La utilización de las nuevas tecnologías de la información y la comunicación en psicología clínica

La utilización de las nuevas tecnologías ha experimentado un incremento considerable en los últimos años. La razón de promocionar el desarrollo y la utilización de estos sistemas en diferentes ámbitos es lograr un beneficio para los ciudadanos que se manifieste en cualquier esfera de sus vidas. En concreto, dentro del marco de la psicología, las tecnologías de la información y la comunicación (TIC) se han aplicado en distintos ámbitos (psicología experimental, clínica, educativa, social, evaluación psicológica, etc.). En este trabajo se presentan algunas de las aplicaciones basadas en TIC desarrolladas y validadas por nuestro grupo de investigación y que están teniendo una gran aplicabilidad para la psicología clínica, como las técnicas de realidad virtual, realidad aumentada y telepsicología basadas en Internet. Se analizan, además, las ventajas que estos sistemas presentan frente a la terapia tradicional, así como algunas de las limitaciones existentes. Por último, se plantean algunas perspectivas de trabajo futuras

Acquisition and extinction across multiple virtual reality contexts: implications for specific phobias and current treatment methods

Victor Wong studied human acquisition learning over multiple contexts using virtual reality. He found that learning an association over multiple contexts can impact subsequent extinction training. This suggests that fears acquired over multiple contexts may be more difficult to treat using exposure-based therapies and will need to be augmented for effectiveness

Virtual Reality Exposure Therapy for Adolescents with Public Speaking Anxiety

Bakgrunn: Presentasjonsangst er en av de vanligste fryktene blant ungdom. Angsten innebærer en redsel for å bli negativt evaluert, etterfulgt av en følelse av å bli flau eller ydmyket når man snakker foran andre. Eksponeringsterapi for presentasjonsangst er utfordrende å gjennomføre, da en trenger et reelt publikum som kan fungere som det fryktede stimuli. Virtual Reality (VR) kan være løsningen, da teknologien er i stand til å skape et virtuelt publikum, som kan oppleves som ekte. For voksne med presentasjonsangt finnes det flere randomiserte kontrollerte VR-studier som viser gode kliniske effekter, men en vet lite om effekten relatert til ungdom. Ingen studier har tidligere evaluert effekten av selvveiledet, automatiserte og spillbaserte VR-intervensjoner for ungdom med presentasjonsangst. Mål: Denne oppgaven adresserte aktuelle kunnskapshull ved å kartlegge den kliniske effekten og gjennomførbarheten av to VR-intervensjoner for ungdom med presentasjonsangst: en terapeutveiledet og en selvveiledet, automatisert og spillbasert intervensjon. Målet med Artikkel I var å undersøke gjennomførbarheten og den kliniske effekten av en terapeutveiledet, enkelt-sesjons VR-intervensjon for ungdom med presentasjonsangst. Hovedmålet med Artikkel II var å undersøke den kliniske effekten av en selvveiledet, automatisert og spillbasert VR-intervensjon sammenlignet med venteliste og en selvveiledet nettbasert intervensjon. Et sekundært mål var å undersøke om VR-intervensjonen førte til en økning i påfølgende eksponeringsøvelser under det nettbaserte eksponeringsprogrammet, sammenlignet med de som mottok nettbasert psykoedukasjons- og eksponeringsprogram. Målet med Artikkel III var å undersøke om intervensjonene rettet mot presentasjonsangst også førte til en reduksjon i symptomer på perfeksjonisme og om symptomer på perfeksjonisme modererte den kliniske effekten av intervensjonene for presentasjonsangst. Metode: To kliniske studier ga data for tre studier: en ikke-randomisert gjennomførbarhet- og pilotstudie (papir I) og en to-faset, firearmet randomisert kontrollert studie (papir II og III). Begge studiene undersøkte effekter og moderatorer av behandling: symptomer på generalisert sosial angst ved baseline og tilstedeværelse i det virtuelle miljøet (artikkel I) og om perfeksjonisme modererte behandlingsresultatet (artikkel III). Selvrapporterte symptomer på presentasjonsangst ble innhentet under intervensjons- og oppfølgingsperioden i begge studiene, i tillegg til hjertefrekvensmålinger under VR-eksponeringen i Artikkel I, selvrapporterte symptomer på generalisert sosial angst i Artikkel II og III, og perfeksjonisme i Artikkel III. Gjennomførbarhets- og pilotstudien i Artikkel I inkluderte N=27 ungdommer som deltok i en terapeutveiledet, 90-minutters VR-intervensjon på én sesjon ved klinikken. To-faset, firearmede randomiserte kontrollerte studien i Artikkel II og III inkluderte N=100 ungdommer som deltok i et seks ukers digitalt selvveiledet intervensjonsprogram. Ungdommene ble randomisert i fire grupper, med følgende fase én + fase to intervensjon; 1) Kun VR, 2) VR + nettbasert eksponeringsprogram, 3) Nettbasert psykoedukasjon + eksponeringsprogram, 4) Venteliste + nettbasert psykoedukasjonsprogram. Resultater: Resultater fra Artikkel I viste en signifikant reduksjon i presentasjonsangstsymptomer fra pre til post, og symptomene holdt seg stabile ved en og tre måneders oppfølging. Basert på tilbakemeldinger fra ungdommene, ble gjennomførbarheten av intervensjonen økt i løpet av studien, noe som resulterte i ingen manglende besvarelser ved oppfølging. Symptomer på generalisert sosial angst ved baseline og tilstedeværelse modererte ikke de kliniske effektene. Det var en liten økning i hjertefrekvensen under VR-eksponeringsoppgavene. Resultater fra Artikkel II viste en signifikant større reduksjon i presentasjonsangstsymptomer blant ungdommene som mottok VR-intervensjonen sammenlignet med ventelistegruppen. Resultatene viste også at VR + nettbasert eksponeringsprogram var like effektivt sammenlignet med kun VR og nettbasert psykoedukasjon + eksponeringsprogram. I tillegg hadde alle fire grupper en signifikant reduksjon i presentasjonsangstsymptomer. I motsetning til hypotesen fullførte ikke ungdommer som mottok VR-intervensjon et høyere antall in-vivo-eksponeringsoppgaver i løpet av nettbasert eksponeringsprogram sammenlignet med de som mottok nettbasert psykoedukasjon og eksponeringsprogram. De kliniske effektene holdt seg stabile ved tre måneders oppfølging. Resultater fra Artikkel III viste at intervensjonene ikke reduserte perfeksjonisme på gruppenivå, men det var signifikante individuelle forskjeller i endringer over tid. En nedgang i perfeksjonisme var assosiert med en større reduksjon på alle utfallsmål fra post til oppfølging. Det var ingen signifikante interaksjonseffekter mellom presentasjonsangstsymptomer og nivået av perfeksjonisme før behandling. Høye nivåer av perfeksjonisme før behandling var assosiert med dårligere langsiktige resultater for begge gruppene som mottok det nettbaserte eksponeringsprogrammet. Konklusjon: Denne oppgaven bidrar til det voksende evidensgrunnlaget for VR-eksponeringsterapi, og den første som demonstrerer potensialet til både terapeutveiledet og selvveiledet VR-behandling for ungdom generelt, og spesielt for de med presentasjonsangst. Resultatene indikerer at VR-behandling kan fungere som et indisert forebyggingsprogram for ungdom med PSA. Studiene som inngår i oppgaven er gjennomført ved hjelp av et solid design. Gjennomførbarhet og pilotering var første trinn, før man for første gang med denne målgruppen evaluerte de kliniske effektene i en randomisert kontrollert studie. I tillegg har oppgaven undersøkt relevante moderatorer av behandlinger; rollen til perfeksjonisme og hvordan den kan hindre bedring. Disse resultatene kan være veiledende for hvordan optimalisere fremtidige intervensjoner for ungdom med presentasjonsangst. Fremtidige studier bør undersøke om VR-terapi har en langsiktig forebyggende effekt på utvikling av generalisert sosial angst da dette fortsatt er uklart for denne aldersgruppen.Background: Public Speaking Anxiety (PSA) is one of the most common fears reported by adolescents. PSA involves the fear of being negatively evaluated, followed by a feeling of being embarrassed or humiliated when speaking in front of others. Providing state-of-the-art in-vivo exposure therapy for PSA is difficult due to the logistics of recruiting an actual audience trained to act as the feared stimuli. An attractive way of resolving this obstacle is through Virtual Reality (VR) technology, which is capable of creating an immersive experience of being in front of a virtual audience, as if it was real. Although there are several randomized controlled trials demonstrating the clinical efficacy of VR exposure therapy for adults with PSA, little is known about its clinical effects on adolescents. Moreover, no past study has evaluated self-guided and automated VR interventions for adolescents with PSA. Aims: This thesis addressed these key knowledge gaps by exploring the clinical effects and feasibility of both therapist-guided and self-guided, and automated VR interventions for adolescents with PSA. The aim of Paper I was to investigate the feasibility and the clinical effects of a therapist-guided, single-session VR-intervention for adolescents with PSA, using low-cost consumer VR hardware. The primary aim of Paper II was to investigate the clinical efficacy of a self-guided, automated, and gamified VR intervention compared with waitlist and self-guided online programs. A secondary aim was to explore whether the VR intervention led to an increase in subsequent exposure tasks during the online exposure program compared to those receiving the online psychoeducation and exposure program. The aim of Paper III was to investigate whether interventions targeting PSA also led to a reduction in symptoms of perfectionism and whether symptoms of perfectionism moderated the clinical efficacy of self-guided interventions for PSA. Methods: Two clinical trials provided data for three studies: one non-randomized feasibility and pilot study (Paper I) and a two-phased, four-armed randomized controlled study (Paper II and III). Both trials investigated effects and moderators of treatment: baseline generalized social anxiety symptoms and presence in the virtual environment (Paper I) and whether perfectionism moderated treatment outcome (Paper III). Self-reported PSA were assessed during the intervention and follow-up period in both studies, in addition to heart rate measurements during the VR exposure in Paper I, self-reported symptoms of generalized SAD in Paper II and III, and perfectionism in Paper III. The non-randomized feasibility and pilot study in Paper I included N=27 adolescents who participated in a therapist-guided, 90-minutes single-session VR intervention at the clinic. The two-phased, four-armed randomized controlled study in Paper II and III included N=100 adolescents who participated in a six weeks digital self-guided interventions program. The adolescents were randomized into four groups, with the following phase one + phase two intervention; 1) VR only, 2) VR + online exposure program, 3) Online psychoeducation + exposure program, 4) Waitlist + online psychoeducation program. Results: Results from Paper I revealed a significant decrease in PSA symptoms from pre to post, and symptoms remained stable at one- and three-month follow-up. Based on feedback from the adolescents, the feasibility of the intervention was increased during the trial, resulting in no missing data. Baseline generalized social anxiety symptoms and presence did not moderate the clinical effects. There was a small increase in heart rate during the VR exposure tasks. Results from Paper II revealed a significantly greater reduction in PSA symptoms among the adolescents who received the VR intervention compared to the the waitlist group. The results also demonstrated that VR + online exposure program was as equally effective as compared to VR only and online psychoeducation + exposure program. Moreover, all groups had a significant reduction in PSA symptoms. Contrary to the hypothesis, adolescents who received VR training did not complete a higher number of in-vivo-exposure tasks during the online exposure program compared to those receiving online psychoeducation and exposure program. The clinical effects remained stable at three-month follow-up. Results from Paper III revealed that the interventions did not reduce perfectionism at a group level, however, there were significant individual differences in changes over time. A decrease in perfectionism was associated with a larger reduction on all outcome measures from post to follow-up. There were no significant interaction effects between PSA symptoms and the pre-treatment level of perfectionism. High pre-treatment levels of perfectionism was associated with poorer long-term outcomes for both groups receiving the online exposure program. Conclusions: In sum, this thesis contributes to the growing evidence base for VR exposure therapy, and is among the first to demonstrate the potential of both therapist-guided and self-guided, VR interventions for adolescents in general and with PSA in particular. The results indicate that VR may serve as an indicated prevention program for adolescents with PSA. The studies included in the thesis is conducted through a strong design with feasibility and piloting as a first step before evaluating, for the first time with this target group, the clinical effects in a randomized controlled trial. Moreover, the thesis has investigated relevant moderators of treatments, specifically the role of perfectionism and how it may hinder treatment improvement. These results can provide guidance on how to optimize future interventions for the large group of adolescents with PSA. Future studies should investigate whether VR interventions have a long-term preventive effect on the development of generalized social anxiety as this remains unclear for this age group.Doktorgradsavhandlin

Evaluating a sensor of skin conductance to assess dental anxiety

Tese de mestrado, Bioinformática e Biologia Computacional (Bioinformática), Universidade de Lisboa, Faculdade de Ciências, 2015The anxiety related problems that adult population experience, are a common issue in Dental Practice. To overcome these problems it would be helpful to have an objective measure of the current anxiety of the patient. With this information, it should be possible to link the measured anxiety to an automated system that could distract the patient by altering the surrounding environment, i.e. Ambient Intelligence. This project consisted in measuring the skin conductance signal and correlating the responses related with documented dental stressful procedures. This was executed in a real clinical environment. Dental anxiety was assessed in over 70 patients with a 3 question survey using the Likert scale. Each answer was registered together with the level of skin conductance measured with a sensor placed in the patient fingers. The results showed a significant association between the dental anxiety score on two of the questions and the quantified skin electrodermal response. These findings aim to help design a future system based on ambient intelligence to distract and reduce dental anxiety during treatment.Uma parte significativa da população adulta tem problemas provocados pela ansiedade originada com a ida à consulta de Medicina Dentária. Seria vantajoso existir uma avaliação objetiva do nível de ansiedade do paciente durante a consulta para se ultrapassar estes problemas. Com esta informação seria possível alterar o ambiente envolvente através da ligação a um sistema automatizado inteligente para a distração do paciente durante a consulta. Este projeto consistiu na medição do sinal de condutividade da pele e correlação desta com as respostas a um questionário relacionado com atos dentários reconhecidos como causadores de grande ansiedade dentária. A ansiedade dentária foi avaliada em cerca de setenta pacientes por um questionário de três perguntas utilizando uma escala de Likert. Simultaneamente foi medida a condutividade da pele por um sensor colocado nos dedos da mão. Os resultados mostram uma associação significativa entre o nível de ansiedade obtido em duas das questões e a alteração da condutividade da pele. Estes resultados visam fornecer uma base para desenhar um futuro sistema de Ambiente Inteligente para distração da ansiedade dentária

A novel integrating virtual reality approach for the assessment of the attachment behavioral system

[EN] Virtual reality (VR) technology represent a novel and powerful tool for behavioural research in psychological assessment. Virtual reality provides simulated experiences able to create the sensation of undergoing real situations. Users become active participants in the virtual environment seeing, hearing, feeling, and actuating as if they were in the real world. Currently, the most psychological VR applications concern the treatment of various mental disorders but not the assessment, that it is mainly based on paper and pencil tests. The observation of behaviors is costly, labor-intensive, and it is hard to create social situations in laboratory settings, even if the observation of actual behaviors could be particularly informative. In this framework, social stressful experiences can activate various behaviours of attachment for a significant person that can help to control and soothe them to promote individual s well-being. Social support seeking, physical proximity, and positive and negative behaviors represent the main attachment behaviors that people can carry out during experiences of distress. We proposed virtual reality as a novel integrating approach to measure real attachment behaviours. The first studies on attachment behavioural system by VR showed the potentiality of this approach. To improve the assessment during the VR experience, we proposed virtual stealth assessment (VSA) as a new method. VSA could represents a valid and novel technique to measure various psychological attributes in real-time during the virtual experience. The possible use of this method in psychology could be to generate a more complete, exhaustive, and accurate individual s psychological evaluation.This work was supported by the Spanish Ministry of Economy, Industry and Competitiveness funded project "Advanced Therapeutically Tools for Mental Health" (DPI2016-77396-R).Chicchi-Giglioli, IA.; Pravettoni, G.; Sutil Martin, DL.; Parra Vargas, E.; Alcañiz Raya, ML. (2017). A novel integrating virtual reality approach for the assessment of the attachment behavioral system. Frontiers in Psychology. 8(959). https://doi.org/10.3389/fpsyg.2017.00959S8959Ainsworth, M. D. S. (1978). The Bowlby-Ainsworth attachment theory. Behavioral and Brain Sciences, 1(3), 436-438. doi:10.1017/s0140525x00075828Andersen, S. M., & Thorpe, J. S. (2009). An IF–THEN theory of personality: Significant others and the relational self. Journal of Research in Personality, 43(2), 163-170. doi:10.1016/j.jrp.2008.12.040Bailenson, J. N., Yee, N., Merget, D., & Schroeder, R. (2006). The Effect of Behavioral Realism and Form Realism of Real-Time Avatar Faces on Verbal Disclosure, Nonverbal Disclosure, Emotion Recognition, and Copresence in Dyadic Interaction. Presence: Teleoperators and Virtual Environments, 15(4), 359-372. doi:10.1162/pres.15.4.359Baños, R. M., Liaño, V., Botella, C., Alcañiz, M., Guerrero, B., & Rey, B. (2006). Changing Induced Moods Via Virtual Reality. Lecture Notes in Computer Science, 7-15. doi:10.1007/11755494_3Beebe, B., Lachmann, F., & Jaffe, J. (1997). Mother—infant interaction structures and presymbolic self‐ and object representations. Psychoanalytic Dialogues, 7(2), 133-182. doi:10.1080/10481889709539172Beebe, B., & Lachmann, F. M. (1994). Representation and internalization in infancy: Three principles of salience. Psychoanalytic Psychology, 11(2), 127-165. doi:10.1037/h0079530Biocca, F. (2006). The Cyborg’s Dilemma: Progressive Embodiment in Virtual Environments [1]. Journal of Computer-Mediated Communication, 3(2), 0-0. doi:10.1111/j.1083-6101.1997.tb00070.xBohil, C. J., Alicea, B., & Biocca, F. A. (2011). Virtual reality in neuroscience research and therapy. Nature Reviews Neuroscience, 12(12), 752-762. doi:10.1038/nrn3122Borrego, A., Latorre, J., Llorens, R., Alcañiz, M., & Noé, E. (2016). Feasibility of a walking virtual reality system for rehabilitation: objective and subjective parameters. Journal of NeuroEngineering and Rehabilitation, 13(1). doi:10.1186/s12984-016-0174-1Boyd, C. (1997). Does immersion make a virtual environment more usable? CHI ’97 extended abstracts on Human factors in computing systems looking to the future - CHI ’97. doi:10.1145/1120212.1120416Cárdenas-López, G., & Rosa-Gómez, A. D. la. (2011). Post-traumatic stress disorder treatment with virtual reality exposure for criminal violence: a case study in assault with violence. International Journal on Disability and Human Development, 10(4). doi:10.1515/ijdhd.2011.061Cassidy, J. (1994). Emotion Regulation: Influences of Attachment Relationships. Monographs of the Society for Research in Child Development, 59(2/3), 228. doi:10.2307/1166148Overall, N. C., Simpson, J. A., & Struthers, H. (2013). Buffering attachment-related avoidance: Softening emotional and behavioral defenses during conflict discussions. Journal of Personality and Social Psychology, 104(5), 854-871. doi:10.1037/a0031798Collins, N. L., Ford, M. B., Guichard, A. C., & Allard, L. M. (2006). Working Models of Attachment and Attribution Processes in Intimate Relationships. Personality and Social Psychology Bulletin, 32(2), 201-219. doi:10.1177/0146167205280907Cummings, J. J., & Bailenson, J. N. (2015). How Immersive Is Enough? A Meta-Analysis of the Effect of Immersive Technology on User Presence. Media Psychology, 19(2), 272-309. doi:10.1080/15213269.2015.1015740Dakanalis, A., Gaudio, S., Serino, S., Clerici, M., Carrà, G., & Riva, G. (2016). Body-image distortion in anorexia nervosa. Nature Reviews Disease Primers, 2(1). doi:10.1038/nrdp.2016.26Fusaro, M., Tieri, G., & Aglioti, S. M. (2016). Seeing pain and pleasure on self and others: behavioral and psychophysiological reactivity in immersive virtual reality. Journal of Neurophysiology, 116(6), 2656-2662. doi:10.1152/jn.00489.2016Gorini, A., Griez, E., Petrova, A., & Riva, G. (2010). Assessment of the emotional responses produced by exposure to real food, virtual food and photographs of food in patients affected by eating disorders. Annals of General Psychiatry, 9(1). doi:10.1186/1744-859x-9-30Gunnar, M. R., Brodersen, L., Nachmias, M., Buss, K., & Rigatuso, J. (1996). Stress reactivity and attachment security. Developmental Psychobiology, 29(3), 191-204. doi:10.1002/(sici)1098-2302(199604)29:33.0.co;2-mHamilton, C. E. (2000). Continuity and Discontinuity of Attachment from Infancy through Adolescence. Child Development, 71(3), 690-694. doi:10.1111/1467-8624.00177Heeter, C. (2000). Interactivity in the Context of Designed Experiences. Journal of Interactive Advertising, 1(1), 3-14. doi:10.1080/15252019.2000.10722040Kane, H. S., McCall, C., Collins, N. L., & Blascovich, J. (2012). Mere presence is not enough: Responsive support in a virtual world. Journal of Experimental Social Psychology, 48(1), 37-44. doi:10.1016/j.jesp.2011.07.001Lombard, M., & Ditton, T. (2006). At the Heart of It All: The Concept of Presence. Journal of Computer-Mediated Communication, 3(2), 0-0. doi:10.1111/j.1083-6101.1997.tb00072.xLoomis, J. M., Blascovich, J. J., & Beall, A. C. (1999). Immersive virtual environment technology as a basic research tool in psychology. Behavior Research Methods, Instruments, & Computers, 31(4), 557-564. doi:10.3758/bf03200735Main, M. (1990). Cross-Cultural Studies of Attachment Organization: Recent Studies, Changing Methodologies, and the Concept of Conditional Strategies. Human Development, 33(1), 48-61. doi:10.1159/000276502Main, M., Kaplan, N., & Cassidy, J. (1985). Security in Infancy, Childhood, and Adulthood: A Move to the Level of Representation. Monographs of the Society for Research in Child Development, 50(1/2), 66. doi:10.2307/3333827Maunder, R. G., Lancee, W. J., Hunter, J. J., Greenberg, G. R., & Steinhart, H. A. (2005). Attachment Insecurity Moderates the Relationship Between Disease Activity and Depressive Symptoms in Ulcerative Colitis. Inflammatory Bowel Diseases, 11(10), 919-926. doi:10.1097/01.mib.0000179468.78876.2dMaunder, R. G., Lancee, W. J., Nolan, R. P., Hunter, J. J., & Tannenbaum, D. W. (2006). The relationship of attachment insecurity to subjective stress and autonomic function during standardized acute stress in healthy adults. Journal of Psychosomatic Research, 60(3), 283-290. doi:10.1016/j.jpsychores.2005.08.013Meyerbröker, 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. doi:10.1002/da.20734Mikulincer, M., & Shaver, P. R. (2005). Attachment theory and emotions in close relationships: Exploring the attachment-related dynamics of emotional reactions to relational events. Personal Relationships, 12(2), 149-168. doi:10.1111/j.1350-4126.2005.00108.xMikulincer, M., Shaver, P. R., & Pereg, D. (2003). Motivation and Emotion, 27(2), 77-102. doi:10.1023/a:1024515519160Parsons, T. D. (2015). Virtual Reality for Enhanced Ecological Validity and Experimental Control in the Clinical, Affective and Social Neurosciences. Frontiers in Human Neuroscience, 9. doi:10.3389/fnhum.2015.00660Persky, S., & Blascovich, J. (2008). Immersive Virtual Video Game Play and Presence: Influences on Aggressive Feelings and Behavior. Presence: Teleoperators and Virtual Environments, 17(1), 57-72. doi:10.1162/pres.17.1.57Ravitz, P., Maunder, R., Hunter, J., Sthankiya, B., & Lancee, W. (2010). Adult attachment measures: A 25-year review. Journal of Psychosomatic Research, 69(4), 419-432. doi:10.1016/j.jpsychores.2009.08.006Riva, G., Bacchetta, M., Baruffi, M., & Molinari, E. (2001). Virtual Reality–Based Multidimensional Therapy for the Treatment of Body Image Disturbances in Obesity: A Controlled Study. CyberPsychology & Behavior, 4(4), 511-526. doi:10.1089/109493101750527079Riva, G., Gutiérrez-Maldonado, J., & Wiederhold, B. K. (2016). Virtual Worlds versus Real Body: Virtual Reality Meets Eating and Weight Disorders. Cyberpsychology, Behavior, and Social Networking, 19(2), 63-66. doi:10.1089/cyber.2016.29025.griRothbaum, B. O., Hodges, L. F., Ready, D., Graap, K., & Alarcon, R. D. (2001). Virtual Reality Exposure Therapy for Vietnam Veterans With Posttraumatic Stress Disorder. The Journal of Clinical Psychiatry, 62(8), 617-622. doi:10.4088/jcp.v62n0808Sanchez-Vives, M. V., & Slater, M. (2005). From presence to consciousness through virtual reality. Nature Reviews Neuroscience, 6(4), 332-339. doi:10.1038/nrn1651Sandstrom, N. J., Kaufman, J., & A. Huettel, S. (1998). Males and females use different distal cues in a virtual environment navigation task. Cognitive Brain Research, 6(4), 351-360. doi:10.1016/s0926-6410(98)00002-0Saribay, S. A., & Andersen, S. M. (2007). Are Past Relationships at the Heart of Attachment Dynamics? What Love Has to Do With It. Psychological Inquiry, 18(3), 183-191. doi:10.1080/10478400701512786Schmidt, S., Nachtigall, C., Wuethrich-Martone, O., & Strauss, B. (2002). Attachment and coping with chronic disease. Journal of Psychosomatic Research, 53(3), 763-773. doi:10.1016/s0022-3999(02)00335-5Schmidt, S., Petersen, C., & Bullinger, M. (2003). Coping with chronic disease from the perspective of children and adolescents - a conceptual framework and its implications for participation. Child: Care, Health and Development, 29(1), 63-75. doi:10.1046/j.1365-2214.2003.00309.xSchönbrodt, F. D., & Asendorpf, J. B. (2011). Virtual social environments as a tool for psychological assessment: Dynamics of interaction with a virtual spouse. Psychological Assessment, 23(1), 7-17. doi:10.1037/a0021049Schönbrodt, F. D., & Asendorpf, J. B. (2012). Attachment Dynamics in a Virtual World. Journal of Personality, 80(2), 429-463. doi:10.1111/j.1467-6494.2011.00736.xCardona, J. F., Kargieman, L., Sinay, V., Gershanik, O., Gelormini, C., Amoruso, L., … Ibáñez, A. (2014). How embodied is action language? Neurological evidence from motor diseases. Cognition, 131(2), 311-322. doi:10.1016/j.cognition.2014.02.001Shute, V. J. (2009). Simply Assessment. International Journal of Learning and Media, 1(2), 1-11. doi:10.1162/ijlm.2009.0014Shute, V. J., & Ke, F. (2012). Games, Learning, and Assessment. Assessment in Game-Based Learning, 43-58. doi:10.1007/978-1-4614-3546-4_4Shute, V. J., Ventura, M., & Kim, Y. J. (2013). Assessment and Learning of Qualitative Physics in Newton’s Playground. The Journal of Educational Research, 106(6), 423-430. doi:10.1080/00220671.2013.832970Skalski, P., & Tamborini, R. (2007). The Role of Social Presence in Interactive Agent-Based Persuasion. Media Psychology, 10(3), 385-413. doi:10.1080/15213260701533102Slater, M. (2009). Place illusion and plausibility can lead to realistic behaviour in immersive virtual environments. Philosophical Transactions of the Royal Society B: Biological Sciences, 364(1535), 3549-3557. doi:10.1098/rstb.2009.0138Sroufe, L. A. (2005). Attachment and development: A prospective, longitudinal study from birth to adulthood. Attachment & Human Development, 7(4), 349-367. doi:10.1080/14616730500365928Sundar, S. S., Xu, Q., & Bellur, S. (2010). Designing interactivity in media interfaces. Proceedings of the 28th international conference on Human factors in computing systems - CHI ’10. doi:10.1145/1753326.1753666Symons, D. K., Adams, S., & Smith, K. H. (2016). Adult attachment style and caregiver attitudes after raising a virtual child. Journal of Social and Personal Relationships, 33(8), 1054-1069. doi:10.1177/0265407515616710Tarr, M. J., & Warren, W. H. (2002). Virtual reality in behavioral neuroscience and beyond. Nature Neuroscience, 5(S11), 1089-1092. doi:10.1038/nn948Tronick, E. Z., & Gianino, A. F. (1986). The transmission of maternal disturbance to the infant. New Directions for Child and Adolescent Development, 1986(34), 5-11. doi:10.1002/cd.23219863403Waters, E., Weinfield, N. S., & Hamilton, C. E. (2000). The Stability of Attachment Security from Infancy to Adolescence and Early Adulthood: General Discussion. Child Development, 71(3), 703-706. doi:10.1111/1467-8624.00179Weinfield, N. S., Whaley, G. J., & Egeland, B. (2004). Continuity, discontinuity, and coherence in attachment from infancy to late adolescence: Sequelae of organization and disorganization. Attachment & Human Development, 6(1), 73-97. doi:10.1080/14616730310001659566Wilson, M. (2002). Six views of embodied cognition. Psychonomic Bulletin & Review, 9(4), 625-636. doi:10.3758/bf03196322Wrzesien, M., Alcañiz, M., Botella, C., Burkhardt, J.-M., Lopez, J. B., & Ortega, A. R. (2014). A Pilot Evaluation of a Therapeutic Game Applied to Small Animal Phobia Treatment. Lecture Notes in Computer Science, 10-20. doi:10.1007/978-3-319-11623-5_2Yee, N., & Bailenson, J. (2007). The Proteus Effect: The Effect of Transformed Self-Representation on Behavior. Human Communication Research, 33(3), 271-290. doi:10.1111/j.1468-2958.2007.00299.

A Framework for Prediction in a Fog-Based Tactile Internet Architecture for Remote Phobia Treatment

Tactile Internet, as the next generation of the Internet, aims to transmit the modality of touch in addition to conventional audiovisual signals, thus transforming today’s content-delivery into skill-set delivery networks, which promises ultra-low latency and ultra reliability. Besides voice and data communication driving the design of the current Internet, Tactile Internet enables haptic communications by incorporating 5G networks and edge computing. A novel use-case of immersive, low-latency Tactile Internet applications is haptic-enabled Virtual Reality (VR), where an extremely low latency of less than 50 ms is required, which gives way to the so-called Remote Phobia treatment via VR. It is a greenfield in the telehealth domain with the goal of replicating normal therapy sessions with distant therapists and patients, thereby standing as a cost-efficient and time-saving solution. In this thesis, we consider a recently proposed fog-based haptic-enabled VR system for remote treatment of animal phobia consisting of three main components: (1) therapist-side fog domain, (2) core network, and (3) patient-side fog domain. The patient and therapist domains are located in different fog domains, where their communication takes place through the core network. The therapist tries to cure the phobic patient remotely via a shared haptic virtual reality environment. However, certain haptic sensation messages associated with hand movements might not be reached in time, even in the most reliable networks. In this thesis, a prediction model is proposed to address the problem of excessive packet latency as well as packet loss, which may result in quality-of-experience (QoE) degradation. We aim to use machine learning to decouple the impact of excessive latency and extreme packet loss from the user experience perspective. For which, we propose a predictive framework called Edge Tactile Learner (ETL). Our proposed fog-based framework is responsible for predicting the zones touched by the therapist’s hand, then delivering it immediately to the patient-side fog domain if needed. The proposed ETL builds a model based on Weighted K-Nearest Neighbors (WKNN) to predict the zones touched by the therapist in a VR phobia treatment system. The simulation results indicate that our proposed predictive framework is instrumental in providing accurate and real-time haptic predictions to the patient-side fog domain. This increases patient’s immersion and synchronization between multiple senses such as audio, visual and haptic sensory, which leads to higher user Quality of Experience (QoE)

Efficacy of Virtual Reality Exposure Therapy in the Treatment of Specific Phobias: A Systematic Review

Specific phobia is defined as a notable and continuous fear of a certain object or a situation that particularly impairs daily life and functioning. It is also one of the most common psychological disorders. Exposure-based interventions are commonly used in the treatment of specific phobias. However, some limitations of the standard methods require the need for alternative approaches. In light of this, the use of virtual reality technology in psychotherapy has become increasingly widespread in recent years and is now integrated with exposure therapy. Virtual reality provides real-time interaction using the computer-generated three-dimensional environment via variety oftechnological tools. Applications of virtual reality in exposure therapy have proven to be an important intervention method, especially in the psychopathologies such as specific phobias. In this study, virtual reality exposure therapy for the treatment of specific phobias is systematically reviewed. Inclusion criteria were taken into account in the scanning performed in APA (PsycINFO), EBSCO, PubMed, Scopus, Web of Science, Science Direct, Ulakbim ve TRDizin databses following the PRISMA method. Following that, ten randomized controlled trials, which included adult participants meeting the diagnostic criteria for specific phobia, examined the efficacy of virtual reality and exposure therapy compared to the control group, and the ones with full text could be accessed, were included in this systematic review. The included studies were evaluated in terms of sample attributes, primary measurement tools, research design, characteristics of the intervention and its efficacy. In general, the findings indicate the efficacy of virtual reality exposure therapy in reducing specific phobia symptoms. Follow-up studies support the long-term maintenance of the results

Healthy You

https://scholarlyworks.lvhn.org/healthy-you/1114/thumbnail.jp