, the patients’ auditory ERP (P300) after the session showed significantly lower latency and high amplitude, when compared with patients’ emotionally
demanding and non-emotionally demanding scenarios
(difficult/emotionally demanding: [t-test, t (17) = -2.64,
p = .017] for fire range, [t-test, t (17) = 2.69, p = .015]
for fire movement interval and (Mann-Whitney, z = 3.67, p = 2.2 × 10-5) for fire speed; not difficult/nonemotionally demanding: [t-test, t (11.6) = -3.05, p =
.010] for fire range; [t-test, t (10.5) = 3.61, p = .004]
for fire movement interval; and (Mann-Whitney, z = 3.59, p = 4.3 × 10-5) for fire speed].
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discussion
In summary, resilience can be defined as the capacity to
recover following stress or trauma exposure by adopting
healthy strategies for dealing with trauma and stress. Although the importance of stress resilience has been recognized, the underlying neurocognitive mediators have
not yet been identified. Thus, the primary goal of this
case study was to investigate memory-related brain activity in a traumatized elder who attended a post-traumatic, Virtual Reality (VR), fire evacuation stress
coping program. During auditory ERP (P300) and ERP
source localization approaches (sms-LORETA), emotionally demanding and non-emotionally demanding
scenarios had to be encoded twice. 3-D tomography
methods such as low-resolution electromagnetic tomography [11] provide a promising approach for source localization of ERPs where no strong a priori hypotheses
exist regarding the number and location of possible generators. LORETA results in a solution that is blurred and
covers the area of maximal activity with a certain degree
of dispersion. For subsequent retrieval, the difficult scenarios were presented as cue stimuli for associating the
category of the prior learned coping mechanisms. Formerly assessed, clinical pattern, stress coping style, and
cognitive parameters were identified at the virtual scenario performance.
results
Less BOLD activation was found in the hippocampus,
parahippocampal gyrus and fusiform gyrus in the nonemotionally demanding condition when compared with
the emotionally demanding condition during encoding.
This was accompanied by slower reaction times in the
trauma condition during later trials. Further impairments
were found in context memory and in the use of positive
cognitive coping strategies.
217
1975;12:189–198. doi: 10.1016/0022-3956 (75)
90026-6.
[2] Fountoulakis K, Tsolaki M, Chantzi H, Kazis A.
Mini-Mental State Examination (MMSE): A validation
study in the Greek elderly population. Encephalos
(Greece) 1994;31:93–102.
[3] Morris JC. The Clinical Dementia Rating (CDR):
current version and scoring rules. Neurology.
1993;43:2412–2414.
[4] Fountoulakis KN, Tsolaki M, Iacovides A, Yesavage
J, O'Hara R, Kazis A, Ierodiakonou C. The validation
of the short form of the Geriatric Depression Scale
(GDS) in Greece. Aging (Milano) 1999;11:367–372.
[5] Papaliagkas VT, Kimiskidis VK, Tsolaki MN,
Anogianakis G. Usefulness of event-related potentials
in the assessment of mild cognitive impairment. BMC
Neurosci. 2008;9:107. doi: 10.1186/1471-2202-9107.
[6] C. Ware, Information Visualization: Perception for
Design, 2nd edition. San Francisco, CA: Morgan Kaufmann, 2004.
[7] A. C. A. Mól, C. A. F. Jorge, P. M. Couto, "Using a
Game Engine for VR Simulations in Evacuation Planning", IEEE Compututer Graphics and Applications,
vol. 28(3), pp. 6-12, 2008.
[8] R.P Darken, B. Peterson, Spatial Orientation,
“Wayfinding, and Representation”, Handbook of Virtual
Environment Technology. Stanney, K. Ed., Lawrence
Erlbaum Assoc.: New Jersey. pp. 493-518, 2002.
This was one of the first effective neuroscience studies
to investigate both auditory ERP VR performance and
MMSE in a PTSD treated, MCI elder. Support was provided for the presence of memory-related disturbances
in brain activity associated with trauma even in a resilient population. The contribution of the changes in
stress coping ability needs to be further examined in longitudinal studies.
[10] Yamaguchi S, Knight RT. P300 generation by novel
somatosensory stimuli. Electroencephalogr Clin Neurophysiol.
1991;78:50–55.
doi:
10.1016/00134694(91)90018-Y.
references
[1] Folstein M, Folstein S, McHugh P. "Mini-Mental
State". A practical method for grading the cognitive
state of patients for the clinician. J Psychiatr Res.
[11] Pascual-Marqui RD, Michel CM, Lehmann D: Low
resolution electromagnetic tomography: a new method
for localizing electrical activity in the brain. International Journal of Psychophysiology. 18: 49-65, 1994.
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[9] F. Ozel, “Time pressure and stress as a factor during
emergency egress”, Safety Science, vol. 38, pp. 65-107,
2001.
218
appliCaTions of TelehealTh: ouTComes
and psyChologiCal proCesses
Telepresence experienced in Videoconference
Varies according to emotions involved in
Videoconference sessions
Véronique Gougeona, Stéphane Boucharda,1,
Stéphanie Dumoulina and Mélanie Michauda
a
Stéphane Bouchard
Canada
E-mail: stephane.bouchard@uqo.ca
1
abstract
Previous studies have linked telepresence to the strength
of the therapeutic relationship experienced during
telepsychotherapy. This finding comes as a surprise to
many people who have been involved in a teleconference
meeting, where telepresence is often considered weak.
The aim of this study is to (re)evaluate the impact of
emotional engagement on telepresence. Participants
were randomly assigned to one of the two conditions: (a)
emotionally charged verbal exchange first (followed by
a more neutral verbal exchange), or (b) emotionally neutral verbal exchange first (followed by an emotionally
charged verbal exchange). A distraction task was performed between the two verbal exchanges in videofoncerence. Results showed that verbal exchanges involving
stronger emotions increase telepresence. These results
may explain why telepresence is so high in telepsychotherapy.
Keywords: Sense of Presence, Videoconference,
Emotional Engagement
introduction
Using videoconference to deliver psychotherapy (i.e.,
telepsychotherapy) is receiving more and more empirical
support. Studies showed a high level of satisfaction from
patients involved in telepsychiatry [1-3] and the therapeutic alliance and bond between the patient and the
therapist appear to be very good [4-6]. For example, Allard et al. [5] assessed the strength of the therapeutic alliance using two measures of alliance, one developed
from a pan theoretical perspective (the Working Alliance
Inventory) and one developed from a psychodynamic
perspective (the California Psychotherapy Alliance
Scales). Both measures were administered after the first,
the fifth and the last therapy session of a cognitive behavior program delivered in face-to-face sessions and in
videoconference sessions to 45 patients suffering from
panic disorder with agoraphobia. In order to reduce social desirability, patients mailed their completed questionnaires directly to the provincial board of
psychologists and were reassured that only their therapist
would know their answers after the study. To reduce the
risks of potential contamination of alliance ratings by
treatment success, the authors focused on data gathered
after the fifth therapy session. Their results showed that
working alliance was very high in both face-to-face and
videoconference sessions, and differences between the
two conditions were very small (eta-squared below .03)
and far from being significantly different.
An examination of treatment processes with the same
sample as Allard et al. [5] further revealed that the
strength of the alliance is mediated by the feeling of
presence in telepsychotherapy [7]. Telepresence can be
defined as the illusion of being there, in the therapy
room with the other person [8,9] and, although it seems
important in telepsychotherapy, most people involved
in a videonference meeting do not report feeling substantially present. One possible explanation could be
the role of emotions experienced during verbal interactions in videoconference sessions. Emotions and presence are correlated [10] and psychotherapy sessions are
usually fuelled by emotionally relevant content, while
business meetings are usually less emotionally charged.
The role of emotions in telepresence has been previously examined [11] but is researched more thoroughly
in this study. This study aims to assess the impact of
the intensity of emotional engagement on the feeling of
telepresence.
methods and Tools
A total of 20 participants enrolled in the study, but two
were excluded due to failure to perform the experimental
task. The study’s sample was composed of 18 participants aged between 20-56 years old. More than half the
participants were women (60%) and participants were
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219
recruited on the university campus. Before the videoconference session, participants were informed about the
aims of the research. They then completed two questionnaires evaluating their immersive tendencies and comfort
toward telecommunications in order to describe the sample and statistically control for the impact of these variables if differences would occur after randomization.
They were requested to list five personal positive life
events that occurred to them in the last six months and
to place them in a hierarchical order according to the degree of pleasure experienced during that event.
results
As a manipulation check, the impact of discussion on
mood was assessed after both videoconference sessions.
A repeated measures ANOVA confirmed the change in
positive mood [F (1,16) = 4.64, p < .05]. A 2 Times X 2
Conditions repeated measures ANOVA was performed
on the presence measure. Both the Time [F (1,16) = .07]
and Condition [F (1,16) = 3.27] main effects were not significant. As expected, results on the Interaction revealed
a clear impact of the emotional content of the discussion
on the feeling of presence [F (1,16) = 5.42, p < .05].
Participants were randomly assigned to one of the following two conditions: (a) emotionally charged verbal
exchange first (followed by a more neutral verbal exchange), or (b) emotionally neutral verbal exchange first
(followed by an emotionally charged verbal exchange).
In the emotionally charged verbal exchange, participants
were asked to discuss the most positive life experience
they had listed over videoconference for 15 minutes. In
the emotionally neutral verbal exchange, participants
were asked to discuss the most neutral life experience
on their list during the videoconference for 15 minutes.
Following each discussion, participants were asked to
fill out two questionnaires assessing presence and the
intensity of their current emotions. A distraction task
was given between each discussion, where patients were
requested to cross the letter “e” each time it occurred in
a three-page article on relaxation.
discussion
Experimentally manipulating the emotional valence of
the verbal exchanges between two people meeting in
videoconference allowed demonstrating the role of emotions on telepresence. It is believed that emotionally
charged discussions improve telepresence and may contribute to the strong feeling of presence experienced in
telepsychotherapy.
The experiment was conducted in two separate rooms
in the research lab. In room A, the participant was seated
in a psychologist office, four feet away from a 32-inch
television and a Tandberg Vision 2500 videoconference
system. A female experimenter (different from the one
who welcomed the participant, went over the ethics procedures and handed the questionnaires) was in room B
and discussed using a similar videoconference system
with the participant. Both systems were linked at 384
kbits per second using six ISDN lines.
The Immersive Tendencies Questionnaire [9] and the
Distance Communication Comfort Scale [12] were administered at the start of the experiment. The Brief
Mood Introspection Scale [13] was used as a manipulation check using the three positive mood items
(happy, joyful, energetic). The dependent variable was
the Telepresence in Videoconference Scale [14], which
is composed of eight items and has a Cronbach’s alpha
of .84.
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references
[1] Doze, S., Simpson, J., Hailey, D., & Jacobs, P. (1999).
Evaluation of telepsychiatry pilot projet. Journal of
Telemedicine and Telecare, 5, 38-46.
[2] Urness, D.A. (1999). Evulation of a canadian telepsychiatry service. Studies in Health and Informatics, 64,
262-269.
[3] Baigent, M.F., Lloyd, C.J., Kavanagh, S.J. Ben-Tovim,
D.I., Yellowlees, P.M. Kalucy, R.S. & Bond, M.J. (1997).
Telepsychiatry : “tele” yes, but what about the “psychiatry”. Journal of Telemedicine and telecare, 3(1), 3-4.
[4] Ghosh, G.J., McLaren, P. M., & Watson, J.P. (1997).
Evaluating the alliance in video-link teletherapie. Journal
of Telemedicine and Telecare, 3, 33-35.
[5] Allard, M., Bouchard, S., Marchand, A., Cournoyer,
L-G., Green-Demers, I., & Renaud, P. (2007). L’efficacité de la psychothérapie pourle trouble panique en videoconference: Réplication et alliance thérapeutique. Revue
Québécoise de Psychologie, 28(2), 43-64.
[6] Bouchard, S., Robillard, G., Marchand, A., Renaud,
P. & Riva, G. (2007). Presence and the Bond Between
Patients and their Psychotherapists in the Cognitive-Behavior Therapy of Panic Disorder with Agoraphobia Delivered in Videoconference. Proceedings of the 10th
220
Tripler Army Medical Center, Pacific
Regional Command
b
Joint Task Force - National Capital Region
Medical Command, Bethesda, MD
Annual International Workshop on Presence, Barcelona
(Spain), October 25-27.
[7] Robillard, G., Bouchard, S., Guitard, T., Lefebvre, C.
(2009). Impact of attitudes and behaviors on the quality
of the working alliance in videoconference for the treatment of panic disorder and agoraphobia. Oral presentation at the 14th Annual CyberTherapy Conference 2009,
Verbania (Italy), June 21-23.
[8] Draper, J.V., Kaber, D.B., & Usher, J.M. (1998).
Telepresence. Human Factors, 40(3), 354-375.
[9] Witmer, B.G., & Singer, M.J. (1998). Measuring
Presence in Virtual Environments: a Presence Questionnaire. Presence, 7(3), 225-240.
[10] Robillard, G., Bouchard, S., Fournier, T., & Renaud, P. (2003). Anxiety and presence during VR immersion: A comparative study of the reactions of phobic and
non-phobic participants in therapeutic virtual environments derived from computer games. CyberPsychology
and Behavior, 6(5), 467-476.
[11] Dumoulin, S., Bouchard, S., & Michaud, M. (2004).
The sense of presence in videoconferencing and emotional engagement. Poster session presented at the Cybertherapy Conference 2004, San Diego, January 10-12.
[12] Schneider, P.L. (1999). Mediators of distance communication technologies psychotherapy: Development
of a measure. Poster presented at American Psychological Association 1999, Boston.
[13] Mayer, J.D.,& Gaschke, Y.N. (1988). The experience and meta-experience of mood. Journal of Personality and Social Psychology, 55, (1), 102-111.
[14] Bouchard, S., & Robillard, G. (2006). Telepresence
Scale – Validation results. Unpublished document. Available online at http://w3.uqo.ca/cyberpsy/en/index_
en.htm, under Productions.
–––––––––––––––––––––––––––––––––––––––––––––
TeleCybertherapy: Contributions and Challenges
from a hospital in the pacific
Raymond A. Folena,1, Melba C. Stetza, Stephen L.
Jonesb, Brenda Edmondsa, Judy Carlsona
and Richard I. Riesa
a
Melba C. Stetz
Tripler Army Medical Center
Pacific Regional Command
2715 Hayashi Street
Honolulu, Hawaii 96819
USA
E-mail: melba.stetz@us.army.mil
1
abstract
The Tripler Army Medical Center (TAMC) is located in
the Pacific Ocean. Most of the beneficiaries are located
in remote areas. Therefore, TAMC is starting a program
to help further reach their patients, with the help of telehealth technology. Preliminary data suggests good appraisal from both patients and mental health providers.
With that said, there are also lessons learned emerging
from this process.
Keywords: Telehealth, Videoteleconferencing,
Psychotherapy, Assessment
Hawaii might be the most isolated major population
center on the Earth. It is physically 2,400 miles from
California and 3,800 miles from Japan. It spreads over
1,500 miles, making it the widest state in the U.S. While
the populated areas of the state span a distance that is
significantly smaller, the eight major islands are separated by water, limiting interisland travel to air and sea.
The Tripler Army Medical Center (TAMC)’s area of responsibility covers 52% of the Earth’s surface. TAMC
is located on the island of Oahu, and is the only Federal
tertiary health care facility in the Pacific. It supports
264,000 active duty and retired military personnel, families, and VA beneficiaries based in Hawaii. It also supports forward-deployed forces in more than 40
countries.
method/Tools
In October 2009, TAMC conducted a quality improvement project to determine if soldiers and providers experienced interviews conducted over high-definition
videoconference (VTC) or webcams (DCO – Defense
Connect Online) equivalently to face-to-face (FTF) in-
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terviews. Soldiers were scheduled in groups of 45, with
each group first receiving a two-minute briefing to reduce stigma and reinforce the importance of engaging
the process in an honest, forthright manner. They then
completed a five-minute, 42-item online questionnaire
that assessed their current psychological status in a number of areas (e.g., substance use, anger, risky behavior,
self-worth, depression, PTSD symptoms, quality of relationships, financial difficulties, sleep, etc.) This was
followed by an interview with the behavioral health
provider who had immediate access to the results of the
online questionnaire.
results
Preliminary data suggested that patients and providers
communicating via telehealth (FTF, VTC or webcam)
are embracing the process. A few times, both patients and
providers experienced a jerky, pixilating screen. Also,
when the camera was not placed at eye level, patients
would get the impression that the clinicians were not
looking at them. Similarly, providers reported getting adequate visual information to do both the assessment and
treatment, but did not appreciate verbal information or
deviations in voice quality. There was also a concern for
patients being left in a dark room if the power would go
out, or having a patient verbalize suicidal/homicidal intent and then walk out of the session. Lastly, providers
also found the telehealth sessions tiring. That is, those
who easily managed eight sessions per day reported fatigue after three to four sessions via VTC.
Conclusion
Conducting clinical assessment or treatment with the
help of technology requires a new set of skills. There is
not only the factor of unfamiliarity/resistance by some
providers about using technology, but also quality concerns. With that said, helping patients via existing technology can be a great addition to the therapeutic
relationship.
references
[1] James, L. C. & Folen, R. A., Behavioral telehealth:
Using telemedicine to expand behavioral medicine services, Journal of Healthcare Information Management, 13,
4, (1999), 15-23.
[2] Folen, R. A., Jones, S. L., Stetz, M. C., Edmonds, B.,
& Carlson, J., The role of telehealth in treating military
personnel, National Register of Health Service Providers
in Psychology, 36, (2010), 8-15.
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221
–––––––––––––––––––––––––––––––––––––––––––––
evaluation of an internet-based intervention
program for Cannabis users
Peter Tossmana,1, Benjamin Jonasa, Marc-Dennan
Tensila, Peter Langb and Evelin Strueberb
a
Delphi Corporation, Berlin
Federal Centre for Health Education (BZgA), Cologne
b
Peter Tossman
Delphi Corporation
Berlin, Germany
E-mail: tossmann@delphi-gesellschaft.de
1
abstract
The World Wide Web is increasingly being used for the
prevention and treatment of addiction disorders. In 2004,
the German Federal Centre for Health Education (BZgA)
has developed “quit the shit” (QTS), a 50-day intervention program for young adults who want to reduce or
cease using cannabis. QTS provides support by trained
psychotherapists and consists of several modules like an
online-diary and various types of tutorials. Recently, a
randomized controlled trial (RCT) was conducted in
order to scrutinize the program’s efficacy. According to
intention to treat analyses (ITT) and per protocol analyses (PP), users of QTS reduced their cannabis consumption significantly more than a control group (CG) which
did not receive any intervention. Furthermore, their consumption related self-efficacy at follow-up was significantly higher compared to the CG. In the PP analyses,
QTS-users exhibited superior results in the development
of anxiety, depression and life satisfaction, too.
Keywords: Cannabis, Internet-based, Online,
Intervention, Counseling, Evaluation
introduction
Due to the relatively high proportion of cannabis users
in the population, problematic forms of cannabis consumption are of considerable relevance for the healthcare
field. The World Wide Web offers new, promising ways
of addressing individuals affected by addiction-related
problems. At present, several web-based interventions
for mental disorders have been shown to be effective [1,
2]. However, empirical evaluations of Internet-based interventions in the field of illegal drugs are still pending
[3]. The present trial aims at assessing the effectiveness
222
of “quit the shit” (QTS), a web-based counseling program for cannabis users who want to reduce or cease
smoking cannabis.
Use frequency and quantity were the primary outcomes
of the study. An increase of use-related self-efficacy and
a positive impact on psychological well being was also
expected.
methods
The study was conducted on the Web site of QTS as a
two-arm-randomized controlled trial with one follow-up
survey after three months. After registering with the
study and filling out the baseline questionnaire, subjects
were randomly assigned to either QTS or to a waiting
list. Members of the waiting list could enter the program
after three months.
Recruitment for the follow-up-survey was done by Email, thus, all QTS-participants (regardless of the duration of program usage) and all waiting list members were
invited three months after trial registration.
At baseline, sociodemographic data, information on
cannabis use, on use-related self-efficacy, and on psychological well-being was collected. Information on the
frequency (days of consumption) and the quantity (in
grams) of cannabis use during the last 30 days was
gathered. The use-related self-efficacy was measured
using a German adaptation of the Drug-Taking Confidence Questionnaire (DTCQ-8) [4]. Three measures of
mental well-being were used: the Trait Scale of the
State-Trait Anxiety Inventory (STAI-T) [5] the General
Depression Scale [6] and the Satisfaction with Life
Scale (SWLS) [7].
In order to examine the efficacy of the program, Analyses of Covariance (ANCOVA) were conducted. In order
to deal with missing follow-up information, Multiple Imputations (MI) imputed data of all randomized participants who did not complete the follow-up.
participants
A total of 1,292 persons registered with the study. Of
these, 429 persons were allocated to the waiting list and
863 to the treatment group. In total, 206 subjects participated in the follow-up survey (QTS: n=100; waiting list:
n=106). The mean age of the 206 follow-up participants
(70.5% male) was 24.7 years old (SD=6.8). On average,
they had consumed cannabis for 8.9 years (SD=6.2). The
vast majority (92.0%) was cannabis dependent according
to DSM-IV criteria.
evaluation results
In the Per-Protocol-analysis (PP) which only included
the data of those who left valid follow-up data, the ANCOVAs yielded significant effects in every outcome variable. Users of QTS showed a significantly stronger
reduction in both consumption measures than members
of the waiting list. The between-group effect sizes in use
frequency and quantity can be considered as moderate
to large. There are moderate effects on use related to selfefficacy and weak to moderate effects on the variables
representing mental well-being. The Intention-to-Treatanalysis (ITT) reveals statistically significant group differences in the use related measures (frequency, quantity
and self-efficacy).
Conclusions
The results suggest that the Web-based counseling program QTS provides effective support for those who want
to quit or significantly reduce their cannabis use. These
effects are presumably not limited to cannabis use, but
also become apparent in the enhanced well-being of the
clients.
references
[1] Andersson, G, Carlbring, P, Holmström, A, Sparthan,
E, Furmark, T, Nilsson-Ihrfelt, E, Buhrman, M, Ekselius,
L. Internet-based self-help with therapist feedback and in
vivo group exposure for social phobia: a randomized controlled trial. J Consult Clin Psychol. 2006, 74(4):677 – 86.
[2] Klein, B, Richards, JC, Austin, DW. Efficacy of internet therapy for panic disorder. J Behav Ther Exp Psychiatry 2006, 37(3):213 – 38.
[3] EMCDDA (2009) Internet-based drug treatment interventions: Best practice and applications in EU Member States, EMCDDA Insights No 10. Lisbon:
EMCDDA.
[4] Sklar SM, Turner NE: A brief measure for the assessment of coping self-efficiacy among alcohol and other
drug users. Addiction 1999; 94(5):723 – 729.
[5] Laux L, Glanzmann P, Schaffner P, Spielberger CD
(1981) Das State-Trait-Angstinventar. Theoretische
Grundlagen und Handanweisung. Weinheim: Beltz Test
GmbH.
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[6] Hautzinger M, Bailer M (1993) Allgemeine Depressions Skala. Weinheim: Beltz Test GmbH.
[7] Schumacher J: SWLS - Satisfaction with Life Scale.
In Diagnostische Verfahren zu Lebensqualität und
Wohlbefinden (Diagnostik für Klinik und Praxis, Band
2). Edited by: Schumacher J, Klaiberg A & Brähler E.
Göttingen: Hogrefe; 2003: 305 – 309.
–––––––––––––––––––––––––––––––––––––––––––––
using online Videoconferencing for Connecting
Caregivers of people with dementia
Emilie Meyersa,1, Linda Garciaa,b and Elsa Marzialic
Interdisciplinary School of Health Sciences,
b
Elisabeth Bruyère Health Institute,
Bruyère Continuing Care
c
Kunin Lunenfeld Applied Research Unit, Baycrest
a
Emilie Meyers
43 Templeton St., Rm. 202
Ottawa K1N 6X1
Canada
E-mail: emeye086@uottawa.ca
1
abstract
Family members play a central role in caring for people
with dementia, yet they are often in need of support themselves. Group interventions have shown great promise in
supporting caregivers, yet accessibility to these face-toface support groups is challenging when one cannot leave
the patient alone at home. The primary objective of this
study is to explore the use of videoconferencing technology to facilitate support groups for caregivers of people
with dementia. A unique password protected Web site was
developed where caregivers met once a week for 20
weeks. Qualitative analyses of the content suggested that
online videoconferencing offers similar support to what
is reported with face-to-face interventions. Despite the
technology, participants could form social bonds and discuss strategies for dealing with some of the most daunting
effects of this disease.
Keywords: Dementia, Caregiver, Online Support
Groups, Videoconferencing, Web Based
Interventions, Technology
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223
introduction
There exists a looming epidemic of dementia in Canada
that is predicted to affect 1,125,200 individuals by 2038
[1]. Informal caregivers are the primary source of care
for people with dementia [2]. Although there have been
many interventions that provide support for caregivers,
group interventions have been shown to offer great
promise in increasing overall quality of life. Many of the
barriers experienced by caregivers wishing to attend
face-to-face support groups, however, could be alleviated
through online support. Numerous studies have demonstrated that telehealth is a method that allows for effective diagnosis and treatment in health care, including
psychotherapy [3]. The primary objective of the study is
to determine the feasibility of using the online videoconferencing technology to offer an effective psychotherapeutic support group for caregivers of people with
dementia.
method
Caring for others [Cfo©] Web site Technical
structure
The Caring for Others (CFO©) Web site was developed
by Marziali and her colleagues [4]. The video components, which required high speed Internet connections
for all users, used only one outgoing stream at any one
time. The outgoing stream was passed around by the facilitator to whoever was the live speaker, while the remaining participants viewed the central stream. The
active window picture located in the center of the screen
(160 x 120 pixels) had little to no lag in the voice component. The active window was surrounded by video
snapshots of the participants and facilitator. The site also
offered a threaded discussion forum, a personal message
center, a conferencing scheduling application, a contact
form, personal profiles, and a complete administration
component. The site administrator had access to all links
and user groups, the professional facilitators had access
to other facilitators, but only to the members within the
groups that they facilitated, and the participants had access only to the members within their group. All e-mail
messages and videoconference sessions were encrypted
and stored on the server. The video footage was downloaded and burned to a CD that also included functionality for “coding” the video footage.
procedure
The participants were recruited from multiple sites in
three cities and were assigned to groups of caregivers
(two English and one French group of spouses; two
224
English groups of adult children) who met online for
one hour during 20 weeks. The first 10 sessions were
facilitated by health professionals who followed the
principles in the training manual. The group then continued to meet for an additional 10 sessions in mutual
self-help mode with one of the group members manipulating the technical aspects of the videoconferencing
meetings. The intervention integrated a) strategies for
educating caregivers, b) self-reflective strategies for understanding the interplay between emotions and problem solving, and c) strategies for coping with
depression symptoms associated with care giving. The
group members had access to a Dementia Information
Handbook, posted on the Web site that provided information about disease diagnosis, courses, patient care
strategies and self-care strategies. Content was coded
on all videos and compared to the goals and objectives
of the psychotherapeutic training manual distributed to
the facilitators.
results
The results mirrored the content of the psychotherapeutic
interventions listed in the training manual and face-toface interventions. Strong social ties were formed
throughout the 20 online sessions, just as they would
have in a face-to-face psychotherapeutic support group.
Participants discussed emotions, strategies for symptom
relief and simply connected by sharing events occurring
in their lives.
[3] V. Germain, A. Marchand, S. Bouchard, M. Drouin,
& S. Guay, Effectiveness of cognitive behavioural therapy administered by videoconference for posttraumatic
stress disorder, Cognitive Behavioural Therapy 38
(2009), 42-53.
[4] E. Marziali, & P. Donahue, Caring for Others: Internet Video-Conferencing Group Intervention for Family
Caregivers of Older Adults With Neurodegenerative Disease, The Gerontologist 48 (2005), 398-403.
[5] E. Marziali, & L.J. Garcia, Dementia Caregivers’ Responses to Two Internet-based Intervention Programs,
Journal of Alzheimer’s Disease & Other Dementias (In
print).
[6] D.L Hoffman, T.P. Novak, & A.E. Schlosser, The
Evolution of the Digital Divide: How Gaps in Internet
Access May Impact Electronic Commerce, Journal of
Computer Mediated Communication 3 (2000).
–––––––––––––––––––––––––––––––––––––––––––––
online self-disclosure and the
Therapeutic relationship
Melanie Nguyena,1 and Andrew Campbella
a
The University of Sydney, Australia
Melanie Nguyen
Faculty of Health Sciences
Cumberland Campus
The University of Sydney
Australia
E-mail: melanie.nguyen@sydney.edu.au
1
Conclusion
Dementia is becoming a large concern and few studies
have looked at the feasibility of using telehealth technologies to provide support to caregivers of people with
dementia. Marziali et al. [5] have shown that videoconferencing is more effective in reducing caregiver stress
than online chat, and this data further supports the use
of the technology to help caregivers connect. This research will be particularly significant for the next cohort of caregivers who will have wider access to the
Internet and who have had significant experience with
its use [6].
references
[1] S. Dudgeon, Rising tide: The impact of dementia on
Canadian society, Alzheimer's Society of Canada.
Toronto, 2009.
[2] K. Cranwick, & D. Dosman, Eldercare: What we
know today, Statistics Canada, Ottawa, 2008.
abstract
E-Mental Health research has focused on the delivery of
psychological interventions through online self-help
packages. However, the Internet can be used to facilitate
the therapeutic relationship. The current study systematically compared the percentage of self-disclosure in social and coaching psychology contexts conducted
face-to-face (FTF), via instant messaging and via e-mail.
It is the first to explore communication differences in the
professional-client relationship across different media.
Sixty participants were randomly allocated to one of six
conditions and interacted with the experimenter as either
a friend or client for one hour a week over four weeks.
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Disclosure frequency decreased over time, but was significantly greater in coaching – compared to social –
conditions. Moreover, disclosure was significantly
greater online and greater amongst e-mail interactions
than instant messaging conversations. There was no significant interaction between media and context. While
further research is required to examine the therapeutic
efficacy of online communication, the current findings
support online delivery of mental health services.
Keywords: Self-disclosure, Synchronicity,
Online Therapy, e-Mental Health
introduction
The Internet is an avenue for consumers to obtain mental health information, engage in self-help interventions
[1] and provide peer-based support [2]. While research
has supported the efficacy of this technology in improving clinical [3] and non-clinical [2] well-being, few
studies have examined the online therapeutic relationship. Key to a successful therapeutic relationship is selfdisclosure.
Greater online self-disclosure (compared to face-to-face
[FTF]) has been largely attributed to anonymity on the
Internet. It is argued that if an individual cannot immediately perceive the reactions of their conversing partner
then the effect of those reactions on the individual’s behavior are diluted [4]. This argument overlooks synchronous online communication. While invisible, a person’s
reactions can be immediately perceived in a real-time instant messaging (IM) conversation. An examination of
self-disclosure differences between IM and e-mail would
contribute to a best-practice model of online communication.
Previous research examined self-disclosure amongst
peers in social [5] and task-based [6] contexts. A therapeutic relationship is notably different. In particular,
clients expect to disclose to mental health professionals
without reciprocated self-disclosure. Moreover, psychological interventions often span multiple interactions,
whereas earlier studies are based on one encounter.
Therefore, a model of online self-disclosure applicable
to e-Health professionals should draw from research examining disclosure differences between contexts, with
expected and no expected reciprocal self-disclosure over
several time points. The current study investigated the
role of synchronicity, reciprocity and time on disclosure
frequency.
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225
method
A 3x2x4 factorial design was used to investigate the role
of communication medium (FTF, IM, e-mail), reciprocity (social versus coaching psychology interactions) and
time (four sessions) on frequency of self-disclosure (operationalized as the percentage of information units that
reveal personal information about the participant). Sixty
participants (41 female, median age=21 years) completed a demographics questionnaire and were randomly
allocated to one of six conditions. Each communicated
with the experimenter for an hour a week over four
weeks. At least four e-mails were exchanged between
communicants in the e-mail condition.
results
A mixed ANOVA investigating the effects of media, context and time on self-disclosure showed significantly
greater disclosure in coaching (M=74.9%) than social
(M=67.6%) contexts (F(1, 54)=11.8, p<0.001). Online
self-disclosure (M=76.3%) was significantly greater than
offline self-disclosure (M=61.1%; p<0.001). Moreover,
disclosure was significantly greater through e-mail
(M=79.1%) compared to IM (M=73.5%; p=0.03). There
was no significant interaction between media and context. Time showed a significantly decreasing linear
(p=0.001) and quadratic trend (p=0.03).
Conclusion
From a communications perspective, these findings support the delivery of psychological interventions via the
Internet, particularly e-mail. The delay in response could
facilitate introspection and reflective writing (hence, increased self-disclosure). However, further research is required to examine the therapeutic efficacy of online
disclosure/communication. Future studies could determine whether disclosure frequency decreases as disclosure depth increases. While further research is required,
the current study suggests that the Internet could be conducive to establishing – or maintaining – an effective
therapeutic relationship.
references
[1] Mackinnon, A., Griffiths, K., Christensen, H. (2008)
Twelve month outcomes for a randomised controlled
trial of an internet delivered cognitive behaviour therapy
program and an online depression information website.
British Journal of Psychiatry, 192,130-4.
[2] Valkenburg, P. M., Peter, J., & Schouten, A. P. (2006).
Friend networking sites and their relationship to adoles-
226
cents' well-being and social self-esteem. CyberPsychology & Behavior, 9, 584-590.
[3] Sethi, S., Campbell, A. J., & Ellis, L. A. (2010). The
Use of Computerized Self-Help Packages to Treat Adolescent Depression and Anxiety. Journal of Technology
in Human Services, 28(3), 144-160.
[4] Suler, J. (2004) The online disinhibition effect CyberPsychology & Behavior, 7(3), 321-326.
[5] Antheunis, M. L., Valkenburg, P. M., & Peter, J.
(2007). Computer-Mediated Communication and Interpersonal Attraction: An Experimental Test of Two Explanatory Hypotheses. Cyberpsychology & Behavior,
10(6), 831-836.
[6] Coleman, L. H., Paternite, C. E., & Sherman, R. C.
(1999). A reexamination of deindividuation in synchronous computer-mediated communication. [doi: DOI:
10.1016/S0747-5632(98)00032-6]. Computers in
Human Behavior, 15(1), 51-65.
–––––––––––––––––––––––––––––––––––––––––––––
a Comparison of Client Characteristics in Cyber
and in-person Counseling
Lawrence Murphya,1 and Dan Mitchella
a
Worldwide Therapy Online Inc., Canada
Lawrence Murphy
Worldwide Therapy Online Inc.
18 Mont Street
Guelph N1H2A4
Canada
E-mail: research@sympatico.ca
1
abstract
As cybertherapy diversifies into a wide variety of modalities, it is incumbent upon researchers and clinicians to
determine the most suitable cybertherapy approach for
clients. Suitability encompasses ethical considerations,
client satisfaction and treatment outcomes. The authors,
working with an Employee Assistance Program agency
based in Canada, provided text-based e-mail counseling
(cybercounseling) to clients across the country. Cybercounseling was accessible to clients through the same
avenues as in-person counseling. Clients self-selected for
either cybercounseling or in-person counseling at intake.
For the purposes of this study, data from 211 clients have
been collected. Client demographic data including age,
gender, presenting problem and marital status were collected for each client. Additional information based on
the Patient Health Questionnaire (PHQ-9), as well as
drug and alcohol use statistics were also collected. Comparing the cyber and in-person client data provides insights into the similarities and differences between cyber
and in-person client groups. Further analysis of the demographic and psychographic information, in context of
outcome data collected, provides us with a preliminary
indication of the characteristics of clients for whom cybercounseling is best suited.
Keywords: Client Characteristics, Employee
Assistance, Cybertherapy, Cybercounseling, Online
Counseling, e-Counseling, e-Therapy
introduction
Given that cybercounseling is one of the newest approaches in the field of psychotherapy [1], it is incumbent upon us to distinguish clients for whom this
approach is best suited, and those for whom the approach
is not. In the case of in-person counseling, the client-therapist relationship is known to be important in client satisfaction and treatment outcomes. However, in the case
of cybercounseling, in addition to the client-therapist relationship [2], the relationship with the technology is also
an important factor and may impact both client satisfaction and treatment outcome [3]. Matching client characteristics to the most appropriate modality is of primary
concern for this emerging approach.
method/Tools
Clients contacted PPC Worldwide Canada (formerly Interlock EAP) online or by phone and were screened by
intake workers. Clients were offered counseling via secure e-mail. Those who choose it received counseling
from Therapy Online’s Affiliate Counsellors. Thus, the
pool of clients from which in-person and online clients
were drawn was the same even though there was a selection process.
Between April 2006 and May 2008, 105 online clients
underwent cybercounseling. A convenience sample of
106 in-person clients, selected from that group of individuals who completed counseling between April 2006
and May 2008, was used as a comparison group. Ethical
review was completed by the authors in accordance with
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the ethical requirements for research laid out by the
Canadian Counselling & Psychotherapy Association [4].
A subsample of 26 cyberclients received an initial and a
closing Global Assessment of Functioning (GAF) score.
This group was compared to a convenience sample of
101 in-person clients who received counseling during the
same period. In addition, 45 cyberclients completed a
Client Satisfaction Survey (CSS). A convenience sample
of 43 in-person clients was used as a comparison group.
Analyses of variance (ANOVA) were conducted using
PROC GLM (SAS Version 9.1, SAS Institute, Cary,
NC), with α = 0.05, to examine differences between
counseling modalities.
results
The cybercounseling and in-person client groups will be
compared on demographic and psychographic data collected. In addition, this data will be explored in light of
outcomes for a subsample of the clients who completed
the GAF and CSS.
Conclusion
Conclusions will review differences between client
groups and suggest hypotheses based on recent research
227
in the field. Constructs like disinhibition will be used to
analyze client choice. Additional conclusions will be
drawn with respect to the impact of the counseling
method regarding the various psychographic and demographic factors.
references
[1] L.J. Murphy, P. Parnass, D.L. Mitchell, S. O'Quinn.
The emerging field of cybercounselling: Personal and
professional reflections. Intervention, 132 (2010), 8493.
[2] L.J. Murphy, D.L. Mitchell. When writing helps to
heal: E-mail as therapy, British Journal of Guidance and
Counselling, 26 (1998) 21–32.
[3] L.J. Murphy, P. Parnass, D.L. Mitchell, R.H. Hallett,
P. Cayley & S. Seagram. Client satisfaction and outcome
comparisons of online and face-to-face counselling
methods. British Journal of Guidance and Counselling,
39 (2009) 627-640.
[4] Code of Ethics: Canadian Counselling & Psychotherapy Association, 2007.
addiCTions, urges and CraVings: ToWards
beTTer undersTanding and TreaTmenTs
–––––––––––––––––––––––––––––––––––––––––––––
attention to smoking and drinking Cues
in Virtual environments
Amy C. Traylora,1, Danielle E. Parrishb, Brian L.
Carterb, Hilary L. Coppc and Patrick S. Bordnickc
University of Alabama, Tuscaloosa, AL, USA
b
University of Houston, Houston, TX, USA
c
Edinboro University of Pennsylvania,
Edinboro, PA, USA
a
Amy C. Traylor
University of Alabama
Tuscaloosa, AL, USA
E-mail: atraylor@sw.ua.edu
1
abstract
Cigarette smokers and dependent drinkers confronted
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with smoking and drinking-related cues, evidence cue
reactivity reactions including increased attentional bias
towards those cues. Less is known about attentional bias
of persons who are both nicotine and alcohol dependent.
This exploratory study using Virtual Reality (VR) investigated the effects of complex drug cue environments,
devoid of proximal alcohol cues, in attention paid to
nicotine and alcohol cues. Also investigated were differences in attention to nicotine and alcohol cues based on
the level of alcohol dependency. Twenty-one nicotine dependent/daily alcohol consuming individuals were divided into groups (alcohol dependent/non-alcohol
dependent), and exposed to two VR environments (office
courtyard and party) containing complex cues including
proximal smoking, but not alcohol, cues, and two VR
neutral environments. Attention to smoking and alcohol
cues and thoughts about smoking and drinking were
recorded upon exiting each environment. Both groups
showed increased attention to perceived alcohol cues in
the party environment and increased attention paid to
228
smoking cues in both drug cue environments. Findings
have research and treatment implications, suggesting
contextual and complex cue exposure should be emphasized with proximal cue exposure to better understand
and treat cue response relationships in co-occurring addictive disorders. VR is ideal for providing this complex
array of cues.
Keywords: Virtual Reality, Cue Reactivity, Nicotine
Dependence, Alcohol Dependence, Contextual Cues,
Complex Cues
introduction
Laboratory studies have demonstrated that cigarette
smokers and dependent drinkers react with significant
subjective and autonomic responses in the presence of
stimuli associated with use. This laboratory method,
which has been used for several decades, is the cue reactivity paradigm. Some cognitive measures of cue reactivity have been conceptualized in terms of
“attentional bias,” that is, the inclination for drug dependent persons to be more highly focused on drug-related stimuli. Regardless of the dependent measure (e.g.,
craving, physiological arousal, attentional bias), cue reactivity responses are conceptualized by most models of
addictive behavior as a reflection of the underlying psychological processes that maintain drug use and interfere
with attempts to remain abstinent.
As noted above, nicotine dependent and alcohol dependent persons manifest similar cue reactivity profiles. However, less is known about the cue reactivity profiles of
persons who are both nicotine and alcohol dependent.
Dually dependent smokers and drinkers, in their everyday lives, have to contend with both nicotine and alcohol
cues presented in complex environments. Although reactivity to smoking-specific and drinking-specific cues
has been well established in separate tests, because
smoking and drinking often co-occur, it is also likely that
a single cue could prompt both smoking and drinking behaviors.
The plight of the dually-dependent smoker/drinker illustrates an inherent weakness in traditional cue reactivity
methods. Typically, the types of cues presented in cue
reactivity research have been direct, specific cues such
as lit cigarettes, or bottles of liquor presented in a laboratory setting. More recently, to address the relatively
complex nature of cue presentation as they occur in the
smoker’s real world, smoking cues have been catego-
rized into proximal, contextual, and complex cues. Findings are fairly consistent, with reported increases in craving associated with smoking-related contextual cues,
which were devoid of proximal cues. To date, however,
the effect of alcohol contextual cues on alcohol dependent persons has yet to be investigated.
This exploratory study used Virtual Reality (VR) to investigate the effects of a complex cue environment,
which was devoid of any proximal alcohol cues, on
measures of attention paid to both nicotine and alcohol
cues. Also investigated were differences in attention to
both types of cues based on the level of alcohol dependency.
methods
Twenty-one nicotine dependent individuals who consumed alcohol daily were divided into groups (alcohol
dependent/non-alcohol dependent). Participants engaged
in a VR session, consisting of four VR presentations
(first neutral, office, party, second neutral) spending three
minutes in each environment. The order of party and office scenarios was counterbalanced across participants.
The office and party environments each provided complex smoking cues, including olfactory stimuli, but no
overt alcohol cues were presented. After presentation of
each context, participants used a game pad to rate the attention they paid to smoking and alcohol cues on a modified Alcohol Attention Scale (AAS), displayed within
the VR context in order to maintain immersion. The AAS
asked participants to rate their level of attention to alcohol and cigarettes on 11-point scales ranging from zero
(didn’t notice at all) to 10 (completely paid attention) for
the following two items: “How much did you pay attention to the sight of alcohol (cigarettes) in the room?”; and
“How much did you pay attention to the smell of alcohol
(cigarettes) in the room?” A third pair of questions addressed thoughts about drinking or smoking on a scale
anchored by zero (didn’t think about drinking alcohol
[smoking cigarettes] at all) and 10 (thought about drinking alcohol [smoking cigarettes] all the time) for the following item “How much did you think about drinking
alcohol (smoking cigarettes) while you were in the
room?”
results
A mixed ANOVA was performed on each dependent
variable with drinker type (dependent/non-dependent) as
a between subjects factor, and VR condition (first neutral, office, party, second neutral) as a within subjects
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factor. Following each ANOVA analysis, post hoc tests
were performed to detect differences between and among
conditions. Attention to perceived alcohol cues was determined by the variables seeing alcohol, smelling alcohol, and thinking about alcohol. Attention to cigarette
cues was determined by the variables attention to cigarette cues, attention to the smell of cigarettes, and
thoughts about cigarettes. Both groups showed increases
in attention to perceived alcohol cues in the party environment and increases in attention paid to smoking cues
in both of the drug cue environments.
Conclusions
The alcohol-related findings illustrate the complex nature of the cue/response relationship in addictive behaviors that traditional cue reactivity research, due to the
methods used, has yet to be explored fully. If alcohol
contextual cues are as powerful in evoking cue responses
in alcohol dependent persons as proximal cues, then this
finding has implications for behavioral change strategies
used to treat alcohol dependence. Alcoholics may be
more sensitive to contextual cues, thus these findings
suggest alcohol treatment strategies may be more effective if more emphasis is placed on contextual and complex cues, in addition to proximal cues, when using
models of behavior change designed to teach effective
coping skills.
The complex nature of how nicotine and alcohol use is
expressed in dependent individuals, based on their environment, their situation, and their internal state is just
now becoming appreciated. There are so many complex
and subtle real world influences that contribute to smoking and excessive alcohol use. It seems clear, given the
complexity of smokers’ and drinkers’ real world environments, that a more sophisticated means of testing
these multiple factors and providing treatment that addresses them lies with a technology that can present them
both together and in isolation. That method is VR.
–––––––––––––––––––––––––––––––––––––––––––––
development of an implicit measure of an
addicitive Craving in a Virtual environment
Deok-Yong Kima,1 and Jang-Han Leea
Chung-Ang University, Department of Psychology
a
Deok-Yong Kim
1
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229
E-mail: dyongkim@gmail.com
abstract
A craving is likely to lead to approaching an addictionrelated stimulus. In this study, the primary method of
evaluating a craving is the Approach-Avoidance Task
(AAT). The AAT uses a joystick, however, it is likely to
be less sensitive because individuals cannot approach the
stimulus, but the stimulus comes toward them. The aim
of the study is the development of the virtual ApproachAvoidance Task (V-AAT). A total of 40 male participants
will be divided into two groups depending on their scores
on the Alcohol Use Disorders Identification Test. The VAAT consists of two groups. In the compatible group,
participants approach an alcohol-related cue by pushing
the joystick. In the incompatible goup, participants move
away from an alcohol-related cue by pushing the joystick.
The results are expected to show that the high social
drinkers (HSD) would show shorter duration in time before they reached the cue than the low social drinkers
(LSD) in the compatible group. On the other hand, the
HSD would show a longer duration in time than LSD in
the incompatible group. The V-AAT would show a high
correlation with the degree of alcohol related cravings.
The expected results are expected to suggest that the VAAT could assess a craving more accurately than other
implicit measures in clinical situations.
Keywords: Approach-Avoidance Task, Virtual
Environment, Cravings, Implicit Measure
introduction
A craving is the sense of the intensive desire to do something related to addictive behaviors such as drinking,
smoking, and gambling, which is one of the important
factors in the maintenance and relapse of addiction. A
substance cue (e.g., alcohol or drinking situations) is
likely to elicit cravings, and increased craving automatically affects reacting to cues and participating in addictive
behaviors [1]. The degree of cravings, thus, is important
to the study of addiction. The method of measuring a
craving is divided into two measurements, explicit (e.g.,
self-report scales) and implicit measures (e.g., behavioral
response tasks). However, explicit measurements have a
limitation, in that participants may conceal their motivations due to social desirability. Implicit measures such as
the stroop-task, the Implicit Association Test (IAT), and
the Approach-Avoidance Task (AAT), in contrast, can as-
230
sess motivation using behavioral responses regardless of
whether individuals are aware of assessment or not. The
stroop-task and the IAT indirectly assess a craving depending on the levels of interference. The AAT, on the
other hand, directly reflects the levels of “approach” or
“avoid” tendencies to or from substance cues using a joystick. Recent studies have suggested that joystick responses (pulling and pushing) give individuals the visual
impression that the stimulus actually moves toward or
away from them. However, the AAT using a joystick has
a lower sensitivity, because the stimulus comes toward
the individuals, but they cannot approach the stimulus [2].
On the other hand, the virtual environment allows them
to feel a greater sense of immersion as related to the stimulus. Therefore, the present study aimed to develop the
Virtual Approach-Avoidance task (V-AAT) and to obtain
a sense of validity compared to other implicit measures
such as the stroop-task and the IAT.
method
A total of 40 male participants will be divided into two
groups depending on their scores of the Alcohol Use Disorders Identification Test (AUDIT): high social drinkers
(HSD) and low social drinkers (LSD). The V-AAT consists of two groups with eight trials in each group, such
as the compatible and incompatible group. In the compatible group, participants approach the substance cues
in the Virtual Environment (VE) by pushing the joystick.
In the incompatible group, participants move away from
the substance cues by pushing the joystick. A dependent
variable is the response time between the time when the
substance stimulus appears and when the participants
move the joystick in either direction (i.e., up, down). The
stimulus consists of four alcohol-related cues (i.e., scenes
of drinking beer with friends) and four control cues (i.e.,
scenes of drinking juice with friends). The alcohol
stroop-task, the alcohol-IAT, and self-report scale will
also be used to evaluate alcohol cravings.
results
[Study in progress] The HSD group would show a significantly shorter duration than the LSD group in the
compatible group. On the other hand, the HSD group
would show a significantly longer duration than the LSD
group in the incompatible group. The V-AAT would
show a higher correlation with the degree of alcohol-related craving than the alcohol-stroop task and the IAT.
discussion
The V-AAT is expected to more sensitively classify the
levels of alcohol craving between high social drinkers
and low social drinkers because it is more immersive,
which participants perceive as prompting them to actually move towards drinking cues. Therefore, we expect
that the V-AAT will help assess the craving of substance
abusers and help to provide treatment using VE therapy.
references
[1] Thewissen, R., Havermans, R. C., Geschwind, N.,
van den Hout, M., & Jansen, A., Pavlovian conditioning
of an approach bias in low-dependent smokers, Psychopharmacology 194(2007), 33-39.
[2] Krieglmeyer, R., & Deutsch, R., Comparing measures of approach-avoidance behaviour: The manikin task
vs. two versions of the joystick task, Cognition and Emotion 24(2010), 810-828.
–––––––––––––––––––––––––––––––––––––––––––––
Virtual reality exposure for nicotine Cravings
Pedro Gamitoa,1, Jorge Olivieraa, André Baptistaa,
Edgar Pereiraa, Diogo Moraisv, Tomaz Saraivaa, Nuno
Santosa, Fábio Soaresa
a
Faculty of Psychology. University Lusofona of
Humanities and Technologies
Pedro Gamito
ULHT, Campo Grande, 376
Lisbon, Portugal
E-mail: pedro.gamito@ulusofona.pt
1
abstract
Several forms of treatment for nicotine dependence that
combine the classical smoking cessation strategies with
new VR exposure techniques to smoking-related cues
are in development. In light of this, the main goal of our
study was to develop a virtual platform in order to induce
craving in smokers. Sixty undergraduate students were
randomly assigned to two different virtual environments
(VE) (high-arousal cues and low-arousal cues). Both environments were based on a three-room apartment with
commercial music playing and virtual characters interacting in a social event. The assessment was carried out
before and after exposure through psychophysiological
activation and self-report data for craving and nicotine
dependence levels. No statistical differences were observed between smokers and non-smokers in psy-
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chophysiological activation. As far as self-report data is
concerned, smokers revealed a significant increase in
craving after the VR exposure to high arousal environments. Overall, results were in line with previous studies
suggesting the use of VEs as a tool for the existing smoking cessation programs.
Keywords: Virtual Reality, Nicotine craving
introduction
Smoking is a major cause of premature death and according to the World Health Organization (WHO), smoking
addiction is a global health problem that affects about a
third of the world population. Smoking can be related to
various chronic diseases [1] and to specific forms of cancer, namely, lung cancer [2].
Within Virtual Reality exposure (VRE), studies [3, 4]
have indicated a significant increase in craving for smoking cues in VRE, but in this later study the authors used
a sample of casual smokers. These authors suggested that
even within a non-clinical sample, craving can be elicited
with VRE, allowing health promotion interventions in
earlier stages of nicotine dependence.
Given the social relevance of addictive behaviors, our
main goal was to develop and to test the application of a
new virtual platform to elicit nicotine cravings. Due to
the previous findings of [3, 4] in smoking cessation, our
intent was to also explore the possible relation with craving, presence and autonomic activation during the exposure to tobacco cues.
method
sample
The sample consisted of 60 undergraduate students (16
male and 44 female) with an average age of 21.68 years
(SD = 4.04). The participants were randomly collected
from a university campus, in which, 32 (53.3%) were
smokers and 28 (46.7%) were non-smokers.
measures
Presence Questionnaire (PQ); Simulator Sickness Questionnaire (SSQ); Questionnaire of Smoking Urges
(QSU); Fagerstrom Test for Nicotine Dependence
(FTND); CNS activation (Heart rate and Skin Conductance Level).
results
Data indicated that VRE to high-arousal cues can elicit
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231
a significant increase (Z = -2.692, p < .01) on craving
level from initial (M = 3.29, SD = 1.14) to final assessment (M = 4.19, DP = 1.45). Both heart rate and Skin
Conductance Level (SCL) were calculated by the difference from baseline and reflect the variation in relation to
the baseline level. However, these data showed no significant differences in smokers during the exposure to
high-arousal and low-arousal environments.
discussion
In line with previous studies, our results indicated that
nicotine craving might increase with the presentation of
VR environments, which are in agreement with our initial purpose suggesting that the exposure to tobacco or
smoking related cues in a VE can elicit nicotine cravings
in smokers. Although our study involved a new approach
to the development of VR applications for health promotion or smoking cessation programs, overall results were
in line with previous studies suggesting the use of VEs
as a tool to complement existing smoking cessation programs, where self-control, stimulus control and improvement of strategies for coping with smoking related
stimulus or situations may occur.
references
[1] Henley S.J et al. (1995) Two large prospective studies of mortality among men who use snuff or chewing
tobacco. Department of Epidemiology and Surveillance
Research, American Cancer Society, Atlanta.
[2] Muscat, J.E., et al. 1997). Smoking and pancreatic
cancer in men and women. Cancer Epidemiology, Biomarkers & Prevention, 6, 15-19.
[3] Ferrer-Garcia et al. (2010). Efficacy of virtual reality
in triggering the craving to smoke: its relation to level of
presence and nicotine dependence. Annual Review of
Cybertherapy and Telemedicine, 154, 123-127.
[4] Carter B. et al. (2008). Location and longing: The
nicotine craving experience in virtual reality. Alcohol
Depend, 95, 73-80.
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evolution of smoking urge during exposure
Through Virtual reality
Irene Pericot-Valverdea,1, Olaya Garcia-Rodriguezb,
Jose Gutierrez-Maldonadoa, Marta Ferrer-Garciaa
and Roberto Secades-Villab
232
a
b
University of Oviedo, Spain
Irene Pericot-Valverde
Department of Personality, Assessment
and Psychological Treatments
08035, Barcelona
Spain
E-mail: ipericot@ub.edu
1
abstract
The use of Virtual Reality (VR) could be a useful tool
for the improvement of Cue Exposure Therapy (CET)
for smoking cessation. Nevertheless, it is necessary to
know the appropriate parameters of exposure in order to
develop efficacious treatment programs. This study was
conducted to analyze the pattern of tobacco desire in a
sample of smokers exposed to VR. Results showed that
the environments were able to generate two different patterns of craving response. These results could contribute
to determining exposure parameters when using VR
technology in CET.
Keywords: Virtual Reality, Cue Exposure Therapy,
Craving Pattern, Smoking
introduction
Cue Exposure Therapy (CET) can be applied through
several modalities of exposure. Specifically, in smoking
research, various modalities including videos, imaginary
procedures and in vivo presentations of cues have been
used. Virtual Reality exposure therapy (VRET) provides
another alternative over traditional methods of exposure
[1]. In the specific field of nicotine dependence treatment, VRET has some advantages [2]: VRET can simulate several real situations related to drug use; proximal
and distal cues related to cigarette use can be simultaneously presented; and the patient can re-experience the
situation as many times as necessary. Thus, the use of
VR for smoking cessation programs could be a good approach [3]. Nevertheless, it is necessary to know the specific parameters of exposition through well controlled
investigations.
The present study aimed to analyze the pattern of subjective craving in a sample of smokers exposed to VR
environments.
method
Forty-six smokers were recruited with the snowball sampling method starting from pre- and post-graduate psychology students from the University of Barcelona. The
sample comprised 26 males and 20 females who smoke
from 10 to 30 cigarettes per day. Inclusion criteria were:
a minimum smoking rate of 10 cigarettes per day; and
aged 18 or older. Exclusion criteria were: being involved
in a smoking cessation treatment; having severe health
problems related to smoke; matching DSM-IV diagnosis
of dependence for substances other than nicotine; and
having a current severe psychiatric disorder. The virtual
environments that we used reproduced two everyday life
situations where people smoke: having lunch at home;
and having breakfast at home. These scenes were selected based on a previous study aimed to assess the capability of eight virtual environments to elicit tobacco
craving [4]. For the present study, we selected the environments that trigger the most and the least craving levels in that study. All subjects were exposed to both
environments in random order.
Before the experiment, participants were asked to smoke
one cigarette to match nicotine levels among participants.
Tobacco craving was assessed before the exposure to the
environments and every minute during navigation with
a visual analogical scale (VAS). Participants had to rate
how strong was their desire to smoke in that moment
from zero (no desire) to 100 (intense desire).
results
We can recognize two different patterns of evolution of
craving for tobacco use. The lunch at home scene generated a quick response of desire that remained similar
after the second minute. On the opposite side, the breakfast at home scene increased gradually the responses of
craving during the exposure and the highest level was
obtained in the last minute.
Conclusions
These results revealed two different patterns of craving
responses when a smoker is exposed to different VR environments with smoking-related cues. The results are
important in order to determine responses and fluctuations on the urge to smoke and to predict patient response
as a function of the environment characteristics.
Enhanced knowledge about the evolution of craving response is essential to delimit exposure parameters if our
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objective is to develop effective programs for smoking
cessation under the CET paradigm.
references
[1] García-Rodríguez O, Pericot Valverde I, Gutiérrez
Maldonado J, Ferrer García M. La Realidad Virtual como
estrategia para la mejora de los tratamientos del
tabaquismo [Virtual Reality as a strategy to improve
smoking treatment].Health and Addictions. 2009;9:39-55.
[2] Baumann SB, Sayette MA. Smoking cues in a virtual
world provoke craving in cigarette smokers. Psychology
of Addictive Behaviors. 2006;20:484-9.
[3] Lee J, Lim Y, Graham SJ, Kim G, Wiederhold BK,
Wiederhold MD, et al. Nicotine craving and cue exposure therapy by using virtual environments. Cyberpsychology and Behavior. 2004 Dec;7(6):705-13.
[4] Ferrer-García, M, García-Rodríguez, O, GutiérrezMaldonado, J, Pericot-Valverde, I Secades-Villa, R.Efficacy of virtual reality for triggering smoking craving:
relation with level of presence and nicotine dependence.
Studies in health technology and informatics, 2010; 154:
123-7.
–––––––––––––––––––––––––––––––––––––––––––––
Validation of Two Virtual environments for the prevention and Treatment of pathological gambling
Claudie Lorangera,1, Stéphane Boucharda, Julie
Boulangera and Geneviève Robillarda
a
Claudie Loranger
Laboratoire de Cyberpsychologie
de l’Université du Québec en Outaouais
283 Alexandre-Taché
CP 1250, Succursale Hull
Gatineau, QC J8X 3X7 Canada
E-mail: lorc08@uqo.ca
1
abstract
Pathological gambling is an increasingly common psychiatric disorder. There is a growing need for effective
treatments and tools for early detection and prevention.
In order to improve already existing relapse prevention
programs, the use of Virtual Reality (VR) could be in-
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233
teresting because it provides therapists with easily accessible gambling-related cues. The objective of this study
was to determine if two virtual environments (bar and
casino) could induce a sufficient craving in gamblers to
be used as tools in prevention and treatment. Sixty-seven
participants (31 gamblers and 36 non-gamblers) had to
rate their desire to gamble on the Gambling Craving
Scale (GACS) after playing for seven minutes in the following four conditions: (a) a game of Scrabble (control
condition); (b) a real Video Lottery Terminal (VLT –
gold standard control condition); (c) playing VLT in a
virtual bar (first VR condition); and (d) playing slot machines in a virtual casino (second VR condition). Results
on the GACS and with skin conductance reveal that both
virtual environments elicited the same desire to gamble
than the real VLT, compared to the control condition, and
cravings were significantly higher than non-gamblers.
Skin conductance while playing the VR conditions
would predict with significant accuracy which participant was a gambler or a non-gambler.
Keywords: Gambling, Craving, Virtual Reality,
Slot Machines
introduction
Pathological gambling is characterized by a loss of control over gambling, deception about the extent of one’s
involvement with gambling, family and job disruption,
theft, and chasing losses, or the effort to win back money
lost while gambling [1]. Even if there is very little
knowledge about what constitutes effective treatment for
pathological gambling, scientific data suggest that combined cognitive and behavioral therapies are more effective than no treatment [6]. An important issue in treating
pathological gambling is that, despite understanding the
negative consequences of continued gambling, problem
gamblers at times experience an overwhelming craving
to gamble [8]. However, the therapeutic work carried out
when patients are emotionally detached from the gambling situation, such as in the psychologist’s office, is
hard to transfer to real life tempting situations. An alternative solution would be to use Virtual Reality (VR) in
order to work on relapse prevention when the person
feels completely immersed in an environment involving
gambling-related cues. The use of VR with pathological
gamblers has already been tested by two research teams
[2,9] but the virtual environments used had less graphic
and immersive qualities than what is proposed in the current project. Also, the addition of adequate control conditions appeared necessary. Thus, the objective of this
234
study was to measure the validity of Video Lottery Terminals (VLT) located in a virtual bar and slot machines
located in a virtual casino to induce cravings. Note that
the choice for VLT and a virtual casino was based on epidemiology in gamblers’ playing habits [4].
methods
participants
The sample consists of 31 gamblers and 36 non-gamblers. A person identified as a gambler had to use slot
machines at least once a month, and a person identified
as a non-gambler had to use slot machines less than twice
a year. People presenting a score of nine or more on the
South Oaks Gambling Screen (SOGS) [5] were excluded
because they are at high risk of showing a pathological
gambling problem and it was considered ethically questionable to elicit urges to gamble in that population without providing an adequate treatment. Mean score for the
SOGS was 3.27 for the gamblers group and 0.08 for the
non-gamblers group.
measures
The desire to gamble was assessed with the Gambling
Craving Scale (GACS) [8] and arousal was measured by
skin conductance. Participants also had to complete the
Presence Questionnaire, the Simulator Sickness Questionnaire [3], and the Immersion Tendencies Questionnaire [7].
procedure
The experiment was conducted in a 90-minute session.
First, a training immersion in VR was performed to allow
participants to learn how to navigate in VR and manipulate the equipment. Second, participants had to play
Scrabble with the experimenter for a period of seven
minutes (a control condition where the game is not significantly based on chance). Then, participants were randomly assigned to seven minutes of playing on: a real
Video Lottery Terminal (VLT – gold standard control
condition); VLT in a virtual bar (first VR condition); and
slot machines in a virtual casino (second VR condition).
results
Results of repeated measures ANOVAs on the GACS
and skin conductance show that the desire to gamble and
the anticipation of positive mood while gambling are statistically higher in the gamblers group than in the nongamblers group for the real VTL and the two virtual
environments. Compared to playing Scrabble, the Desire
and Anticipation subscales of the GACS, and skin con-
ductance, were increased as significantly when playing
the real VLT than the virtual VLT and the slot machines
in the virtual casino. Significant correlations were found
between the SOGS and GACS while immersed in VR
(between 0.50 and 0.70 for the real VLT, between 0.47
and 0.50 for the VLT in the virtual bar, and between 0.50
and 0.63 in the virtual casino). A discriminant analysis
could correctly classify 65% of the participants among
the gambler or non-gambler groups solely based on skin
conductance.
discussion
Results reveal that the virtual environments (bar and
casino) created can provoke among gamblers the same
desire to gamble as a real machine. In addition, the physiological reactions while playing in the virtual bar could
allow detecting who is a risk for pathological gambling.
These two VR environments could become interesting
to use as part of a larger treatment program that include
relapse prevention.
references
[1] Amercian Psychiatric Association. (1994). Diagnostic
and statistical manual of mental disorders (4th ed.).
Washington, DC: Author.
[2] Botella, C. (2004). A virtual environment for the
treatment of pathological gambling. Paper presented at
38th Annual AABT Convention. New Orleans (USA)
November 18-21.
[3] Kennedy, R., Lane, N., Berbaum, K., & Lilienthal,
M. (1993). Profile analysis of simulator sickness symptoms- Application to virtual environment systems. Presence: Teleoperator and Virtual Environement, 1(3),
295-301.
[4] Ladouceur, R., Sylvain, C., Boutin, C., & Doucet, C.
(2002). Understanding and treating the pathological
gambler. West Sussex, England: Wiley.
[5] Lesieur, H.R., & Blume, S.B. (1987). The South Oaks
Gambling Screen: A new instrument for the identification of pathological gamblers. American Journal of Psychiatry, 144, 1184-1188.
[6] Toneatto, T., & Ladouceur, B. (2003). Treatment of
Pathological Gambling: A Critical review of the Literature. Psychology of Addictive Behaviors, 17 (4), 284292.
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[7] Witmer, B.G., & Singer, M.J. (1998). Measuring
presence in virtual environments: A presence questionnaire. Presence: Teleoperators and Virtual Environments,
7(3), 225-240.
[8] Young, M. M., & Wohl, M. J. A. (2008). The Gambling Craving Scale: Psychometric Validation and Behavioral Outcomes. Psychology of Addictive
Behaviuors, 23 (3), 512-522.
[9] Young, M. M., Wohl, M. J. A., Matheson, K., Baumann, S. B., & Anisman, H. (2008). The desire to gamble:
The influence of outcomes on the priming effects of gambling episode. Journal of Gambling Studies, 24, 275-293.
–––––––––––––––––––––––––––––––––––––––––––––
alexithymia, Coping styles and interpersonal
behavior in the Context of internet addiction
Francesco Contia,1 and Ivan Formicaa
Department of Pedagogy and Psychology,
University of Messina, Italy
a
Francesco Conti
Department of Pedagogy and Psychology
University of Messina, Italy
E-mail: fconti81@gmail.com
1
abstract
The object of this study is to evaluate the correlation
among alexithymia, a problematic use of the Internet,
coping strategies and interpersonal behavior. Two-hundred students were administered the following tests: TAS20, IAT, COPE-NVI, SIB. We studied the correlation
among the individual test scores and carried a differential
analysis on independent groups identified on the basis of
the TAS-20 test. Our results show the existence of a link
between alexithymia and Internet addiction. Furthermore,
we discuss the role of these behaviors in avoiding stressful situations and interpersonal discomfort.
Keywords: Alexithymia, Coping, Internet Addiction
introduction
Firstly, Internet addiction is a complex phenomenon that
is not fully understood yet [1]. The hallmark of this work
is a wide spectrum approach to the study of the relationship between man and technology using heterogeneous
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235
psychology tools (dependence, alexithymia, coping, assertiveness).
The main hypotheses of this study are:
• H1- Whether there is a positive correlation between Internet abuse and alexithymic behavior
• H2- Whether there is a positive correlation between Internet abuse and interpersonal behavior discomfort
• H3- Whether Internet-addicted and non-addicted subjects show a substantial difference in the use of coping
strategies
• H4- Whether a different attitude towards the “virtual environment” correlates with the risk of Internet addiction.
methods
The study was carried out on a sample of 200 university
and professional school students of aged between 18-34
years (mean=22.11; standard deviation= 2.99).
The subjects were administered the following tests:
• TAS-20 [2];
• IAT (Internet Addicion Test) [3] [4];
• COPE-NVI (Coping Orientation to Problems Experienced – Nuova Verione Italiana) [5];
• SIB short version (Scale for Interpersonal Behavior) [6].
Statistical analysis was performed with the SPSS software. Correlation among IAT, TAS-20 and SIB scores
was assessed with the Pearson correlation coefficient. For
the differential analyses significance was assessed with
the Mann-Whitney U test and the Kruskal-Wallis H test.
results
Our results confirm the existence of a correlation between Internet abuse and alexithymic behavior (H1)
(r=0.363, p< 0.01) [7] and between Internet abuse and
interpersonal behavior discomfort (H2) (r=0.172, p<
0.05). We found a positive correlation between IAT and
SIB scores in discomfort (r=0.172, p< 0.05), in particular
in expressing and managing personal limits (r=0.196, p<
0.01) and in initiative assertiveness (r=0.172, p< 0.05).
Comparison between Internet-addicted and non-addicted
subjects confirmed the existence of characteristic coping
strategies (H3) in an addictive use of the net. The subjects that showed an addictive use of the net preferentially use avoidance strategies when challenged with
stressful events (U=1107.5, p< 0.01) and refrain from a
problem solving approach (U=1553, p< 0.05). By grouping the subjects by their attitude towards the “virtual environment” (attraction, fear or neutral) we identified
236
significant differences in Internet abuse and addiction
(H4) (H=15.310, p< 0.01): those attracted by the “virtual
world” show increased tendency towards Internet abuse
and avoidance strategies (H=13.799, p< 0.01) and show
decreased tendency towards strategies such as humor and
religion (H=13.799, p< 0.01).
Conclusions
We find that alexithymic behavior is associated with Internet abuse. In the net, alexithymic subjects may find a
means of encapsulation and neutralization of their own
emotional states: techno-mediated experiences may
function as an external regulator of feelings. As far as
coping strategies are concerned, there is an evident correlation between addiction and avoidance strategies. This
correlation is well documented in the literature about
drug addiction and appears to be pertinent to addictive
Internet usage as well.
references
[1] Mark Griffiths, Does Internet and Computer “Addiction” Exist? Some Case Study Evidence, CyberPsychology & Behavior 3 (2000), 211-218.
[2] Cinzia Bressi, Graeme Taylor, James Parker, & al.,
Cross Validation of the Factor Structure of the 20-item
Toronto Alexithymia Scale: an Italian Study, Journal of
Psychosomatic Research 41 (1996), 551-559.
[3] Kimberly S. Young, Internet Addiction: the Emergence of a New Clinical Disorder, CyberPsychology &
Behavior 1 (1998), 237-244.
[4] Giovanni Ferraro, Barbara Caci, Antonella D’Amico,
Marie Di Blasi, Internet Addiction Disorder: an Italian
Study, CyberPsychology & Behavior 10 (2007), 170175.
Those who abuse the net show increased discomfort in
managing their relationships with other people and in expressing limits, needs and wants from a verbal and a behavioral point of view. Such discomfort is shown
independently of the number of daily interactions the
subject actually experiences. Such discomfort is not
linked to an actual failure in social interactions but rather
to a systematic negative opinion of one’s own role in interpersonal relationships.
[5] Claudio Sica, Cristina Magni, Marta Ghisi, & al.,
Coping Orientation to Problems Experienced - New Italian Version, Psicoterapia Cognitiva e Comportamentale
14 (2008), 27-53.
Clinically, our evidence suggests that Internet addiction should be approached by keeping in mind both
the subject’s personality and his social adaptation. Future studies will address the correlation between these
two variables.
[7] Domenico De Bernardis, Alessandro D’Albenzio,
Francesco Gambi, & al., Alexithymia and Its Relationships with Dissociative Experiences and Internet Addiction in a Nonclinical Sample, CyberPsychology &
Behavior 12 (2009), 67-69.
[6] Willem Arrindel, Cristiana Bartolini, Sanavio Ezio,
Italian Version of the Scale for Interpersonal Behavior,
Psicoterapia Cognitiva e Comportamentale 5 (1999), 99107.
human dimensions in online soCial neTWorKs
–––––––––––––––––––––––––––––––––––––––––––––
online social networking amongst Teens:
friend or foe?
Bridianne O’Deaa,1 and Dr. Andrew Campbella
a
Bridianne O’Dea
Faculty of Health Sciences
Cumberland Campus,
1
Email: bridianne.odea@sydney.edu.au
abstract
The impact of Internet communication on adolescent social development is of considerable importance to health
professionals, parents and teachers. Online social networking and instant messaging programs are popular
utilities amongst a generation of techno-savvy youth. Although these utilities provide varied methods of communication, their social benefits are still in question. This
study examined the relationship between online social
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interaction, perceived social support, self-esteem and
psychological distress amongst teens. A total of 400 participants (Mage = 14.31 years) completed an online survey consisting of parametric and nonparametric
measures. No significant relationship was found between
online interaction and social support. However, time
spent interacting online was negatively correlated with
self-esteem and psychological distress. While previous
research has focused on young adults, this study examined the impact of online social networking on emerging
teens, and highlighted the need for continued caution in
the acceptance of these utilities.
Keywords: Adolescents, Online Social Networking,
Psychological Wellbeing
introduction
With over 500 million users connecting every day, online
social networks are transforming the nature and process
of human relationships. Traditional social interaction is
now replicated online as a result of increased Internet access, particularly amongst youth. The Internet has come
to represent not only an information tool, but a space
where teens can offer and receive support [1]. Online social networking sites (SNS) such as Facebook and MySpace have vastly augmented the ability of individuals
to interact regardless of demographic or geographic restrictions [2]. The popularity of these utilities, combined
with their ability to bridge offline and online connections, create a unique context for exploring the changing
nature of adolescent socialization and the implications
for their wellbeing.
Adolescent self-esteem can be affected by the tone of
feedback received from online social profiles [3]. Recent
studies have also demonstrated that online social networking does not lead to emotionally closer relationships
offline [4]. With previous research focusing on young
adults (18-25 years), little is known about the impact of
online social interaction on younger teens (13-16 years).
This is a crucial developmental phase where meaningful
friendships begin to emerge. Teens experiment with various social behaviors and experience different emotional
responses to that of older adolescents [5]. The aim of this
study was to explore the effect of online interaction on
social support, self-esteem and psychological distress
amongst emerging adolescents. It was hypothesized that
online social interaction would have no effect on social
support, but would be negatively correlated with self-esteem and psychological distress.
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237
method
A total of 400 participants (54.8% female; Mage = 14.3
years, SD: 1.2 years) completed an online survey under
the supervision of a researcher. This survey consisted of
the Multidimensional Scale for Perceived Social Support
(MSPSS) [6], the Self-Esteem Scale [7] and the K6 for
Psychological Distress [8]. It also included questions relating to Internet use and activity.
results
SNS were used by 83.8% of participants. Participants reported spending an overall 2.5 hours (SD: 1.8) per day
on the Internet. On a typical day, participants visited their
SNS 2.7 times (SD: 3.9) and spent an average of 63 minutes on their site (SD: 58.4).
Users of online SNS (M: 21.39, SD: 5.63) reported significantly lower levels of social support from their family
than non-users (M: 22.53, SD: 6.23) [p = .017]. There
were no significant differences in other independent variables. A significant negative correlation was found between time spent on SNS and self-esteem (rs = -.146, n
= 281, p <.05) as well as psychological distress (rs = .139, n = 281, p < .05). A significant negative correlation
was also found between SNS visits and MSPSS for family (rs = -.129, n = 280, p <.05). Multiple regression
analysis was used to assess the ability of SNS time to
predict levels of self-esteem. Time spent on SNS and
MSPSS were found to be significant predictors of selfesteem (R2 = .096, F (2, 278) = 14.736, p < .001).
Conclusion
This study highlights an important relationship between
social Internet use and psychological wellbeing. Results
suggest that spending time online for social purposes
may increase psychological distress and have a negative
impact on self-esteem. In an age where technology has
become omnipresent in the social lives of young people,
this study emphasizes the need for serious consideration
towards the unregulated use of online social utilities
amongst teens.
references
[1] Stjernsward, S., & ÖStman, M. (2006). Potential of
e-health in relation to depression: short survey of previous research. Journal of Psychiatric and Mental Health
Nursing, 13(6), 698-703.
[2] Hinduja, S., & Patchin, J. W. (2008). Personal information of adolescents on the Internet: A quantitative con-
238
tent analysis of MySpace. Journal of Adolescence, 31(1),
125-146.
[3] Valkenburg, P. M., Peter, J., & Schouten, A. P. (2006).
Friend Networking Sites and Their Relationship to Adolescents' Well-Being and Social Self-Esteem. CyberPsychology & Behavior, 9(5), 584-590.
[4] Pollet, T. V., Roberts, S. G. B., & Dunbar, R. I. M.
(2010). Use of Social Network Sites and Instant Messaging Does not Lead to Increased Offline Social Network Size or to Emotionally Closer Relationships with
Offline Network Members. CyberPsychology, Behavior and Social Networking, (Advance Online Publication), 1-6.
[5] Gerrig R.J., Zimbardo P.G., Campbell A. J., Cumming S.R., Wilkes F.J. (2009) Psychology and Life.
Frenchs Forest, Australia: Pearson Education Australia.
[6] Zimet, G. D., Dahlem, N., W., Zimet, S. G., & Farley,
G. K. (1988). The Multidimensional Scale of Perceived
Social Support. Journal of Personality Assessment,
52(1), 30-41.
[7] Rosenberg, M. (1965) Society and adolescent selfimage. Princeton, NJ: Princeton University Press.
[8] Kessler, R. C., Barker, P. R., Colpe, L. J., Epstein, J.
F., Gfroerer, J. C., Hiripi, E., Walters, E. E., & Zaslavsky,
A.M. (2003). Screening for Serious Mental Illness in the
General Population. Archives of General Psychiatry,
60(2), 184-189.
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perceived stress and life satisfaction:
sns use as a moderator
Qikun Niua,1, Yihao Liua, Zitong Shenga, Yue Hea
and Xiaolin Shaoa
Department of Psychology, Peking University
a
Qikun Niu
Peking University
P.R. China
E-mail: billy.nqk@gmail.com
1
abstract
Social Network Service (SNS) has become a buzzword
in recent media coverage with the development of second generation web-based communities. In China,
SNS has played an increasingly important role in its
users’ daily lives, especially among students. With a
sample of 471 college students, we tested the direct relationship between perceived stress and life satisfaction using regression analysis. Moreover, we found
SNS use could buffer the negative effect of perceived
stress. This study has practical implications on Internet
users’ SNS use.
Keywords: Social Network Service, Perceived Stress,
Life Satisfaction, Internet
introduction
Stress occurs when people face events or situations perceived as dangerous, physically and psychologically, or
when the physical and psychological limit of the organism is coerced and threatened. Studies have proved that
college students need to manage many stressors of college life, and many studies have proved that perceived
stress can negatively predict sequent life satisfaction [1].
Therefore, based on previous research, we hypothesized
that perceived stress is negatively related to students’ life
satisfaction.
Social Network Service (SNS) has recently become popular in many countries around the world, including
China. SNS allows individuals to present themselves, articulate their social networks, and establish or maintain
connections with others [2]. For those who score lower
on SNS use, perceived stress might negatively predict
their life satisfaction since they are not actively seeking
an approach for coping. However, for those who score
higher on SNS use, it’s easier for them to gain social support, which can be an effective way of coping with stress
and help them release stress. For these students, perceived stress can no longer predict their life satisfaction.
Therefore, we hypothesized that the negative relationship
between students’ perceived stress and life satisfaction
is moderated by SNS use.
methods
With a sample of 471 participants, we tested a moderation model following Baron and Kenny’s (1986) approach. Control variables, independent variable,
moderator, and the interaction term of independent variable and moderator were subsequently entered into the
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regression equation. A simple slope analysis was made
after the interaction term was found significant.
As predicted, life satisfaction is negatively related to students’ perceived stress, and the negative relationship between students’ perceived stress and life satisfaction is
moderated by SNS use.
references
[1] K.B. Matheny, W.L. Curlette, F. Aysa, A. Herrington,
C.A. Gfroerer, D. Thompson, & E. Hamarat, Coping resources, perceived stress, and life satisfaction among
Turkish and American university students, International
Journal of Stress Management 9 (2002), 81–97.
[2] N.B. Ellison, C. Steinfield, & C. Lampe, The benefits
of facebook “friends”: Social capital and college students’ use of online social network sites, Journal of Computer-Mediated Communication 12 (2007), 1143–1168.
–––––––––––––––––––––––––––––––––––––––––––––
interweaving interactions in Virtual
Worlds: a Case study
Matteo Cantamessea,1, Carlo Galimbertia and
Gianandra Giacoma
Università Cattolica del Sacro Cuore, Centro Studi e
Ricerche di Psicologia della Comunicazione,
Milano, Italy
a
Matteo Cantamesse
Centro Studi e Ricerche di Psicologia
della Comunicazione,
Milano, Italy
E-mail: matteo.cantamesse@gmail.com
1
abstract
The aim of this study was to examine the effect of playing the online game World of Warcraft (WoW) both on
adolescents’ (effective) social interaction and on the
competence they developed in playing it. Social interactions within the game environment have been investigated by integrating qualitative and quantitative
methods: conversation analysis and social network
analysis (SNA). From a psychosocial point of view, the
in-game interactions, and in particular conversational ex-
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239
changes, turn out to be a collaborative path of the joint
definition of identities and social ties, with reflection on
in-game processes and out-game relationship.
Keywords: Videogame, Interaction,
Social Network, Identity
introduction
The aim of this study was to examine the effect of playing
the online game World of Warcraft (WoW) both on adolescents’ (effective) social interaction and on the competence they developed in playing it. WoW is a Massive
Multiplayer Online Role Playing Game (MMORPG), and
involves recognizing the processes of co-construction of
meanings and interactional strategies made available in
such games, which can be defined as “inhabitated cyberplaces” in which the dialectic of Self, plural identity, subjectivity and inter-subjectivity unfolds in analogy to what
happens in face-to-face social spaces [1]. WoW, produced
by Blizzard Entertainment, is currently the MMORPG.
As stated by Krzywinska and Lowood, “[It] is a complex
world indeed, an extraordinary mixture of art and design,
technologies, economics, the social and the cultural. It is
a game, a virtual world, and an online community”[2].
We can therefore consider it as a laboratory where the social and behavioral sciences can observe and experiment
socially realistic situations.
method and Tools
The research involved seven classes, with a overal sample of 149 students, from the first course at the Liceo Scientifico Statale Marconi (Milano, Italy). The classes
were divided into three experimental groups defined as:
• Group 1 (Lab): composed of two classes whose students have participated in the experience in the computer
lab, accessing the game for two hours a week;
• Group 2 (House): composed of three classes that received a game license (with software and manual),
whose students were allowed to play at home;
• Group 3 (Control group): composed of two classes.
Game sessions and data gathering meeting lasted for two
months (for a total of 10 game sessions). In this study
we analyzed, from a psychosocial approach, the social
interaction within the game environment, integrating
qualitative and quantitative methods: conversation analysis and social network analysis (SNA). Conversational
data have been gathered by means of a modified version
of the internal chat logger, set up in order to automati-
240
cally log every channel (public chat, group chat, guild
chat) except for the private channel (also called “Whisper”). Social network data are based on a questionnaire
administered during the first week of school and after the
last, tenth game session.
results
A first level of analysis of the chats shows that first sessions are characterized by very short conversations, or
in some cases, no use of in-game chat. This situation is
understandable in light of ethnographic observations; in
fact, as we noted during the first session, the students resorted almost exclusively to the out game channel, often
moving away from their desk and speaking to friends or
neighbors. In the subsequent sessions, although characterized by constant out game buzz, there is an increased
use of in-game chat channels. The analysis revealed the
emergence of a structure that gives form to the conversations. In detail, we found three stable phases: alignment, coordination, closure. Such result is coherent with
recent studies on conversational dynamics in virtual
worlds [3], and can be read as an evolving path towards
the co-definitions of roles and meanings.
references
[1] C. Galimberti, “Segui il coniglio bianco. Strategie
identitarie e costruzione della soggettività nelle interazioni mediate.” In Identità in relazione. Le sfide odierne
dell’essere adulto, edited by C. Regalia and E. Marta,
Milano: McGraw Hill, (2010), 73-127.
[2] T. Krzywinska, H. Lowood, Guest Editors' Introduction, Games and Culture October 1 (2006), 279-280.
[3] C. Galimberti, G. Belloni, M. Cantamesse, “The development of an integrated psychosocial approach to effective usability of 3D Virtual Environments for
Cybertherapy.” PsychNology Journal 4.2 (2006), 161-180.
–––––––––––––––––––––––––––––––––––––––––––––
Comparing face-to-face and online
Communications
Maciek Lipinskil-Hartena,1 and Romin W. Tafarodia
a
University of Toronto, St. George Campus
Maciek Lipinskil-Harten
University of Toronto
St. George Campus
Canada
E-mail: mac.lipinski.harten@utoronto.ca
1
Conversely, a confirmation of the social changes aroused
by the in-game interaction can be found in the social network of the classes. The SNA shows a change in terms
of structural indicators, as regards the classes in Group
1, with little or nothing to show for classes of Groups 2
and 3. In particular, a substantial increase can be observed for transitivity, and reciprocity and density. The
qualitative analysis of patterns shows fewer outsiders
and isolated nodes in the classes of the Lab group, contrasting a tendency towards clustering of classes of the
Control and Home groups.
Conclusions
The results showed that the group experience and the cooperation required by this video game allowed the
classes to interact in a controlled environment, where
users experience social ties, roles and responsibilities. As
shown by conversations analysis, such dynamics don't
have a priori features, but are defined within a series of
incremental steps, also influencing social relationships
outside the game.
From a psychosocial point of view, the in-game interactions, in particular, conversational exchanges, turn out to
be a collaborative path of the joint definition of identities
and social ties.
abstract
Three studies compared social outcomes of dyadic faceto-face conversations with synchronous online chat conversations. Study 1 examined free-form conversations
and found that online conversations enabled social leveling for females and individuals who experience difficulties in face-to-face communications. Study 2 examined
attitude-specific conversations and found that participant
attitudes converged following face-to-face conversations,
whereas attitudes diverged following online chat. Study
3 examined conversations pertaining to a novel stimulus,
seeking to replicate the effects found in study 2 and to
demonstrate these to be a product of reduced presence
and accountability in online communications.
Keywords: Synchronous Online Communication,
Attitudes, Persuasion, Relationship Formation
introduction
As modern communications translate workplace negoti-
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ations, relationship development and attitude formation
onto synchronous, text-based, online platforms such as
Windows Live Messenger and Blackberry Messenger,
the social psychological dynamics of these processes are
also changed. To examine these changes, our research
compares traditional face-to-face conversations against
their text-based, online counterparts. Examining both
conversation transcripts and psychological outcomes, our
studies considered how the structure of conversation was
affected by the affordances of each communication’s
medium and the implications that such changes had for
persuasion, attitude formation and the development of
interpersonal relationships.
method
Participants were tested in same sex dyads and engaged
in either face-to-face conversations or anonymous online
chat room conversations. Those in the latter condition
conversed in separate locations and did not directly encounter one another either during or after the study. In
study 1, participants engaged in open-ended, “getting acquainted” conversations. In study 2, participants were
pre-selected based on their level of agreement on an attitude that they were then instructed to discuss. In study
3, participants were asked to read and discuss a short
story. In studies 2 and 3, participant attitudes toward the
topic of discussion were measured both before and after
conversations occurred.
results
Using the tools of conversation analysis [1, 2] in tandem
with the actor-partner interdependence model of dyadic
effects [3], study 1 found that online conversations leveled
face-to-face differences in assertive elements between
male and female conversations. Online conversations also
allowed more frequent users of this medium to compensate for communicative deficiencies experienced in faceto-face conversation. Online conversations were also
found to be significantly more disjointed in structure.
Study 2 found that conversation partners’ attitudes toward
the subject of conversation became less similar following
online conversations, but more similar following face-toface conversation. Data from study 3, currently in
progress, thus far support the results of study 2 and further
suggest that the disjointed structures of online conversations contribute to this difference in outcomes.
discussion
Thus far, results suggest that communicative outcomes
of online conversation significantly differ from tradi-
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241
tional, face-to-face conversation. Particularly, online
conversations emphasize differentiation of the individual
over mutual understanding and affect. Understanding
this difference is crucial to the effective use of online
technologies in the numerous institutions for which these
have become a key communications resource.
references
[1] E.A. Schegloff, Sequence organization in interaction:
A primer in conversation analysis, New York, Cambridge
University Press, 2007.
[2] R. Wooffitt, Conversation Analysis and Discourse
Analysis, London, Sage Publications, 2005.
[3] D.A. Kenny, D.A. Kashy & W.L. Cook, Dyadic data
analysis, New York, Guilford, 2006.
–––––––––––––––––––––––––––––––––––––––––––––
gender stereotyping of emotion presentation in
Computer-mediated Communication
Shu-Cheng Choua, Yi-Ting Wanga
and Chih-Chien Wangb,1
National Taiwan University
National Taipei University
a
b
1
Chih-Chien Wang
PO. Box 4-1
Sansia Township
New Taipei City 23799
Taiwan
E-mail: wangson@mail.ntpu.edu.tw
abstract
The study conducted an experiment to investigate the
gender stereotyping of emotion presentation in e-mail
and face-to-face communication. The empirical studies
results revealed that the gender stereotype of emotion
still exist in e-mail communication, although no facial
communication is available in e-mail communication
context. Based on this study, we can conclude that the
gender stereotype of emotion is a popular phenomenon
existing in our culture, rather than being dependent on
facial communication.
Keywords: Gender, Stereotype, E-mail,
Computer-Mediated Communication
242
introduction
People usually believe males and females differ in emotion expression [1-3]. This gender stereotyping of emotion is relative with facial expression [3]. Nevertheless,
in Computer-Mediated Communication (CMC), information is mainly sent as text. From the point of media
richness theory, Face-to-Face (F2F) communication is a
very rich medium while e-mail is the leanest medium [4].
This study aims to investigate if the gender stereotyping
of emotions exists in CMC.
This study focuses on the gender stereotype of emotion
presentation in CMC. Receivers’ perception to senders’
emotion presentation in e-mail and in F2F communication are investigated. Today, CMC is now one popular
alternative to communicate with others. This study is
useful in understanding if gender stereotyping of emotion presentation is worsened or mitigated in CMC.
senders than male ones in e-mail (t=-2.86; p<.01) and
face-to-face communication (t=-2.29; p<.05). Nevertheless, if subjects held a low gender stereotype subjects’
did not perceive higher levels of anger from female
senders in both e-mail and face-to-face communication.
Thus, gender stereotypes moderate individuals’ perception to senders’ presentation of emotion.
Conclusion
Previous studies revealed that gender stereotype is relative with facial communication. However, this study revealed that gender stereotyping of emotional
presentation still exists in CMC, although no facial communication is available in it. The message sender’s gender will moderate individuals’ emotional perception in
CMC communication. Participants with a high gender
stereotype perceive higher levels of angry from a female
sender than from a male one.
method
This study recruited 104 (35 male) voluntary participants
from one university. Before the experiment, subjects
were asked to fill the gender stereotype scale developed
by Plant, Hyde, Keltner, and Devine (2000). Afterwards,
participants were randomly assigned to one of four scenarios. A 2 (media type: email and face-to-face) × 2 (gender of message sender: male, and female) between
subjects design was employed to test the gender stereotyping of emotion presentation in e-mail and face-to-face
communication. In the face-to-face communication scenario, subjects were asked to view a video of an angry
(female/male) customer complaining about service in a
restaurant service. In the e-mail communication scenario,
subjects were asked to view a complaint e-mail from an
angry (female/male) customer. Then, subjects’ emotional
perceptions were measured. The study adopted the perception of anger emotion scale, which was proposed by
Diener, Smith, and Fujita [5]. This scale included four
items. All items of gender stereotype and perceived of
emotion were based on a seven point Likert-type.
references
[1] D. W. Birnbaum, T. A. Nosanchuk, & W. L. Croll.
Children's stereotypes about sex dfferences in emotionality. Sex Roles, 29 (1980), 435-443.
data analysis
This study found that subjects perceived higher levels of
the emotion of anger from female senders than from
male ones (t=-2.31; p<.05). Therefore, this study found
that people perceive higher levels of emotion from female senders than male senders.
–––––––––––––––––––––––––––––––––––––––––––––
The Therapeutic lan: a group intervention
method involving network Video game as
social simulator
Also, subjects holding a gender stereotype concerning
emotion perceived a higher amount of anger from female
[2] R. A, Fabes, & C. L. Martin, Gender and age stereotypes of emotionality. Personality and Social Psychology
Bulletin, 17(1991), 532-540.
[3] E. A. Plant, J. S. Hyde, D. Keltner, & P. G. Devine.
The gender stereotyping of emotions. Psychology of
Women Quarterly, 24(2000), 81-92.
[4] V. Lee, & H. Wagner. The effect of social presence
on the facial and verbal expression of emotion and the
interrelationships among emotion components. Journal
of Nonverbal Behavior, 26(2002), 3-25.
[5] E. Diener, H. Smith, & F. Fujita, The personality
structure of affect. Journal of Personality and Social Psychology, 69(1995), 130-141.
Samuelle Ducrocq-Henrya,1
a
Département de création et nouveaux médias,
UQAT, (Canada)
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Samuelle Ducrocq-Henry
Département de création et nouveaux médias
UQAT (Canada)
E-mail: Samuelle.Ducrocq-Henry@uqat.ca
1
abstract
The Therapeutic LAN (TL) is a group intervention
method, a product of 10 years of research involving
teenagers that are video gamers (LAN party). It uses the
strengths of Virtual Reality (VR), networks, and serious
gaming with a social, fun and interactive immersion of the
patients. Serious games represent a promising market for
video games by promoting education, therapy, etc. On interconnected computers that are part of a network (LAN),
the TL puts participants in contact through a video game
transformed into a collective or individual simulator. The
TL uses popular games that are turned into "mods" at lowcost, by adapting the original script to the needs of the
speaker. It promotes learning and socialization through interaction, introspection and communication around issues
about identity and social roles. It connects patients to their
self and to others, according to a cathartic and reflexive
process specific to the virtual space, but reinforced by the
group's presence and a therapeutic monitoring of behavioral analysis (via group therapy, impact techniques, etc.)
Its educational and therapeutic perspectives in education
and psychosocial interventions, especially, intend to fight
against dropping out of school, video game addiction, attention deficit disorder, and the inhibition or disengagement of boys in class.
Keywords: Serious Game, Simulation, Network Video
Games, Group Therapy, Socialization
introduction
This presentation is based on a long case study about network video gamers in the context of competition, which
examines the communicational and educational potential
of a new type of social and technical event: the LAN
party [1]. The LAN party is a competition of video
games based on a local network system which can gather
many hundreds of players divided into teams, for several
days, at the same place. A computer network is connected to local servers with computers provided by all
players, in order to hold a tournament in which the players compete using strategy and shooting in multiplayer
games. Since 2001 some surprising observations have
been documented: hundreds of players specify that their
knowledge of English and data processing, their tactical
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243
and sporting attitude, and their proximity with team
members and close opponents, is due to the practice of
local network video game competitions.
By means of the social proximity that it offers, the LAN
reveals an opportunity of passing rite, based on tribal organization [2], in which the competitive circumstances
favor socialization, initiation and expansion of new abilities [3-4], which is a stunning parallel against various
social movements such as Baden-Powel’s scouting
movement. Exploratory and ethnographic, at first raised
from intuition, this multi case study has been conducted
between 2001 and 2009, and was supported by the interactionist current, centered on the relationships between
players. So, its main theme was that interaction is seen
as a “field of mutual influence” [5]. The study revealed
that social networking based on video game competitions
favor elements of learning and socialization. But can the
model of LAN party be used in others contexts such as
therapeutic and professional intervention? The study
confirms this point and offers a theoretical model applied
as a group intervention method for therapy, called “Therapeutic LAN” (TL). A TL is a method using network
video games that lets people engage in role-playing and
social interactions within a therapeutic context. For this,
the TL favors human interactions analysis of the network
users, their social attitudes and self-perception, to reveal
support and hopefully, solve socialization and addiction
issues or maladjusted behaviors. They can guide and support systemic approaches [6], like family and group therapies [7], or the use of impact techniques [8], through
the reenactment of daily social situations.
method
The research used ethnographic tools of a field investigation such as pictures, a log book, hundreds of completed forms and interviews of hundreds of casual
gamers chosen randomly from main LAN parties in Quebec in 2003 and 2007 (LAN ETS, ATI, etc.). As an exploratory study of an emergent cultural practice, no
theoretical framework was used to initially support the
research, but the concepts of socialization, learning, motivation and identity, emerged later from the analysis of
the first collections of data. Taking the inductive form of
a method inspired from the Grounded Theory [9] that allows exploration, as the investigated field of LAN parties
was a new social event without direct documentation in
2001, the new conceptual model of the “Pedagogical and
Therapeutic LAN” (PL and TL) synthesized our conclusions.
244
results
By joining the initiation to an experience in which motivation operates as a fundamental function [10] and taking inspiration from the theory of activity according to
Engeström [11], the systematic modeling of the LAN reveals that the player’s identity thrives on an introspective
and progressive socialization through levels (the four
ages of players) inspired from Piaget [12]. It is reinforced
through the experience of “Flow” [13], supplied by the
practice of multiplayer video games through a local network. With a background composed of optimized initiation through the typical interactions in LAN,
introspection is favored in the virtual mode and the social
feedback in a present mode. The conceptual model of PL
or TL proposes the simultaneous superposition of a unifying communicational device taking place in two
worlds at the same time. This device is transposable to
any other discipline having a computing class.
Through systemic approaches like family or group therapy, the immersive power of the LAN stimulates the
senses of users: it allows the mobilization of sensory
memory and the analysis of their “self” [14] through introspection and thoughts on the way they act in the game,
and through social retroaction and roles they play with
other users of the TL in a present mode.
Conclusion
To conclude, this type of LAN process, transposed in a
therapeutic context, allows the application of the immersive experience on the collective behavior and advocates
the creation of pedagogic or therapeutic scenarios applicable to existing games while adapting them as “mods.”
By diverting the practice of popular multiplayer video
games, the LAN is able to mobilize, for other means, the
interests of generations whose games are also part of
their culture and language.
references
[1] S. Ducrocq-Henry, Les tribus ludiques du « LAN party
» : perspectives d’apprentissage et de socialisation en contexte de compétition de jeux vidéo en réseau local, Phd The-
sis, UQAM, Montréal, 2011.
[2] M. Maffesoli, Le temps des tribus : le déclin de l'individualisme dans les sociétés de masse. Coll. Le livre de poche,
Paris, Librairie générale française, 2000.
[3] G. Brougère, Jouer et apprendre, Economica, Paris, 2005.
[4] J. P. Gee, What video games have to teach us about learning and literacy, Palgrave MacMillian, New-York (USA),
2007.
[5] D. Le Breton, L’interactionnisme symbolique, Presses
universitaires de France, Paris, 2004.
[6] G. Bateson, Vers une écologie de l’esprit, T.1, Seuil,
Paris, 1977.
[7] V. Satir, Conjoint family therapy, Sciences and behavior
books, Palo Alto, 1967.
[8] E.E. Jacob, Impact therapy, Par, Florida, 1994.
[9] B. Glaser, G. Barney G. and A. L. Strauss. Discovery of
Grounded Theory: Strategies for Qualitative Research. Reed.
1999, AldineTransaction, Piscataway (NJ, USA), 1967.
[10] R. J. Vallerand and E. Thill (dir.), Introduction à la psychologie de la motivation, Editions études vivantes, Laval,
1997.
[11] Y. Engeström, M. Reijo and P. Raija-Leena, Perspectives on Activity Theory, Cambridge University Press, 1999.
[12] J. Piaget and I. Bärbel, La psychologie de l'enfant, PUF,
Quadrige, 2004.
[13] M. Csikszentmihali, Vivre, la psychologie du bonheur,
Robert Laffont, Paris, 2005.
[14] D. Beaulieu, Techniques d’impact, Quebecor, Montreal, 2010.
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245
3-d enVironmenTs for eaTing
disorders and sChizophrenia
male body dissatisfaction and attentional
bias on 3-d body images
Ara Choa,1 and Jang-Han Leeb
Department of Psychology,
Chung-Ang University, Seoul, Korea
a
Ara Cho
Department of Psychology,
Seoul, Korea
E-mail: eoqkdghk@hanmail.net
1
abstract
This study aimed to identify the relationships between
male body dissatisfaction and exposure to muscular ideal
body images through examination of attentional bias.
Twenty-eight male university students (13 for high body
dissatisfaction group; 15 for low body dissatisfaction
group) underwent an eye-tracking task consisting of 3D images of four body types (i.e., thin, normal, fat, and
muscular body of a male). Results showed that both of
groups gave more attention to the muscular body than
other body stimuli. This finding suggests that both men
of high and low body dissatisfaction choose the ideal
muscular body as a comparison target when exposed to
bodies, but the process and effect of comparison might
be different in the level of body satisfaction.
Keywords: Male Body Image, Attentional Bias, Body
Dissatisfaction, Eye-Tracking
introduction
Many researchers have found that exposure to media images of ultra-thin female models was associated with increased body dissatisfaction, body size distortion, mood
disturbance and decreased self-esteem in females [1].
Similarly, males exposed to muscular media ideal have
shown profound negative influences on young male’s
body images [2]. Exposure to mass media images depicting muscular males is associated with poor body images
[3]. When exposed to a muscular ideal body, males who
were dissatisfied with their own body showed more increased body dissatisfaction than before, possibly lead-
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ing to muscle dysmorphia, steroid uses, and cosmetic
surgery [4]. Females with body image disturbance are
more likely to show attentional bias toward body-related
stimuli. Many studies have shown the relationships between attentional bias toward appearance-related images
and body dissatisfaction of females. Since body dissatisfaction of males is increasing these days, it appears to
be necessary to identify the effects of muscular ideal
image through measuring attentional bias.
Therefore, the aim of this study is to identify the relationships between male body dissatisfaction and exposure to muscular ideal images through the examination
of attentional bias. We hypothesized that high body dissatisfaction group would give more attention to idealized
muscular male body stimuli, compared to low dissatisfaction group.
method
Twenty-eight male university students (mean age=23.00,
SD=1.61) were divided into two groups (13 for high body
dissatisfaction group: high BD; 15 for low body dissatisfaction group: low BD) based on the Body Esteem Test
(BET; Franzoi & Shields, 1984) and Body Cathexis Scale
(BCS; Sorcord & Jourad, 1953). 3D program, Poser v
7.0.1.97 SRI was used to construct images of four types
which are thin, normal, fat and muscular body of male.
Thirteen sets of four images (total of 72 image) were used
for an eye-tracking task. Participants sat in front of the
19” computer monitor for measuring eye movements
(EMs) using iView XTM Red - IV Eye Tracking System
(Sensomotoric Instruments). The eye-tracking equipment
was calibrated for each participant. In the EM task, each
trial started with a central cross fixation for 1,000ms,
which was replaced by a set of 3-D images shown side
by side for 4,000ms. Two practice trials and 72 critical
trials were conducted. Before starting the trials, the following instructions were displayed: "From now on, the
trials start. A pair of pictures will appear for 4 seconds
after the ‘+’ sign. Do not talk or move your head during
the experiment." After the eye-tracking task, participants
reported their height, weight, and how often they exercised. The procedures took about 15minutes.
results
A 2(group: high BD, low BD) × 4(stimuli types; thin,
246
normal, muscular and fat stimuli) repeated-measures
ANOVA for dwell time indicated a significant main effect of stimuli type (F(3,28) =10.97, p < 0.01), but there
was no significant main effect of group and interaction
of group × stimuli type. Independent t-test did not show
a significant single main effect in any stimulus, and high
BD group was significantly higher than low BD group
in the frequency of exercise (t(26) = -3.03, p <0.05).
discussion
From this study, it was showed that the high BD group
gave more attention to muscular ideal body than other
body stimuli. From this finding, it could be possible to
provide the evidence of relationship between social comparison theory and increased body dissatisfaction of males.
references
[1] H. A. Hausenblas, C. M. Janelle, R. E. Gardner, & A.
L. Hagan, Effects of exposure to physique slides on the
emotional responses of men and women, Sex Roles
47(2002), 569-575.
[2] R. A. Leit, J. L. Gray & H. G. Jr. Pope, The media’s
representation of the ideal male body: A cause for muscle
dysmorphia? International Journal of Eating Disorders
31(2002), 34-338.
[3] S. Grabe, L. M, Ward, & J. S. Hyde, The role of the
media in body image concerns among women: A metaanalysis of experimental and correlational studies. Psychological Bulletin 134(2008), 483-491.
[4] A. Blond, Impacts of exposure to images of ideal
bodies on male body dissatisfaction: A review, Body
Image 5(2008), 244-250.
–––––––––––––––––––––––––––––––––––––––––––––
Virtual reality exposure in patients with eating
disorders: influence of symptom severity
and presence
Marta Ferrer-Garciaa,1 and Jose Gutierrez-Maldonadoa
a
Marta Ferrer-Garcia
Barcelona, Spain
E-mail: martaferrerg@ub.edu
1
abstract
The aim of this study was examining the influence of
several modulating variables on subjective discomfort
experienced by patients with eating disorders while exposed to virtual environments that were emotionally significant for them. Severity of symptoms and sense of
presence were analyzed. Both variables influenced the
level of subjective discomfort experienced in the virtual
environments.
Keywords: Virtual Reality, Eating Disorders,
Subjective Discomfort
introduction
Virtual Reality (VR) is a useful technology for body
image disturbance assessment and treatment [1, 2]. Nevertheless, a necessary condition for the successful use of
VR in therapeutic intervention is that the virtual environment (VE) should elicit the same degree of anxiety as
the real-life situation [3, 4]. Previous studies assessed the
capability of VR environments to provoke responses of
anxiety and depression in participants with eating disorders [5, 6]. High-calorie environments and social situations produced the highest levels of anxiety and
depression. Given the capability of VR environments to
produce emotional responses in ED patients, the aim of
this study was exploring possible modulating variables
such as symptoms severity and sense of presence that
may influence the results.
method
participants
Seventy-one patients with eating disorders (49 women
with anorexia nervosa and 22 women with bulimia nervosa) participated in the study. All of them were undergoing treatment.
assessment
• Subjective discomfort: Measured with a visual analogical scale from 0 to 100
• Sense of presence: Measured with the Spanish translation of the Presence Questionnaire (PQ) [7]
• ED symptoms: Measured with the Eating Attitudes
Test-26 (EAT-26) [8]
procedure
Tests were administered in two stages. In the first stage,
participants were requested to fill in the EAT-26 and
were measured and weighed in order to obtain their Body
Mass Index. In the second stage, participants were ex-
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posed to six VEs: Neutral room, kitchen with low-calorie
food, kitchen with high-calorie food, restaurant with
low-calorie food, restaurant with high-calorie food, and
swimming pool. First, they visited the neutral virtual environment and subjective discomfort (SUD) and sense
of presence were assessed. Then, the five experimental
VEs were randomly administered. In the interval between the presentations of each environment, experienced subjective discomfort and sense of presence were
again assessed.
results
As expected, ED patients showed significantly higher
levels of subjective discomfort in the kitchen with lowcalorie food (F[5, 71]= 25.79, p< .001, η2= 0.27), the
kitchen with high-calorie food (F[5, 71]= 200.40, p<
.001, η2= 0.74), the restaurant with low-calorie food
(F[5, 71]= 54.12, p< .001, η2= 0.44), the restaurant with
high-calorie food (F[5, 71]= 148.30, p< .001, η2= 0.68),
and the swimming-pool (F[5, 71]= 101.07, p< .001, η2=
0.60) than in the neutral room. High-calorie environments and social situations produced the highest levels
of subjective discomfort.
We also explored whether the presence of possible modulating variables influenced the results. Symptoms severity and sense of presence were analyzed. The sample was
divided into three groups depending on EAT-26 scores:
Mild, moderate, and severe symptomatology. A repeated
measures analysis of variance 3 x 6 was conducted. The
simple effect of symptoms severity (F[2, 71]= 22.77, p<
.001, η2= 0.40) was significant. The interaction between
the VE and the severity of symptoms was significant in
the high-calorie kitchen, the low-calorie restaurant, the
high-calorie restaurant, and the swimming pool. The
group with severe symptoms showed the greatest disparity between discomfort experienced in these situations
and the neutral room.
Similar results were found when analyzing sense of presence. ED patients with a high sense of presence (25% with
highest scores in the PQ) showed higher levels of discomfort in all situations (F [2, 71]= 7.57, p= .01, η2= 0.19)
than the low presence group (25% with lowest scores in
the PQ). Furthermore, the interaction between presence
and VE was significant in the kitchen with low-calorie
food, the restaurant with low-calorie food, and the restaurant with high-calorie food (Table 1). The high presence
group showed the greatest disparity between discomfort
experienced in these situations and the neutral room.
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247
Conclusions
As previously found in different studies [4, 5], exposure
to VEs produced changes in ED patients’ mood. Highcalorie environments and social situations elicitated the
highest levels of subjective discomfort among subjects.
Moreover, emotional reactions to VEs differed depending
on the severity of the ED symptomatology and the sense
of presence experienced during the VR exposure. Patients
with severe symptoms reacted more strongly than patients
with mild and moderate symptoms. This difference was
stronger in situations where participants had to eat highcalorie food and in social situations. Also, higher levels of
presence were related with higher subjective discomfort.
references
[1] C. Perpiñá, C. Botella, & R.M. Baños, Virtual reality
in eating disorders, European Eating Disorders Review
11 (2003), 261-278.
[2] G. Riva, M. Bacchetta, M. Baruffi, & E. Molinari.
Virtual reality-based multidimensional therapy for the
treatment of body image disturbances in obesity: a controlled study, CyberPsychology & Behavior 4 (2001),
577-526.
[3] A. Gorini, E. Griez, A. Petrova, & G. Riva, Assessment of emotional responses produced to real food, virtual food and photographs of food in patients affected by
eating disorders, Annals of General Psychiatry 9 (2010),
doi:10.1186/1744-859X-9-30.
[4] M. Slater, D.P. Pertaub, C. Barker, D.M. Clark, An
experimental study on fear of public speaking using a
virtual environment, CyberPsychology & Behavior 9
(2006), 627-633.
[5] J. Gutiérrez-Maldonado, M. Ferrer-García, A.
Caqueo-Urízar, A. Letosa-Porta, Assessment of emotional reactivity produced by exposure to virtual environments in patients with eating disorders,
CyberPsychology & Behavior 9 (2006), 507-513.
[6] M. Ferrer-García, J. Gutiérrez-Maldonado, A.
Caqueo-Urízar, E. Moreno, The validity of virtual environments for eliciting emotional responses in patients
with eating disorders and in controls, Behavior Modification 3 (2009), 830-854.
[7] M. Slater, A. Steed, J. McCarthy, F. Maringelli, The
influence of body movement on subjective presence in
248
virtual environments, Human Factors 40 (1998), 469477.
groups, although the difference will be larger for the
overweight group of children.
[8] D.M. Garner & P.E. Garfinkel, The Eating Attitudes
Test: An index of symptoms of anorexia nervosa, Psychological Medicine 9 (1979), 273-279.
Keywords: Exergaming, Childhood Obesity,
Game Design, Acceptability
–––––––––––––––––––––––––––––––––––––––––––––
Comparison between an exergaming platform and
Traditional physical activity: acceptability and use
preferences in overweight and normal Weight
Children samples
Ausiàs Cebollaa,c, Rosa María Bañosb,c,1, Jaime
Guixeresd, Julio Álvarezc,e, MªIsabel Torrosc,e, Cristina
Botellaa,c and Mariano Alcañizc,d
a
Universitat Jaume I
Universitat de València
c
CIBER de Fisiopatología de la Obesidad y
Nutrición (CIBEROBN)
d
I3BH Innovation & Research Institute on Bioengineering for Humans- Universidad Politécnica de Valencia
e
Child & Adolescent Cardiovascular Risk Unit, Pediatric Service, University General
Hospital, Valencia
b
Rosa María Baños
Universitat de València
c
CIBER de Fisiopatología de la Obesidad y
Spain
E-mail: banos@uv.es
1
abstract
Physical Activity is a fundamental component in the prevention and treatment of childhood obesity. Problems are
posed by low motivation and adherence to guidelines
proposed by clinicians. The use of new technologies like
videogames (Exergaming) in the treatment of childhood
obesity can be useful to facilitate the adherence to physical activity tasks. Exergaming refers to the use of
videogames to improve health and the fitness. The objective of this study is to compare the acceptability and
use preferences of an Exergaming platform in two samples of children, overweight and a normal weight in a
laboratory setting. This study is in progress. It is expected to find better acceptance and use preferences of
this platform compared to a traditional system in both
introduction
Obesity is a chronic, complex and multifactor disease
which usually appears in childhood and adolescence; currently, it is an important and increasingly common public
health problem. Excess body weight is the most common
childhood disorder in Europe according to the European
Association for the Study of Obesity [1]. Physical activity
is a basic component of childhood obesity treatment aided
by dietary modification patterns. Traditionally, the clinician provides guidelines of physical activity and sport to
children, but the problem is low motivation and adherence to these guidelines. In recent years, new “active
video games” have been developed, whose objective is
the involvement of the body in the game. “Exergaming”
refers to the use of videogames to improve health and the
fitness [2]. These platforms have been growing in popularity in recent years (Nintendo WII, Microsoft Xbox
Kinect, Sony Playstation 3 Move, etc.) Similarly to the
emergence of these platforms, an increasing interest has
emerged in the study on their effectiveness in the promotion of physical activity. The results of several studies
shows that the energy expended by children playing active video games in short periods of time is comparable
with energy expended in traditional vigorous activities
like brisk walking, climbing stairs or running [3]. Thus,
the new Exergaming Platforms can be a suitable tool to
promote physical activity at home in childhood overweight groups. They have also shown high acceptance
levels in normal weight children [4]. So far, there has not
been a study conducted to address use preferences and
acceptability in a clinical overweight group.
objective
The objective of this study is to compare the acceptability and use preferences of an Exergaming platform in
two children samples (overweight and a normal weight)
in a laboratory setting.
method
A total sample of 50 children was recruited from a summer school (Control group) and a Hospital unit specialized in the treatment of overweight children (Overweight
group) in Valencia, Spain. The age of the participants
ranged from 10-13 years old. The children had to per-
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249
form traditional physical activity on a treadmill and an
Exergaming exercise. All the children used both systems
in a counterbalanced design. They were asked to fulfill
a questionnaire before and after the exercise to measure
self-efficacy and use preferences.
[4] Graves L, Stratton G, Ridgers ND, Cable NT. (2007)
Comparison of energy expenditure in adolescents playing new generation and sedentary computer games: cross
sectional study. British Medical Journal,335, 1282 –
1284.
results
The study is currently in progress.
–––––––––––––––––––––––––––––––––––––––––––––
using Virtual reality to study paranoia in
individuals With and Without psychosis
Conclusion
It is expected to find better acceptability and higher use
preferences for the Exergaming Platforms in both
groups, but the overweight group will show more preferences and a higher rate of acceptability as compared to
the traditional group. The Exergaming platforms are an
interesting tool to promote physical activity and change
habits in a clinical context, specifically in childhood obesity treatment, a population that is traditionally less active. These platforms can be an extra reinforcement for
children use to be active, mixing video games with the
sport. It is also expected to facilitate motivation to practice physical activity. In just a few years there have been
a growing number of Exergaming platforms (Sony
Playstation, Wii, Kinect), and it is a suitable moment to
study if they are an effective clinical tools.
Acknowledgements
CIBERobn is an initiative of ISCIII. This research it
has been realized ,in part, supported by Ministerio de
Ciencia e Innovación (Plan Nacional de Investigación
Científica, Desarrollo e Innovación Tecnológica 20082011), in the project (PSI2008-04392/PSIC), and the
Excelence Research Program PROMETEO (Generalitat Valenciana. Conselleria de Educación; 2008/157).
references
[1] European Association for the study of Obesity
(2003). Obesity in Europe: The case for Action (on
line). Accessed 5 April 2008. Avalaible in:
wwwiotf.org.
[2] Maddison R, Mhurchu CN, Jull A, Jiang Y, Prapavessis H, Rodgers A. (2007) Energy expended playing video console games: an opportunity to increase
children’s physical activity? Pediatric Exercise Science,
19,334 –343.
[3] Daley, A. (2009) Can Exergaming Contribute to Improving Physical Activity Levels and Health Outcomes
in Children?. Pediatrics, 124, 763-771.
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Willem-Paul Brinkmana,1, Wim Velingb,
Emily Dorrestijnb, Guntur Sandinoc, Vanessa Vakilia
and Mark van der Gaagb,d
Delft University of Technology, The Netherlands
b
Parnassia Psychiatric Insitute, The Hague,
The Netherlands
c
CleVR, The Netherlands
d
VU University, Amsterdam, The Netherlands
a
Willem-Paul Brinkman
Delft University of Technology
Mekelweg 4, 2628 CD
Delft, The Netherlands
E-mail: w.p.brinkman@tudelft.nl
1
abstract
A Virtual Reality (VR) environment was created to
study psychotic symptoms of patients that experience
psychosis. In the environment people could navigate
through a bar with a gamepad while wearing a head
mounted display. Their task was to find five virtual characters that have a small label number on their chest. The
density and ethnic appearance of the virtual characters
in the bar was controlled. To study the effect of these
two factors a 2 by 2 experiment was conducted with a
group of 24 non-patients, and two patients. For the nonpatient group results showed a significant main effect
for density on participant’s physiological response, their
behavior, reported level of discomfort, and their ability
to remember place and location of the numbered avatars.
The avatars’ ethnicity had a significant effect on nonpatients’ physiological responses. Comparison between
the two patients and non-patient group shows a difference in physiological responses, behavior and reported
level of discomfort.
Keywords: Virtual Reality, Psychosis, Social Scene,
Psychotic, Paranoia, Exposure
250
introduction
Psychosis is a mental condition whereby people have
delusions or prominent hallucinations. For example, individuals in a state of paranoid psychosis can experience
fear as they believe that others intend to harm them. One
key variable of understanding psychosis is the social environment. Epidemiological studies have shown high
rates of psychotic disorders in densely populated urban
environments and among immigrants who live in neighbourhoods with a low proportion of ethnic minorities,
likely reflecting the causal influence of environmental
risk factors [3]. Recreating the social environment in virtual reality (VR) has been put forward as a means to
study psychotic symptoms [2]. A VR system was therefore developed including the control of two potential environmental stressors: population density and ethnic
appearance of an avatar group in a bar. A study is reported into the effect of these factors on a group of nonpatients and two patients.
method
Individuals could freely navigate through the bar consisting of an indoor and outdoor setting. Potential stressors that could be set were: (1) ethnic appearances of an
avatar group, either mainly white-European or mainly
North-African; and (2) the density of the avatars in the
bar either between 7-9 or between 34-38 avatars. To engage the people with these avatars the system randomly
gave five of these avatars a number, visible on their
clothing, which participants had to find. During this task
the navigation behavior with Logitech Chillstream
Gamepad was automatically recorded. Participants wore
an Emagin Z800 3D Visor with a resolution of SVGA
800x600 24 bit, with 40 degrees diagonal Field of View,
and build in 3DOF tracker.
Participants were a white Dutch non-patient group consisting of university staff and students, including four females and 20 males, with average age of 29 years (SD =
9.2); and two male Dutch patients, 36 and 25 years old,
who completed technical and vocational training for 1216 year-olds and for 16-18 year-olds. The experiment
was set up with a 2 by 2 within-subjects design for the
two factors of the avatar group (ethnicity and density).
As a baseline measurement for galvanic skin response,
a three-minute neutral physiological measurement was
taken, where participants sat in a chair. After this, participants had a training session in which they navigated
through the VR world and looked for the numbered
avatars. Once this was completed participants were ex-
posed to the four experimental conditions, with a maximum of three minutes each for the non-patients group
and four minutes for the patients. The experiment of the
non-patient group was conducted in a university lab,
while the two patients participated at the mental health
clinic.
results
To study the effects for ethnicity and density a series of
MANOVAs with repeated measures were conducted.
Compared to low density conditions, in the high density
conditions: fewer locations (F(1,23) = 7.07, p. = 0.014)
and numbers (F(1,23) = 10.47, p. = 0.004) were correctly
remembered of the labelled avatars; self-reported level
of discomfort was higher (F(1,23) = 5.24, p. = 0.032);
standard deviation of the heart rate was larger (F(1,23)
= 10.09, p. = 0.004); average distance towards an avatar
was smaller (F(1,23) = 4.86, p. = 0.038) in a two meter
radius of a visible avatar. Compared to white-European
avatars, in the conditions with a majority of NorthAfrican avatars, the standard deviation of heart rate was
larger (F(1,23) = 4.70, p. = 0.041) and standard deviation
of galvanic skin response was larger (F(1,22) = 4.40, p.
= 0.048). The data obtained from the two patients were
compared with a series of One-sample t-tests with means
of the non-patient group. Compared to the non-patient
group the overall trends across the conditions for these
two patients was that they positioned themselves more
closely to the avatars in the two meter radius of the
avatar. Furthermore, their heart rate was higher, they
sweated more, and their self reported level of discomfort
was higher.
Conclusion and discussion
Results seem to indicate that density and ethnicity had
an effect on the non-patients group. The latter seems to
support earlier reports on physiological responses towards the ethnicity of avatars [1]. The collected data
from the non-patient groups forms a baseline to compare
patients with, as was done for two patients that showed
differences in their physiological responses, their behavior and their reported level of discomfort. Besides a baseline comparison, future work could also consider
in-depth analysis of a specific patient behavior towards
various types of avatars, e.g., gender, and ethnicity.
references
[1] R. Dotsch, Wigboldus, D.H.J., Virtual prejudice.
Journal of experimental social psychology 44 (2008),
1194-1198.
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[2] D. Freeman, Studying and treating schizophrenia
using virtual reality: a new paradigm, Schizophrenia Bulletin 34 (2008), 605-610.
251
[3] van Os, J., Kenis, G., Rutten, B.P.F. The environment and schizophrenia. Nature 468 (2010), 203212.
VirTual humans: The nexT generaTion of
personal CoaChes
mindfulness Training and Coaching via a Virtual
synthetic Character
tablish a regular practice. Below we briefly describe the
virtual mindfulness coach and an evaluation study of its
effectiveness, and discuss the findings.
Eva Hudlickaa,1
Psychometrix Associates, Blacksburg, VA, US
a
Eva Hudlicka
Psychometrix Associates
Blacksburg, VA, US
E-mail: hudlicka@ieee.org
1
abstract
The past decade has witnessed an increasing interest in
the use of virtual coaches in healthcare. We describe a
virtual coach that provides mindfulness meditation training, and the coaching support necessary to begin a regular practice. The coach is implemented as an embodied
conversational agent, capable of multi-modal interaction
with the user (via natural language and non-verbal facial
expressions). The coach adapts both its facial expressions and the dialogue content to the user’s learning
needs and motivational state. Findings from a pilot evaluation study indicate that the coach-based training is
more effective in helping users establish a regular practice than self-administered training via written and audio
materials.
Keywords: Virtual Coaches, Mindfulness, Adaptive
Training, Embodied Conversational Agents
introduction
In spite of the demonstrated benefits of mindfulness
meditation [1-3], access to mindfulness training remains
limited, due in part to a lack of adequately trained
providers, and a lack of access to training programs. To
address this problem, we developed a virtual computer
coach that provides customized, adaptive training in
mindfulness meditation, and the coaching required to es-
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method
The virtual mindfulness coach is an embodied conversational agent [4], capable of conducting mixed-initiative,
natural-language dialogue with the user. The coach is
represented by an image of a face, capable of showing a
range of facial expressions. The coach guides the student
through the didactic material, including recorded guided
meditations, and provides customized advice about meditation practice, based on the student’s expressed concerns.
The coach’s effectiveness was evaluated in a 7-week
study, to assess its ability to provide mindfulness training
(weeks 1-4), and support students in establishing a regular practice (weeks 5-7). An experimental group used
the coach, and a control group used written and audio
materials. Participants (N=32; 75% female) were asked
to meditate 5x/week, for 20 minutes each time.
results
The results indicate that the coach provides more effective training and coaching than a self-administered program, using written and audio materials. Specifically,
the coach group participants practiced more frequently
(4.5 days/week vs. 3.2), and for longer time (19’ vs. 16’),
than the controls. This effect was particularly evident
during the 3-week follow-up period (frequency: 4.3
days/week coach vs. 2.7 control; length: 18.5’ coach vs.
13.6’ control).
The coach group participants found the experience more
rewarding, enjoyable, beneficial, and engaging than the
controls. The coached participants appeared to be in
more advanced stages of change, in terms of the transtheoretical model of behavior change, and felt more confident in their ability to maintain a regular practice. All
252
of these findings were statistically significant (p < .05).
The conceptual and practical knowledge about mindfulness meditation was equal for both groups.
Conclusions
The findings from a pilot evaluation study indicate that
the coach-based training is more effective in helping
users establish a regular practice than self-administered
training via written and audio materials. These results
demonstrate the feasibility of using a virtual computer
coach to provide mindfulness meditation training, and
warrant further coach development, to enhance its adaptive capabilities, and a further study, focusing on the specific elements of the coach features, and the user-coach
interaction, that contribute to its effectiveness.
references
[1] J. Kabat-Zinn. Mindfulness-based interventions in
context. Clinical Psychology: Science & Practice 10(2),
(2003) 144-156.
[2] J.D. Teasdale, Z.V. Segal, J.M.G.Williams, V.A.Ridgeway, J.M.Soulsby, M.A.Lau. Prevention and relapse/recurrenct in Major Depression by MBCT. Jnl. of
Consulting & Clinical Psychology 68(4), (2000), 615-623.
[3] C. Germer. Mindfulness. In Mindfulness & Psychotherapy. C.K.Germer, R.D.Siegel, P.R.Fulton, Eds.
NY: Guilford. (2005) 3-27.
[4] J. Cassell,, J. Sullivan, S. Prevost & E. Churchill. Embodied Conversational Agents. Cambridge, MA: MIT
Press. (2000).
–––––––––––––––––––––––––––––––––––––––––––––
people like Virtual Counselors That
highly-disclose about Themselves
abstract
In this paper, we describe our findings from research designed to explore the effect of self-disclosure between
virtual human counselors (interviewers) and real human
users (interviewees) on users’ social responses in counseling sessions. To investigate this subject, we designed
an experiment involving three conditions of self-disclosure: high-disclosure, low-disclosure, and non-disclosure. We measured users’ sense of copresence – feelings
of connection and togetherness with interaction partners
– and social attraction to virtual counselors. The results
demonstrated that users reported more copresence and
social attraction to virtual humans who disclosed highly
intimate information about themselves than when compared to other virtual humans who disclosed less intimate
or no information about themselves.
Keywords: Virtual Counselors, Virtual Humans, Virtual
Agents, Self-disclosure, Copresence, Social Attraction,
Rapport, Anonymity, Affective Behavior,
Contingency, Nonverbal Feedback, Psychotherapy
introduction
The goal of our ongoing studies is to investigate the
potential use of virtual humans as counselors in psychotherapeutic situations. Researchers in clinical psychology argue that people like their counselors more
when the counselors disclose highly intimate information about themselves as compared to when they disclose lowly intimate information in face-to-face
counseling interactions. The literature suggests that
self-disclosure is a pre-requisite for verbal psychotherapy, and that this is enhanced when social connections
between the client and therapist are strengthened by
mutual self-disclosure. However, we do not know yet
whether we can consistently achieve similar outcomes
in interactions between virtual humans and real human
users.
Sin-Hwa Kanga,1 and Jonathan Gratcha
Institute for Creative Technologies, University of
Southern California
a
Sin-Hwa Kang
USC Institute for Creative Technologies
12015 Waterfront Drive
Playa Vista, CA 90094
USA
E-mail: sinhwa.kang@gmail.com
1
Although studies have found users’ engagement by perceiving copresence and social attraction to partners
when interacting with virtual humans, few studies have
investigated whether users like virtual human counselors who talk about themselves in counseling situations. No other study has explored whether a counselor’s
level of self-disclosure affects a person’s social responses, including feelings of copresence and social attraction, when he interacts with a virtual human as a
counselor. Therefore, we explored this subject through
designing an experiment involving different levels of
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self-disclosure from virtual counselors in interaction
during an interview.
method
The experimental design was a between-subjects experiment involving three conditions of self-disclosure:
High-Disclosure, Low-Disclosure, and Non-Disclosure.
In the Disclosure (Hi- and Low-) conditions, virtual humans preceded each interview question with some information about themselves. We measured users’ feelings
of copresence and social attraction. We used the Rapport
Agents [Gratch et al., 2006] that presented timely nonverbal feedback as virtual counselors. Fifty-seven people
(53% women, 47% men) from the general Los Angeles
area participated in this study. The participants were randomly assigned to one of three experimental conditions.
Participants were given instruction describing the counseling interview interaction. The interview questions
were designed to gradually increase levels of intimate
self-disclosure from the participants. Participants in all
conditions saw the virtual humans displayed on a 30-inch
computer monitor. The typical interaction was allowed
to last about thirty minutes, but participants were not informed of any specific time limitation.
results
Copresence was composed of fourteen items in two categories: perceived copresence and self-reported copresence (Cronbach’s alpha = .87). Social Attraction was
composed of the six items (Cronbach’s alpha = .88). The
between-subjects MANOVA analysis showed that users
reported feelings of copresence and being attracted to
their partners more when they were interviewed by the
virtual humans that preceded each interview question
with high-disclosure information about themselves than
interaction with other virtual humans with low- or nondisclosure about themselves.
Conclusion
We found that virtual counselors’ level of self-disclosure,
specifically a high level of self-disclosure, positively affected users’ sense of copresence and social attraction to
virtual counselors. Based on the outcomes, we argue that
people are more likely to like virtual humans who precede
interview questions with highly intimate information
about themselves in a counseling interview interaction.
This has been found in face-to-face counseling interactions with real human counselors. Therefore, the findings
of this study suggest a possibility of using virtual humans
as counselors in psychotherapeutic situations.
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253
–––––––––––––––––––––––––––––––––––––––––––––
Virtual reality and fitness: effects of a Virtual Coach
on enjoyment, attentional focus and behavior
Daniel R. Mestrea,1, Marine Ewalda
and Christophe Maianoa
a
Institute of Movement Sciences,
CNRS & Aix-Marseille University, France
Daniel R. Mestre
Institute of Movement Sciences,
CNRS & Aix-Marseille University
France
E-mail: daniel.mestre@univmed.fr
1
abstract
We herein report an experimental study testing the potential positive effects of Virtual Reality (VR) feedback
during an indoor bicycling exercise. Using a regular bike
coupled with a VR system, we observed an increased
level of enjoyment of physical activity, when compared
to a regular exercise situation and VR conditions. We
also observed a shift in the subjects’ attentional focus,
from association without feedback to dissociation in the
VR conditions. Moreover, the presence of a virtual coach
in the virtual environment triggered a systematic regulation of the (virtual) displacement speed, whose relationship with perceived enjoyment and exertion require
further work.
Keywords: Virtual Reality, Physical Exercise, Virtual
Coach, Affective State
introduction
The general idea behind coupling a traditional indoor cycling device with a Virtual Reality (VR) system is that
the latter, through sensorial feedback, will increase users’
involvement and adherence to the exercise, a major issue
in sports fitness [1]. Indeed, very few studies have tested
the effect of a VR setup on affective states and performance [2,3]. From these studies, it is not clear whether VR
exercise systems truly enhance mood states and, more
specifically, physical activity enjoyment. Furthermore,
the relationship between psychological and performance
effects of VR are not straightforward. Annesi and Mazas
[4] suggested that VR might enhance performance, by
diverting the participants’ attention from unpleasant bodily sensations. Thus, VR effects on exercise might be re-
254
lated to a shift from an association attentional focus, in
which participants focus their attention on internal sensations, to a dissociation focus in which attention is directed to external distracting stimuli [5]. The present
experiment was designed to investigate the relationship
between performance, attentional focus and physical activity enjoyment, while participants carried out a physical exercise at moderate intensity levels (usual fitness
condition).
experimental design
The experimental setup consisted of a stationary bike,
installed in front of a display screen and connected to a
computer on which the Tacx Trainer VR software controlled a virtual cyclist on an indoor racing circuit. During the exercise, the software controlled the effort
feedback sent to participants through a pad fixed on the
rear wheel. The software also recorded participants’ pedalling speed, via an optical detector placed on the same
device. Finally, the software used the participants’ pedalling speed to control his/her displacement speed in the
virtual environment. The participants’ performance (instantaneous speed, power, pedalling frequency, heart rate
– via a Polar® monitor) was recorded by the system for
off-line analysis.
During a preliminary session, six healthy participants
(between 19 and 25 years of age) were tested (without
VR feedback). They were asked to maintain a moderate
exercise intensity level for an average duration of 15
minutes. Heart rate was monitored and had to be at least
110 bpm throughout the exercise. Each participant's average speed was used as a reference in later sessions.
Subsequently, on a weekly basis, three conditions were
tested, in random order across participants. In the first
condition (condition 1), no feedback (except the effort
feedback) was provided. In the second condition (condition 2), participants were immersed in the virtual environment (visual and auditory [crowd] feedback). In the
third condition (condition 3), they had to follow a virtual
coach, acting as a pacer, whose speed was calibrated to
each participant's performance (average speed) during
the initial session. Finally, at the end of each session, participants had to fill out questionnaires (using visual analog scales), measuring perceived exertion (Borg scale),
physical activity enjoyment (PACES scale) and attentional focus (association-dissociation scale).
results
All participants were easily able to achieve the task (at a
moderate intensity level). Statistical analysis of individual data failed to reveal any significant difference in average speed between the three sessions, suggesting that
participants were able to maintain regular exercise intensity. Each session consisted of 25 laps on the indoor
track. We analyzed average speed for each lap and speed
variation between laps. We found that average speed was
roughly constant for the first two conditions (no feedback and VR feedback). However, for the third condition
(virtual coach providing direct access to the target speed
in the virtual environment) we observed a systematic
speed regulation. In this condition, it appeared that participants were able to slow down for a while, accelerating
afterwards to hold on to the “pacer.” At the same time,
we observed that the participants’ attentional focus was
significantly more dissociative in VR conditions (conditions 2 and 3). Finally, physical activity enjoyment was
significantly increased from condition 1 (no feedback)
to condition 2 (VR feedback), as well as between condition 2 and 3 (virtual coach).
Conclusions
In line with previous work [6], this study suggests that
VR promotes a dissociative attentional focus (acting as a
distractor from the exercise intensity). It also suggests that
having a virtual coach present in the virtual environment,
acting as a pacer delivering contextual information about
the target intensity level, increases exercise enjoyment
and also enables the participant to regulate his/her displacement speed around an average target speed. The correlation and causality links between these behavioral and
psychological aspects of physical activity require further
investigations, in relation with VR effects on long term
commitment to physical activity, in a fitness context.
references
[1] R.K. Dishman, Exercise adherence, In R. N. Singer,
M. Murphey, & L.K. Tennant (Eds.), Handbook of Research on Sport Psychology (pp. 779-798). New York,
Macmillan, 1993.
[2] W.A. Ijsselsteijn, Y.A. De Kort, J. Westerink, M. De
Jaggerand, R. Bonants, Virtual Fitness: Stimulating exercise behavior through media technology, Presence 15
(2006), 688-698.
[3] S. Huang, P. Tsai, W. Sung, C. Lin, T. Chuang, The
comparisons of heart rate variability and perceived exertion during simulated cycling with various viewing devices, Presence 17 (2008), 575-583.
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[4] J.J. Annesi, J. Mazas, Effects of virtual reality-enhanced exercise equipment on adherence and exerciseinduced feeling states, Perceptual Motor Skills 85
(1997), 835-844.
[5] J.C. Hutchinson, G. Tenenbaum, Attention focus during physical effort: The mediating role of task intensity,
Psychology of Sport and Exercise 8 (2007), 233-245.
[6] D. Mestre, C. Maïano, V. Dagonneau, C.-S. Mercier,
Does Virtual Reality Enhance Exercise Performance, Enjoyment and Dissociation? An Exploratory Study on a
Stationary Bike Apparatus, Presence 20 (2011).
–––––––––––––––––––––––––––––––––––––––––––––
simulated interviews 3.0: Virtual humans to Train
abilities of diagnosis – usability assessment
Claudia Peñaloza-Salazara,1, Jose Gutierrez-Maldonadoa, Marta Ferrer-Garciaa, Azucena Garcia-Palaciosb,
Antonio Andres-Pueyoa and Angel Aguilar-Alonsoa
b
University Jaume I, Spain
255
problems to be solved, facilitating learning by bringing
students progressively closer to the best performance.
Diagnostic interviews in psychology require the mastery of several skills and abilities that have to be
trained. Nevertheless, interaction with real patients
should be avoided during the initial stages of training.
Instead, training should be provided under guidance
from a professor, in controlled settings that mimic real
life situations as closely as possible. The objective of
this study was to develop a virtual environment that
simulates a situation where the trainees interact with
virtual patients. These simulated patients are realistic
objects constructed using a series of parameters that define their verbal, emotional and motor responses. The
high level of interactivity achieved increases the
trainees’ sensation of participating in the simulated situation, and thus improves the learning of required
skills. Simulated Interviews 3.0 includes several virtual
interviews to patients with different disorders. The purpose of the interviews is to obtain enough data to formulate a diagnosis.
a
Claudia Peñaloza Salazar
Paseo de la Vall d’ Hebrón, 171
08035, Barcelona, Spain
E-mail: claudia_penaloza@hotmail.com
1
abstract
Diagnostic interviews in psychology require the mastery
of several skills and abilities that have to be trained. The
purpose of this study was to develop a virtual environment that simulates a situation where the trainees interact
with virtual patients. The usability of the application was
assessed. Results suggested that the simulated interviews
are friendly and motivating for psychology students’
training.
Keywords: Virtual Humans, Diagnostic Interview,
Training, Psychology, Usability
introduction
Virtual Reality (VR) is widely used for health care professionals’ training [1]. This technology provides
trainees with simulations of real life situations where
they can learn-by-doing in a safe educational context.
Furthermore, VR allows graduating the difficulty of the
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method
participants and procedure
Sixty seven undergraduate students participated in the
study. Mean age was 24.70 (SD= 3.25) and most of
them were female (77.6%).
assessment
The usability of Simulated Interviews 3.0 was assessed
with the Software Usability Measurement Inventory
(SUMI) [2].
procedure
Simulated Interviews 3.0 was included as a task for undergraduate students to perform during the academic
year at the University of Barcelona and the University
Jaume I. Once finished, participants assessed the usability of the application.
results
Participants showed a good level of general satisfaction
with the application and found it easy to use. More
specifically, 92.5% of participants agreed that the way
the information was presented was clear and understandable, and 88% agreed that instructions and
prompts were helpful. Furthermore, 85.1% of participants agreed that working with this software was satisfying, 85.1% considered that the software had a very
256
attractive presentation, 85.1% enjoyed the sessions, and
88% would recommend it to their colleagues.
Conclusions
Simulated Interviews 3.0 is a VR application for psychopathological diagnostic skills training. The software
provides trainees a motivating and friendly training context that allows them to develop diagnostic interview
skills, according to their needs and at their own pace.
references
[1] F. Mantovani, G. Castelnuovo, A. Gsggioli, & G.
Riva, Virtual reality training for health-care professionals, CyberPsychology & Behavior 6 (2003), 389395.
[2] J. Kirakowski & M. Corbett, SUMI: The software
measurement inventory, British Journal of Educational
Technology 24 (1993), 210-212.
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New IOS Press Publication!
Annual Review of Cybertherapy
and Telemedicine 2011
Advanced Technologies in the Behavioral, Social and Neurosciences
Cybertherapy – the provision of healthcare services using advanced technologies – can help improve the lives of many of us, both patients and
health professionals, while tackling the challenges to healthcare systems.
INFORMATICS 167
benefits
and the
technical
Despite the potential of cybertherapy,
its
ma
turity of the applications, the use
of cybertherapy
services
is still
limited,
and the market remains highly
countries
–
fragmented.
Although
many
including USA, Europe, Korea
and
Japan
–
have
expressed
their
com
mitment to wider deployment
of cybertherapy,
most
cybertherapy
ini
tiatives are no more than one-off,
small-scale
projects
that
are
not
in
tegrated into healthcare systems.
TECHNOLOGY AND
Annual Review of
Cybertherapy and
Telemedicine 2011
Advanced Technologies in Behavioral,
Social and Neurosciences
these new
types
of services
It is recognized that integrating
in healthcare
systems is a challenging task. The aim of this book is to support and en
courage all the interested countries
by identifying
and
in this endeavor,
helping to address the main barriers
hindering
the
wider
use
of
cy
bertherapy and by providing evidence
to
build
trust
and
acceptance.
Healthcare systems focus on meeting the needs of patients. Achieving
cybertherapy’s potential, therefore, depends on patients being convinced
of its ability to satisfy their healthcare needs. Acceptance by patients depends crucially on acceptance by the health professionals treating them,
given the high degree of trust the former place in the latter. An important
factor for ensuring the confidence and acceptance
of health professionals
is enhanced dissemination of the evidence base regarding
the effective
ness of cybertherapy services, their safety features and user-friendliness.
Editors: Brenda K. Wiederhold
Stéphane Bouchard
Giuseppe Riva
Contents:
• Critical Reviews summarize and evaluate emerging cybertherapy topics,
including Interreality, CyberAddiction and Telemedicine;
• Evaluation Studies are generally undertaken to solve some specific
practical problems and yield decisions about the value of cybertherapy
interventions;
• Original Research presents research studies addressing new cybertherapy methods or approaches;
• Clinical Observations include case studies or research protocols with
a long-term potential.
Volume 167 Studies in Health Technology and Informatics
Editors: B.K. Wiederhold, S. Bouchard,
and G. Riva
June 2011, 224 pp., hardcover
ISBN: 978-1-60750-765-9
Price: US $167 / Euro 115 / £104
Visit our Web site for more information or order online at
www.iospress.nl or www.booksonline.iospress.nl
259
posTer presenTaTions
––––––––––––––––––––––––––––––––––––––––––––––
investigations of executive functions using
Virtual multiple errands Test and
psychophysiological measures
Pietro Cipressoa,c,1, Simona Raspellia, Federica
Pallavicinia, Alessandra Grassia,b, Anna Balgerac, Andrea
Gaggiolia,b, Marco Villamirac, Giovanni Alabanid,
Alessandro Maurod and Giuseppe Rivaa,b
IRCCS Istituto Auxologico Italiano, Milan, Italy
b
Department of Psychology, Catholic University of
Milan , Milan, Italy
c
IULM University, Milan, Italy
d
Division of Neurology and Neurorehabilitation, San
Giuseppe Hospital, IRCCS-Istituto Auxologico Italiano,
Piancavallo (VB), Italy
a
Pietro Cipresso
Applied Technology for Neuropsychology Lab
IRCCS Istituto Auxologico Italiano
Milan, Italy
E-mail: p.cipresso@auxologico.it
1
abstract
In this work we investigate both electroencephalographic
and cardio-respiratory activity during the use of a tool for
the assessment of executive functions in patients with different aetiologies by customizing a virtual reality (VR)
version of the Multiple Errands Test (VMET). An approach based on combined use of psychophysiological
and neurophysiological measures and psychological tests
such as VMET, together with the aetiology of the disease
represents a better chance to classify diseases and differentiate from other diagnosis.
ferent aetiologies by customizing a virtual reality (VR)
version of the Multiple Errands Test (VMET). This task
is supported by the use of advanced technologies capable
of providing an ecologically valid context for the patient
while he/she is involved in a complex planning task [1].
Cardiovascular indexes can give us a large amount of information about sympathovagal interaction [2]. Electroencephalographic and cardio-respiratory indexes also need
to assess measures of both global cognitive function and
attention/executive function [3].
One of the most widely used instruments to analyze these
aspects is the EEG. In particular, the frontal EEG activation asymmetry has been generally used, providing evidence that greater left frontal activity seems to be higher
related to positive mood, whereas greater right frontal activity seems to be more involved in stress, anxiety and depression, and this factor affect the related diseases in many
aspects. There are indications, even if more studies are required, that greater right hemisphere activity is due to increased levels of stress and decreased levels of immune
functioning. Furthermore, according to other interesting
studies (e.g., Schmidt et al., 1999; Tops et al., 2005; Lewis
et al., 2007), there is evidence of higher cortisol levels in
individuals with greater right frontal activity and according to many authors cortisol is more likely to be released
from the right hemisphere than the left.
Keywords: Psychophysiology, Biosensors, Virtual Reality, Executive Functions, Multiple Errands Test
In this work we investigate both electroencephalographic
and cardio-respiratory activity during the use of a tool for
the assessment of executive functions in patients with dif-
An approach based on combined use of psychophysiological and neurophysiological measures and psychological
tests such as VMET, together with the aetiology of the diseases, represents a better chance to classify and differentiate from other diagnosis.
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260
We propose to test the responses of the central and peripheral nervous system by means of BVP (Blood Volume
Pulse), GSR (Galvanic Skin Response) and RSP (chest
respiration). For also explore the use of an Epoc, a neurosignal acquisition and processing wireless neuroheadset
device for the acquisition of 14 EEG (electroencephalogram) channels (plus CMS/DRL references, P3/P4 locations). Channel names based on the International 10-20
locations are: AF3, F7, F3, FC5, T7, P7, O1, O2, P8, T8,
FC6, F4, F8, AF4. We expect that patients and controls
have distinct patterns of abnormality in heart rate variability and EEG spectra during VMET.
references
[1] Raspelli et Al. A neuro VR-based version of the multiple errands test for the Assessment of executive functions: A possible Approach Journal of CyberTherapy &
Rehabilitation.
[2] Magagnin V, Mauri M, Cipresso P, Mainardi L, Brown
E N, Cerutti S, Villamira M, Barbieri R (2010) Heart Rate
Variability and Respiratory Sinus Arrhythmia Assessment
of Affective States by Bivariate Autoregressive Spectral
Analysis. Computing in Cardiology 37: S32.
[3] Mauri M, Magagnin V, Cipresso P, Mainardi L, Brown
E N, Cerutti S, Villamira M, Barbieri R (2010) Psychophysiological signals associated with affective states In: Conf
Proc IEEE Eng Med Biol Soc. (EMBC) 3563-3566.
––––––––––––––––––––––––––––––––––––––––––––––
standardized scoring of the
Virtual multitasking Test
Kim Héberta, Hélène Forgeta,1, Pierre Nolinb, Geneviève
Foresta, Frédéric Banvilleb and Stéphane Boucharda
Université du Québec en Outaouais, Gatineau, Canada
b
Université du Québec à Trois-Rivières,
Trois-Rivières, Canada
a
Hélène Forget
Gatineau, Canada
E-mail: helene.forget@uqo.ca
1
abstract
The purpose of this study is to present the development
of standardized scoring for the Virtual Multitasking Test
CT16 Poster Presentations
(V-MT). V-MT is a virtual reality (VR) system inspired
by the Multiple Errands Test [1] with the principal objective of evaluating multitask and prospective memory
problems frequently seen in dysexecutive syndrome.
Keywords: Virtual Reality, Multitasking Test, Executive
Functions, Neuropsychological Assessment
introduction
The term “executive functions” describes a set of highorder cognitive abilities that are needed for complex or
non-routine tasks. They include the ability to initiate and
stop actions and to monitor and change behavior as
needed. Executive functions allow us to anticipate outcomes and adapt to changing situations. Their change in
aging or after brain damage can compromise successful
adaptation and performance in real-life situations.
Usually, standardized neuropsychological assessment uses
highly unusual stimuli and paradigms, which are non-ecologic and non-representative. Moreover, a normal performance on standardized tests can be compatible with
impaired behavior in everyday life situations. In response
to these problems, virtual reality (VR) offers several benefits and advantages for assessment and treatment.
The main goal of this poster is to present the development
of standardized scoring for our Virtual Multitasking Test
(V-MT) [2] inspired by the Multiple Errand Test [1],
where the principal objective is an assessment of prospective memory and executive functions in daily life.
methods
participants
Two groups of people will participate in the study. The
first consist of healthy young subjects (aged from 18-30
years old). The second is composed of older subjects between 65-80 years old without motor and cognitive impairment.
measures
A functional V-MT was created by Banville et al. [2]. This
environment includes a virtual apartment which consists
of an entryway, a kitchen, a living room, a bathroom, two
bedrooms, and an office (see Fig.1). One measure is used
to assess the ecological validity of the V-MT: the DEX [3].
The self-rating DEX is a 20-item questionnaire that asks
participants to rate the frequency with which particular behavioral difficulties associated with executive functioning,
such as inhibition control and planning, occurs in their
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day-to-day lives. The MoCA is used to evaluate cognitive
functioning [4].
scoring method
We are interested in developing a standardized scoring
method for V-MT. The score sheet will allow identification
of specific task errors or omissions, other inefficiencies,
rule breaks, time to completion, and strategy use. For each
task and rule specified in the V-MT, as inclusive a list as
possible of performance errors will be developed to allow
judges to specify errors accurately. Moreover, we will
evaluate qualitative aspects such as flexibility, perseverance, etc.
planned analyses
Initial data collection and analysis is intended to commence in January 2011. Descriptive analyses will be conducted for all measures by group. Ecological validity will
be determined by comparing V-MT scores with scores on
the DEX questionnaire.
perspective and Conclusion
In the future, we will establish the psychometric properties
of the V-MT with a aim to its potential clinical utility. For
example, the concurrent validity of V-MT will be evaluated by correlations between V-MT performance and standard neuropsychological tests. After the experiments with
control subjects (young and older), a clinical trial among
patients with brain damage is envisaged.
references
[1] T. Shallice, P.W. Burgess. Deficits in strategy application following frontal damage in man. Brain 114 (1991),
727-741
[2] F. Banville, P. Nolin, J. Cloutier, S. Bouchard. The development of the virtual multitasking (V-MT) for the identification of dysexecutive functioning in everyday living.
Virtual Rehabilitation: From Vision to Reality, Canada,
2007.
[3] B.A.Wilson, N. Alderman, N. Burgess, H. Emslie, J.J.
Evans. BADS:Behavioural Assessment of the Dysexecutive Syndrome. Bury St. Edmunds, UK, 1996.
[4] Z.S. Nasreddine, N.A. Phillips, V. Bédirian, S. Charbonneau, V. Whitehead, I. Collin, J.L. Cummings, H.
Chertkow. The Montreal Cognitive Assessment (MoCA):
A brief screening tool for mild cognitive impairment.
J.Am.Geriatr. Soc. 53, (2005), 695-699.
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––––––––––––––––––––––––––––––––––––––––––––––
Validation of a narrative as an emotional-induction
Technique through different non-invasive psychophysiological monitoring devices: preliminary results
Simona Raspellia, Federica Pallavicinia, Alessandra
Grassia,b, Pietro Cipressoa,c, Anna Balgeraa, Daniela
Meazzia, Andrea Gaggiolia,b, Marco Villamirac and
Giuseppe Rivaa,b
b
Department of Psychology, Catholic
University of Milan, Milan, Italy
c
IULM University Via Carlo Bo 8, 20143
Milan, Italy
a
Simona Raspelli
Milan, Italy
E-mail: s.raspelli@gmail.com
1
abstract
The purpose of this study was to investigate the capability
of an emotional narrative to induce a congruent emotional
response. For this purpose, different psychophysiological
indexes, including cardio-respiratory activity, physiological arousal, and neurophysiological indexes were monitored. Two audio narratives were presented to 20
participants. The first narrative was assumed to be neutral
and was adapted from Sinha [1]. The second narrative
was assumed to induce a negative emotional response.
The narrative depicted an oral academic examination and
was derived from the imagery-based technique suggested
by Lang [2].
Keywords: Emotional Induction, Emotional Narrative,
Imagery, Biosensors
The goal of the present study was to examine the capability of an emotional narrative to induce a congruent emotional response. Two audio narratives were presented to
20 participants. The first narrative was assumed to be neutral and was adapted from Sinha [1]. The second one, assumed to induce a negative emotional response, depicted
an oral academic examination and was derived from the
imagery-based technique suggested by Lang [2]. More
262
specifically, it was based on specific units such as those
connected with stimulus (auditory, visual, olfactory, etc.)
and those connected with answer (verbal, visceral, etc.).
Both narratives were audio recorded in order to standardize the exposure time (at least one minute) and to minimize variables able to influence physiological parameters
detection.
The study included a sample of 20 right-handed undergraduate students from an introductory psychology class
at IULM University. Participants were requested to close
their eyes and visualize, as vividly as possible, the presented situations as they were directly happening to them.
As psychological measures, the study involved the qualitative subjective measures of the Visual Analogue Scale
for Anxiety (VAS-A) [3] before and after the stimuli presentation and after a baseline period. As physiological
measures, facial electromyography Zygomatic (EMG-Z),
Blood Volume Pulse (BVP), Thoracic (chest) Respiration
(RSP), and Skin Conductance (SC/GSR) were used. Before beginning the experiment, a three-minute baseline of
physiological parameters was recorded. Following this
procedure, subjects were asked to complete the VAS-A.
Then, the experimental session began and physiological
parameters were recorded until the end of the task. During
this phase, two audio narratives were presented to the
subjects (in counterbalanced order) and physiological parameters were recorded. A five-minute break was planned
between the exposures to the two narratives. Following
the presentation, participants completed the VAS-A.
expected results
Once extracted, all biosignals are worked in Matlab and
branched into three categories: Baseline; Neutral; and
Emotive. Each category contains all the psychophysiological signals of that session and can be computed for
signal processing procedures in order to extract a series
of indexes for the statistical analysis.
From ongoing data analysis, we expect an increased level
of negative emotions (anxiety), measured both through
psychological and physiological indexes during the emotional narrative, compared to during the neutral one.
Acknowledgments
The work in preparing this paper was partially supported
by the European funded project "Interstress: Interreality
in the Management and Treatment of Stress-Related Disorders,” FP7-247685.
references
[1] R. Sinha, Multivariate Response Patterning of Fear and
Anger, Cognition & Emotion, (1996), 173- 198.
[2] P.J. Lang, A bio-informational theory of emotional imagery, Psychophysiology, 16 (1979), 496-512.
[3] D.D. Price, P.A. McGrath, & A. Rafii, The validation
of visual analogue scales as ratio scale measures for
chronic and experimental pain, Pain 17 (1983), 45-56.
––––––––––––––––––––––––––––––––––––––––––––––
neuroVr 2 - a free Virtual reality platform for
Cyberpsychology and CyberTherapy
Giuseppe Rivaa,b,1, Andrea Gaggiolia,b, Alessandra
Grassia,b, Simona Raspellia, Pietro Cipressoa, Federica
Pallavicinia, Cinzia Vignaa, Andrea Gagliatic, Stefano
Gascoc and Giuseppe Donvitoc
b
Psychology Department,
Catholic University of Milan, Italy
c
Virtual Reality & Multimedia Park, Turin, Italy
a
Giuseppe Riva
Milan 20149, Italy
E-mail: giuseppe.riva@unicatt.it
1
abstract
The data of the two leading clinical databases — MEDLINE and PsycINFO — underline an increase in the
health applications of Virtual Reality (VR): under the
"virtual reality" keyword, there are 3,033 papers listed in
MEDLINE and 3,838 in PsycINFO (accessed 11 January
2011). Much of this growth, however, has been in the
form of feasibility studies and pilot trials: many researchers are trying to use VR, but only a few are able to
deepen their initial results in controlled and/or multicentric trials. A critical issue is the lack of standardization in
VR hardware and software, and the limited possibility of
tailoring the virtual environments (VEs). To overcome
these issues we developed a new version – NeuroVR 2
(http://www.neurovr2.org) – of the NeuroVR software: a
free VR platform based on open-source software, that allows non-expert users to adapt the content of different
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pre-designed VEs to meet the specific needs of the clinical or experimental setting. The new features include advanced action triggering based on both user behavior
(proximity and collision) and on therapist choice (keyboard), realistic walk-style motion, advanced lighting
techniques for enhanced image quality, and streaming of
videos using alpha channel for transparency.
Keywords: Virtual Reality, Assessment, Therapy,
NeuroVR, Open Source
introduction
The use of Virtual Reality (VR) in medicine and behavioral neurosciences has become more widespread. This
growing interest is also highlighted by the increasing
number of scientific articles published each year on this
topic: searching PsycINFO with the keyword “virtual reality,” we found that the total number of publications has
increased from five in 1991, 144 in 1996 and 758 in
2001, to 3,838 in 2011, showing an average annual
growth rate of nearly 55%. Although it is undisputable
that VR has come of age for clinical and research applications [1-3] much of this growth, however, has been in
the form of feasibility studies and pilot trials. A critical
issue is the lack of standardization in VR hardware and
software, and the limited possibility of tailoring the virtual environments (VEs).
To help researchers in developing cybertherapy VR applications and in sharing their concepts, we presented
NeuroVR (http://www.neurovr.org), a free VR platform
based on open-source software [4], at MMVR 2007. The
software allows non-expert users to adapt the content of
14 pre-designed VEs to the specific needs of the clinical
or experimental setting.
Following the feedback from 1,000 users who downloaded the first version, we developed a new version –
NeuroVR 2 (http://www.neurovr2.org) – that improves
the possibility for the therapist to enhance the patient’s
feeling of familiarity and intimacy with the virtual scene
by using external sounds, photos or videos.
neuroVr 2
Using NeuroVR 2, the user can choose the appropriate
psychological stimuli/stressors from a database of objects
(both 2-D and 3-D) and videos, and easily place them into
the VE. The edited scene can then be visualized in the
Player using either immersive or non-immersive displays.
Currently, the NeuroVR library includes 18 different vir-
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263
tual scenes (apartment, office, square, supermarket, park,
classroom, etc.), covering some of the most studied clinical applications of VR: specific phobias, cognitive rehabilitation, panic disorders and eating disorders.
The VR suite leverages two major open-source projects
in the VR field: Delta3D (http://www.delta3d.org) and
OpenSceneGraph (http:// www.openscenegraph.org).
Both are building components that integrate with ad-hoc
code to handle the editing and the simulation. The NeuroVR2 Editor's GUI is now based on the QT cross-platform application and UI framework from Nokia
(http://qt.nokia.com/) that allows for a greater level of
editing and customization over the editor functionalities,
while the graphical rendering is done using OpenSceneGraph, an open source high performance 3-D graphics
toolkit (http://www.openscenegraph.org/projects/osg).
The new features include advanced action triggering based
on both user behavior (proximity and collision) and on
therapist choice (keyboard), realistic walk-style motion,
advanced lighting techniques for enhanced image quality,
and streaming of videos using alpha channel for transparency.
The NeuroVR2 Player has also been largely rewritten to
grant a more efficient workflow for the scenes playback
and has a brand new startup interface written in QT. The
whole suite is developed in C++ language, targeted for the
Microsoft Windows platform, but fully portable to other
systems if needed.
references
[1] A. Gorini and G. Riva, Virtual reality in anxiety disorders: the past and the future, Expert Review of Neurotherapeutics 8 (2008), 215-233.
[2] T.D. Parsons and A.A. Rizzo, Affective outcomes of
virtual reality exposure therapy for anxiety and specific
phobias: A meta-analysis, Journal of Behavior Therapy
and Experimental Psychiatry 39 (2008), 250-261.
[3] G. Riva and A. Gaggioli, Virtual clinical therapy, Lecture Notes in Computer Sciences 4650 (2008), 90-107.
[4] G. Riva, A. Gaggioli, D. Villani, A. Preziosa, F. Morganti, R. Corsi, G. Faletti, and L. Vezzadini, NeuroVR: an
open source virtual reality platform for clinical psychology and behavioral neurosciences, Studies in Health Technology and Informatics 125 (2007), 394-399.
264
––––––––––––––––––––––––––––––––––––––––––––––
a hapto-Visual Virtual reality Tool for Visual-motor
skills Testing of people with learning disabilities
Paul Bazineta, Brahim Chebbia,1, Line Tremblaya,
Elizabeth Emptagea and Stephane Bouchardb
a
Laurentian University
Université de Québec à Gatineau
b
Brahim Chebbi
Laurentian University
935 Ramsey Lake Road
Sudbury ON P3E 2C6
Canada
E-mail: bchebbi@laurentian.ca
1
abstract
It has been demonstrated that learning disabilities (LDs)
negatively impact visual-motor skills. The present investigation explores the use of Virtual Reality (VR) for visual-motor skills testing of adults with LDs. A tool using
3-D computer graphics and a haptic device for the visual
and the tactile feedbacks, respectively, has been developed. Male and female student participants will be recruited for testing of their visual-motor skills using this
tool. Half of these participants will be selected such that
they have been diagnosed with LDs and the other half
not. Different difficulty levels necessary for the testing
have been implemented. The proposed research will address the relationships between adults’ visual-motor skills
and LDs. These experiments permit the assessment of the
value of using VR technology, in healthcare and in educational environments to support adults with LDs.
Keywords: Virtual Reality, Haptics, Learning
Disability, Visual-motor Skills
introduction
According to the American Psychological Association [1],
a learning disability (LD) is a disorder that interferes with
the skills of learning. While 1.61% of undergraduate students have been identified with an LD [2], it is a chronic
and lifelong condition that can remain undetected. Regardless of their education level, adults with LDs often experience underlying deficits in self-confidence, difficulties
in coordinating multiple tasks, reading, and in visual-spatial and visual-motor functioning. Research has demonstrated that LDs tend to negatively impact children’s
visual-motor skills which can be described as hand-to-eye
coordination. Little research exists that have explored the
early visual-motor and motor coordination of children
with LDs and even fewer exist that have explored this
question in adulthood [3]. Typically, childhood visualmotor abilities are measured through the use of general
paper-and-pencil methods; however, very few methods
exist for the measurement of visual-motor skills in adults
with LDs. The advances of new Virtual Reality (VR) technologies, such as haptics, offer promising solutions in this
regard. Finally, little research has been conducted on: 1)
the effect of LDs on the visual-motor functioning of
adults; and 2) the effect of LDs on motor performance in
interactive VR measures.
description of Tools, experiments and methodology
To better understand the visual-motor performance in
adults with LDs, the current research uses a VR system
that allows for precise and direct feedback, in order to investigate the impact of LDs on the motor functioning of
adults. This system was modified from an earlier version
[4] in order to be used for the present work. It makes use
of 3-D computer graphics and simulates the sensation of
touch through the use of a haptic device. It is a VR version
of the game “Operation,” where the user lifts organs from
enclosures in a human body. The challenge is to lift the
organs without touching the enclosure’s walls, which necessitates coordination of the lifting movement and controlling the instability due to the weight of the organs. This
tool was selected since it requires visual-motor skills. In
addition, since it is computer controlled, it facilitates repetition, monitoring, and recording [5]. The degree of difficulty can be increased by narrowing the enclosures or
increasing the weight of the organs. Four difficulty levels
were implemented. A sensory feedback consisting of vibration and noise is generated when the organs touch the
enclosure. The proposed research will address the relationships between adults’ visual-motor skills and LDs, the
impact of various individual factors on visual-motor abilities, and the benefits of using VR technology, in healthcare and in educational environments to support adults
with LDs.
One hundred twenty university students (60 males and 60
females) will be recruited to participate in this project. In
both male and female groups, only 30 participants will
have been pre-diagnosed with an LD. The participants will
be administered pre-screening tests of: 1) general intelligence; 2) motor ability; 3) stress level; and 4) experience,
motivation, and other potential influencing factors. After
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completing these tests and getting practice on the tool, the
participant will start the testing procedures one-by-one by
increasing difficulty level. The participant will then complete the Post-Mood Questionnaire. A second trial will be
conducted after approximately one week. The participant
will repeat the tests with increasing levels of difficulty.
From the obtained results we will try to gain more understanding of the relationship between adults’ visual-motor
skills and LDs. If found to be effective, the tool could be
used to support visual-motor development in individuals
with LDs, and as a visual-motor training or assessment
tool in areas requiring fine visual-motor skills.
references
[1] American Psychiatric Association (APA) (2000), Diagnostic and statistical manual of mental disorders (DSMIV-TR) (4th ed.). Washington, DC.
[2] Voytecki, K., Anderson, P., Semon, P., Seok, S. (2009).
Assistive Technology Supports for Postsecondary Students with Disabilities. In Gibson et al. (Eds.) Proceedings
of Society for Information Technology and Teacher Education International Conference 2009, p. 3990-3995.
[3] Getchell, N., McMenamin, S., Whitall, J. (2005). Dual
motor task coordination in children with and without
learning disabilities. Adapted Physical Activity Quarterly,
22, p.21-38.
[4] Chebbi, B., Heijdens, C., Boisvert, S., Riches, I., Saracino, R., Sweeney, T., and Vollebek, E. (2009). Virtual reality hapto-visual systems for remote training and motor
rehabilitation. (S. Pennacchio, Ed.) Recent Advances in
Control Systems, Robotics and Automation , 1 (3).
[5] H. Sveistrup, “Motor rehabilitation using virtual reality,” J. Neuroengineering Rehabil., 1(1):10. December 10,
2004.
––––––––––––––––––––––––––––––––––––––––––––––
perceptual strategies to avoid obstacle
Collision in a Virtual environment
Gayatri Aravinda,b, Anuja Darekara,b,
Anouk Lamontagnea,b,1 and Joyce Funga,b
School of Physical and Occupational Therapy,
McGill University
b
Feil and Oberfeld Research Center of the Jewish
Rehabilitation Hospital (Research cite of CRIR)
a
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265
Anouk Lamontagne
School of Physical and Occupational Therapy
McGill University
3654 promenade Sir William-Osler
Montreal H3G 1Y5 Canada
E-mail: anouk.lamontagne@mcgill.ca
1
abstract
The estimated distance to collision with a moving object
might be an important perceptual determinant in shaping
the strategy of obstacle circumvention in daily life. Any
deficits in the perception or avoidance of obstacle collision would lead to barriers in community ambulation. We
have devised a virtual environment (VE) coupled with a
joystick in a sitting task to investigate the perceptual and
navigational ability to detect and avoid obstacle collision.
In a pilot study conducted with six healthy subjects, we
have observed that all subjects under-estimated the distance to collision, regardless of the moving direction of
the obstacle. Nevertheless, all subjects estimated a remarkably larger distance needed or perceived safe distance for clearance when circumventing an obstacle when
approaching diagonally instead of straight ahead. How
this behavior compares to a real locomotor circumvention
task is yet to be investigated to devise novel rehabilitation
interventions with VE.
Keywords: Virtual Reality, Visuo-spatial Perception,
Navigation, Locomotion
introduction
Community ambulation is a complex task often involving
negotiation of one’s course around stationary as well as
mobile obstacles [1]. The ability to correctly judge the distance and time to collision is an important visuo-spatial
perceptual determinant for the initial planning of an obstacle circumvention strategy, while online adjustments in
body speed or trajectory must be made during any functional locomotor task. Understanding the perceptual and
biomechanical factors involved in shaping locomotor or
navigational strategies is essential in devising efficacious
rehabilitation interventions to facilitate independence in
community ambulation.
method
Participants included six healthy subjects (age: 31.57 ±
10.07 years, gait speed: 1.27 ± 0.14 m/s). Individual subject’s preferred overground speed was used to program
the joystick movement in space during the sitting exper-
266
iments (A and B). The virtual environment consisted of a
rich textured room scaled to the physical dimension of
the laboratory area in which subjects could walk (11m x
7m). Three obstacles in the form of red cylinders of a diameter of 1m and height corresponding to the participant,
located along three positions (straight ahead and 30°
left/right) at an arc of 3.5m-radius were visible at the initiation of the trial, along with a circular blue target placed
at eye-level. The VE was viewed with a helmet–mounted
display (NVisor, field-of-view of 60°, 1280x1084 pixels).
In experiment A, one of the three obstacles, randomly selected, approached the subjects in the same speed as they
virtually advanced in the VE, but disappeared at a distance of 2m before reaching the pre-determined potential
point of collision (TPC). Subjects were instructed to click
at a spatial point where they thought that the collision
would have occurred. The error in distance estimation
(relative to TPC) was acquired. In experiment B, the moving obstacle did not disappear and subjects were instructed to move the joystick sideways (in the ML
direction) to avoid a collision, or to accelerate/decelerate
the self motion by moving the joystick forward/backward, respectively. The outcome acquired was the AP distance from the obstacle at which the ML deviation was
initiated.
results and discussion
The perceived distance at which a collision would have
occurred was similar between subjects and regardless of
approach direction (experiment A). All subjects under-estimated the collision at an average distance of 0.78±0.02m
before reaching the TPC. This could be interpreted as a
perceived safe distance for obstacle clearance that a subject would prefer to maintain as they circumvent obstacles
in physical or virtual environments [2,3]. Such safe margins were also observed in the joystick navigation task
(experiment B) but subjects initiated substantially larger
ML deviations from the obstacle as it approached diagonally from the left (6.04±0.49 m) or right (5.9±0.56m), as
compared to straight ahead (0.99 ± 0.31m).
Conclusion
VR can be used to test perceptual and navigational strategies involved in obstacle circumvention. Subjects underestimate the distance to collision in a VE regardless of
obstacle approach in order to keep a safe distance for
clearance, but they demonstrate an estimate of a substantially larger distance from the obstacle approaching diagonally in the navigation task to avoid collision. This pilot
study prepares for future research to examine locomotor
strategies of dynamic obstacle circumvention in VE and
physical environments, in order to devise effective rehabilitation intervention with VR.
references
[1] S.E Lord, M Weatherall, L Rochester, Community ambulation in older adults: which internal characteristics are
important?, Arch Phy Med Rehab 91 (2010), 378–383.
[2] M. Gerin-Lajoie, C.L.Richards, J.Fung, B.J.McFadyen, Characteristics of personal space during obstacle
circumvention in physical and virtual environments, Gait
Pos 27 (2008), 239-247.
[3] P.W.Fink, P.S.Woo, W.H.Warren, Obstacle avoidance
during walking in real and virtual environments, ACM
Trans Appl Percpt 4 (2007), 1-18.
––––––––––––––––––––––––––––––––––––––––––––––
a Virtual reality-based Task to investigate
locomotor steering strategies
Anouk Lamontagnea,b,1 and Andrei Garcia Popovb
School of Physical and Occupational Therapy,
McGill University, Montreal, Canada.
b
Feil and Oberfeld Research Centre of the Jewish
Rehabilitation Hospital (CRIR), Laval, Canada
a
Anouk Lamontagne
School of Physical and Occupational Therapy
McGill University
3654 promenade Sir William-Osler
Montreal H3G 1Y5 Canada
E-mail: anouk.lamontagne@mcgill.ca
1
abstract
Steering strategies were examined while progressing toward virtual targets and being exposed to optic flows having foci of expansion (FOE) in different locations. Young
(n=10) and older (n=2) adults steered toward the targets
using mouse displacements while sitting or while changing body position and orientation during walking. Heading errors were larger with eccentric target and FOE
locations. Older adults showed larger heading errors than
the younger adults in the mouse task but not the walking
task. Results support the feasibility of a virtual realitybased paradigm to assess steering strategies in young and
older adults.
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Keywords: Gait, Heading, Aging, Visual Motion
introduction
Locomotor steering is important for community ambulation and is affected by aging [1] and stroke [2]. To date,
experimental paradigms that allow for the investigation
of the effects of perceived self-motion and target location
on steering strategies are still lacking.
methods
Ten healthy, young subjects (19-29 years old) and two
older subjects (66 and 68 years old) were evaluated in a
seated position while performing a mouse-driven steering
task with their dominant hand in a virtual environment
(VE) rearprojected onto a large screen (Experiment A)
and during an overground walking task in which the same
VE was displayed in a helmet-mounted display (NVisor)
(Experiment B). Body coordinates were acquired with reflective markers placed on body landmarks and a 12-camera Vicon™ system. Subjects’ camera view was updated
in real time based on mouse position (Exp. A) or head coordinates (Exp. B). The VE represented a room with a
centrally located target at eye level 7m away. Target and
FOE locations, initially at 0°, remained unchanged or
shifted to ±20° at 1.5m of forward displacement. Subjects
were instructed to “head or walk toward the target” and
trials ended at 5m of forward displacement.
results
Subjects used lateral mouse displacements (Exp. A) or
changed body location and orientation (Exp. B) to align
themselves with the targets. Net heading errors (NHEs),
calculated as the difference between the subjects’ camera
view and the target, were within 2.5° and 6°, for the sitting and walking tasks, respectively. NHEs were larger
with eccentric targets and FOEs, causing subjects to over
and undershoot their heading, when FOEs and targets
were located ipsi- and contralaterally, respectively. Older
subjects exhibited a larger variable and larger NHE than
younger subjects in the mouse task, but not in the walking task.
discussion and Conclusion
Results support the feasibility of a virtual reality-based
paradigm to assess steering strategies in healthy individuals. The altered performance of the older adults in
the mouse steering task may be due to a difficulty integrating rule-based information [3] to scale and transforming small mouse movements into large
displacements in a VE.
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267
references
[1] M.R. Paquette, J.R. Fuller, A.L. Adkin, L.A. Vallis.
Age-related modifications in steering behaviour: effects
of base-of-support constraints at the turn point. Exp Brain
Res. 190 (2008), 1-9.
[2] A. Lamontagne, J. Fung. Gaze and postural reorientation in the control of locomotor steering after stroke. Neurorehabil Neural Repair. 23 (2009), 256-266.
[3] W.J. Tippett, L.E. Sergio. Visuomotor integration is
impaired in early stage Alzheimer's disease. Brain Res.
1102 (2006), 92-102.
––––––––––––––––––––––––––––––––––––––––––––––
body ownership illusion Through the
use of a Virtual arm
Yohan Sona, Jinsick Parka, Hyeongrae Leea, Jeonghun
Kua, In Young Kima and Sun I. Kima,1
Department of Biomedical Engineering,
Hanyang University, Seoul, Korea
a
1
Sun I. Kim
Department of Biomedical Engineering
Hanyang University
Seoul,Korea
E-mail: sunkim@hanyang.ac.kr
abstract
Body ownership illusion is the phenomenon that causes
confusing an artificial body and one's own. Recently,
there have been many ongoing studies regarding body
ownership illusion. In previous studies, body ownership
can be produced by visual and tactile stimulations on an
artificial body [1, 2]. The aim of this study is to induce
body ownership illusion using Agency, and we used objective and subjective methods to prove the aim of this
study. Through the objective method, we observed significant differences between the position corresponding
to where the participant felt their right hand was and the
actual position of their right hand when the virtual arm
and participant’s arm move congruently. However, we did
not observe significant differences when the virtual arm
and participant’s arm moved inversely. Also, in the subjective method using a questionnaire, participants in the
congruent condition recorded a higher score than in the
inverse condition for responses about body ownership.
268
These results showed that body ownership illusion can be
induced through Agency.
Keywords: Body Illusion, Agency, Virtual Reality
introduction
Body ownership is the feeling that your body belongs to
you. It is necessary in order to realize our body is a part of
ourselves. In previous studies, body ownership can be produced by afferent factors such as visual and tactile stimulations on an artificial body [1, 2]. But, in order to
perfectly realize our body, we need an efferent factor such
as Agency, as well as an afferent factor. Thus, in this study,
we used Agency – the sense that “I am the initiator or
source of the action” – to induce body ownership illusion
to the artificial body in the absence of tactile stimulation.
Furthermore, we provide subjective and objective evidence for this.
methods
Nine healthy, right-handed male participants were recruited. A Head Mounted Display (HMD) was used to
provide an immersive virtual environment (VE). In this
experiment, a virtual arm was used as the artificial body
in order to incur body ownership illusion. The experimental tasks were composed of two conditions. In the
first task, the virtual arm and participant’s arm moved
congruently. In the second task, the virtual arm and participant’s arm moved inversely. In each condition, the
images from the HMD were presented as follows: (a)
blank screen (b) virtual arm, located center (c) virtual
arm, located to the side. These images were presented
randomly. In order to observe proprioceptive drift indicating intensity of body ownership illusion, sensors were
attached to the participant’s left index finger and right
hand. The order of the experiment was as follows: experimenter recorded value of the sensor attached to the
participant’s right hand before the participant moved his
arm, then the participant began to move his right arm.
After 75 seconds, participants were instructed to stop
moving their arm at the starting point. Participants were
then instructed to close their eyes and place their left
index finger three times over the shelf in a position corresponding to where the participant felt their right hand
was. To calculate proprioceptive drift we calculated the
difference between the average value of the left sensor
and right sensor value that was recorded before the participant moved their arm. After the experiment, participants filled out a questionnaire on responses about body
ownership.
results
In the experiment, we measured the difference between
the average value of the left sensor and right sensor value
when the virtual arm was located in the center and when
the virtual arm was located to the side. As a result, we observed a significant difference of 3.8975cm (p < 0.005)
between when the virtual arm was located in the center
and when the virtual arm was located to the side in the
congruent condition. But, we did not observe a significant
difference in the inverse condition. Also, participants in
the congruent condition recorded a higher score than the
inverse condition in the questionnaire about body ownership illusion.
Conclusion
In this study, we try to induce body ownership illusion
through Agency to the virtual arm and proved this concept through proprioceptive drift and questionnaire responses. As a result, in the congruent condition, the
virtual arm induced body ownership illusion. This study
opens up a variety of possibilities in that the whole virtual
body could be felt as one’s own. These findings could be
useful in the fields of Virtual Reality and Rehabilitation
Engineering.
references
[1] Petkova, V. and H. Ehrsson, If I were you: perceptual
illusion of body swapping. PLoS One, 2008. 3(12)p.
3832.
[2] Botvinick, M. and J. Cohen, Rubber hands' feel'touch
that eyes see. Nature, 1998. 391(6669): p. 756-756.
––––––––––––––––––––––––––––––––––––––––––––––
social aggregation in Virtual settings depends
on avatars’ Visual aspect
Catherine L. Lortiea,b,1 and Matthieu J. Guittona,b
Faculty of Pharmacy, Laval University,
Quebec City, QC, Canada
b
Centre de recherche Université Laval Robert-Giffard
(CRULRG), Quebec City, QC, Canada
a
Catherine L. Lortie
Faculty of Pharmacy
Laval University
Quebec City, QC, Canada
E-mail: catherine.lortie.2@ulaval.ca
1
JCR
abstract
Humans interact and form social groups in virtual environments through avatars. However, the parameters
which favor interindividual social structuring in those settings are still far from understood. Particularly, the putative influence of anthropomorphic similarity of visual
aspect on social organization of avatars is a key issue in
understanding the cognitive processes used to form social
interactions in virtual worlds. Using the highly popular,
massively multiplayer online role-playing game World of
Warcraft as a model of a socially active virtual setting,
we analyzed the social behavior of 11,649 avatars as a
function of their visual aspect. We show here that social
structuring in virtual settings clearly depends on proximity to human visual aspect. Social groups formed by
human-like avatars displayed more homogeneity than
what the optimal use of the interface would predict, while
this effect was not observed for social groups formed by
non-human avatars. Thus, immersion in virtual environments depends more on visually triggered social dynamics than on strictly game-related factors. Furthermore, the
interrelations between visual aspect and social dimension
may represent a major factor of immersion in virtual environments.
Keywords: Anthropomorphism, Avatar, Group
Dynamics, Social Interactions, Virtual Setting, Visual
Representation
269
zard Entertainment) [3,7]. Groups were collected using
the searchable database of the “World of Warcraft Armory” website (www.wowarmory.com), which provides
information regarding avatars, their server and group affiliation [7]. Eighty Guilds were chosen equally from the
two allegiances of the virtual setting (40 human-like Alliance Guilds, and 40 non-human Horde Guilds).
results
Eighty groups, gathering a total of 11,649 avatars, were
chosen equally from the two allegiances of the virtual
setting. Social groups formed by human-like avatars
displayed more homogeneity than what the optimal use
of the interface would predict, while this effect was not
observed for social groups formed by non-human
avatars [6].
Conclusion
Our results showed different group structuring strategies
depending on the visual aspect (human-like/not human)
of the avatars. Our results clearly demonstrate that visual
aspect strongly impacts the formation of social groups in
the virtual setting of World of Warcraft [6]. Thus, social
structuring in virtual settings depends on proximity to
human visual aspect, suggesting that the choice of a given
appearance during the creation process may be a critical
element [6]. Furthermore, our results clearly add emphasis
to the multimodal integration between sensory and cognitive factors [6].
introduction
One of the main characteristics of virtual environments is
the fact that they are social spaces [1,2]. However, the parameters which favor social structuring in virtual settings
are still far from understood [3]. Visual aspect is clearly
one of the central sensory parameters of virtual worlds
[1,4]. Some studies have suggested that proximity to
human standard visual aspect (anthropomorphic similarity) could play a role in the social aggregation of people
in virtual settings [5]. Although, it is unclear whether this
putative effect of proximity to human standard visual aspect on social aggregation can be generalized to long-lasting cyber-environments. More importantly, it is unknown
whether the visual aspect is a consequence or a trigger of
social structuring. Using the highly popular, massively
multiplayer online role-playing game World of Warcraft
as a model, we attempted to solve this question [6].
[4] F.Giard, & M.J. Guitton, Beauty or realism: The dimensions of skin from cognitive sciences to computer
graphics, Computers in Human Behavior 26 (2010), 17481752.
methods
We selected as a model the highly popular, massively multiplayer online role-playing game World of Warcraft (Bliz-
[5] J. Kim, I want to be different from others in cyberspace: The role of visual similarity in virtual group identity, Computers in Human Behavior 25 (2009), 88-95.
JCR
references
[1] T.L. Taylor, The Social Life of Avatars: Presence and
Interaction in Shared Virtual Environments, Springer-Verlag, London, 2002.
[2] N. Yee, Motivations for play in online games, Cyberpsychology & Behavior 9 (2006), 772-775.
[3] C.H. Chen, C.T. Sun, & J. Hsieh, Player guild dynamics and evolution in massively multiplayer online games,
CyberPsychology & Behavior 11 (2008), 293-301.
270
[6] C.L. Lortie, & M.J. Guitton, Social organisation in virtual settings depends on proximity to human visual aspect,
Computers in Human Behavior, In press.
[7] M.J. Guitton, Cross-modal compensation between
name and visual aspect in socially active avatars, Computers in Human Behavior 26 (2010), 1772-1776.
––––––––––––––––––––––––––––––––––––––––––––––
occupational Therapists’ expectations of a Virtual
World program for Client education
Rashid Kashania,1, Ray Jonesa, Anne Robertsa
and Maged N.K. Boulosa
University of Plymouth, Edmonton, Canada
a
Rashid Kashani
University of Plymouth
Edmonton, Canada
E-mail: rashid.kashani@plymouth.ac.uk
1
abstract
Preliminary stages of developing a virtual world (VW)
program as a rehabilitation teaching tool are presently
being undertaken by the authors. The overall objective
is to create a VW program aimed at teaching joint protection principles to clients living with rheumatoid arthritis and then perform a pilot randomized control trial
(RCT) to determine feasibility of a full RCT. Clinicians
involved in teaching arthritis self-management programs
participated in the initial stages of development. Occupational therapists, who were involved in patient education on joint protection to manage RA, were interviewed
qualitatively. As a result of this stage of the study, there
have been a few surprising results. One of these was the
role strain and scope of an occupational therapist working with clients living with RA. Another was the limited
use of measures to determine clinical efficacy of interventions presently in use. A third was the scarcity of concern regarding online safety in this type of eHealth
initiative. These findings are perhaps indicative of the
need to continue to educate occupational therapists about
issues arising around the new social web and may need
to be included as a preamble or introductory module in
learning to use a VW program for client teaching. The
aim of this part of the larger study in progress is to develop a VW program based on therapist input and receive
feedback.
Keywords: Virtual World, Occupational Therapist,
Rheumatoid Arthritis, Joint Protection, Client Education
introduction
A significant benefit to be realized by Canadians is the use
of a virtual world (VW) platform to deliver self management programs to clients. Given the large geographic area
and concentration of health professionals in urban areas,
self-management programs offered on a regional basis may
be difficult to access or unavailable for long periods of
time. In this study, preliminary work has been completed
to determine what occupational therapists expectations are
for essential content in a joint protection program aimed at
clients living with rheumatoid arthritis (RA) and their impressions of using a VW as the media to deliver the content.
This study is being done in three stages to culminate in a
pilot randomized control trial (RCT) for partial fulfilment
of a Ph.D. study at the University of Plymouth. What is described here are the results of preliminary stages of this
study involving qualitative interviewing and thematic
analysis of clinician interviews about this technology.
method
Ethics approval was obtained and invitation letters were
sent to six occupational therapists with specialized training
in delivering an Arthritis Self Management Program
(ASMP) and/or had experience delivering a similar type
of program while working on a dedicated Rheumatic Disease Service. Of the six therapists, five expressed interest
in participation with no response being received from the
sixth. Respondents all met the inclusion criteria, as an occupational therapist with experience in delivering a form
of ASMP. Experience as an occupational therapist varied
from 4-24 years in the field. The primary place of employment included acute care, community care, home care and
a rehabilitation hospital. Of the five participants, three
were actively involved with present delivery of an ASMP
program aimed at all types of arthritis; two were involved
in delivering an ASMP dedicated to management of RA.
One of the subjects was also an occupational therapist who
had been living with RA for 20 years.
Once the subjects had agreed to participate and had an opportunity to ask questions, informed consent was obtained
via an approved form. Interviews were recorded using a
predetermined set of open-ended questions primarily centered on the subject’s experiences in delivering an ASMP
and their expectations of the content of such a program.
Other information about how the therapist presently measured knowledge transfer of concepts and how much time
JCR
was spent dedicated to teaching joint protection during an
ASMP was also gathered. Perceptions about the proposed
method of delivery, via a VW platform, were also gathered
in the interviews. These interviews were audio recorded
and then transcribed by a transcriptionist. The transcript
was reviewed for accuracy and tapes were played back
while the transcript was reviewed. Each interview was reread several times to get an overall impression of the primary concerns and points that each subject was making.
When some broadly scattered information was found
throughout several transcripts, copies were made of the
transcripts and this information was highlighted and saved
as a working theme within the data. For example, basic
daily living activities were found throughout the interviews. Some informants discussed the difficulty in discussing these in groups, while other identified specific
activities that ought to be included in a joint protection
program for clients living with RA. Once saturation of
working themes was reached, the data was reviewed again
to determine if any of the statements made would fit into
another theme. No further themes could be derived, so it
was concluded that no new information was arising from
the data collected and that further thematic analysis using
software to better organize the themes should occur.
From these initial working themes, data was entered into
a student version of nVivo and these were then sought out
in the transcribed interviews. Becoming immersed in the
transcriptions revealed there was overlap between themes
as some content was coded in more than one theme.
These themes were then reviewed first by going over the
transcripts in their original form to determine if any statements did not fit within one – usually more than one –
theme after data analysis using the nVivo software. Upon
finding no new themes again, member checks were employed with all of the original five informants. Other than
three who agreed with the thematic analysis, two had inquiries about specific content which were captured in the
themes. For example, one subject asked if driving was
covered, which was captured in several places within the
daily living activity and work themes derived from thematic analysis.
results
One main theme was the how challenged the subjects felt
in meeting the broad scope of practice required of an occupational therapist working with clients living with RA.
The limited use of measures to determine knowledge
transfer was also a common theme with few tangible ex-
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271
amples of how it was determined if joint protection information had been retained or applied by clients. A general
lack of concern regarding online safety using this type of
media for eHealth was evident, even with prompting subjects about potential concerns about online safety for
themselves or clients. In general, informants also felt that
the development of a VW based means of delivering this
information was not a threat to their position, but that it
would be a useful tool or adjunct to the interventions
presently used.
Themes which provided information about the proposed
content for the VW program included a theme regarding
daily living activities such as activities at home including
bathing, transfers, housework, childcare, dressing, personal hygiene, and basic mobility /hand function issues.
Another theme was leisure and RA. Though this topic was
not brought up by everyone, it included specific activities
such as golf, driving, community mobility, and it was felt
that it should include overall fitness. Content themed
around work included activities concerning body mechanics in lifting and computer use. Less concrete features
around content included the ability to problem solve, practice and to have aspects of realism. Across all themes there
was a recommendation to emphasize avoidance of deforming positions during activities.
discussion
As a result of the themes derived and suggestions for specific content, there are presently 15 “stations” planned in
a building with modular construction using the Second
Life® (SL) platform. At the time of writing, eight of these
stations are nearing completion. There is also an already
completed separate house that will serve as a meeting
place and potential place for group sessions. Prior to having the informants test out the program, themes and activities will again be checked against the content.
Use of this technology may be a cost effective means of
delivering interventions to clients with limited access to
clinicians, limited community mobility and limited access
to programs. As no such program exists, what must first
occur is the development of a VW program with input
from clinician experts who deliver classes on this topic
using traditional in person methods. This stage will determine that the content is valid from an expert clinician
perspective. What would then follow is a subsequent pilot
study with a small group of clients to gather qualitative
data regarding the lived experiences of client users with
this program. The qualitative information gathered will
272
determine that it is valid based on the perceived needs of
client users. The qualitative themes derived from this stage
of the study will then determine what measures would be
most valid in a pilot RCT. To date, reviews of the literature
reveal that this is a novel means of delivering educational
information to this population of clients.
Conclusion
These findings are perhaps indicative of the need to continue to educate occupational therapists about issues arising around the new social web and may need to be
included as a preamble or introductory module in learning
to use a VW program for client teaching. Guidelines and
recommendations for more commonly used forms of the
new social web are being developed to better educate occupational therapists given publicized issues with online
privacy and safety [1].
references
[1] R. Kashani, S. Burwash, and A. Hamilton, To be or not
to be on Facebook: That is the question, Occupational
Therapy Now 12(6) (2010), 19-22.
––––––––––––––––––––––––––––––––––––––––––––––
effect of bilateral Cerebral motor Cortex
stimulation in amyotrophic lateral sclerosis model
Yong-Il Shina,1, Hyojoon Kimb, Hyoung-Ihl Kimc, Wan
Kima, Yong-Beom Shina and Hyun-Yoon Koa
Department of Rehabilitation Medicine,
Pusan National University School of Medicine
b
Department of Neurosurgery,
Presbyterian Medical Center
c
Graduate-Program of Medical System Engineering,
Gwangju Institute of Science and Technology
objective
The aim of the study was to evaluate the effects of bilateral
epidural cortical stimulation on the progress of disease in
an ALS mouse model.
methods
We studied 19 SOD1-G93A mice of ALS. The animals
were randomly divided into three groups: sham control
group (n=6); unilateral cortical stimulation group (n=7);
and bilateral cortical stimulation group (n=6). Epidural
motor cortex stimulation was delivered via programmable
stimulator from the second day after the onset of disease
symptoms. Stimulation amplitude was set to half of the
movement threshold for individual animals, while 50 Hz
frequency, 220 ㎲ pulse duration, and 24 hours anodal
stimulation were uniformly used. We checked the onset of
disease symptom and the survival time.
results
The survival time of the bilateral epidural cortical stimulation group was significantly prolonged compared to the
sham control group (p<0.05). However, the onset of disease symptoms and the mean of the duration of the disease showed no significant difference between the three
groups.
Conclusions
Bilateral epidural cortical stimulation is considered to be
one of the possible trial treatment neurorehabilitation
methods in ALS models.
a
Yong-Il Shin
Department of Rehabilitation Medicine,
Pusan National University School of Medicine
Yangsan-city
Republic of Korea
E-mail: rmshin01@gmail.com
1
abstract
background
Epidural cortical stimulation has been applied to amyotrophic lateral sclerosis (ALS) and has some effect on
delaying the progress of disease.
Keywords: Amyotrophic Lateral Sclerosis, Epidural,
Motor Cortex Stimulation, Survival Time,
Neurorehabilitation
––––––––––––––––––––––––––––––––––––––––––––––
The effects of the menstrual Cycle on sexual
preferences and the feeling of presence:
The biological notion of intentionnality
Marie-Eve Turpina,1, Marie-Ève Paquette-Birona
and Patrice Renauda
a
Marie-Eve Turpin
Canada
E-mail: marie.eve.turpin@gmail.com
1
JCR
abstract
Linked to the notions of biological preparation of intentionality, the present study aims at verifying if the menstrual cycle and its variations in fertility have effects on
the expression of sexual preferences, such as expressed
through the feeling of sexual presence, or through the effect of illusion engendered by synthetic sexual stimuli.
By using a program allowing the personalization of the
genitalia of a virtual man, and by asking participants to
evaluate the level of realism and attraction of a sequence
of virtual and real images of naked men and women, it
will be possible to see the relationship between these various concepts. In fact, the period of the menstrual cycle
should influence the results. Therefore, it is possible to
suppose that the menstrual cycle has an effect on the sexual preferences and the feeling of presence (determined
by the level of realism perceived and attractiveness felt).
Hormonal measures will be used in order to support the
reported measures by the participants.
Keywords: Menstrual Cycle, Sexual Preferences,
Presence, Intentionality
introduction
Links have been well established between the follicular
phase of the menstrual cycle (fertility phase) and the
choice of partners. In fact, women prefer men with the
most masculine secondary sexual features (e.g. voice and
face shape) [2-4, 6, 9]. With Virtual Reality (VR) it seems
now possible to estimate the sexual preferences [7] in
connection with the development of the feeling of presence: "the perceptual illusion of non-mediation" [8]. The
concept of intentionality allows for linking the influence
of the menstrual cycle on sexual preferences to the feeling
of presence. In fact, bio-psychological states, among
those of hormonal nature, can create a predisposition to
be attracted by certain stimuli (in this case, sexual stimuli)
and favor the feeling of presence by offering a combination of shape and content supporting the intentions.
The purpose of this project will be to estimate the influence of the menstrual cycle on the personalization of the
genitalia of a virtual man, as well as to determine the influence of hormones produced during the fertile period.
The whole will be made possible by the means of software allowing for the conception of virtual characters.
It will also allow estimating the influence of the menstrual cycle, according to the implication of hormones,
on the feeling of presence and the perception of realism
and attraction. The main hypothesis is that the menstrual
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273
cycle will have an influence on the various observed
variables.
methods and Tools
The participants for this study are heterosexual women
aged between 20 and 30 years old. They must have a regular menstrual cycle and not use oral contraception or any
other kind of hormonal contraception. Participants were
recruited in the Outaouais region and they were all volunteers.
The participants were invited to complete three different
tasks. The first task was a control task. The participants
had to adjust the length of a line so that it concurs with the
control line. This task was developed to verify the absence
of influence from the visual perception. The second task
was the personalization task. The participants had to customize the genitalia of a virtual man with different parameters, so that he has the characteristics that they would
want to see if they were about to have a sexual relation
with him. After the customization, they were asked to
complete a questionnaire based on the realism and attractiveness. The third task was the evaluation of the realism
and the attractiveness of a sequence of pictures. Two different sequences were developed, with virtual and real
men and women.
The participants met twice: once during her fertility phase;
and once when she was not in her fertility phase. The results obtained during the two meetings have been compared. The first time, they had to first complete three
questionnaires in order to obtain an overview of each of
them (Eysenck Personality Questionnaire [1], MAACL
[5] and Immersive Tendency Questionnaire [10]). The participants were also asked to give salivary samples to measure the levels of testosterone (hormone related to mating)
and of estradiol (hormone produced in the fertility phase
of the menstrual cycle). Estradiol was tested at the beginning of each session in order to make sure that the woman
was really in her fertility phase (or not). Testosterone was
tested twice; at the beginning and after the personalization
task. By comparing of the values obtained, it is possible
to see if the participant was attracted to the virtual man for
which she had customized the genitalia.
results
This research is still in progress, making it impossible at
the moment to give any results. On the other hand, it is
possible to suppose that the results will be influenced by
the time in the menstrual cycle. Participants should design
274
bigger genitalia (different proportion to) when they are in
their fertility phase. It is also possible to suppose that the
production of testosterone should be higher in that phase.
discussion
This research is different from any other research on the
topic by its use of VR. Indeed, while permitting the personalization of genitalia on a virtual model, it allows seeing subtle differences in the level of sexual preferences.
By using VR and hormonal measures, it also makes it possible to assess the relationship between the menstrual
cycle and the feeling of presence.
[9] K. Wallen and H.A. Rupp, Women's interest in visual
sexual stimuli varies with menstrual cycle phase at first
exposure and predicts later interest, Hormones and Behavior 57 (2010), 263-268.
[10] B.G. Witmer and M.J. Singer, Measuring Presence in
Virtual Environments: A Presence Questionnaire, Presence: Teleoperators & Virtual Environments 7 (1998),
225-240.
––––––––––––––––––––––––––––––––––––––––––––––
identifying men Who sexually abused Children with
Virtual immersion and penile plethysmography
references
[1] S.B. Eysenck, H.J. Eysenck, and P. Barrett, A revised
version of the Psychoticism scale, Personality and Individual Differences 6 (1985), 21-29.
[2] S.W. Gangestad, R. Thornhill, and C.E. Garver-Apgar,
Fertility in the cycle predicts women's interest in sexual
opportunism, Evolution and Human Behavior 31 (2010),
400-411.
[3] A.C. Little, B.C. Jones, and R.P. Burriss, Preferences
for masculinity in male bodies change across the menstrual cycle, Hormones and Behavior 51 (2007), 633-639.
[4] A.C. Little, B.C. Jones, and L.M. DeBruine, Preferences for variation in masculinity in real male faces
change across the menstrual cycle: Women prefer more
masculine faces when they are more fertile, Personality
and Individual Differences 45 (2008), 478-482.
[5] B. Lubin, M. Zuckerman, P.G. Hanson, T. Armstrong,
and et al., Reliability and validity of the Multiple Affect
Adjective Check List—Revised, Journal of Psychopathology and Behavioral Assessment 8 (1986), 103-117.
[6] I.S. Penton-Voak, D.I. Perrett, D.L. Castles, T.
Kobayashi, D.M. Burt, L.K. Murray, and R. Minamisawa,
Menstrual cycle alters face preference, Nature 399 (1999),
741-742.
[7] P. Renaud, J.L. Rouleau, L. Granger, I. Barsetti, and
S. Bouchard, Measuring sexual preferences in virtual reality: A pilot study, Cyberpsychology and Behavior 5
(2002), 1-9.
[8] G. Riva, Virtual reality and telepresence, Science 318
(2007), 1240-1242.
Sarah Michelle Neveua,1, Dominique Trottiera, Mathieu
Goyettea, Joanne-L. Rouleaua and Patrice Renaudb
a
Université du Québec en Outaouais (UQO)
b
Sarah Michelle Neveu
C.P. 6128, Station Centre-ville
Montréal (Québec)
H3C 3J7 Canada
E-mail: sarah.michelle.neveu@umontreal.ca
1
abstract
Knowing that deviant sexual preference is a factor of recidivism for sexual offenders, the precision of methods
of evaluation is of great importance. Penile plethysmography (PPG) is traditionally used to assess sexual arousal,
but the possible falsification by participants is an issue
that needs to be taken care of. A combined use of virtual
immersion and PPG were tested for their utility in discriminating men who sexually abused children and a control group. A 3-D helmet, eye-tracking device and a PPG
were used in this study. We compared the sexual responses of sexual offenders towards children (n=29) with
those of a control group (n=27). The virtual immersion
comprises three conditions: neutral; adults; and children.
We expected that penile response would be linked to the
group of the participants. Some promising results were
found. There is an interaction between the group and the
condition: men who sexually abused children responded
more to the “children” condition compared to the control
group; and the control group responded more to the
“adult” condition compared to the group of men who sexually abused children. As expected, there was no differ-
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ence between groups in the neutral condition. Our findings suggest that combining virtual immersion with PPG
is a valid technique to discriminate men who sexually
abused children and men without any known sexual deviance.
Keywords: Penile Plethysmography, Sexual Arousal
Towards Children, Sexual Offenders, Virtual
Immersion, Eye-tracking Device
introduction
The combined use of virtual immersion and penile
plethysmography (PPG) is a promising approach in evaluating sexual arousal towards children. Virtual immersion
assesses some of PPG’s issues, because PPG alone is subject to falsification by participants with overt visual
avoidance and cognitive distractions strategies. At the
same time, virtual immersion is also a technique on its
own, providing oculomotor and perceptual-motor indicators with the eye-tracking device and making the setting
of the experiment much closer to reality than with PPG
alone. The goal of this study was to compare two groups
of men (one group of men who sexually abused children
and one control group) on their response to three different
conditions (neutral, adult and children). We expected that
men who sexually abused children would have a significantly greater response to the “children” condition and a
significantly lower response to the “adult” condition,
when compared with the control group. We expected that
both groups would have no difference on the neutral condition.
method
In this study, we compared two groups of men: 29 FrenchCanadian men who abused children; and 27 French-Canadian men without any known sexual deviance. Participants
wore a helmet which allowed them to see the previously
validated computer-generated stimuli in 3-D. There was
one image in the neutral condition and two images for
each of the remaining conditions (adult and children). An
eye-tracking device was used to obtain oculomotor and
perceptual-motor indicators, and PPG was used to evaluate their sexual arousal.
results
We found promising results; no difference was found in
the neutral condition. For the “adult” condition, the group
of men who sexually abused children had a lower penile
response than the control group. For the “children” condition, the opposite can be found: the group of men who
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275
sexually abused children showed a greater penile response
than the control group.
results
Our results give empirical support for the combined use
of PPG and virtual immersion with sexual abusers. The
results show that it is possible to discriminate men who
sexually abused children and a control group with this
technique. Moreover, adding virtual immersion to PPG
makes is more difficult for the participants to try to modify
their penile response, since overt avoidance strategy can
be detected.
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electronic pda dietary and physical activity
register in a Weight loss Treatment program for
Children: a study on acceptability and satisfaction
Elia Oliverc, Rosa Maria Bañosa,c,1, Ausias Cebollaa,b,
Cristina Botellaa,b, Irene Zaragozáa,d, MarianoAlcañiza,d
and Azucena García-Palaciosa,b
CIBER de Fisiopatología de la Obesidad y Nutrición
(CIBEROBN)
b
Universidad Jaume I
c
d
4I3BH Innovation & Research Institute on Bioengineering for Humans- Universidad Politécnica de Valencia
a
Rosa Baños
CIBER de Fisiopatología de la Obesidad y Nutrición
Spain
E-mail: banos@uv.es
1
abstract
Obesity is one of the greatest public health challenges of
the 21st century and the most prevalent health problem
among children in Europe. The use of dietary and physical activity registers is considered to be central to cognitive-behavioral weight control programs. Traditionally,
these self-registers are made with paper and pencil mode,
but this has some problems including the inconvenience
and the difficulties associated with recording information
in real time and poor rates of adherence to treatment. New
mobile technologies such as PDA can solve these limitations. The aim of this study is to study the levels of acceptability and satisfaction with a PDA self-register
method specifically designed for recording food and
physical activity for the treatment of childhood obesity.
276
The sample was composed of 30 children recruited from
a Paediatric Service. Subjects randomly completed the
two experimental conditions – an electronic system
(PDA) and traditional method (pencil and paper) in a
counterbalanced design. The study is in progress. It is expected that self-registers through the PDA method will
show higher levels of acceptance and satisfaction than
traditional self-registers.
Keywords: Electronic Diary, Personal Digital Assistant,
Obesity, Ecological Momentary Assessment, Self-report
introduction
Cognitive-Behavioral Treatment (CBT) programs for obesity include components designed to promote changes in
behavior and cognitive and emotional patterns that contribute to obesity [1]. The guidelines that have proven to
be the most useful are the use of self-registers for self-evaluation and self-control (recording information about eating
and physical activity), stimulus control, psychoeducation,
cognitive techniques for changing thoughts and dysfunctional attitudes, interpersonal relationships and relapse prevention. Self-register techniques are considered necessary
for both the assessment and treatment phases. It is important to record the behavior immediately in order to minimize memory bias. This permits the examination of events
and experiences in their natural, spontaneous context.
Traditionally, the use of these conventional dietary and
physical activity registers have been created using pen and
paper methods; however, they have several limitations, including the inconvenience and the difficulties of recording
information in real time [2] and it has poor rates of adherence to treatment [3]. In recent years, personal digital assistants (PDAs) and mobile phones have become more
readily available, thus generating new interest in developing systems adapted for these tools. Research has indicated
that the use of PDAs improves dietary self-monitoring frequency and adherence to treatments [4] over paper diary
methods. The aim of this study is to study the levels of acceptability and satisfaction with the PDA self-register
methods specifically designed to record food and physical
activity for the treatment of childhood obesity.
method
The sample was composed of 30 subjects recruited from
a Paediatric Service located in a public hospital specializing in childhood obesity treatments. All of the subjects
were receiving weight loss treatment based on nutritional
and behavioral modification. It was a counterbalanced
study in which the subjects randomly completed two experimental conditions (PDA and pencil and paper). The
electronic method was a PDA with software specifically
designed for recording the type and amount of food eaten,
emotions before eating, and thoughts before intake. Participants also recorded the type and duration of physical
activity. The degree of acceptance and satisfaction was
evaluated with scales specifically designed for this study
at the end of the recording time.
results
Work in progress. Regarding the degree of acceptance and
satisfaction, it is expected that participants prefer the PDA
to register food and physical activity and they assess the
PDA as easier to transport and to use, as well as more entertaining.
Conclusion
New mobile technologies such a PDA diaries are useful
tools for both the assessment and treatment of childhood
obesity, because they may support self-regulation and enhance patient motivation and readiness for change. Additionally, these mobile devices enable direct communication
between therapists and patients through the Internet, which
facilitates real time monitoring. In recent years, the use of
new technologies by clinicians is increasing, generating interest in the development of new software programs
adapted for specific populations and needs.
references
[1] Sarwer, D.B., Foster, G.D. & Wadden, T.A. (2004).
Treatment of obesity I: Adult obesity. En J.K. Thompson
(Ed.) Handbook of eating disorders and obesity. New
York. Wiley and Sons.
[2] Burke, L.E., Choo, J., Music, E., Warziski, M., Styn,
M.A., Kim, Y. & Sevick, M.A. (2005). PREFER study: A
randomized clinical trial testing treatment preference and
two dietary options in behavioral weight management: rational, design and baseline characteristics. Contemporary
Clinical Trials, 27, 34-48.
[3] Baker R., & Kirschenbaum D. (1993) Self-monitoring
may be necessary for successful weight control. Behavioral Therapy, 24, 377–394.
[4] Boutelle, K.N. & Kirschenbaum, D.S. (1998). Further
support for consistent self-monitoring as a vital component for successful weight control. Obesity Research, 6,
219-224.
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development and evaluation of an online guided
self-help intervention aimed at problematic game
behavior among dutch adolescents
Maria Haagsmaa,1, Marcel Pietersea and Oscar Petersa
University of Twente, Faculty of Behavioral Sciences,
Department of Psychology & Communication of
Health & Risk
a
Maria Haagsma
University of Twente
Faculty of Behavioral Sciences
Department of Psychology & Communication
of Health & Risk
Citadel H425, P.O. Box 217
7500AE, Enschede, The Netherlands
E-mail: m.c.haagsma@utwente.nl
1
abstract
The aim of this study was to develop and evaluate an online guided self-help intervention, to prevent and reduce
problematic game behavior and its negative consequences
for adolescents’ wellbeing. An online program is able to
reach a hidden population of problem gamers, because it
is anonymous and easily accessible. In cooperation with
the Brijder Addiction Care Group, an innovative online
program was developed, which is partly based on an existing online intervention for adolescent alcohol and
cannabis abuse. The objectives of this program are to increase awareness and readiness to change, and reinforce
self-control of game behavior. Ultimately, this intervention
aims to contribute to a reduction of psychosocial problems
caused by excessive game behavior. To evaluate the effects of the intervention, a randomized controlled trial with
baseline, post-program, and three month follow-up measurements is planned in April 2011. The planned trial will
include two parallel groups, an experimental condition (N
= 145); the online training “Gaming under Control,” and
a control condition (N = 145); and a “'waitinglist” comparison group where the participants are offered the online
training after three months (from baseline).
Keywords: Videogame Addiction, Problematic Game
Behavior, Online Intervention, Prevention
introduction
Playing videogames is one of the most popular activities
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277
among adolescents. Recent studies have showed that most
Dutch adolescents play videogames every week [1]. Although several studies show that playing games may have
beneficial effects, there is some evidence that playing
videogames may have serious negative effects, including
the risk for some people to develop addictive patterns of
gaming [2,3]. Lemmens concluded in a recent study that
2% of Dutch adolescents are addicted to games [4].
The purpose of the study is to conduct a randomized controlled trial with the online training “Gaming under Control” as an intervention to: 1) develop an online guided
self-help intervention to prevent and reduce problematic
game behavior and its negative consequences for adolescents’ wellbeing; 2) evaluate the effects of the intervention
with post-program and three month follow-up measurements; 3) determine how many adolescents are willing to
participate in an online intervention; and 4) reach a hidden
population of problem gamers by offering a training that
is anonymous and easily accessible.
method
In cooperation with the Brijder Addiction Care Group, an
innovative online program was developed, which is partly
based on an existing online intervention for adolescent alcohol and cannabis abuse. The objectives of this program
are to increase awareness and readiness to change, and reinforce self-control of game behavior. Ultimately, this intervention aims to contribute to a reduction of psychosocial
problems caused by excessive game behavior.
This two week program consists of four assignments
which are derived from evidence-based methods, like motivational interviewing and self-regulation techniques. In
the first assignment, participants report their current wellbeing and game-related problems by completing a “mood
board” of their life. The second assignment involves selfmonitoring of their gaming behavior by keeping a “gaming diary.” In the third assignment, the participants are
motivated to make a decisional balance by analyzing positive and negative consequences of gaming. In the last assignment, they examine personal “risk situations” leading
to excessive gaming, and exercise avoiding and altering
those situations. During the program, the participants are
guided by a coach via online chat.
The usability of the intervention was determined in a pilot
study. To evaluate the effects of the intervention, a randomized controlled trial with baseline, post-program, and
three month follow-up measurements is planned in April
278
2011. The planned trial will include two parallel groups,
an experimental condition (N = 145); the online training
“Gaming under Control,” and a control condition (N =
145); and a “waitinglist” comparison group where the participants are offered the online training after three months
(from baseline). To obtain an indication of effectiveness,
we will monitor the effects of following the program on
game behavior, self-control, and game cognitions such as
intention, attitude and motives.
This online program is innovative and unique, because it
is the first online intervention to prevent problematic game
behavior and its negative consequences. Furthermore, a
hidden population can be reached by offering an anonymous and easily accessible training.
references
[1] Van Rooij, A., Schoenmakers, T. M., Meerkerk, G. J.,
& Van de Mheen, D.,Videogames en Nederlandse jongeren. Rotterdam: IVO, 2008.
[2] Griffiths, M. D., Davies, M. N. O., & Chappell, D.,
Breaking the Stereotype: The Case of Online Gaming, CyberPsychology & Behavior, 6 (2003), 81-91.
[3] Griffiths, M. D., Video Game Addiction: Further
Thoughts and Observations. International Journal of Mental Health and Addiction, 6 (2008), 182-185.
[4] Lemmens, J., Valkenburg, P., & Peter, J., Development
and validation of a game addiction scale for adolescents.
Media Psychology, 12 (2009), 77-95.
––––––––––––––––––––––––––––––––––––––––––––––
ClinicaVR: Classroom as a screening Tool for sport
Concussions in adolescents
Pierre Nolina,1, Annie Stipanicica, Yves Lachapellea,
Dany Lussier-Desrochersa, Mylène Henrya
and Philippe Allainb
Virtuelle (LARI-RV). Université du Québec à
Trois-Rivières, Québec, Canada
b
Laboratoire de Psychologie «Processus de pensée et
interventions» (PPI-EA 2646), Angers, France
a
Pierre Nolin
Laboratoire de recherche Interdisciplinaire en réalité virtuelle
1
Département de psychologie
C.P. 500, Université du Québec à Trois-Rivières
G9A 5H7 Canada
E-mail: Pierre.Nolin@uqtr.ca
abstract
There is a controversy about the cognitive effects of sport
concussions. This study aimed to verify if Virtual Reality
(VR) could contribute to a better comprehension of this
population. Fifteen adolescents, enrolled in a Sport and
Education Programme, were compared to 15 control
adolescents, whether or not they had experienced a sport
concussion during the previous years. Participants were
evaluated using the ClinicaVR: Classroom Vigil-CPT.
The results confirmed that sport concussions were associated with subtle deficits in attention. The results also
demonstrated that VR could detect these deficits. These
results are interesting for clinicians who work in this
area. However, further studies are needed to replicate
these results.
Keywords: Sport Concussion, Adolescents, ClinicaVR:
Classroom, Attention, Virtual Classroom
Two meta-analyses [1,2] revealed a controversy regarding
the evolution of symptoms, days and months following a
sport concussion. Since one of the sources of controversy
is certainly the relationship between symptoms and the
sensitivity of the tools that were used to assess participants, we believe that Virtual Reality (VR) will allow a
significant advance in this area.
method/Tools
Group 1 (sport concussion) was composed of 15 adolescents enrolled in a Sport and Education Programme (SEP)
at l’Académie les Estacades de Trois-Rivières (Québec,
Canada). They suffered a concussion during previous
years by practicing their sport (mainly hockey, basketball
and soccer). Average age was 13.73 years (SD = 1.22
year). Group 2 (controls) consisted of 15 adolescents who
did not undergo a sport concussion and who were also enrolled in the SEP. Average age was 13.87 years (SD = 0.92
year). They had no history of neurological, psychological
or learning disabilities. The Virtual Classroom was developed by Rizzo [6] and was revised by Digital MediaWorks
(http://www.dmw.ca/) under the name ClinicaVR: Classroom. Participants had to complete a six-minute CPTVIGIL test, presented on the classroom blackboard. While
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performing this task, participants had to resist visual and
auditory distractors (students moving, bell ringing, etc.).
results
T-tests showed that there was no significant difference between the two groups for total omissions [t (28) = 1.53, p
= .14], total commissions [t (17.46) = 1.44, p = .16], and
average reaction time [t (28) = 0.71, p = .48]. However,
the results showed significant differences between the two
groups for head movements: right/left [t (15.71) = 2.80, p
= .01]; up/down [t (21.18) = 2.96, p =. 01]; and tilt
right/left [t (28) = 2.07, p = .05].
Conclusion
Results showed, as in previous studies, that the deficits resulting from a sport concussion are subtle, since the scores
on standard variables of attention (omissions, commissions, and recation time) revealed no difference between
the two groups. However, new variables that were derived
from VR (different types of head movements) were able
to detect significant differences between the two groups.
These results therefore support the idea that VR is a tool
sensitive to subtle effects of sport concussions and encourage its use in this area. Further studies are needed to better
support these observations.
––––––––––––––––––––––––––––––––––––––––––––––
how Virtual reality helps us understand
attentionnal processes among healthy Children
Annie Stipanicica,1, Mylène Henrya, Emilie Cyra, Yves
Lachapellea, Danny Lussier-Desrochersa and Pierre Nolina
Virtuelle (LARI-RV). Université du Québec à TroisRivières, Québec, Canada
a
Annie Stipanicic
Laboratoire de recherche Interdisciplinaire en réalité virtuelle
Département de psychologie
C.P. 500, Université du Québec à Trois-Rivières
G9A 5H7 Canada
E-mail: Annie.Stipanicic@uqtr.ca
1
abstract
The ClinicaVR: Classroom Vigil-CPT is an ecological
tool which gives a picture of attentional components.
Sixty-one healthy children, divided in three age groups,
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279
were evaluated using the traditional and virtual version
of the CPT Vigil. The results confirmed the heterogeinity
of maturation of specific attention components. The Virtual Reality (VR) showed the same developmental trajectories for sustained/selective attention and for inhibition
responses. However, the VR seemed to be more accurate
in evaluating processing speed (reaction time). These results are interesting for clinicians who work with a clinical children population, since we know that the majority
of neurodevelopmental or acquired disorders present a
cognitive slow down. More studies are needed to explore
this question.
Keywords: Attention, Processing Speed, Children,
ClinicaVR: Classroom, Virtual Classroom
Developmental research has identified different developmental trajectories for specific attentional components.
Until now, studies document relatively early development
of basic selective attention indicating rapid maturation in
infancy and early childhood. Complex attention, including
shifting and inhibition responses, has been found to
progress slowly in early childhood with a more dramatic
development into adolescence. One criticism of these results is the use of tasks with low ecological validity.
method/Tools
The target group was composed of 61 children (34 boys,
29 girls) of Trois-Rivières (Québec, Canada). The boys’
average age was 8.38 years (SD = 1.74 year), and the girls’
average age was 8.34 years (SD = 1.78 year). The participants were divided into three age groups: gr1 6-7 years
old; gr2 8-9 years old; gr3 10-12 years old. They had no
history of neurological, psychological or learning disabilities. Each participant had to perform two different tasks:
the traditional CPT Vigil; and the CPT Vigil in a virtual
environment (a classroom). In this version (ClinicaVR:
Classroom) CPT VIGIL is presented on the classroom
blackboard for six minutes. While performing this task,
the participants had to resist auditory and visual stimulations like in a real classroom. In the traditionnal CPT, the
task is exactly the same, but without any other environment stimulations.
results
ANOVAs showed significant differences between the ages
groups (1<2; 1<3) for the omission errors at the traditional
[F(2,58)=5.72 p=.005] and the virtual [F(2,59)=7.26
p=.002] CPT Vigil. No difference between the ages was
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280
found for the commission errors. For reaction time, the results showed differences between the age groups for the
traditionnal [F(2,58)=6.31 p=.003] CPT (1<2; 1<3) and
virtual [F(2,59)=3.09 p=.053] CPT (1<3; 2<3). On paired
t-tests for all age groups, only the results of reaction time
were different depending on the version used (traditional
vs. virtual) [gr1: t(24)=4.47, p=.000; gr2: t(19)=12.17,
p=.000; gr3: t(15)=21.46, p=.000].
Conclusion
As in previous studies, the development of the
sustained/selective attention follows a relatively constant
evolution after the end of childhood, while the inhibition
responses develop more dramaticaly into adolescence. The
trajectories seem the same using the traditional or virtual
version. However, the speed processing results suggest a
different development across the ages depending on the
CPT version. Globally, the children are faster in the virtual
CPT and show more subtle progressions across the age.
––––––––––––––––––––––––––––––––––––––––––––––
The Value of a Virtual Kitchen to assess the
activities of daily life in alzheimer’s disease
Philippe Allaina,1, Paul Richardb, Mickael Naudb,
Jeremy Besnarda, Lisa Massenota, Pierre Nolinc
and Didier Le Galla
a
Laboratory of Psychology,
University of Angers, France
b
LISA, University of Angers, France
c
LARI-RV, University of Québec in
Trois Rivières, Canada
Philippe Allain
Faculté des Lettres
Langues et Sciences Humaines
11 boulevard Lavoisier
49045 Angers Cedex 01
France
E-mail : philippe.allain@univ-angers.fr
1
abstract
Patients with Alzheimer’s disease (AD patients) experience difficulties in everyday life activities that effect independence. These difficulties can be tested using virtual
reality (VR) environments that simulate real life situations. The purpose of this study was to examine the value
of a virtual kitchen as an assessment tool of everyday life
activities in AD patients. We focus on the assessment results obtained in a group of AD patients on a virtual
kitchen designed to assess their ability to prepare a virtual
cup of coffee using a virtual coffee machine. An identical
real daily living task was tested. Twenty-four AD patients
were matched to 32 healthy elderly controls. Significant
differences in performance between research and control
groups were detected on the virtual and the real tasks,
with the research group performing worse. In addition,
regression analyses revealed that the number of errors in
the virtual test was the best predictor for the real assessment and the Instrumental Activities of Daily Living
score. This provides initial support for the sensitivity and
the ecological validity of the virtual kitchen as an assessment tool of everyday life activities in AD patients.
Keywords: Alzheimer’s Disease, Everyday Activities,
Virtual Kitchen, Assessment
Most traditional neuropsychological tests were developed
within a diagnostic tradition. Hence, they often lack ecological validity and may not be suitable to provide answers
to questions with respect to daily life problems. In order
to bridge the gap between diagnostic measurement tools
and ability to function in natural environments, virtual reality (VR) techniques could be used. The benefits of VR
evaluations include the ability to objectively measure behavior in ecologically-valid environments, while maintaining strict experimental control over stimulus delivery
and measurement [1].
With all these arguments in mind, we developed the virtual
kitchen project to evaluate brain-damaged patients’ abilities during the execution of everyday activities. These activities require serial ordering of task steps and object
selection to achieve practical goals. These activities are
routinely performed with subjective ease by healthy subjects. However, among individuals with brain damage, errors are frequent and may preclude achievement of the
task goal. Our virtual kitchen was developed in order to
assess the sensitivity and ecological validity of this test for
the assessment of everyday life activities of patients with
brain lesions. Here, we focus on the assessment results obtained in AD patients on a virtual situation designed to assess their ability to prepare a virtual cup of coffee using a
virtual coffee machine.
method/Tools
The user is seated in front of a screen monitor and first re-
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ceives general verbal information about the assessment
task and the virtual kitchen usage. A training session is
available to enable him to get acquainted with the virtual
environment. Then, he has to select and move virtual objects placed on a virtual table via the computer mouse to
execute 14 steps (open the coffee machine drawer, put the
filter inside the machine, etc.). User’s actions are recorded
in real-time and saved. Some outcome measures are calculated by the computer from data recorded while he completes the task (total time to complete the task, total
number of errors, accomplishment score). An identical real
daily living task is tested and scored following the same
procedure.
The participants were 24 AD patients (14 females; mean
age: 76.9 years; average education level 9.3 years since
first grade; Mean MMSE score: 21.8; Mean Instrumental
Activities of Daily Living score: 2.6) and 32 matched
healthy elderly (HE controls; 25 females; mean age: 74.1
years; average education level 9.6 years; Mean MMSE
score: 29.1).
results
In the virtual condition, AD patients took longer
(647.3sec) than HE controls (374.1sec) to perform the virtual task (p<.0001). The average number of errors was significantly higher (p<.0001) for AD patients (3.1) than HE
controls (0.5). The accomplishment score was significantly lower (p=.0002) for AD patients (86.1%) than HE
controls (97.8%). The same pattern of performance was
observed in the real condition. Multiple regression analyses revealed that the number of errors in the virtual kitchen
test was the best predictor for the real assessment kitchen
(r2 =.20, p<.03 for the number of errors) and the IADL
score (r2=.55, p<.005) in AD patients.
Conclusion
Our work confirms that a simple virtual kitchen allows detecting disturbances in AD patients’ activities of daily living and that this test has a predictive value for AD patients’
functioning in daily life situations [2, 3].
references
[1] A.A. Rizzo, M.T. Schultheis, K.A. Kerns, C. Mateer,
Analysis of assets for virtual reality applications in neuropsychology, Neuropsychological Rehabilitation 14 (
2004), 207–239.
[2] C. Christiansen, B. Abreu, K. Ottenbacher, K. Huffman, B. Masel, R. Culpepper. Task performance in virtual
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281
environments used for cognitive rehabilitation after traumatic brain injury, Archives of Physical Medicine and
Rehabilitation 79 (1998), 888–892.
[3] J.H. Lee, J.H. Ku, W. Cho, W.Y. Hahn, I.Y. Kim, S.
Lee, Y. Kang, Y.K. Deog, T. Yu, B.K. Wiederhold, M.D.
Wiederhold, S.I. Kim. A virtual reality system for the assessment and rehabilitation of the activities of daily living,
CyberPsychology & Behavior 6 (2003), 383–888.
––––––––––––––––––––––––––––––––––––––––––––––
Virtual simulator of deep brain stimulation
in parkinson’s disease
Giovanni Albania,1, Angelo Franzinib, Cinzia Vignac,
Pietro Cipressoc,d, Alessandro Mauroa
and Giuseppe Rivac,e
a
Department of Neurosciences, IRCCS Istituto
Auxologico Italiano, Piancavallo-Verbania, Italy
b
Department of Neurosurgery, Neurological
Institute “Carlo Besta,” Milan, Italy
c
IRCCS Istituto Auxologico Italiano, Milan, Italy
d
IULM University, Milan, Italy
e
Department of Psychology, Catholic University
of Milan, Milan, Italy
1
Gianni Albani
Department of Neurosciences
IRCCS Istituto Auxologico Italiano
Piancavallo-Verbania
Italy
E-mail: giannialbani@libero.it
abstract
Deep brain stimulation (DBS) in Parkinson’s disease
(PD) is a widely used surgical approach which includes
two steps: the identification of the neuronal population of
the target to be stimulated, and the implant of the stimulating electrode in the region of the interest of the target.
The clinical aim of this surgical approach is to ameliorate
motor symptoms in PD patients with motor fluctuations
of their performances (on-off periods), so that a continuous “on” is maintained for the entire day. We have set up
a virtual methodology which reproduces all the real stages
of the intervention in 3-D by the exact view of the patient.
Sounds, voices and times of the operating room are recreated in an immersive three-hour session in a dedicated
282
space simulating the operating bed position. We believe
that this tool will significantly reduce the intraoperatory
stress of the patient, improving his collaboration and thus,
the outcome of the intervention.
point of view of the patient. Sounds, voices and times of
the operating room are experience in an immersive threehour session in a dedicated space simulating the operating
bed position.
Keywords: Virtual Reality, Simulator, Parkinson’s
Disease, Deep Brain Stimulation, Surgery
The simulating session includes the same stress conditions
of the real one, so that the patient will perform it in the
early morning, after an overnight fasting without consuming breakfast, and experience a drug withdrawal of 12
hours.
Deep brain stimulation (DBS) is a surgical procedure used
to treat a variety of disabling neurological symptoms – most
commonly, the debilitating symptoms of PD, such as
tremor, rigidity, stiffness, slowed movement, and walking
problems. The procedure is also used to treat essential
tremor, a common neurological movement disorder. At
present, the procedure is only used for patients whose symptoms cannot be adequately controlled with medications.
DBS uses a surgically implanted, battery-operated medical
device called a neurostimulator – similar to a heart pacemaker – to deliver electrical stimulation to targeted areas
in the brain that control movement, blocking the abnormal
nerve signals that cause tremor and PD symptoms.
The intervention includes two steps: the identification of
the neuronal population of the target to be stimulated, and
the implant of the stimulating electrodes in the region of
the interest of the target.
The first step of surgery is performed with local anaesthesia because it requires the collaboration of the conscious
patient. Indeed, when the microelectrode reaches the region of interest by stereotaxis, the most accurate identification of the neuronal network to recovery is needed. For
this reason, the patient is asked to perform standardized
tasks (for instance finger tapping, or counting), so that
when the stimulating electrode is working, these performances will improve simultaneously, and this will confirm
that the region of interest has been reached successfully.
At this point, the second part of the intervention (with the
patient under total anaesthesia) will begin, which includes
the definitive implant of the electrode.
During the simulation some clinical parameters are noted,
such as blood pressure, heartrate, glucose blood level, skin
temperature, and oxygen saturation, which are continuously updated in a dedicated display. This, by means of a
biofeedback approach, may affect the control of the stress
of the virtual surgery scene.
We believe that this tool will significantly reduce intraoperatory stress of the patient by improving his collaboration
and thus, the outcome of the intervention.
references
[1] Anthony E. Lang, M.D., and Andres M. Lozano, M.D.
Parkinson's Disease. N Engl J Med 1998; 339:1130-1143
October 15, 1998.
[2] Appleby BS, Duggan PS, Regenberg A, Rabins PV
(2007). "Psychiatric and neuropsychiatric adverse events
associated with deep brain stimulation: A meta-analysis
of ten years' experience". Movement Disorders 22:1722–
1728.
[3] Ferroli P, Tringali G, Acerbi F, Aquino D, Franzini A,
Broggi G. Brain surgery in a stereoscopic virtual reality
environment: a single institution's experience with 100
cases.Neurosurgery. 2010 Sep; 67.
––––––––––––––––––––––––––––––––––––––––––––––
interactive Television to facilitate social
inclusion of elderly people
Luciano Gamberinia,1, Tijana Debelica, Anna Spagnollia
and Francisco Ibanezb
The clinical aim of this surgical approach is to ameliorate
motor symptoms in PD patients with motor fluctuations
of their performances (on-off periods), so that a continuous “on” is maintained for the entire day.
We have set up a virtual methodology, which reproduces
all the real stages of the intervention in 3-D by the exact
Università degli Studi di Padova, Italy
b
Brainstorm, Spain
a
Luciano Gamberini
1
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Padova, Italy
Tel.: +39 0498276605
Fax: +39 0498276600
E-mail: luciano.gamberini@unipd.it
abstract
SeniorChannel is a European project that aims to develop
an Interactive Digital Television channel to offer entertainment and improve the social interaction of elderly
people. The final prototype will be an integrated TV studio and production center that will enable communitydriven broadcasting, and will be designed and developed
with a user-centric approach to meet the specificity of its
target users. The main usability recommendations and the
specific solutions to elicit users' requirements are described here.
Keywords: Elderly People, Usability, Social Inclusion,
Interactive Television
introduction
Although is been proven that older adults are less likely
than younger adults to use technology, a television is
owned by almost all households in Europe [1]. Also, research shows that TV viewing increases after 55 years of
age [2]. Its potentiality, though, is much greater than mere
entertainment. SeniorChannel (a European project within
the Ambient Assisted Living program, AAL-2009-2-090)
plans to use a Digital Interactive Television (DITV) as a
communication and information-retrieving device to empower older people. Through this device, users will familiarize themselves with a new technology, and interact with
their community by broadcasting their own content. Pursuing these goals involves two challenges: (a) the DITV
interface must suit the limitations in perception, cognition
and motor abilities that are associated with aging; and (b)
the involvement of the users in the design process should
take into account their lack of familiarity with the features
of a digital interface. The way in which these challenges
are approached is briefly described in the next paragraphs.
usability guidelines
The design of the SeniorChannel IDTV interface is informed by a set of usability guidelines based on state-ofthe-art knowledge of age-related changes in cognition and
motor abilities (e.g. [3,4,5,6,7]). Emphasis was placed on:
(a) presence of tutoring/help functions, since elderly people process information more slowly, are less familiar with
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283
new technologies and require one and a half times more
time to acquire new knowledge;
(b) good color contrasts and limited recourse to scrolldown functions, since vision declines in most seniors;
(c) large error tolerance, allowing users to make errors and
providing immediate corrective feedback;
(d) information positioning on the screen, avoiding areas
that are not as noticeable, such as the bottom left corner
of the screen.
An expert evaluation has been carried out based on the usability guidelines, and a prototype is undergoing its first
refinement phase.
strategies for Collecting requirements
Similarly to the expert evaluation, information is currently
gathered from primary and secondary users (i.e. elderly
people and the caregivers). They are asked for an opinion
about the nature of the functionalities to be implemented
in the IDTV, and the type of content to broadcast. Their
possible lack of familiarity with the service was taken into
account in the interview protocol by relying on “product
probes” and on a variety of the card sorting technique. In
the former group, users are exposed to short video fragments extracted from a number of TV programs belonging
to different genres. This will remind them of the familiar
experience of watching TV, and, through a subsequent
structured interview and focus group, will provide a starting point from which to express opinions and recommendations on existing and desired functionalities. The
illustrated card sorting is used to discuss and rank possible
content to broadcast, using pictorial evidence to remind
elderly people of the different content options while judging their relative importance.
Conclusions
The requirement collection in Spain and Sweden takes
place in February 2011 after a series of pilots for the refinement of the protocol. Results will be included in the
final version of this paper.
references
[1] European SeniorWatch Observatory and Inventory- a
market study about the specific ICT needs of older people
to guide industry, RTD and policy. IST-1999-29086.
[2] K. Reid, Lifeline or Leisure?: TV's Role in the Lives
of the Elderly. Retrieved on October 11, 2010 on
http://www.medialit.org/reading-room/lifeline-or-leisuretvs-role-lives-elderly.
284
[3] M. Gill, A. Perera, Accessible Universal Design of Interactive Digital Television, In Proceedings of First European Interactive Television Conference (2003), 83-89.
[4] M. Rice, N. Alm, Designing New Interfaces for Digital
Interactive Television Usable by Older Adults, Computers
in Entertainment 6, (2008), 1-20.
[5] K. Chorianopoulos, User Interface Design Principles
for Interactive Television Applications, International Journal of Human-Computer Interaction 24, (2008), 556 – 573.
[6] A.D. Fisk, W. A. Rogers, N. Charness, S.J. Czaja, J. Stuart,
Designing for older adults, Principles and Creative Human
Factors Approaches, CRC Press, Boca Raton (FL), 2004.
[7] N. Charness, C.W. Schaie, Impact of Technology on
Successful Aging, Springer, New York, 2003.
––––––––––––––––––––––––––––––––––––––––––––––
usability of Virtual reality environments to Treat
posttraumatic stress disorder for
Criminal Violence Victims
Georgina Cárdenasa,1 and Anabel De La Rosaa
National Autonomous University of Mexico
a
Georgina Cárdenas López
Universidad Nacional Autónoma de México
Facultad de Psicología
Laboratorio de Enseñanza Virtual y Ciberpsicología
Ciudad de México
E-mail: mgcl@servidor.unam.mx
1
abstract
The problem of criminal violence is impacted by mental
health problems such as depression and substance use and
abuse. However, one of the most important psychological
problems linked with the victims of violence is posttraumatic stress disorder (PSTD). In Mexico, according to the
ENSI-5 in 2008, 11% (6,800/for each 100 thousands of
habitants) of the population over 18 years, old experienced a crime. One in four of victims of violence develop
PSTD symptoms. Due to this socially relevant problem
and to support the efficacy of treatments, it is important
to design treatments involving the use of Virtual Reality
(VR), because it can help overcome some of the limitations of traditional therapy using exposure. The present
paper presents data of usability of five VR environments
to treat PTSD in a non-clinical sample.
Keywords: Virtual Reality, Usability, Posttraumatic Stress
Disorder Treatment, Criminal Violence, Assault
introduction
Violence is an issue of great importance for the general
population because of the health and economic implications. Assaults in the public streets create an atmosphere
of danger and vulnerability. According to the World Health
Organization[1], violence has important implications, both
psychologically and physically; among the consequences
of violence are depression, alcohol use and substance
abuse. The most important psychological difficulty experienced by victims is posttraumatic stress disorder (PTSD).
In Mexico, according to data reported by the National Survey on Insecurity (2007) [2] reported that 11% (6,800/per
100 thousand inhabitants) of the population over 18 years
old was a victim of a crime. Over these cases, one in four
had PTSD symptoms. Contemplating this background, it
is important to note the great impact of violence on mental
health. It is remarkable that PTSD requires attention because those who suffer from this disorder have elevated
degrees of anxiety, fear and avoidance, which could be
presented in different ways, that interfere in the personal
development and everyday lives of these people. For this
reason, this paper contemplates a treatment using Virtual
Reality (VR), because it can help overcome some of the
limitations of traditional therapy using exposure. It could
simulate the traumatic event with a high degree of realism
and thus, help patients, regardless of their ability to imagine. This innovative treatment implies high benefits; such
procedures and recent studies reported effectiveness in
treating anxiety disorders, eating disorders, addictions,
pain management, palliative care and rehabilitation [3]. In
particular, the use of VR for combat-related PTSD has a
growing literature reporting successful outcomes for clinical applications [4].
The present paper presents the virtual environments developed for the treatment of PTSD for victims of criminal
violence and presents the results from the usability evaluation and the role of Presence and Reality Judgment [5],
an initial evaluation made prior to clinical application.
pTsd scenario settings
The current study is arranged in two phases. In the first
phase, two virtual environments related to traumatic
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285
events for exposure treatment of PTSD, such as streets of
Ciudad Juarez scenario, which includes a pedestrian
bridge, a gunfire scene, an assault/robbery scene, a lock
(police checkpoint) and a kidnapping room, are developed
with the aim of exposing the patient to the memories of
the trauma. The second phase will address the clinical validity of virtual reality exposure treatment (VRET) for patients with PTSD who have been victims of criminal
violence.
[5] Baños, R., Quero, S., Salvador, S., & Botella, C.
(2005). The Role of Presence and Reality Judgement in
Virtual Environments in Clinical Psychology. Paper
presented at the Cybertherapy 2005, Basel, Switzerland.
In order to achieve immersion of the participant, each scenario is navigable and interactive. Note that virtual environments are designed taking into account the social and cultural
context appropriate for the target users of the system.
Alessandra Grassia,b,1, Federica Pallavicinia,c,
Simona Raspellia, Silvia Serinoa, Giulia Spagnolia,
Pietro Cipressoa,d, Marco Villamirad,
Andrea Gaggiolia and Giuseppe Rivaa,b
––––––––––––––––––––––––––––––––––––––––––––––
using Video Clips to induce negative
emotional responses
Istituto Auxologico Italiano, Milano , Italy
b
Comunicazione, Università Cattolica del
Sacro Cuore, Milano, Italy
c
Università degli studi Milano Bicocca,
Milano, Italy
d
IULM, Università di Milano, Italy
The VR models contain flexible variables such as: 1) the
number of people or policeman, 2) physical characteristics
of virtual characters (type of clothing, gestures), and 3)
environmental sounds (sound of beating or shooting a
firearm, activation of car alarms, etc.), that are controlled
by the therapist, thus exposing the patient to their own
symptoms, teaching him to confront and manage them.
preliminary Conclusions
The incorporation of new technologies into psychological
treatment seems to be a promising alternative for the care
of PTSD in victims of criminal violence, a problem which
has a great impact on our country. Having an effective
treatment program to help people overcome stressful traumatic events that are disturbing might positively impact
society and support the spread of empirically validated
treatments in the Mexican mental health field.
references
[1] World Health Organization. Composite International
Diagnostic Interview (CIDI) version 15. Ginebra, Suiza:
WHO, 2002.
[2] Instituto Ciudadano de Estudios sobre la Inseguridad,
A.C. (ICESI). La percepción de inseguridad en las principales regiones urbanas de México. Gaceta Informativa.
(2007). Disponible en: www.icesi.org.mx.
[3] Rizzo, A. State of the Art in Virtual Rehabilitation. CyberPsychology & Behavior; (2006). 9 (2). 113.
[4] Norrholm, S.; Jovanovic, T.; Rothbaum, B.; Davis, M.;
Braddley, R.; Crowe, C; Skelton, K. & Duncan, E. Optimization of reseach and clinical applications for combatrelated posttraumatic stress disorder. (2010). Ed. Nova.
JCR
a
Alessandra Grassi
Milano, Italy
E-mail: a.grassi@auxologico.it
1
abstract
Each individual’s event evaluation modifies the subjective emotional state and the personal event adaptation.
This process generates an emotional change and helps the
subject to select his feedback and to regulate his emotional response. Each emotion, both positive and negative, is influenced by the subjective appraisal. In the last
decades the interest on the roles of cognitive appraisal
and emotions, and specifically on the emotion induction
process using clip video as stimuli, has been growing. The
general aim of the present study is to explore the individual emotional reactions after the presentation of video
clips showing stressful situations that occur in everyday
life. The goal of this research is to assess the efficacy of
selected “stressful scenarios” in eliciting negative emotional responses (anxiety).
Keywords: Emotions, Emotion Induction Procedure,
Video Clip, Anxiety
286
In the last decades one of the main aims of research on
the emotion induction process has been to study the relation between emotion and facial expression [1], the relation between emotions and the Automatic and Central
Nervous System, and to check individual differences in
emotional answers [2, 3]. Different studies have been carried out to explore the emotion induction process using
new media, specifically video clips [4, 5]. The main aim
of these studies was to investigate if video clips are useful
to induce an emotional change (positive or negative).
Gross and Levenson [2] studied the emotion induction
process using video clips in order to induce discrete emotions in subjects. In this study, the definition of emotion
is related to the Appraisal theory [6]. According to
Scherer, emotions are answers following an individual
evaluation of the situation: each event has a specific individual meaning that influences the subjective emotional
state. The Appraisal theory [6] postulated that each different emotion is a result of a sequence of stimulus events
and stimulus’s evaluation that determine subjective emotional answers. According to the Multicomponential
Model of emotion proposed by Scherer [6], the research
carried out by Gross and Levenson [2] confirmed that an
individual’s evaluation of an event could trigger personal
behaviors and subjective emotional and psychological answers. Building on Gross and Levenson’s study [2], the
aim of this study is to explore the effectiveness of video
clips in inducing discrete emotions. A review of literature
focused on exploring stressful situations in everyday life
[7, 8, 9]; twelve situations were selected. The goal of this
research to assess the efficacy of the selected stressful
video clips in eliciting negative emotional responses (anxiety) and to rank the emotional valence of 12 scenarios,
presented as video-clips. These newly selected scenarios
will be compared with two emotion-inducing stimuli that
have already been tested [2]. The emotion-inducing video
clips will be tested in a non-stressed sample (undergraduate students). The study has a within subjects design.
The dependent variable is the emotional valence, assessed
by Facial Expression Database questionnaire [10], administered pre- and post-intervention, and the Post Vision
Questionnaire [2] administered post-intervention. The
sample is composed of 90 university students (45 male
and 45 female) aged between 20-25 years old.
expected results
At the moment the study is in progress. Expected results
were identified: the 12 video-clips and the two additional control video-clips are able to modify the emo-
tional state in participants, specifically, the videos selected are able to elicit discrete negative emotions. According to these results, it will be possible to create a
ranking of the selected stressful videos according to
their emotional impact.
Final results will be presented during the 16th CyberPsychology and CyberTherapy Conference.
Acknowledgments
The work in preparing this paper was partially supported
by the European funded project "INTERSTRESS-Interreality in the management and treatment of stress-related
disorders,” FP7-247685.
references
[1] P. Ekman, R. J. Davidson, The Nature of Emotion:
Fundamental Questions. NYC: Oxford University Press,
1994.
[2] J. Gross, R. W. Levenson, Emotion elicitation using
films. Cognition and emotion. 9(1), 87-108, 1995.
[3] B. L. Fredrickson, The role of positive emotions in
positive psychology: The broaden-and-build theory of
positive emotions. American Psychologist, 56, 218-226,
2001.
[4] B. L. Fredrickson, R. A. Mancuso, C. Branigan, & M.
M. Tugade, The undoing effect of positive emotions. Motivation and Emotion. 24, 23, 2000.
[5] A. Lang, J. Newhagen, B Reeves, Negative video as
structure: Emotion, attention, capacity, and memory. Journal of Broadcasting & Electronic Media, 40, 460-477,
1996.
[6] K. R. Scherer, On the nature and function of emotion:
A component process approach. In K.R. Scherer e
P.Ekman (eds) Approaches to emotion, Hillsadle, N.J.,
Erlbaum, 1984.
[7] M. Zeidner, N. S. Endler, Handbook of coping: theory,
research, applications, John Wiley & sons Inc, 1994.
[8] A. V. Ravindran, K. Matheson, J. Griffiths, Z. Merali,
H. Anisman, Stress, coping, uplifts, and quality of life in
subtypes of depression: a conceptual frame and emerging
data, Journal of Affective Disorders, Volume 71, Issue 1,
Pages 121-130, 2002.
JCR
[9] P. Dewe, T. Cox, E. Ferguson, Individual strategies for
coping with stress at work: A review, in Work and Stress,
Vol. 7, no. 1, pp. 5-15. 1993.
[10] P. Ekman, W. V. Friesen, Facial Action Coding System: A method for the measurement of facial movement.
Palo Alto, Calif, Consulting Psychologist Press, 1978.
––––––––––––––––––––––––––––––––––––––––––––––
influence of Computer-anxiety on the
new forms of digital divide
Filippo La Pagliaa,1, Rosalinda Rizzob
and Daniele La Barberaa
Dipartimento di Biomedicina Sperimentale e
Neuroscienze Cliniche, Università degli
Studi d Palermo, Italy
b
Dipartimento di Scienze Pedagogiche e
Psicologiche, Università degli Studi di Messina, Italy
a
Filippo La Paglia
Dipartimento di Biomedicina Sperimentale e Neuroscienze Cliniche
Università di Palermo
Palermo, Italy
E-mail: filippolapaglia@gmail.com
1
abstract
This study analyzes perceived levels of computer-expertise, computer self-efficacy, Internet attitudes and computer-anxiety in a population of 77 Italian teachers (29
male, 48 female; mean age=43 years, SD= 9 years). A
multiple regression analysis showed that low computer
self-efficacy predicts anxiety toward computers, whereas
this is not the case of low computer-expertise or low Internet attitude. Such outcomes suggest the possibility to
design training or psychological treatments aimed at
modifying negative perceptions toward computers of
techno-stressed people more than increasing their effective computer expertise or feelings toward the Internet.
Keywords: Computer Anxiety, Computer
Self Efficacy, Digital Divide
introduction
The central role of information and communication technologies (ICT) for our society creates new forms of exclusion for those people who are unable to discover and
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287
to use the potentialities of these technologies. Such a phenomenon, labeled as digital divide or digital inequality,
refers to the difference between individuals who own and
properly use a computer and those who don’t [1-3]. The
phenomenon is also influenced by different factors, such
as the physical resources or the technical means available
to people for managing a personal computer, and individual levels of computer expertise and computer self-efficacy. Also, authors evidenced that some demographic
variables such as gender, age or occupation influence the
individual differences in the digital divide. Specifically,
females tend to deal less with technology, and they own
and use computers to a lesser degree than males. Moreover, females attend a fewer number of computer-science
training classes and are less enthusiastic than males in interacting with computers [4], also, showing higher levels
of techno-stress or computer-anxiety [5]. The present research is specifically aimed at studying the gender differences related to digital inequality and to techno-stress in a
population of Italian Teachers.
methods
participants
The research was carried out on a group of 77 teachers (29
males and 48 women) aged from 28-61 years old (mean
age = 43 years old; SD= 9). Participants were randomly
selected from different schools in Palermo.
All the participants were asked to complete four self-report questionnaires:
- Computer-Expertise Questionnaire [6] – an 11-item scale
measuring the individuals’ computer and Internet expertise
- Computer Self-efficacy Scale [6] – a 30-item scale exploring the individuals’ computer self-efficacy expectations
- Internet Attitudes Scale [7] –a 28-item scale measuring
positive and negative attitudes toward the Internet
- Computer Anxiety Rating Scale [8] – a 19-item scale that
investigates the perceptions of stressors associated with
computer usage
statistical analyses
In order to examine the Italian teachers' levels of computer-expertise, computer-self-efficacy, Internet attitudes
and computer-anxiety as a function of Gender, a multivariate analysis of variance (MANOVA) was performed
using each of the questionnaire scores as dependent variables and Gender (Male versus Female) as a between-subject factor. After calculating the correlations among the
scales, a multiple regression analysis was performed to
determine the predictability of the effect of computer ex-
288
Table 1
Participants’ Mean Averaged Scores and Standard Deviations at Computer- Expertise Questionnaire, Computer
Self-efficacy Scale, Computer Anxiety Rating Scale and Internet Attitude Scale (N=77).
perience, computer self-efficacy and Internet attitude on
computer anxiety.
cover the potentialities of these technologies and to decrease their higher levels of computer anxiety.
results
Participants’ scores on each questionnaire were averaged
and standards deviations were calculated (see Table 1).
references
[1] P. Norris, Digital Divide, Civic Engagement, Information Poverty and the Internet Worldwide, Cambridge University Press, Cambridge, 2001.
As reported in Table 1, participants scored lower on Computer-Expertise and Computer-Anxiety and scored higher
on Computer Self-Efficacy and Internet Attitudes. Hence,
Italian Teachers exhibit moderate levels of computer-expertise, but perceive themselves as highly effective in
computer usage.
Results at MANOVA evidenced a multivariate effect of
Gender (F1-75=3.512, p<.01). The successive univariate
tests showed that male Italian teachers scored higher than
females on the Computer Self-efficacy Scale (F1-75=12.5,
p<.01) and Internet Attitude Scale (F1-75=8.3, p<.01).
Conversely, female Italian teachers scored higher than
males on the Computer Anxiety Rating Scale (F1-75=9.9,
p<.01).
Conclusions
The present paper investigates some interesting aspects of
digital inequality, as well as techno-stress, in an Italian educational context. Consistent with the international
panorama as related to the digital divide, our data show a
sort of gender gap concerning the perceived competence
of efficacy in using technologies, as well as concerning
the perceived levels of technostress. Specifically, male
Italian teachers revealed both higher levels of computerself-efficacy and more positive attitudes toward the Internet than females, whereas female Italian teachers exhibited
higher levels of computer-anxiety than males.
We present our data within a social-cognitive framework,
discussing further research which could be performed in
order to modify the female Italian teachers’ negative attitudes toward computers, and to allow them both to dis-
[2] M. Warschauer, Reconceptualizing the digital divide,
First Monday 7 (2002).
[3] P. Di Maggio, E. Hargittai, From the Digital Divide to
digital inequality: studying the Internet as penetration increase, Princeton University Center for Arts and Cultural
Policy Studies, Working Paper 15, summer. 2001.
[4] Pinkard, N. How the perceived masculinity and/or
femininity of software applications influences students’
software preferences. Journal of Educational, Computing
Research, Vol. 32, 1, 57-78. 2005.
[5] Rosen, L.D., Sears, D.C. and Weil, M.M. Computerphobia, Behavior Research Methods, Instrumentation &
Computers, 19, 2, 167-79. 1987.
[6] Chifari, A., Ottaviano, S., D’Amico, A., and Cardaci,
M. Studying The Teachers’ Self Efficacy Beliefs Towards
Computers. Proceedings Of Istas 2000. Roma, 8-10 Settembre. 2000.
[7] Sam, H.K., Othman, A.E.A., and Nordin Z.S. Computer Self-Efficacy, Computer Anxiety And Attitudes Toward The Internet: A Study Among Undergraduates In
Unimas. Educational Technology And Society, 8 (4), 205219. 2005.
[8] Rosen, L.D., and Weil, M.M. Computer Anxiety: A
Cross-Cultural Comparison Of University Students In Ten
Countries. Computers In Human Behavior, 11 (1), 45-64.
1995.
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The effectiveness of self-help Virtual
reality for arachnophobia
C. Darren Pierceya,1, Kate Charltona
and Carl Callewaertb
University of New Brunswick
b
Fundi3D
289
VRCBT is effective and acceptable by patients. However,
it comes and a high cost. Virtual Reality (VR) typically
uses real-time computer graphics, body tracking devices,
visual displays, and other sensory input devices that expose participants to a virtual environment [2]. VR systems
range in price from $5,000 to $10,000 depending on the
equipment used.
a
C. Darren Piercey
Psychology Department
University of New Brunswick,
PO Box 4400, Fredericton, N.B.
Canada, E3B 5A3
E-mail: piercey@unb.ca
1
abstract
Virtual Reality cognitive behavioral therapy (VRCBT) has
been shown to be effective for the treatment of specific
phobias. However, the equipment and software used to
present the 3-D environments is very expensive. Also, the
costs associated with having a therapist present during exposure therapy prevent many individuals from benefiting
from VRCBT. The purpose of this study is to determine
the effectiveness of inexpensive self-help software for the
treatment of arachnophobia. Participants practiced exposure therapy on their own. They performed relaxation techniques and exposed themselves to the VR scenario using a
standard PC and 3-D anaglyph glasses. The software consisted of five levels that progressively increased in the
amount of fear they evoked. Skin conductance and heart
rate were measured before and after each session to determine if the software was producing a fear response. Participants completed five self-report questionnaires before
and after four VR sessions. A comparison between the VR
group and a control group was made. The results of this
work in progress will be presented at the CyberTherapy
and CyberPsychology Conference in June 2011.
Keywords: Virtual Reality, Arachnophobia, Exposure
Therapy, Cognitive Behvioral Therapy, Self-help
introduction
Virtual Reality cognitive behavioral therapy (VRCBT) has
been proven as an effective alternative to CBT [1].
VRCBT exposes participants to virtual counterparts of the
feared stimuli. This tends to be more attractive than CBT
for many participants [2].
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Attempts have been made to determine the effectiveness
of more cost effective VR software [3] and delivery methods [4]. The purpose of the present study is to determine
the effectiveness of VR exposure for the treatment of
arachnophobia using cost effective equipment and cost effective software [5]. The 3-D software is presented to participants on a desktop display using anaglyph glasses with
no intervention from the researchers. Participants used the
software in the same manner they would if they had their
own copy to use at home on their own computers.
methods
Four hundred undergraduates from introductory psychology at UNB completed the Fear of Spiders Questionnaire
(FSQ) [6] and received course credit for participating.
Fourteen students that scored 80 or above on the FSQ, and
were willing to take part in the second component of the
study were randomly assigned to either the wait group
(WG) or the VR group (VRG).
Participants in the WG and the VRG completed five selfreport questionnaires during the first and last sessions: 1)
State-Trait Anxiety Inventory; 2) Spider Beliefs Questionnaire; 3) Presence Questionnaire; 4) Preference Questionnaire; and 5) Fear of Spiders Questionnaire. VRG
participants took part in four VR sessions. Heart rate and
skin conductance were measured before and after each VR
session using a NN310 Wrist-Ox oximeter and a UFI
model 2701 Bioderm Skin Conductance meter.
Participants donned red-blue anaglyph glasses. The
NN310 Wrist-Ox oximeter and the 2701 Bioderm Skin
Conductance meter were attached to their hand. Their
heart rate, and skin conductance were recorded prior to
and after each VR exposure session. The participants were
asked to work through as many levels as they felt comfortable for approximately 25 minutes. Instructions were
displayed on the monitor at the beginning of every session,
explaining the process of exposure therapy and progressive muscle relaxation (PMR). They were instructed to use
the pause button when anxiety reached an uncomfortable
level and practice PMR.
290
results and discussion
The results of this work in progress will be presented at
the CyberTherapy and CyberPsychology Conference in
June 2011. Future research will include determining the
effectiveness of the software without the use of any form
of 3-D glasses. Also, a study determining the preference
for 3-D, 3-D with anaglyph glasses and 3-D with shutter
glasses will be performed. The results of this experiment
and future experiments will have an impact on clinicians
and patients by making this technology available at a reasonable price. This software can be used by a clinician in
their private practice and then given to patients to help
them practice the techniques learned in the therapist’s office (i.e. used as homework).
references
[1] Wallach, H.S., Safir, M.P., & Bar-Zvi, M. (2009). Virtual reality cognitive behavior therapy for public speaking
anxiety: A randomized clinical trial. Behavior Modification 33, 314-338.
[2] Powers, M. B., & Emmelkamp, P. (2008). Virtual reality exposure therapy for anxiety disorders: A meta-analysis. Journal of Anxiety Disorders, 22, 561–569.
[3] Bouchard, S., Cote, S., St-Jacques, J., Robillard, G., &
Renaud, P. (2006). Effectiveness of virtual reality exposure in the treatment of arachnophobia using 3d games.
Technology and Health Care 14, 19–27.
[4] Lister, H., Piercey, C., & Joordens, C. (2010). The effectiveness of 3-D Video Virtual Reality for the Treatment
of Fear of Public Speaking. Journal of Cybertherapy &
Rehabilitation. 3, 4, 375-382.
[5] Fear of Spiders Treatment (1.0) [Software]. (2011). CyberPsyc Software Solutions Inc. http:www.cyberpsyc
.com.
[6] Szymanski, J. & O'Donohue, W., (1995). Fear of Spiders Questionnaire. Journal of Behavior Therapy and Experimental Psychiatry 26, 31–34.
––––––––––––––––––––––––––––––––––––––––––––––
inducing anxiety using a “Contaminated”
Virtual environment: first steps in the
Validation of a Treatment Tool for
obsessive-compulsive disorder
Mylène Laforesta and Stéphane Bouchardb
a
b
Mylène Laforest
3-308 Nelson, Ottawa
Canada, K1N 7S4
E-mail: mlafo012@uottawa.ca
1
abstract
Obsessive-compulsive disorder (OCD) is characterized
by the presence of obsessions and compulsions. Its treatment includes exposure to feared stimuli and prevention
of rituals performed to reduce anxiety. The aim of the
present study is to examine the effectiveness of a contaminated virtual environment (VE) to provoke anxiety in 20
healthy adults. Results will be discussed. This is the first
of a series of studies aiming to validate a VE in order to
determine its possible use in the treatment of OCD with
contamination subtype.
Keywords: Anxiety, Obsessive-compulsive Disorder,
Virtual Environment, Contamination, Disgust
introduction
Obsessive-compulsive disorder (OCD) is characterized by
recurrent and intrusive thoughts, impulsions, or doubts
that provoke marked anxiety, and by repetitive behavioral
or mental rituals that are performed in response to an obsession in order to reduce associated distress [1]. In the
case of the contamination subtype of OCD, examples of
obsessions are fear of dirt or germs, excessive preoccupation with cleaning, fear of disease or of spreading germs,
somatic obsessions, and disgust related to bodily fluids or
feces. According to the literature, cognitive-behavioral
therapy (CBT) has proven to be the most effective treatment for OCD, this being mostly linked to a therapy technique called exposure and response prevention (EX/PR).
OCD sufferers are usually treated by in vivo exposure, that
is, they are exposed to contaminated stimuli and are prevented from conducting their rituals. This treatment has
its limitations, such as availability of stimuli, breach of
confidentiality, and risk of disease. Studies have shown
the efficacy of virtual environments (VEs) to elicit a fear
reaction in participants [2], as well as to be an exposure
tool in the treatment of different anxiety disorders. To our
knowledge, only one study by Kim et al. [3] has shown in
virtuo exposure to be an anxiety-provoking tool in the
checking subtype of OCD. The objective of the present
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study is to examine the effectiveness of a “contaminated”
VE in anxiety provocation in healthy adults. This is the
first study in a series of studies aiming to validate a VE
and to determine its effectiveness in the treatment of OCD
with contamination subtype.
method
The present study used a pretest posttest protocol in order
to test the efficacy of a VE in anxiety provocation in
healthy adults. In order to be effective, results need to
show a significant increase in anxiety induced by the immersion in a dirty virtual public toilet.
participants
Twenty healthy adults (n=20) between the ages of 18 and
65 were recruited throughout the population at-large. Exclusion criteria were respected.
procedure
After an evaluation, participants were immersed in a “neutral” control VE followed by an immersion in a VE with
various degrees of contamination. Self-report questionnaires were completed following both immersions. Physiological parameters were recorded wirelessly during
baseline and immersions to provide objective measures of
anxiety.
material
The virtual reality (VR) equipment consisted of a six-wall
Cave-like immersive system, 3-D glasses, and an Intersense Wand. Psychological measures included the Structured Clinical Interview for DSM Disorders (SCID), the
Yale-Brown Obsessive-Compulsive Scale (YBOCS), the
State-Trait Anxiety Inventory (STAI), the Immersive Tendencies Questionnaire, the Presence Questionnaire, and
the Cybersickness Questionnaire. As for physiological
measures, heart rate and skin conductance were obtained.
results
Repeated measures ANOVAs revealed a significant effect
of the immersion on participants.
discussion
Interpretation of results will be discussed, as well as clinical implications for the treatment of OCD sufferers.
references
[1] American Psychiatric Association, Diagnostic and statistical manual of mental disorders (4thed., text revised).
Washington, DC, 2000.
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291
[2] G. Robillard, S. Bouchard, T. Fournier, & P. Renaud,
Anxiety and presence during VR immersion: A comparative study of the reactions of phobic and non-phobic participants in therapeutic virtual environments derived from
computer games, Cyberpsychology and Behavior 6
(2003), 467-476.
[3] K. Kim, C.-H. Kim, K. R. Cha, J. Park, K. Han, Y. K.
Kim, et al, Anxiety provocation and measurement using
virtual reality in patients with obsessive-compulsive disorder. Cyberpsychology and Behavior 11 (2008), 637-641.
––––––––––––––––––––––––––––––––––––––––––––––
how does the feeling of presence impact analgesic
properties of Virtual reality on pain during
a Cold-pressor Test?
Véronique Gougeona,1, Stéphanie Dumoulina,
Stéphane Boucharda and Claudie Lorangera
a
Veronica Gougeon
Cyberpsychology lab of UQO
47 de Bazin
Gatineau, Canada
E-mail: Veronique_gougeon@live.ca
1
abstract
The present study aims to document the impact of the
feeling of presence on the analgesic effect of Virtual Realty (VR) during a cold-pressor test. While performing a
cold-pressor test and immersed in a virtual environment,
30 participants (15 women and 15 men) were asked to
evaluate their feeling of presence, as well as their level
of pain, to explore the correlation between these concepts.
Keywords: Presence, Virtual Reality, Cold-pressor Test
introduction
Defined as a complex phenomenon, pain cannot be completely understood according to a reductionist point of
view. Pain can only be understood by taking into account
both the psychological and the physiological elements
[1]. According to the International Institute for the study
of pain, pain can be defined as an unpleasant feeling and
an emotional response to an attack on tissue, real or potential, or described in these terms [2]. Virtual reality
(VR) could be a tool worth considering for reducing the
292
unpleasant effects of pain. Distraction has an analgesic
effect and is defined as “an intentional means that the individual adopts in order to divert his attention of the pain
or other harmful feelings towards more pleasant stimuli
or emotionally neutral stimuli” [4,5]. The analgesic effect
of distraction in VR may involve both an increased cognitive load and act of drawing the focus of attention away
from painful cues.
VR, as an application which makes it possible for the user
to navigate and to interact in real-time with a 3-D environment generated by computers [6], may require the use
of sophisticated equipment. Can VR have an analgesic effect when used with less immersive technologies? Actually, immersion fosters presence, or the illusion of being
in the virtual environment [7,8]. Therefore, the objective
of this study is to determine the impact of the feeling of
presence on the analgesic capacity of VR during a coldpressor task. The hypothesis is that a stronger feeling of
presence will be significantly correlated with tolerance to
pain, as measured by the time the participant can leave
their hand in cold water.
methods and Tools
The participants are 30 adults (15 women and 15 men)
aged 18 years old and above. The following exclusion criteria were used, based on participants’ answers to a prescreening interview: suffering from epilepsy, diseases
contributing to cybersickness (e.g., vestibular dysfunctions,), cardiovascular circulatory diseases (e.g., Reynaud’s Syndrome), blood pressure problems or diabetes.
Participants taking medication inducing an important
physiological or psychological effects were excluded.
The experiment was carried out during one session lasting
approximately 60 minutes for each participant. Participants were randomly assigned to one of the following
four conditions: (1) low distraction and high attention; (2)
high distraction and high attention; (3) low distraction and
low attention and (4) low distraction and low attention.
Each participant was asked to put his non-dominant forearm 30 cm deep in the cooler for up to five minutes. A
baseline measure was taken to determine participant’s
threshold for pain.
The relationship between pain and presence was assessed
with a self-report. Participants were asked to rate their
level of pain with a Visual Analogue Scale and complete
the McGill Pain Questionnaire [9], the Fear of Pain Questionnaire III [10], the Pain Catastrophizing Scale [10] and
their self-efficacy to cope with pain. Presence was assessed with the Gatineau Presence Questionnaire. The Immersive Tendencies Questionnaire [12] and the Simulator
Sickness Questionnaire [13] were also administered.
results
The sample for the analyses was composed, after all exclusions, of nine women and 12 men (N=21). Firstly, a
correlation was done to quantify the link between the level
of pain felt during the first immersion and the sense of
presence. The results showed a moderated and negative
correlation [r= -0.41, p= 0.04]. A hierarchical regression
was used to determinate the link between the ratio of flies
killed in function of the duration of the immersion, the
pain catastrophizing and the sense of presence at the first
immersion. Results obtained show showed that the addition of presence contribute significantly to regression [F
(3,19) = 4.92, p< 0.05; R2 change = 0.19; Adj R2 = 0.38].
The respective contribution of each variable is: pain catastrophizing (sr= 0.49, p< 0.05), ratio of killed flies (sr =
0.19, ns) and presence (sr = 0.43, p< 0.05).
Conclusion
In conclusion, results confirm the hypothesis which posed
that the higher the sense of presence, the lower the pain
would be rated during the first immersion. This also confirms the importance of presence as a variable in the analgesic capacity of VR. Furthermore, results are consistent
with multiples studies showing that VR can be used as a
possible non-pharmacological way to reduce pain. However, more studies have to be done to support these assumptions. Finally, results are promising concerning the
implication of the cognitive load of a virtual task in order
to reduce pain. Due to the exclusion of some participants
for the analysis, it will be interesting to recreate this study
with a larger sample.
references
[1] Marchand, S. (2009). Le phénomène de la douleur. (2e
éd.). Montréal, Québec : Chenelière Éducation.
[2] Calvino, B. (2006). Les bases neurales de la douleur.
Psychol NeuroPsychiatr Vieil, 4(1), 7-20.
[3] Calvino,B., & Grilo, R.M. (2006). Le contrôle central
de la douleur. Revue du rhumatisme, 10-18.
[4] Dumoulin, S., Bouchard, S., & Rivard, V. (2007). La
réalité virtuelle est-elle un moyen de gérer la douleur
aiguë? Revue québécoise de psychologie, 28(2), 65-91.
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[5] Jaanist, T.,Hayes, B., & von Baeyer, C.L. (2007). Effects of preparatory information and distraction on children’s cold-pressor pain outcomes: Randomized
controlled trial. Behaviour Research and Therapy, 45,
2789-2799.
[6] Pratt, D.R., Zyda, M., & Kelleher, K. (1995). Virtual
reality: In the mind of the beholder. IEEE Computer, 28
(7), 17-19.
[7] Hoffman, H.G., Sharar, S.R., Coda, B., Everett, J.J.,
Ciol, M., Richard,T., et al. (2004). Manipulating presence
influences the magnitude of virtual reality analgesia. Pain,
111, 162-168.
[8] Barfield, W., & Hendrix, C. (1995). The Effect of Update Rate on Sense of Presence within Virtual Environment. Virtual Reality, 1 (1), 3-16.
[9] Melzack, R. (1987). The short-form McGill Pain Questionnaire. Pain, 30, 191-197.
[10] McNeil, D.W., & Rainwater, A.J. (1998). Development of the Fear of Pain Questionnaire III. Journal of Behavioral Medecine, 21(4), 389-410.
[11] French, D.J., Noël, M., Vigneau, F., French, J.A.,
Cyr, C.P. & Evans, R.T. (2005). L’échelle de dramatisation face à la douleur PCS-CF. Adaptation canadienne en
langue française de l’échelle «Pain catastrophizing
scale». Revue canadienne des science du comportement,
37(3), 181-192.
[12] Witmer, B.G., & Singer, M.J. (1998). Measuring presence in virtual environments: A presence questionnaire.
Presence: Teleoperators and Virtual Environments, 7(3),
225-240.
[13] Kennedy, R., Lane, N., Berbaum, K., & Lilienthal,
M. (1993). Profile analysis of simulator sickness symptoms- Application to virtual environment systems. Presence: Teleoperator and Virtual Environement, 1(3),
295-301.
––––––––––––––––––––––––––––––––––––––––––––––
The influence of pain Catastrophizing on
distraction Through immersion in Virtual reality
Claudie Lorangera,1, Stéphanie Dumoulinb, Stéphane
Boucharda and Véronique Gougeona
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293
b
a
Claudie Loranger
Laboratoire de Cyberpsychologie de
l’Université du Québec en Outaouais
283 Alexandre-Taché
CP 1250, Succursale Hull
Gatineau, QC
J8X 3X7 Canada
E-mail: lorc08@uqo.ca
1
abstract
Pain catastrophizing (PC) is one of the best predictors of
the subjective experience of pain. PC is described as an
exaggerated negative orientation toward current or anticipated pain, which involves a feeling of helplessness and
leads the person to communicate his or her pain. In order
to reduce the impact of PC in the life of people in pain,
various strategies have been tested. Distraction seems to
be a promising non-pharmacological solution. It allows
for diverting the cognitive resources of a person towards
something different than the painful stimulus. Virtual reality (VR), i.e. three-dimensional universes generated by
computers with which the subject can interact, affords
very effective distraction. Thirty participants were subjected to a cold pressor test while being distracted in VR.
Participants were randomly assigned to four experimental
conditions with various distracting potentials. Repeated
measures of pain level were taken in order to determine
if PC has an impact on the analgesic effect of VR. The
results show that a higher level of PC is related to a less
pronounced analgesic effect.
Keywords: Virtual Reality, Pain Catastrophizing,
Distraction, Acute Pain, Cold Pressor Test
introduction
Pain is a highly subjective phenomenon which can be influenced by many psychological and physiological variables [3]. According to Leventhal and colleagues’ model
(1979), distraction is an effective method to cope with
pain. It directs attention elsewhere than on the emotional
or sensory components of a painful perception [6]. However, distraction from painful stimulation is difficult for
certain people. This would be case for people presenting
high rates of pain catastrophizing (PC), because this phenomenon is associated with a difficulty of diverting attention from thoughts, feelings and sensations related to pain
294
[7]. Very few studies [1, 6] have yet attempted to establish
a relation between distraction and PC. Moreover, distraction tasks employed in these studies do not offer an optimal distraction potential. The current study will test the
impact of virtual reality (VR), a promising method to facilitate pain management [2]. The objective of this study
will be to determine the influence of PC on distraction induced in VR when participants are submitted to an experimental acute pain.
methods
participants
The sample consists of 30 healthy adults (15 men and 15
women). Subjects presenting predispositions to cybersickness or Reynaud’s Syndrome were excluded. Unfortunately, nine participants had to be excluded because they
did not comply adequately with the study’s procedures.
Virtual environment
A virtual environment (VE) was used under four experimental conditions, with two levels manipulating attention
(with more or less cognitive load involvement) and two
levels manipulating distraction (with or without visual recall of the hand immersed in cold water), which were created. The cognitive load was manipulated by having to aim
and shoot at flies in an environment with either a low or
high number of flies. Focusing attention away from pain
was manipulated by displaying a live video stream of either
the participant’s hand immersed in cold water, or their feet,
in the participant’s center field of view, while shooting at
flies. Participants were randomly assigned to the different
conditions of this 2 X 2 repeated factorial design.
measures
The Pain Catastrophizing Scale [5], the McGill Pain Questionnaire [4] and visual analogue scales were administered
after baseline and post-immersion. The pain intensity assessed by the visual analogue scale was defined as the dependent variable.
procedure
The experiment was conducted in a 60-minute session.
First, a baseline duration time on the cold pressor test
(5°C) was taken without a task recruiting attention or allowing distraction. Second, an initial training immersion
in VR was performed without inducing pain to allow participants to learn how to navigate in VR and manipulate
the equipment. Then, four immersions were conducted
while participants had their forearm immersed in cold
water while attention and distraction were manipulated.
Participants were told they could take their arm out of the
water at any time, although they should try to tolerate the
pain as long as possible.
results
Results show that PC’s level during first immersion is associated with baseline [r=0.39, p<.05] and first immersion’s [r=0.54, p<.01] pain levels. PC’s level at first
immersion is also associated with the reduction in pain
(residualized change score) from baseline and first immersion in VR. A standard multiple regression was performed
between pain intensity at first immersion as the dependent
variable and PC, participant’s age, and pain intensity at
baseline as independent variables. The analysis reveals
that R2 (83%) and R2 adjusted (80%) were significant
[F(3,19)=26.11, p<.001].
Conclusion
According to the results, high catastrophizers benefit less
from distraction in VR in order to reduce their pain than
low catastrophizers. In a future study, it could be interesting to measure the effect of time on the capacity of high
catastrophizers to be distracted.
references
[1] Campbell, C. M., Witmer, K., Simango, M. , Carteret,
A., Loggia, M. L., Campbell, J. N., Haythornthwaite, J.
A., & Edwards, R. R. (2010). Catastrophizing delays the
analgesic effects of distraction. Pain, 149 (2), 202-207.
[2] Gold, J.I., Kant, A.J., Kim, S.H., & Rizzo, A. (2005).
Virtual anesthesia: The use of virtual reality for pain distraction during acute medical interventions. Perioperative
Medicine and Pain, 24, 203-210.
[3] Janssen, S. A. (2002). Negative affect and sensitization
to pain. Scandinavian Journal of Psychology, 43, 131-137.
[4] Melzack, R. (1987). The short-form McGill Pain Questionnaire. Pain, 30, 191-197.
[5] Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995).
The Pain Catastrophizing Scale: Development and Validation. Psychological Assessment, 7 (4), 524-532.
[6] Quartana, P. J., Burns, J. W., & Lofland, K. R. (2007).
Attentional Strategy Moderates Effects of Pain Catastrophizing on Symptom-Specific Physiological Responses in
Chronic Low Back Pain Patients. Journal of Behavioural
Medicine, 30, 221-231.
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[7] Van Damme, S., Crombez, G., & Eccleston, C. (2004).
Disengagement from pain: the role of catastrophic thinking about pain. Pain, 70, 70-76.
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body dissatisfaction: eliciting emotions by
social Comparison in a Virtual bar
Tanya Guitarda,1, Annie Aiméb, Stéphane Bouchardb,
Claudie Lorangerb and Karine Cottonb
a
b
Olga Gutiérrez-Martínez
08035, Barcelona
Spain
E-mail: olgagutierrez@ub.edu
1
abstract
Body image disturbances are viewed as a key risk factor
in the development of eating disorders. It has been proposed that social comparison may play an important role
in maintaining such body dissatisfaction. Since then,
many treatment programs now include social comparison.
We therefore set out to evaluate the potential of virtual
reality (VR) to elicit social comparison tendencies in a
sample of weight-preoccupied subjects. In order to do
so, we assessed the emotional impact of exposure to
avatars with different body shapes in a virtual bar. The
sample consists of 17 shape-concerned participants.
Their reactions were assessed using physiological and
self-reported measures during two experimental immersions. Preliminary results support the hypothesis that exposure to both stimuli generates emotional reactions, a
reaction which is even more significant when confronted
to a thin-ideal stimulus.
Keywords: Body Image, Emotion Enduction,
Virtual Reality, Avatars, Social Comparison
introduction
The internalization of the thin-ideal that is conveyed by
numerous stereotypes associated with beauty represents
an important risk factor in the development of serious
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295
body image and weight concerns [1]. Moreover, these preoccupations are frequently present in people, especially
women [2] and are associated with the development of
cognitive distortions towards body image that, in time, can
lead to a greater risk of developing problematic eating behaviors [3].
Social comparison plays an important role in the structure
of body image and, in some cases, can contribute to maintaining the concerns over one’s body [4]. Festinger [5] first
proposed two types of social comparison, either downward or upward comparison. This theory suggests that, in
the case of downward comparison, one will compare himor herself to a person seen as being “worse off” based on
physical appearance, whereas upward comparison is to
compare one’s self to someone perceived as “better off.”
Festinger proposes that upward comparison would lead to
negative affect whereas downward comparison would lead
to positive affect. Numerous studies were conducted on
the subject and findings support the theory [6, 7]. In fact,
social comparison is now included in various treatment
options for body-dissatisfied women [4].
The objective of the present study was to assess whether
adults preoccupied with their body image would react
more negatively when confronted to situations in a virtual
bar where judgmental comments were made towards: (a)
an overweight avatar or (b) a thin avatar. We proposed that
both avatars would provoke a negative reaction on the
subjects but that the impact would be greater when exposed to the person representing a thin-ideal, thus activating upward social comparison and therefore exacerbating
anxiety and feelings of inadequacy.
method
participants
A sample of 17 weight-preoccupied subjects was recruited. All but one participant was female. The following
inclusion criteria were applied: normal body mass index
(BMI; 18.5 to 24.9), at least a mild body image concern
without meeting the criteria for an eating disorder (ED).
This criterion was assessed with the Eating Attitudes Test
(EAT-26), where a cutoff score of 15 was selected.
Virtual environments
A virtual environment (VE) created for another study was
modified to fit the requirements of the present project. The
VE represents a bar where a waitress is the main focus of
attention. The waitress is either thin or overweight, depending on the condition.
296
measures
The following self-reported measures were administered
throughout the experimentation: Eating Attitudes Test
(EAT-26), State-Trait Anxiety Inventory (STAI-Y1), Positive and Negative Affect Schedule (PANAS), Beck Depression Inventory (BDI-II), Eating Disorder Inventory
(EDI) and the Body Esteem Scale (BES).
Heart rate and skin conductance were also measured during the experimentation in order to assess the level of
stress in each immersion.
procedure
Experimentation was conducted in a 90-minute session
with three virtual immersions. First, subjects were immersed in a neutral VE in order to familiarize themselves
with navigation in the CAVE-Like system. Then, they
were randomly assigned to one of the two conditions and
immersed in VR. Between each immersion, questionnaires were completed in order to assess the subjects’ reactions towards the stimuli. At the end of the study, a short
debriefing session was held.
[5] L. Festinger, A theory of social comparison processes,
Human Relations 7 (1954), 117-140.
[6] L. Lemyre, P.M. Smith, Intergroup discrimination and
self-esteem in the minimal group paradigm, Journal of
Personality and Social Psychology 49 (1985), 660-670.
[7] M. Testa, B. Major, The impact of social comparisons
after failure: The moderating effects of perceived control,
Basic and Applied Social Psychology 11 (1990), 205-218.
––––––––––––––––––––––––––––––––––––––––––––––
evaluation of the usability of Virtual scenarios as
auxiliaries for obesity Treatment
Gonzalo Torres-Villalobosa, Georgina Cárdenasb,
Giuseppe Rivac, Andrea Gaggiolic and Perla Martínezb
a
Medica Sur Foundation
c
Milan Axiology Institute
b
Georgina Cárdenas
Avenue Universidad
Copilco-Coyoacan
Mexico
E-mail: cardenas.georgina@gmail.com
1
results
Preliminary results show that exposure to the avatars does
in fact elicit negative affect as reported on the Body Esteem Scale and supported by a significant peak in heart
rate when immersed in the experimental VEs. Further results will be discussed including the implications of such
findings on additional research on body image and VR.
references
[1] C. Jacobi, C. Hayward, M. de Zwann, H.C. Kraemer,
W.S. Agras, Coming to terms with risk factors for eating
disorders: Application of risk terminology and suggestions
for a general taxonomy, Psychological Bulletin 130
(2004), 19-65.
[2] H.W. Hoek, D. Van Hoeken, Review of the prevalence
and incidence of eating disorders, International Journal of
Eating Disorders 34 (2003), 383-396.
[3] R.H. Striegel-Moore, D.L. Franko, D. Thompson, B.
Barton, G.B. Schreiber, S.R. Daniels, Changes in weight
and body image over time in women with eating disorders,
International Journal of Eating Disorders 36 (2004), 315327.
[4] C.G. Fairburn, Cognitive behavior therapy and eating
disorders, The Guilford Press, New York, NY, 2008.
abstract
In the world, approximately one billion adults are currently overweight (BMI 25-29.9 Kg/m²), and a further
475 million are obese. In Mexico, the prevalence of
being overweight and obese in children is around 26%,
26.8% in females and 25.9% for males. In those older
than 20 years, the prevalence of being overweight and
obese is 71.9% for females and 66.7% for males (ENSANU2006). Due to poor results obtained with traditional obesity therapies, new treatments are required for
this epidemic. A collaborative study between Medica Sur
Foundation and the Virtual Education and Cyberpsychology Laboratory of the National Autonomous University
of Mexico, has been developed. The main objective was
to evaluate the efficacy of a Virtual Reality (VR) treatment program for obesity. Five virtual scenarios will be
used for the treatment of obesity. This project will present the results obtained with 30 patients having previously signed informed consent. The study exposed the
participants, with a VR head-tracker, a Vuzyx ear®
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VR920 and a joystick, to five different virtual scenarios.
These VR scenarios were adapted for the Mexican population. The evaluation instruments measured the variables using anxiety indicators like the galvanic response
of the skin, temperature and heart rate. Also, judgment
and reality questionnaires were used.
Keywords: Virtual Reality, Obesity,
Mexican Population, Weight Loss
introduction
Obesity represents one of the most important problems
in public health, and according to recent publications, it
is dramatically increasing around the world. Approximately one billion adults are currently overweight (BMI
25-29.9 Kg/m²), and a further 475 million are obese (2010
International Obesity Taskforce). The WHO also projects
that if this tendency continues, by the year 2015, 2.3 billion people will be overweight and 700 million will be
obese. In Mexico, the National Health Survey indicates
that the prevalence of being overweight and obesity in
children between five to 11 years old is around 26%,
26.8% in females and 25.9% for males. Furthermore, one
in every three teenagers, men or women between 12 and
19 years old, are overweight or obese. In those older than
20 years, the prevalence of being overweight and obese
was of 71.9% for females and 66.7% for males (ENSANU2006).
297
of alimentary disorders, specifically for patients with
anorexia nervosa and bulimia.
Nowadays, obesity is becoming an overwhelming problem for many countries like Mexico, and obesity related
diseases are the main causes of mortality in the Mexican
population. Due to poor results obtained with traditional
obesity therapies, new treatments are required for this epidemic.
method/Tools
A collaborative study between Medica Sur Foundation and
the Virtual Education and Cyberpsychology Laboratory
of the National Autonomous University of Mexico, has
been developed. The main objective was to evaluate the
efficacy of a VR treatment program for obesity. This was
developed by Riva (2006) for the Mexican population.
In the first step of this project, five virtual scenarios will
be used for the treatment of obesity at the Medica Sur
Foundation Hospital. The VR scenarios will expose the
patients to difficulties they may confront in the real world.
The exposure would help the patient to improve his behavioral and cognitive abilities to confront the situations
that can trigger inadequate behaviors for weight loss or
weight maintenance.
This project will present the results obtained with 30 patients having previously signed informed consent. The
study will expose the participants, with a VR head-tracker,
a Vuzyx ear® VR920 and a joystick, to five different virtual scenarios. These VR scenarios were adapted for the
Mexican population and they evaluate the presence and
preferences usability index of the participants. The evaluation instruments informed about the measured variables
using anxiety indicators like the galvanic response of the
skin, temperature and heart rate. Also, judgment and reality questionnaires were used (Baños et al. 2006).
Currently, the results of different treatments for patients
with obesity and who are overweight are disappointing.
Crawford, Jeffery, and French (2000), performed a study
with 804 patients which evaluated the success of keeping
the same weight for three years. Of those patients, 53.7%
regained their weight in the first 12 months and only one
of every 20 patients maintained their weight loss successfully. In patients with morbid obesity, the only successful
treatment is bariatric surgery (Korenkov, Sauerland, &
Junginger, 2005); regardless of this success, in some
cases patients regain weight in the long term. Riva reported that treatment failures (2006) are because treatments are focused on the ratio between ingested and
burned calories, and behavioral changes and social factors
are underestimated.
results
VR software was adapted for the Mexican population including five different scenarios that expose the patient to
different levels of anxiety. This software will be helpful
to develop more effective treatments for obesity.
Virtual Reality (VR) has effective results for the treatment
of anxiety disorders. In such treatments the patient is exposed gradually to computer generated 3-D anxiety triggering stimulus, which allows real-time interactions. In
addition, VR has been used successfully in the treatment
Conclusion
VR simulation scenarios are novel therapeutic options
that will be helpful to maintain weight loss, and also to
lose more weight in obese patients and in patients with
previous bariatric surgery.
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The impact of Virtual Covert sensitization on
reducing alcohol Cravings of heavy social drinkers
Yoon-Jeong Choia and Jang-Han Leea,1
the client’s imagination. However, the effectiveness of CS
relies heavily on an individual’s ability to imagine. In the
present study, we utilized a virtual reality (VR) program
that we designed in 2008 to overcome the limitation of
CS, by providing stimulation to be able to imagine vivid
experiences, as well as a sense of realism.
Chung-Ang University, Department of Psychology
a
Jang-Han Lee
South Korea
Tel:+82 2 820 5751
Fax: +82 2 816 5124
E-mail: clipsy@cau.ac.kr
1
abstract
Covert sensitization (CS) is an aversive treatment aiming
to decrease cravings and induce aversion towards abused
substances. In the present study, we used virtual reality
(VR) to increase the effects of CS. Our aims were to verify virtual covert sensitization (VCS) treatment effectiveness on alcohol cravings of heavy social drinkers through
self-report questionnaires, the Alcohol-Stroop task, and
the Alcohol-IAT. Participants were Heavy Social Drinkers
(HSD, N=20) and Light Drinkers (LD, N=20). Self-report
questionnaire results indicated that in the HSDs’ cravings
significantly decreased after VCS treatment. The Alcohol-IAT also showed a marginally significant decrease in
a positive association between alcohol and pleasant words
for HSDs. Finally, in the Stroop task, there was an attentional bias for both alcohol groups, and these biases decreased after VCS treatment. VCS could positively
influence many addictive treatment programs, as well as
supplement current methods of treatment.
Keywords: Virtual Reality, Alcohol Cravings, Covert
Sensitization, Alcohol-IAT
introduction
In many cultures, alcohol abuse is a serious and continuing
public-health issue. Despite the harmful influences of excessive drinking, cessation of risky drinking is very difficult. One of the main reasons why abusive drinkers show
difficulty in controlling their drinking is associated with
alcohol cravings, which is a predictor of automatic alcohol
seeking and drinking behaviors in abusers. Therefore, we
aim to reduce alcohol cravings using covert sensitization
(CS), which is verbal aversion therapy through the use of
In order to assess decreases in alcohol cravings, we used
explicit and implicit measurements, such as self-report
questionnaires, the Alcohol Stroop task, and the AlcoholIAT. Many substance abusers, such as alcoholics and
heavy drinkers, tend to have an unconscious attentional
bias for alcohol stimuli and automatic cognitive associations towards substance using behaviors, which is known
to be caused by cravings. Therefore, we focused on implicit measurements which participants cannot consciously control.
method
A total of 40 male participants were selected based on their
Alcohol Use Disorders Identification Test (AUDIT)
scores. A score of 18 points or higher was assigned to the
HSD condition (N=20) and a score of less than seven
points was assigned to the LD condition (N=20). Based
on a previous study, a Virtual Covert Sensitization (VCS)
scenario was used to reduce alcohol cravings using the
NeuroVR software. The Alcohol Urge Questionnaire
(AUQ), the Alcohol-IAT, and the Alcohol-Stroop task
were used to evaluate a baseline of alcohol cravings, followed by VCS treatment. After VCS treatment, baseline
measurements were taken again, in an identical fashion as
the first measurement procedure.
results
There was a main effect of AUQ scores. Both groups
showed a significant decrease after receiving VCS treatment, F(1,34)=20.90, p<0.01. On the Alcohol-IAT, a marginally significant interaction emerged, F(1,38)=3.88,
p=0.06. HSDs tended to show a weaker positive association to alcohol after VCS compared to the LDs. Stroop
task results indicated a decrease in attentional bias after
VCS treatment in both groups, F(1,35)=4.31, p<0.05.
discussion
Although the fact that only one VCS session was conducted could be a limitation, our results indicated that
VCS treatment was effective in reducing cravings in heavy
social drinkers. The administration of CS within a VR environment seems to be an effective treatment method in
reducing cravings by offering a vivid aversive experience.
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This treatment, therefore, could positively influence many
addictive treatment programs, as well as supplement current methods of treatment.
references
[1] Kearney, A. J. (2006). A Primer of Covert Sensitization. Cognitive and Behavioral Practice 13, 167–175.
[2] Rosenberg, H. (2009). Clinical and laboratory assessment of the subjective experience of drug craving. Clinical
Psychology Review, 29, 519-534.
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T3 european project: advanced new
Technology to improve the learning process
Juana Bretón-Lopeza,1, Soledad Queroa,c, Cristina
Botellaa,c, Rosa María Bañosb,c, Yolanda Vizcaínoa,
Luis Farfallinia and Rocío Herroroa
Universidad Jaume I
c
CIBER de Fisiopatología de la Obesidad
y Nutrición (CIBEROBN)
a
b
Juana Bretón-Lopez
Universidad Jaume I
Facultad de Ciencias Humanas y Sociales
Departamento de Psicología Básica
Clínica y Psicobiología. Av. Vicente Sos Baynat
s/n12071 Castellón de la Plana, Spain
E-mail: breton@psb.uji.es
1
abstract
In recent years, research has generated a wide range of
tools for the application of technology in learning. Despite major investment, the majority of modern e-learning
continues to be based either on video-lessons or on pageturning Web sites. The strategic goal of T3 is to develop
an innovative teaching program to promote the use of advanced learning technology in three countries (Spain,
United Kingdom and Italy) by university teaching staff,
secondary school teachers and trainers involved in enterprise. Key features of the program will include practical
workshops in which learners simulate learning sessions
and gain familiarization with technologies. A previous
classification of available learning technologies was carried out within the T3 project in order to provide each
country selected with more adequate tools according to
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299
the participants. Then, the technologies will be validated
in a six-day workshop carried out to teach the selected
technologies to a maximum of 20 participants per group.
The aim of this work is to describe the technologies used
in Spanish trials: E-Adventure, Eutopia and Palma systems. The final output will be a set of freely available
tools designed to encourage uptake of new learning technologies for use in universities.
Keywords: Information and Communication Technologies, University Training, e-learning, Serious Games
introduction
In recent years, Communication and Information New
Technologies has generated a wide range of methodologies and tools for the application of technology in learning.
Some of the techniques that have been validated for elearning include virtual environments, simulations of
inter-social processes, serious gaming, the use of Web 2.0
technology, and the use of robots. Outside the laboratory,
however, the use of these technologies is scarce. Teaching
to Teach with Technology (T3) project is a research project
funded by the Lifelong Learning Programme, 505169LLP-1-2009-1-IT-KA3-KA3MP. The strategic goal of this
project is to develop an innovative teaching program to
promote the use of advanced learning technology by: (i)
university teaching staff; (ii) secondary school teachers;
(ii) trainers involved in enterprise. The consortium is composed by five groups from Italy, the United Kingdom and
Spain: University Jaume I (UJI), University from Napoli
Federico II, University of London Goldsmiths, Institute
of Science and Technology of the Cognition and a Small
and Medium Enterprise, ENTROPY. The aim of the present work is to describe the technologies used by UJI partner for university teachers and the procedure during the
six-day workshop.
method
A classification of the learning technologies was carried
out within the T3 project. The resulting categories were
based on the new trends of educational psychology and
took two variables into account: type of the technology
(based on instructions or the more constructivist one) and
type of teaching (experimenting, soft skills or exploring).
UJI partner selected the three most adequate technologies
to teach soft skills: E-Adventure [1], Eutopia [2] and
Palma [3] systems. These tools are designed to support
distance learning and let users write scripts for on-line
role-playing games where users can choose the roles and
goals of individual avatars. A common workshop consist-
300
ing of six days has been prepared by the three partners to
teach the selected technologies to 20 participants per country. This workshop has the following structure: 1) a theoretical introduction; 2) a practical application of the tool;
and 3) a post-evaluation about the experience of the participants. The assessment protocol includes closed questions about the satisfaction of the participants [4] and an
open focus group about their experience [5]. The professors will be encouraged to use new learning technologies.
The staff will offer technical support and a set of paper
and electronic learning materials.
results
Work in progress.
Conclusions
The main aim of this project is to promote the use of innovative teaching for the learning process. The first impact will thus be on the participants in the T3 course,
university teachers. The ultimate beneficiaries will be students and pupils. In addition, the exchange of experience
and know-how among the partners will make a significant
contribution to improving their respective know-how and
teaching practices.
references
[1] Complutense University of Madrid. http://e-adventure.e-ucm.es/ (2010).
[2] Unina. http://www.nac.unina.it/eutopia/download.htm
(2010).
[3] Entropy. http://www.entropykn.net/edugames/Pagine/
Palma.htm (2010).
[4] LabPsitec. Game Satisfaction Scales (2008).
[5] Teaching to Teach with Technology. Focus group:
General Goals Questionnaire (2010).
––––––––––––––––––––––––––––––––––––––––––––––
synchronous group Cybersupervision
Cass Dykemana,1
Oregon State University
a
Cass Dykeman
Oregon State University
1
460 Waldo Hall, Corvallis
Oregon, 97331, USA
E-mail: dykemanc@onid.orst.edu
abstract
The professional literature on the use of synchronous
group cybersupervision is almost nonexistent. This poster
presentation aimed to partially address this dearth by examining the use of a full-spectrum version of synchronous group cybersupervision. Full-spectrum was defined
as the use of a real-time combination of (1) text-chat, (2)
VoIP audio, (3) webcam video streaming, and (4) psychotherapy session video and audio playback. Adobe
Connect® 7.5 was the online environment employed. Supervisee assessment of the usefulness, telepresence, and
barriers of full-spectrum synchronous group cybersupervision was conducted and results were presented.
Keywords: Clinical Supervision,
Cybersupervision, Synchronous Web,
Telepresence, Group Supervision
introduction
Watson [1] defined cybersupervision as a supervisor interacting over the Internet with supervisees at multiple
sites utilizing real-time video and audio processes. Little
appears in the professional literature about the use of any
form of synchronous group cybersupervision [2]. Vaccaro
and Lambie [3] speculated that the absence of certain sensory and contextual cues could limit the usefulness of cybersupervision. A number of authors posited potential
training (e.g., use of ViOP) and logistical (e.g., bandwidth
limitations) issues that could hinder the impact of cybersupervision [3-5]. However, the two studies that have been
published on the impact of cybersupervision suggest these
issues didn’t hinder the usefulness of this form of supervision. Coker et al. [6] examined supervisee assessment
of text-chat versus text-chat plus webcam video streaming
synchronous individual cybersupervision. They found
both modalities rated equally high with supervisees in reference to supervisory working alliance. Nelson et al. [7]
found similar results using a real-time combination of textchat, electronic whiteboard, and VoIP (i.e., Skype ®) for
synchronous group cybersupervision.
problem
No studies exist about the usefulness of a full-spectrum
synchronous group cybersupervision approach to clinical
supervision. For the purpose of this study, full-spectrum is
defined as the use of a real-time combination of (1) text
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chat, (2) VoIP audio, (3) webcam video streaming, and (4)
psychotherapy session video and audio playback. The research question for the study is: What is the supervisee’s
assessment of full-spectrum synchronous group cybersupervision in terms of usefulness, telepresence, and barriers?
method
Pre-service mental health and school counselors will be
surveyed at the end of their first graduate practicum course
as to their assessment of the usefulness, telepresence, and
barriers of a full-spectrum synchronous group cybersupervision. This cybersupervision will be delivered via an
Adobe Connect ® 7.5 online environment. Usefulness will
be assessed by the Group Supervision Impact Scale [8-9].
Telespresence will be assessed by the Igroup Presence
Questionnaire [10] modified for use with full-spectrum
synchronous group cybersupervision. Barriers will be assessed by the Group Supervision Hindering Phenomena
Survey [11] also modified for use with full-spectrum synchronous group cybersupervision.
results
Supervisee assessment of the usefulness of full-spectrum
synchronous group cybersupervision delivered via an
Adobe Connect ® 7.5 online environment will be reported.
Conclusion
This poster will present the outcomes of a research project
on the use of a full-spectrum synchronous group cybersupervision modality.
novelty/discussion
The results presented in the poster presentation will help
fill a present research gap in cyberpsychology.
references
[1] Watson, J. C. Computer-based supervision: implementing computer technology into the delivery of counseling supervision. Journal of Technology in Counseling
3 (2003), 7.
[2] Chapman, R. A. Cybersupervision of entry-level
practicum supervisees: the effect on acquisition of counselor competence and confidence. Journal of Technology
in Counseling 5 (2008), 3.
[3] Vaccaro, N., & Lambie, G. W. Computer-based counselor-in-training supervision: ethical and practical implications for counselor educators and supervisors.
Counselor Education & Supervision 47 (2007), 46-57.
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[4] Miller, K. L., Sanders, S. A., & Miller, S. M. Requisite
computer technologies and infrastructures for providing
live, remote, clinical cybersupervision. In G. R. Walz, J.
C. Bleuer, & R. K. Yep (Eds.) Compelling perspectives on
counseling VISTAS 2009 (pp. 317-328). ACA, Alexandria, VA, 2009.
[5] Miller, K. L., & Miller, S. M. Challenges and solutions
in the delivery of clinical cybersupervision. In S. P. Ferris
& R. Zheng (Eds.), Understanding online instructional
modeling; theories and practices (pp. 223-241), Idea
Group, Inc, Hershey, PA, 2007.
[6] Coker, J., Jones, W., Staples, P. A., & Harbach, R. L.
Cybersupervision in the first practicum: implications for
research and practice. Guidance & Counseling 18 (2002),
33-39.
[7] Nelson, J. A., Nichter, M., & Henriksen, R. (2010).
On-line supervision and face-to-face supervision in the
counseling internship: An exploratory study of similarities
and differences. In G. R. Walz, J. C. Bleuer, & R. K. Yep
(Eds.) Ideas and research you can use: VISTAS 2010
(n.p.). ACA, Alexandria, VA, 2010.
[8] Getzelman, M. A. Development and validation of the
Group Supervision Impact Scale. PhD diss., University of
Southern California, 2003.
[9] Kellum, K. E. H. Structured reflecting teams in group
supervision: a qualitative study with school counseling interns. PhD diss., University of Iowa, 2009.
[10] Enyedy, K. C., Arcinue, F., Puri, N. N., Carter, J. W.,
Goodyear, R. K., & Getzelman, M. A. Hindering Phenomena in Group Supervision: Implications for Practice. Professional Psychology: Research and Practice 34 (2003),
312-317.
[11] Schubert, T., Friedmann, F., & Regenbrecht, H. The
experience of presence: factor analytic insights. Presence:
Teleoperators and Virtual Environments 10 (2001), 266281.
––––––––––––––––––––––––––––––––––––––––––––––
building Collective memories on the Web:
The nostalgia bits project
Andrea Gaggiolia,1, Luca Morgantia
and Silvio Bonfigliob
302
ATN-P Lab, Istituto Auxologico Italiano, Milan, Italy
b
FIMI S.r.l, Saronno, Italy
a
Andrea Gaggioli
ATN-P Lab, Istituto Auxologico Italiano
Milan, Italy
E-mail: andrea.gaggioli@auxologico.it
1
newspapers, postcards, photos and other documents. A
web-based platform will be developed where tangible artifacts of an elderly person’s life experience can be uploaded and become a significant resource for use by other
generations, and a means for connecting the elderly users
with members of their own generation. In particular, the
NoBits system will allow users to connect with at least
three interaction context groups:
abstract
In recent years, there has been growing interest towards
the development of digital systems that support reminiscing for older people. The Nostalgia Bits (NoBits) project
aims at fostering social interaction between the elderly and
their family, through capturing their memories, personal,
family and local history embodied by letters, newspapers,
postcards, photos and other documents. A web-based platform will be developed where tangible artifacts of an elderly person’s life experience can be uploaded and become
a significant resource for use by other generations, and a
means for connecting the elderly users with members of
their own generation. Here, we describe the main results
of a user needs analysis carried out to define the expectations for the NoBits system. The investigation was conducted by means of in-depth interviews and focus groups
with prospect end-users. The sample was composed of 23
elderly participants (mean age = 65,83 sd = 6,32) and 310
children (mean age = 11,29, sd. = 2,28) from different
classes and educational institutions in the urban Milan
area. Findings from this preliminary user needs analysis
showed that the NoBits service concept was well-accepted
by both samples and that supporting collaborative reminiscing with social media is a promising approach to increase cross-generational interactions and mentoring.
• Network throughout their lifetime (work, interests, education etc.): allowing seniors to reconnect with lost or unknown acquaintances
• Family and friends: facilitating Internet-based connection with the user’s own family and friends
• Community and society: Elderly users could provide
valuable experiential knowledge and insight to learners
not only in terms of modern history, but also in terms of
the experience gained during their working life
Keywords: Reminiscing System, Ambient Assisted
Living, Cross-generational Communication,
Social Networks, Autobiography
results
Findings from the interviews showed seniors' deep awareness about the importance of sharing memories. Participants regarded the sharing of memories as an important
condition for the unfolding of culture. Most seniors reported that sharing memories is a pleasurable activity that
they enjoy doing with both peers and younger generations.
Reminiscing with peers can improve the quality and richness of memories, because they can integrate new information and details. At the same time, reminiscing with
younger generations can create a bridge between generations and enhance the sense of respect towards older people. Sharing memories is a participatory activity that
stimulates interesting discussions and leverages each
other’s knowledge. Quite interestingly, most seniors
introduction
Reminiscing is a pleasurable activity for seniors and can
improve their wellbeing by providing rich opportunities
for communication with peers and family. In recent years,
there has been growing interest towards the development
of digital systems that support reminiscing for older people [1]. Nostalgia Bits (NoBits) is a project funded under
the EU "Ambient Assisted Living" research program,
which aims at fostering social interaction between the elderly and their family, through capturing their memories,
personal, family and local history embodied by letters,
The collective memories shared on the Nostalgia Bits platform supplies a valuable historical resource as well. Here,
we describe the main results of a user needs analysis carried out to define the expectations for the NoBits system.
methods and results
user needs analysis
Here, we describe the main results of a user needs analysis
carried out to define the expectations for the NoBits system. The investigation was conducted by means of indepth interviews and focus groups with prospect
end-users. The sample was composed of 23 elderly participants (mean age = 65,83 sd = 6,32) and 310 children
(mean age = 11,29, sd. = 2,28) from different classes and
educational institutions in the urban Milan area.
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pointed out that even negative memories have a positive
value, by helping to avoid pitfalls in the future. Preferred
reminiscences are “memories of travels,” several participants indicated “youth and own childhood events,”
whereas few female participants suggested “romantic moments and events” (i.e. marriage). In general, reminiscence
preferences by gender quite closely reflect the classification proposed by McCarthy and colleagues in their seminal work on computer-supported reminiscing [1].
Although almost all participants felt that the best way to
share reminiscences is through spoken, face-to-face storytelling, they perceived the importance and usefulness of
creating a digital repository for sharing memories with
others. However, about half of respondents said they
would not share memories that contain personal information with strangers.
As concerns the sample of children, findings from focus
groups showed that children like the idea of collaborating
with their grandparents in creating digital reminiscences.
Children are very much interested in what life was like
before they were born and want to learn more about it.
Most of the children reported a preference for old photos
documenting how life was in the past (i.e. places, foods,
clothes etc). In particular, children liked the idea of collaborating with their grandparents for creating a digital
version of their reminiscences.
In sum, findings from this preliminary user needs analysis
suggest that the NoBits service concept was well-accepted
by both samples and that supporting collaborative reminiscing with social media is a promising approach to increase cross-generational interactions and mentoring.
references
[1] Mc Carthy, S. et al (2004) MemoryLane: Reminiscence for Older Adults, Proceedings of the Reminiscence
Systems Workshop at the 23rd British Human Computer
Interaction (HCI), full paper available at: ceur-ws.org/Vol499/paper05-McCarthy.pdf.
––––––––––––––––––––––––––––––––––––––––––––––
iphone g3 for Telemedicine
303
José Luis Mosso
School of Medicine, Universidad Panamericana
HGR 25 IMSS
Mexico
E-mail: jmosso@up.edu.mx
1
abstract
objective
Three cases were remotely diagnosed using the iPhone
G3, successfully implementing telemedicine.
methodology
One iPhone G3 was used to transmit clinical cases: medical images of four rurally located patients were sent to
three physicians located in Mexico City, a 12-hour drive
away.
results
Three medical diagnoses were made by one surgeon, one
dermatologist and two psychiatrics using text format, images of each patient and X-rays. A problem that we experienced was a delay in image transmission.
Furthermore, videos were impossible due to the length of
the delay.
Conclusions
People who live without medical services, for example,
residents in remote mountain ranges, will have the possibility of receiving telemedicine services using the
iPhone G3, while Internet reception is available. Dermatology lesions could be the first diagnosis to utilize
telemedicine. It is mandatory to use video to increase the
range of medical areas telemedicine can be applied to,
such as neurology and orthopedics, where clinicians need
to observe patient’s motions in order to evaluate their
movements and behavior and make a diagnosis. The
technology of the iPhone G4 is an alternative to improve
telemedicine.
Keywords: iPhone G3, Telemedicine, Remote Patients,
University, Indigenous
José Luis Mossoa,1, Gregorio Tomás Obradora, Fernando
Macouzeta, Gonzalo Torresa and Timothy Lacyb
––––––––––––––––––––––––––––––––––––––––––––––
Client satisfaction and outcome Comparisons of
Cyber and face-to-face Counseling methods
School of Medicine, Universidad
Panamericana, HGR 25 IMSS
b
U.S. Air Force
Lawrence J. Murphya,1, Paul Parnassa, Dan L. Mitchella,
Rebecca H. Halleta, Paula Cayleyb
and Samantha Seagramb
a
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304
Worldwide Therapy Online Inc., Canada
b
PPC Worldwide Canada (formerly
Interlock EAP), Canada
a
Lawrence J. Murphy
Worldwide Therapy Online Inc.
18 Mont Street, Guelph
ON N1H2A4 Canada
E-mail: research@sympatico.ca
1
abstract
This paper compares Global Assessment of Function
(GAF) and Client Satisfaction Survey (CSS) scores for
clients receiving either face-to-face (FTF) counseling or
text-based e-mail counseling (cybercounseling). Clients
were screened and assigned to one of the two modalities.
Analyses of variance were conducted with a 1⁄4 0.05, to
examine differences between counseling modalities. No
significant differences were found for degree of change
in GAF between assessment and closing between the two
modalities. Some differences were found in CSS scores.
Implications for screening and cybercounseling practice
are discussed.
Keywords: Social Work and IT, Evidence-based
Practice, Research and Evaluation,
Cybercounseling, E-mail Therapy
introduction
Given that cybercounseling is one of the newest approaches in the field of psychotherapy, it is incumbent
upon us to determine its effectiveness. There are limited
studies comparing the effectiveness of face-to-face (FTF)
and cybercounseling. Most of these studies are limited by
one or more factors, including sample size and comparison
of cyberclients with FTF clients from different studies [1].
It stands to reason that the client-counselor relationship is
as important online as in FTF counseling [2]. This study
included an extensive course of cybercounselor training
[3] that’s primary goal was to train counselors how to establish and maintain a strong therapeutic relationship
through cybercounseling.
method/Tools
Clients contacted PPC Worldwide Canada (formerly Interlock EAP) online or by phone and were screened by intake workers. Clients were offered counseling via secure
e-mail. Those who choose it received counseling from
Therapy Online’s Affiliate Counsellors. Thus, the pool of
clients from which FTF and online clients were drawn was
the same even though there was a selection process.
Between April 2006 and May 2008, 105 online clients underwent cybercounseling. A convenience sample of 106
FTF clients, selected from that group of individuals who
completed counseling between April 2006 and May 2008,
was used as a comparison group. Ethical review was completed by the authors in accordance with the ethical requirements for research laid out by the Canadian
Counselling & Psychotherapy Association [4].
A subsample of 26 cyberclients received an initial and a
closing Global Assessment of Functioning (GAF) score.
This group was compared to a convenience sample of 101
FTF clients who received counseling during the same period. In addition, 45 cyberclients completed a Client Satisfaction Survey (CSS). A convenience sample of 43 FTF
clients was used as a comparison group.
Analyses of variance (ANOVA) were conducted using
PROC GLM (SAS Version 9.1, SAS Institute, Cary, NC),
with α = 0.05, to examine differences between counseling
modalities.
results
The cybercounseling and FTF client groups were compared on GAF and CSS data collected. No significant differences were evident on these measures between clients
who received FTF counseling and cybercounseling.
Conclusion
The results suggest that cybercounseling can be as satisfying and impactful for clients as FTF counseling. Counselors can establish a comfortable environment, help
clients develop plans and effectively communicate their
skills to help their clients. The assistance that cybercounselors provide improves clients’ work and home lives. All
of this can be done as well as in FTF.
references
[1] A. Barak, L. Hen, M. Boniel-Nissim and N. Shapira.
A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions,
Journal of Technology in Human Services, 26, (2008)
109–60.
[2] L.J. Murphy, D.L. Mitchell. When writing helps to
heal: E-mail as therapy, British Journal of Guidance and
Counselling, 26 (1998) 21–32.
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[3] L.J. Murphy, R.J. MacFadden and D.L. Mitchell. Cybercounseling online: The development of a universitybased training program for e-mail counselling, Journal of
Technology in Human Services, 26 (2008) 447–69.
[4] Code of Ethics: Canadian Counselling & Psychotherapy Association, 2007.
––––––––––––––––––––––––––––––––––––––––––––––
designing a serious game to assess real life
decision making under stress
Federica Pallavicinia,1, Fabrizia Mantovania
and Luigi Anollia
Università degli studi Milano-Bicocca, Milano, Italy
a
Federica Pallavicini
Università degli studi Milano-Bicocca
Milano, Italy
E-mail: pallavicini.federica@gmail.com
1
abstract
The effect of stress on decision making is of special interest because many decisions have to be made under
stress in daily life. The main problem in decision making
under stress research is that it is missing a tool that both
assesses this process in a scientific and naturalistic way.
To overcome this limitation, we want to develop and test
a serious game designed to simulate a virtual interactive
experience of real-context stressful decisions.
Keywords: Decision Making, Stress,
Emotions, Serious Game
introduction
The impact of stress on decision making is being recognized increasingly by decision research in recent years.
Making a decision in a stressful context, in fact, has significant effects in people’s daily lives, both in their personal and professional contexts.
Some studies have demonstrated that stress has significant
effects on decision making, such as anticipating the effects
of decisions functioning as a somatic state or being present
incidentally during this cognitive process [1,2].
To better understand the relationship between stress and
decision making, it seems critical to develop instruments
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305
that, at the same time, allow a scientific and realistic assessment of this process.
What do We Know about decision
making under stress?
Despite the fact that stress and decision making are two
fields of research that have been deeply investigated individually, the relationship between them is still a part of
human behavior that remains unexplored. The literature
in this area, in fact, is extremely complex and inconclusive. The results of studies are quite heterogeneous, depending on the specific methods used to induce and to
assess stress, and on the different decision making tasks.
Within this research field, neuropsychology and naturalistic decision making approaches are more interesting
than others for two different causes. On one hand, neuropsychological studies have the advantage of using standardized tools and assess decision making in a laboratory
setting. However, they are limited to using decision tasks
unrelated to real life problems (as gamble tasks) and induce stress in an artificial way. On the other hand, naturalistic decision making, even if less rigorousness than
neuropsychology, has more ecological validity due to the
fact that it describes how people actually make decisions
in real world settings [3,4].
serious game to assess decisions under stress
To overcome the limits of both neuropsychological and
naturalistic decision making studies, we want to develop
and test a serious game designed to simulate a real life
context in which subjects will be asked to make a stressful
decision.
Well developed serious games, which leverage the proprieties of games and simulation, appear to present exciting opportunities for creating immersive experiential
environments for the assessment of decision making
under stress [5].
We believe that the use of a serious game for this purpose
represents a promising approach, since it enhances the
ecological validity of the decision assessment through the
use of a realistic setting, preserving the possibility to monitor subjects in a laboratory context.
references
[1] S. D. Preston, T. W. Buchanan, R. B. Stansfield, A.
Bechara, Effects of Anticipatory Stress on Decision Making in Gambling Task, Behavioral Neuroscience, 121(2)
(2007), 257-263.
306
[2] A. J. Porcelli, M. R. Delgado, Acute Stress Modulates
Risk Taking in Financial Decision Making, Psychological
Science, 20(3) (2009), 278-283.
[3] G. Klein, Naturalistic Decision Making, Human Factors: The Journal of the Human Factors and Ergonomics
Society, 50 (2008), 456-460.
[4] G. Klein, Applied Decision Making, Human performance and ergonomics, (1999), 87-107.
[5] E. M. Raybourn, Applying simulation experience design methods to creating serious game-based adaptive
training systems, Interacting with Computers, 19 (2007),
206-214.
––––––––––––––––––––––––––––––––––––––––––––––
Teo: an online emotional Therapy system to
apply homework assignments in the Treatment of
adjustment disorders
Soledad Queroa,c,1, Cristina Botellaa,c, Mª Angeles PérezAraa, Sabrina Andreu-Mateua, Rosa María Bañosb,c
and Diana Castillaa
a
Universidad Jaume I
c
de Fisiopatología de la Obesidad y
b
Soledad Quero
Universidad Jaume I
Clínica y Psicobiología
Av. Vicente Sos Baynat s/n
12071 Castellón de la Plana
Spain
E-mail: squero@psb.uji.es
1
abstract
Adjustment Disorders (AD) are a very important public
health problem. Regarding its treatment, only a series of
general guidelines are available. Our research team has
developed a cognitive-behavioral treatment (CBT) supported by Virtual Reality (VR) that has shown its utility
in the treatment of AD. A CBT approach gives a crucial
role to homework assignments. So far, studies that use
Information and Communication Technologies (ICT) for
psychological treatments have been centered on how to
use the technologies to deliver treatment within the therapeutic context. No study is available in the literature
that uses ICT to apply homework assignments. Therefore, in the present work we pretend to go one step beyond and join the use of the VR EMMA system within
the therapy sessions, with the use of other ICT to apply
homework assignments between sessions in the treatment of AD. TEO is a completely open Online Emotional Therapy system based on Web technology that
allows, in a simple and effective way, to create personalized therapeutic material to present to the patient over
the Internet. The aim of the present work is to describe
the TEO system and the study that is being conducted to
test its efficacy and efficiency.
Keywords: Cognitive-behavioral Treatment,
Online Therapy, Internet, Homework Assignments,
Adjustment Disorder
introduction
The diagnosis of Adjustment Disorders (AD) is very popular among clinicians [1] and is an important public health
problem [2]. However, regarding its treatment, only a series of general guidelines are available [3]. Our research
team has developed a cognitive-behavioral treatment
(CBT) which is supported by Virtual Reality (VR) and
also includes positive psychology strategies [4]. Preliminary data about its utility is already available [5].
A CBT approach gives a crucial role to homework assignments from the very beginning. However, studies so far
that use Information and Communication Technologies
(ICT) for psychological treatments have been centered on
how to use the technologies to deliver treatment within the
therapeutic context. This is the case for EMMA, the VR
system used in the aforementioned studies. EMMA is a
VR adaptive display that adapts its presentation to the patient’s therapeutic needs, with the main objective of reflecting and evoking emotional responses in them to allow
emotional processing to occur.
As far as we know, there is no study that uses ICT to apply
homework assignments. Therefore, in the present work we
pretend to go one step beyond, and combine the use of the
VR EMMA system within the therapy sessions in the consulting room (which has already showed its utility), with
the use of other ICT to apply homework assignments in the
treatment of AD. It implies the transfer of ICT to the patient’s home – the homework the patient has to do between
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sessions is also important. TEO is a completely open Online Emotional Therapy system base on Web technology
that allows, in a simple and effective way, to create personalized therapeutic material to present to the patient over the
Internet (http://www.psicologiaytecnologia.es /teo). The
aim of the present work is to describe the TEO system and
the study that is being conducted to test its efficacy.
method
In order to compare the differential efficacy and efficiency of two different ways of applying homework assignments in the treatment of AD, a between group study
with two experimental conductions will be use: 1)
Homework assignments using the TEO system and; 2)
Homework assignments in the traditional way (material
reading and writing tasks). Participants will be randomly
assigned to each of the experimental conditions. The assessment protocol will include different efficacy outcome measures (therapeutic goals, AD specific
questionnaires, interference measures) and satisfaction
with the treatment measures.
307
[4] C. Botella, R.M. Baños & V. Guillén. Creciendo en la
adversidad. Una propuesta de tratamiento para los
trastornos adaptativos (pp. 129-154). In C. Vázquez & G.
Hervás (Eds.), Psicología Positiva aplicada. Bilbao: DDB,
2008.
[5] R.M. Baños, V. Guillén, C. Botella, A. García-Palacios,
M. Jorquera & S. Quero. Un programa de tratamiento para
los trastornos adaptativos: un estudio de caso. Apuntes de
Psicología 26 (2008) 303-316.
––––––––––––––––––––––––––––––––––––––––––––––
l2l european project: a serious game
for leadership Training
Mª Angeles Pérez-Araa, Soledad Queroa,c,1, Cristina
Botellaa,c, Juana Bretón-Lópeza and Rosa María Bañosb,c
a
Universidad Jaume I
c
de Fisiopatología de la Obesidad y
b
results
Work in progress.
Conclusion
This is the first time that a homework assignments component that can be completely self-administered over the
Internet has been developed. TEO will permit the creation
and administration of assessment and treatment protocols
to be completely personalized; each session will be
adapted to the patient’s needs. Furthermore, because it is
based on the Web it will increase the possibilities for therapy – it can be used in blended mode (complementing the
therapy), or in tele-assistance mode (being the own selfadministered therapy).
references
[1] J.N. Despland, L. Monod & F. Ferrero. Clinical relevance of adjustment disorder in DSM-III-R and DSM-IV.
Comprehensive Psychiatry 36 (1995) 454-460.
[2] J.L. Van der klink, R.W. Blonk,A.H. Schene & F.J. van
Dijk. Reducing long term sickness absence by an activating intervention in adjustment disorders. Occupational and
Environmental Medicine 60 (2003) 429-437.
[3] J.J. Strain & A. Diefenbacher. The adjustment disorders: The conundrums of the diagnoses. Comprehensive
psychiatry 49 (2008) 121-130.
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Soledad Quero
Universidad Jaume I
Clínica y Psicobiología
Av. Vicente Sos Baynat s/n
12071 Castellón de la Plana, Spain
E-mail: squero@psb.uji.es
1
abstract
Effective leaders manage the underlying group dynamics
in ways that help the team meet its objectives. Leaders
need people management skills, resource management
and organization. Despite the offer of leadership skills
training programs, effective and valid training in these
areas is scarce and it is usually available only in master
programs of high quality or large corporations. The
Learn 2 Lead (L2L) Project consortium has designed and
developed a leadership skills training online game that
aims to increase the availability of these programs as
well as give people a more active role in the learning
process. The aim of this work is to describe both the serious game and the research design to be user in order to
test the efficacy of the game in leadership training. The
training is going to be applied in two different modes: 1)
online self-administered mode; and 2) blended mode. A
308
pilot study and a large scale trial will be carried out to
test this game and to compare the differential efficacy
between these two training modes. Future results from
these studies will provide empirical evidence about the
validity and utility of new technologies, specifically serious games, in leadership skills training.
Keywords: Information and Communication Technologies, E-learning, Serious Game, Leadership Training
introduction
In recent years, a wide range of methodologies, tools and
resources have been developed for the implementation
of technology in learning in any discipline. However, its
use remains low in practice; this is the case of leadership
skills training. Effective leaders manage the underlying
group dynamics in ways that help the team meet its objectives. In addition to technical knowledge related to
their area of business, leaders need people management
skills, resource management and organization. Despite
the offer of leadership skills training programs, effective
and valid training in these areas is scarce and usually
tends to be available only in master programs of high
quality or large corporations. In that sense, it is necessary
to increase the availability of these programs as well as
giving people a more active role in the learning process.
By using new technologies, it is pretended to boost the
acquisition of these skills by making learning much more
interactive, flexible and attractive, leaving the user
him/herself to be the one who marks his/her pace, and
facilitates access to these programs regardless of the geographical area where the person lives. This allows for
an important cost reduction as well as contact
trainee/tutor reduction. In spite of the advantages that online courses may have, we have not found empirical evidence of these programs. Therefore, testing this kind of
training is needed. Learn to Lead (L2L) is a research
project funded by the Lifelong Learning Program
(502903-LLP-1-IT-LEONARDO-LMP) of the European
Agency for Audiovisual, Culture and Education. Different European countries participate in the project (Italy,
France, United Kingdom and Spain) with the main aim
of designing and developing a serious game for training
leadership skills. The aim of this work is to describe both
the serious game and the leadership skills training program that is going to be used to test the efficacy of the
game.
method
The training is going to be applied in two different modes:
1) online self-administered training mode; and 2) blended
training mode where the game is also self-administered
but supported by a tutor. A pilot study and a large scale
trial are going to be conducted in three different countries
(Italy, France and Spain). The pilot study will be aimed at
identifying the methodological and technical problems
that could potentially reduce the effectiveness of the learning experience. The main objective of the large-scale trial
is to assess the learning outcomes to compare the differential efficacy between the two training modes. In both
trials, participants will be randomly assigned to each training mode. The assessment protocol will include leadership
efficacy measures (self-report measures and objective data
regarding performance and gain of knowledge registered
through the game) and satisfaction measures (Game Satisfaction Scales [1], Game Assessment Questionnaire [2]
and Satisfaction evaluation of the L2L learning path).
results
Work in progress.
Conclusions
The implementation of this project involves the development of new tools based on information technologies and
communication. These tools are intended to facilitate the
learning of leadership skills and improve the availability
of such training. The data obtained in the future from these
studies could provide empirical evidence about the validity and utility of the new technologies in leadership skills
training programs.
references
[1] LabPsitec. Game Satisfaction Scales (2008).
[2] Van der Heiden. User acceptance of hedonic information systems. Mis Quarterly 28 (4) (2004), 695-704.
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309
CyberproJeCTs
IN THIS FEATURE, we will try to describe the characteristics of current cyberpsychology and rehabilitation research. In particular, CyberProjects aims at
describing the leading research groups and projects, actually running around the world, with a special focus
on European research.
- The system will provide the means to assess patient
adherence to therapy through a multimodal BNCI.
- The proposed BNCI will combine multiple levels of
neural information with the resulting motion (biomechanical) data.
beTTer: brain-neural CompuTer
inTeraCTion driVen roboTiC physiCal
Therapies in sTroKe rehabiliTaTion of
gaiT disorders
- It will determine if training the activation of signals
that control lower limb tasks in combination with robotics devices is beneficial for restoring lower limb
function.
proJeCT obJeCTiVes:
Cerebral vascular accident (CVA, or stroke) is the most
prevalent neurological condition leading to physical
impairment in Western society. About 4.7 million stroke
survivors are alive today. Impaired walking ability contributes to post-stroke walking disability; walking incorrectly creates a stigma and makes patients more
susceptible to injury, affecting their quality of life. The
most promising interventions to restore walking function are based on robotic systems that intend to restore
function by focusing on actions at the periphery of the
body (a BOTTOM-UP approach). It is not clear how effective these treatments are and a major problem is noncompliance or non-adherence to the therapy.
- BETTER will provide means for objective evaluation
of the BNCI-based physical rehabilitation therapy and
its usability and acceptability.
The main objective of the project is to improve physical
rehabilitation therapies of gait disorders in stroke patients based on Brain-Neural Computer Interaction
(BNCI) assistive technologies, improving systems, providing guidelines for further improvements, and developing benchmarking tools.
The project will validate, technically, functionally and
clinically, the concept of improving stroke rehabilitation with robotic exoskeletons based on a TOP-DOWN
approach: motor patterns of the limbs are represented
in the cortex, transmitted to the limbs and fed back to
the cortex:
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BETTER proposes a multimodal BNCI with the main
goal to explore the representations in the cortex, characterize user involvement and modify the intervention
at the periphery using ambulatory and non-ambulatory
means.
ConTaCT informaTion
ABAD RUIZ Carlos Manuel
AGENCIA ESTATAL CONSEJO SUPERIOR DE
INVESTIGACIONES CIENTIFICAS
Pinar 25 E-28006
SPAIN
Tel: +34915668852
Fax: +34915668913
http://www.iai.csic.es/better/
Compiled by Giuseppe Riva, Ph.D.,
and Simona Raspelli, Ph.D.
Data provided by ICT Results
(http://cordis.europa.eu/ictresults)
310
CyberfoCus
New technologies are developing at a rapid pace. To help you stay abreast of the latest trends in advanced technologies and healthcare, this feature showcases upcoming 2011 events which will provide you with the opportunity to
connect with leading experts worldwide and remain on the cutting edge of the most recent developments.
The CyberFocus column welcomes your contributions. To supply relevant information for this feature, please send
an e-mail to: office@vrphobia.eu.
Cyberpsychology & CyberTherapy 17
September 12-15, 2012
Brussels, Belgium
www.interactivemediainstitute.com
The Journal of CyberTherapy & Rehabilitation is the official journal of the CyberPsychology & CyberTherapy Conference (CT17). CT17 brings together researchers, clinicians, policy makers and funding agents to share and discuss
advancements in the growing discipline of CyberTherapy & Rehabilitation, which includes training, education, prevention, rehabilitation, and therapy. The focus of next year’s conference is two-fold–first, “Technologies as Enabling
Tools” will explore the use of advanced technologies in diagnosis, assessment and prevention of mental and physical
disorders. In addition, attention will be drawn to the role of interactive media in training, education, rehabilitation
and therapeutic interventions. Second, CT17 will investigate how new technologies are influencing behavior and society, for example, through healthy aging initiatives, positive and negative effects of social networking tools, and
online gaming. Technologies featured at the conference include VR simulations, videogames, telehealth, the Internet,
robotics, brain-computer interfaces, and non-invasive physiological monitoring devices. Conference attendees have
the opportunity to explore interactive exhibits at the Cyberarium as well.
----------------------------------------------------------------------------------------------------------------------------------------7th international Congress of Cognitive psychotherapy
June 2-5, 2011
http://www.iccp2011.com/
Istanbul, Turkey
----------------------------------------------------------------------------------------------------------------------------------------international Conference on Virtual rehabilitation 2011
June 27-29, 2011
http://www.virtual-rehab.org/2011/
Zurich, Switzerland
----------------------------------------------------------------------------------------------------------------------------------------international Conference on iCT for health (iCiCTh)
July 14-16, 2011
http://www.ineag.gr/ICICTH/index.php
Samos Island, Greece
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----------------------------------------------------------------------------------------------------------------------------------------4th international Conference on interactive mobile and Computer aided learning
July 20-22, 2011
http://iimss-11.kesinternational.org/
University of Piraeus, Greece
----------------------------------------------------------------------------------------------------------------------------------------american psychological association Conference 2011
August 4-7, 2011
http://www.apa.org/convention/
Washington D.C.
----------------------------------------------------------------------------------------------------------------------------------------siggraph 2011
August 7-11, 2011
http://www.siggraph.org/s2011/
Vancouver, Canada
----------------------------------------------------------------------------------------------------------------------------------------11th international Conference on intelligent Virtual agents (iVa 2011)
http://iva2011.ru.is/
Reykjavik, Iceland
----------------------------------------------------------------------------------------------------------------------------------------Joint Virtual reality Conference 2011
http://www.nottingham.ac.uk/jvrc2011/
Nottingham UK
----------------------------------------------------------------------------------------------------------------------------------------aal forum – september
http://www.aalforum.eu/
Lecce, Italy
----------------------------------------------------------------------------------------------------------------------------------------association for behavioral and Cognitive Therapies (abCT 2011)
November 10-13, 2011
http://www.abct.org/Conv2011/
Toronto, Canada
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general informaTion
ISSN: 1784-9934
GTIN-13 (EAN): 9771784993017
Journal of CyberTherapy & Rehabilitation is published
quarterly by the Virtual Reality Medical Institute, 64 Rue
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journal explores the uses of advanced technologies for
therapy, training, education, prevention, and rehabilitation. Areas of interest include, but are not limited to, psychiatry, psychology, physical medicine and rehabilitation,
neurology, occupational therapy, physical therapy, cognitive rehabilitation, neurorehabilitation, oncology, obesity, eating disorders, and autism, among many others.
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E-mail: office@vrphobia.com
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JCR
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CopyrighT
Copyright © 2011 by Virtual Reality Medical Institute.
All rights reserved. Journal of CyberTherapy & Rehabilitation is owned by Virtual Reality Medical Institute
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The Journal of CyberTherapy & Rehabilitation (JCR) is the official journal of the International Association of CyberPsychology, Training & Rehabilitation (iACToR.) Its mission is to explore the uses of advanced technologies for education, training, prevention, therapy, and rehabilitation.
Why Subscribe to JCR?
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Wounds of War III: Coping with
Blast-related Traumatic Brain
Injury in Returning Troops
EDITED BY:
Professor Dr. Brenda K. Wiederhold, Ph.D., MBA, BCIA
WOUNDS OF WAR III: COPING WITH
BLAST-RELATED TRAUMATIC BRAIN
INJURY IN RETURNING TROOPS
On February 20-22, 2011 the NATO Advanced Research “Wounds of War III: Coping with Blast-related Traumatic Brain
Injury in Returning Troops” drew over 30
eminent experts from 11 countries to discuss the topic of increased Traumatic Brain
Injury (TBI) in our service men and
women.
Held in Vienna, Austria at the Hotel Regina,
discussion topics included increased TBI as
a result of missions, as well as how TBI
may be prevented. Research has shown
that those who have served in both combat
missions and peacekeeping operations are
at an increased risk for TBI. The ultimate
aim of the workshop was critical assessment of existing knowledge and identification of directions for future actions. The
co-organizers of the workshop alongside
Professor Brenda K. Wiederhold included
Professor Kresimir Cosic, Professor Mark D.
Wiederhold and Colonel Carl Castro.
Full papers were published with IOS Press
TO ORDER: cybertherapy@vrphobia.com
The post-conference book reflects the key topics
discussed in the four sections at the workshop:
First Session - Characterization of TBI
Second Session - Diagnostic and Assessment
Issues Surrounding TBI
Third Session - Treatment of TBI
Fourth Session - Quality of Life
The Interactive Media Institute
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phone: (858) 642-0267 – fax: (858) 642-0285 – www.interactivemediainstitute.com
True North Logistics Headquarters
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Downers Grove, IL 60505
True North Logistics (TNL) is a small business providing complete warehouse management services either in one of our existing warehouses or in the warehouses of our
clients. We are positioned to acquire an existing warehouse or build a new facility to
meet our client’s specific needs. Types of services we offer our clients include warehouse operations and kitting; inventory management and tracking; inventory optimization; and warehouse management system (WMS) implementation and support.
While TNL is a new company, in name only, individuals on the TNL team have over
100 years of industry experience in distribution management and commercial real estate development.
• Tom Glisson – Lieutenant General (Ret.) US Army. Former Director of the Defense
Logistics Agency, and independent consultant.
• Dennis Gilhooley – Former Associate Partner at IBM Consulting and Logistics Director
at Zenith Electronics.
• Steve Kozarits –Commercial Real Estate Investment/Development Executive with a
focus on industrial properties.
Our parent company, True North Investments, is a Chicago area based real estate acquisition and development company. The principal's of the company have been partners for over twenty-six years. Together they have acquired over 18,000,000 square feet
of commercial product valued in excess of $800,000,000.
To get more information on TNL please feel free to reach out to us.
Tom Glisson – tom.glisson@truenorthlogistics.com, 877-319-3504, Ext 740
Steve Kozarits – steve.kozarits@truenorthlogistics.com, 877-319-3504, Ext 742
Dennis Gilhooley – dennis.gilhooley@truenorthlogistics.com, 877-319 3504, Ext 744
TNL is an active member of International Warehouse Logistics Association (IWLA).
APPROVED CE CREDIT PROVIDER
9565 Waples Street, Suite 200
San Diego, CA 92121
1-866-822-8762
frontoffice@vrphobia.com
www.interactivemediainstitute.com
322
CT16 Abstracts
firsT auThor index
281
Albani, G.
280
Allain, P.
265
Aravind, G.
171
Baus, O.
264
Bazinet, P.
209
Bernier, F.
197
Bouchard, S.
299
Bretón-Lopez, J.
249
Brinkman, W.P.
239
Cantamesse, M.
284
Cárdenas, G.
159
Cardullo, S.
248
Cebolla, A.
245
Cho, A.
298
Choi, Y.J.
241
Chou, S.C.
259
Cipresso, P.
235
Conti, F.
176
Drummond, J.
242
Ducrocq-Henry, S.
149
Dumoulin, S.
169
Dünser, A.
300
Dykeman, C.
179
Emmelkamp, P.
179
Faubert, J.
246
Ferrer-Garcia, M.
220
Folen, R.A.
187, 301
Gaggioli, A.
205
Galimberti, C.
282
Gamberini, L.
230
Gamito, P.
203
Georgieva, I.
167
Geslin, E.
218, 291
Gougeon, V.
194, 285
Grassi, A.
295
Guitard, T.
147
Gutiérrez-Maldonado, J.
145
Gutiérrez-Martínez, O.
277
Haagsma, M.
260
Hébert, K.
175
Henry, M.
188
Hill, E.
251
Hudlicka, E.
252
Kang, S.H.
270
Kashani, R.
229
Kim, D.Y.
155
Klinger, E.
207
Kozarić-Kovačić, D.
178
Krausz, G.
190, 287
La Paglia, F.
290
Laforest, M.
266
Lamontagne, A.
162
Lamoth, C.
240
Lipinski-Harten, M.
233, 293
Loranger, C.
268
Lortie, C.L.
199
Malbos, E.
212
Mert, A.
253
Mestre, D.R.
181
Meyerbröker, K.
223
Meyers, E.
160
Moliner, R.
152
Monthuy-Blanc, J.
154, 303
Mosso, J.L.
184
Mühlberger, A.
226, 303
Murphy, L.
274
Neveu, S.M.
238
Niu, Q.
224
Nguyen, M.
278
Nolin, P.
182
O’Connor, K.
236
O’Dea, B.
275
Oliver, E.
305
Pallavicini, F.
255
Peñaloza-Salazar, C.
307
Pérez-Ara, M.A.
231
Pericot-Valverde, I.
289
Piercey, C.D.
157
Power, K.
192
Pusch, A.
306
Quero, S.
174, 261
Raspelli, S.
204, 262
Riva, G.
163
Robillard, G.
193
Rodríguez, A.
165
Roucaut, F.X.
185
Ruwaard, J.
211
Sears, K.C.
272
Shin, Y.I.
200
Silva, C.
267
Son, Y.
151
Stetz, M.C.
279
Stipanicic, A.
214
Tarnanas, I.
296
Torres-Villalobos, G.
227
Traylor, A.
272
Turpin, M.E.
221
Tossman, P.
202
Voiskounsky, A.
196
Walshe, D.
JCR
INJURY CREATION SCIENCE
The Next Generation of Injury Simulation Today
Prosthetic tissue, wounds, and life saving skills training
devices used in the training of medical professionals
•
•
•
•
•
•
Cricothyrotomy Skills Trainer
Needle Decompression Skills Trainer
Bleeding Wound Skills Trainer
Amputation Skills Trainer
Burn Wound Skills Trainer
Odor Wound Skills Trainer
Merging latest special effects technology with medical and
material sciences research to replace live tissue and training.
Physiologically based research and development
program focused on providing enhanced training
capabilities for medical professionals to include:
•
•
•
•
•
Cricothyrotomy
Skills Trainer
Severe Amputation
Skills Trainer
Basic Life Support
Patient Assessment
Hemorrhage Control
Fracture Management
Shock Prevention & Treatment
Needle Decompression
Skills Trainer
Bleeding Wound
Skills Trainer
Simulated Burn
Wound Package
Odor Simulation
Wound Kit
Visually Realistic - Comfortable - Easy to Use
Durable - Reusable - Tactilely Realistic
FOR MORE INFORMATION, CONTACT:
Mark D. Wiederhold, M.D., Ph.D. FACP
The Virtual Reality Medical Center
858.642.0267 mwiederhold@vrphobia.com
www.vrphobia.com
The Official Conference of the International Association of
CyberPsychology, Training & Rehabilitation (iACToR)
This year's conference focus is two fold:
First, Technologies as Enabling Tools
CT17 will explore the uses of advanced technologies such as Virtual Reality simulations, videogames, telehealth, video-conferencing, the internet, robotics, brain computer interfaces, wearable computing, and noninvasive physiological monitoring devices, in the diagnosis,
assessment, and prevention of mental and physical disorders. In
2012 CALL FOR PAPERS
addition, we will look at interactive media in training, education,
SUBMISSION/REGISTRATION
rehabilitation, and therapeutic interventions.
DEADLINES:
Second, The Impact of New Technologies
CT17 will investigate how new technologies are influencing behavior and society, for example, through healthy aging initiatives,
positive and negative effects of social networking tools, and online gaming.
For more information please visit
http://www.interactivemediainstitute.com/conferences.html
or e-mail cybertherapy@vrphobia.com
Abstract Deadline
Submission: March 1, 2012
Notification of Acceptance/Rejection of
Abstract: April 1, 2012
Full Paper/Presenter Requirements
Deadline: June 1, 2012
Early Registration Deadline:
July 1, 2012

JCR 4(2) - Virtual Reality Medical Institute

Transcription

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