Virtual and Augmented Reality: New Frontiers for Clinical Psychology

In the last decades, the applied approach for the use of virtual reality (VR) and augmented reality (AR) on clinical and health psychology has grown exponentially. These technologies have been used to treat several mental disorders, for example, phobias, stress-related disorders, depression, eating disorders, and chronic pain. The importance of VR/AR for the mental health field comes from three main concepts: (1) VR/AR as an imaginal technology, people can feel “as if they are” in a reality that does not exist in external world; (2) VR/AR as an embodied technology, the experience to feel user’s body inside the virtual environment; and (3) VR/AR as connectivity technology, the “end of geography’. In this chapter, we explore the opportunities provided by VR/AR as technologies to improve people’s quality of life and to discuss new frontiers for their application in mental health and psychological well-being promotion

The Binge Eating Scale: Structural Equation Competitive Models, Invariance Measurement Between Sexes, and Relationships With Food Addiction, Impulsivity, Binge Drinking, and Body Mass Index

Introduction: The Binge Eating Scale (BES) is a widely used self-report questionnaire to identify compulsive eaters. However, research on the dimensions and psychometric properties of the BES is limited.Objective: The aim of this study was to examine the properties of the Spanish version of the BES.Methods: Confirmatory Factor Analyses (CFAs) were carried out to verify the BES factor structure in a sample of Spanish college students (N = 428, 75.7% women; age range = 18–30). An invariance measurement routine was carried out across sexes, the latent means were compared, and estimates of reliability and convergent and discriminant validity were presented.Results: A one-factor model fit the data best and was also equivalent between sexes. The scalar invariance model showed statistically significant differences across sexes, with a higher prevalence in women. Regarding reliability, the results were excellent. Finally, high statistically significant correlations were obtained with other measures of binge eating (BE), food addiction, impulsivity, binge drinking, and body mass index (BMI).Conclusion: The Spanish 16-item BES is a valid and reliable scale to evaluate BE in the youth population

What is the Current and Future Status of Digital Mental Health Interventions?

The prevalence of mental disorders continues to increase, especially with the advent of the COVID-19 pandemic. Although we have evidence-based psychological treatments to address these conditions, most people encounter some barriers to receiving this help (e.g., stigma, geographical or time limitations). Digital mental health interventions (e.g., Internet-based interventions, smartphone apps, mixed realities -virtual and augmented reality) provide an opportunity to improve accessibility to these treatments. This article summarizes the main contributions of the different types of digital mental health solutions. It analyzes their limitations (e.g., drop-out rates, lack of engagement, lack of personalization, lack of cultural adaptations) and showcases the latest sophisticated and innovative technological advances under the umbrella of precision medicine (e.g., digital phenotyping, chatbots, or conversational agents). Finally, future challenges related to the need for real world implementation of these interventions, the use of predictive methodology, and hybrid models of care in clinical practice, among others, are discussed

Qualitative analysis of the best possible self intervention: underlying mechanisms that influence its efficacy

Background The Best Possible Self is a Positive Psychology Intervention which asks participants to write down about themselves in their best possible future. Previous studies have shown its efficacy to enhance wellbeing, but the mechanisms that underlie its efficacy are still unknown. Objective The aim of this study was to analyze the content of the essays of the BPS intervention and to examine how this content was related to the efficacy of the intervention to increase positive affect. Method Participants (N = 78) were randomized to either the Best Possible Self condition, or one of two variants of the intervention: one''s best self in the present, and one''s best self in the past. Qualitative analyses of the texts were carried out to explore the main themes and features of the essays. Then, a mixed-methods approach with quantitative and qualitative data was followed, in order to analyze the relationship between the content of the texts and the change in positive affect produced by the interventions. Results Significant differences between conditions were found in the content of the compositions. Regression analyses showed that different variables predicted the change in positive affect depending on the condition. Mediation analyses also found differences among conditions. Conclusions These findings suggest that these interventions respond to different underlying mechanisms which influence their efficacy. This study contributed to a better understanding of how Positive Psychology Interventions work, and how to increment their efficacy

Psychological intervention using virtual reality for patients with cancer.

El objetivo de este trabajo es presentar las principales aportaciones de la Realidad Virtual (RV) en el tratamiento psicológico con pacientes oncológicos, y describir un programa de intervención que utiliza esta tecnología para promover bienestar emocional en pacientes hospitalizados. La RV se presenta como una prometedora herramienta de apoyo al paciente oncológico. Diversos estudios plantean su utilidad para hacer algunos tratamientos médicos más tolerables, para reducir los niveles de distrés y dolor, así como promover mayores niveles de emociones positivas. Se ha empleado principalmente con pacientes ambulatorios, existiendo una menor proporción de propuestas dirigidas al período de hospitalización. La intervención que ha desarrollado nuestro grupo aborda esta condición desde un foco también poco explorado: la promoción de bienestar. Esta intervención se compone de 4 sesiones (módulos de distracción y reminiscencia) implementadas individualmente en la habitación del paciente. Antes y después de cada sesión se evaluó el estado emocional (escalas visuales), la percepción de paso del tiempo (en minutos), de cambio en el estado de ánimo y de satisfacción con el procedimiento. Los resultados iniciales señalan incrementos en las emociones positivas después de cada sesión, existiendo cambios significativos en la primera y tercera sesión. Además, la mayoría de pacientes informó que su estado de ánimo había mejorado después de las sesiones. A partir de estos hallazgos se observa que los entornos virtuales y las tecnologías de la información y la comunicación muestran utilidad no sólo para disminuir el malestar sino también para promover bienestar emocional, especialmente durante períodos de tratamiento y hospitalización.The purpose of the present study is to review the main contributions of Virtual Reality (VR) to the field of psychological treatment with cancer patients, and to describe an intervention that uses this technology to promote emotional well-being on inpatients. VR appears as a promising tool for supporting psychological treatments in cancer patients. Several studies explore its utility for promoting more tolerable medical treatments, lowering the level of distress and pain, as well as increasing positive emotions. VR has been mainly used with outpatients, with a minor proportion of proposals oriented to the hospitalization period. The intervention developed by our group addresses this issue from a focus not very much explored: the promotion of well-being. This intervention is composed of 4 sessions (distraction and reminiscence modules) implemented individually in the patients’ room. Emotional state (visual analog scales), perceived time duration (minutes), perception of mood change and satisfaction with the procedure were assessed before and after sessions. Preliminary results showed an increase in positive emotions after each session, being these changes significant in the first and third session. Besides, most patients perceived themselves in a better mood after the sessions. Virtual environments and information and communication technologies could be useful not only to diminish discomfort but also to promote emotional well-being, especially during medical procedures and hospitalizatio

Manipulating Self-Avatar Body Dimensions in Virtual Worlds to Complement an Internet-Delivered Intervention to Increase Physical Activity in Overweight Women

[EN] Virtual reality has been found to be a useful tool for positively influencing relevant psychological variables in order to increase physical activity (PA), especially in the overweight population. This study investigates the use of avatars and their physical variations to extend the effectiveness of existing interventions to promote PA. The main objective is to analyze the influence of the avatars' body dimensions on the efficacy of an Internet intervention to increase PA levels and improve other relevant variables (motivation toward PA, enjoyment, anxiety, self-efficacy, and PA goals). A total of 42 overweight women received a brief online intervention, and they were randomly assigned to one of three conditions: the "Ideal avatar" (IAC: participants are represented by avatars with ideal body dimensions); the "Real avatar" (RAC: participants are represented by avatars with participants' current body dimensions); and the "Non avatar" (NAC: participants are not represented by avatars). Results showed that the online intervention was effective in increasing PA practice and self-efficacy expectations. However, manipulating the body dimensions of avatars did not improve this intervention, although ideal avatars helped to reduce the anxiety experienced during PA in this population.This study was funded by "INTERSABIAS" project (PROMETEO/2018/110, Conselleria d'Educacion, Investigacio, Cultura i Esport de la Generalitat Valenciana) and by CIBER of Physiopathology of Obesity Nutrition, an initiative of ISCII (ISCII CB0603/0052).Navarro, J.; Cebolla, A.; Llorens Rodríguez, R.; Borrego, A.; Baños, RM. (2020). Manipulating Self-Avatar Body Dimensions in Virtual Worlds to Complement an Internet-Delivered Intervention to Increase Physical Activity in Overweight Women. International Journal of Environmental research and Public Health (Online). 17(11):1-14. https://doi.org/10.3390/ijerph17114045S1141711Ding, D., Lawson, K. D., Kolbe-Alexander, T. L., Finkelstein, E. A., Katzmarzyk, P. T., van Mechelen, W., & Pratt, M. (2016). 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Using Avatars to Model Weight Loss Behaviors: Participant Attitudes and Technology Development. Journal of Diabetes Science and Technology, 7(4), 1057-1065. doi:10.1177/193229681300700430Petkova, V. I., & Ehrsson, H. H. (2008). If I Were You: Perceptual Illusion of Body Swapping. PLoS ONE, 3(12), e3832. doi:10.1371/journal.pone.0003832Serino, S., Scarpina, F., Keizer, A., Pedroli, E., Dakanalis, A., Castelnuovo, G., … Riva, G. (2016). A Novel Technique for Improving Bodily Experience in a Non-operable Super–Super Obesity Case. Frontiers in Psychology, 7. doi:10.3389/fpsyg.2016.00837Song, H., Kim, J., & Lee, K. M. (2014). Virtual vs. real body in exergames: Reducing social physique anxiety in exercise experiences. Computers in Human Behavior, 36, 282-285. doi:10.1016/j.chb.2014.03.059Bandura, A. (1986). The Explanatory and Predictive Scope of Self-Efficacy Theory. Journal of Social and Clinical Psychology, 4(3), 359-373. doi:10.1521/jscp.1986.4.3.359Ng, Y.-L., Ma, F., Ho, F. K., Ip, P., & Fu, K. (2019). Effectiveness of virtual and augmented reality-enhanced exercise on physical activity, psychological outcomes, and physical performance: A systematic review and meta-analysis of randomized controlled trials. Computers in Human Behavior, 99, 278-291. doi:10.1016/j.chb.2019.05.026Peña, J., Khan, S., & Alexopoulos, C. (2016). I Am What I See: How Avatar and Opponent Agent Body Size Affects Physical Activity Among Men Playing Exergames. Journal of Computer-Mediated Communication, 21(3), 195-209. doi:10.1111/jcc4.12151Peña, J., & Kim, E. (2014). Increasing exergame physical activity through self and opponent avatar appearance. Computers in Human Behavior, 41, 262-267. doi:10.1016/j.chb.2014.09.038Li, B. J., Lwin, M. O., & Jung, Y. (2014). Wii, Myself, and Size: The Influence of Proteus Effect and Stereotype Threat on Overweight Children’s Exercise Motivation and Behavior in Exergames. 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J., Taylor, M. J., Cooper, Z., & Fairbum, C. G. (1987). The development and validation of the body shape questionnaire. International Journal of Eating Disorders, 6(4), 485-494. doi:10.1002/1098-108x(198707)6:43.0.co;2-oCRAIG, C. L., MARSHALL, A. L., SJ??STR??M, M., BAUMAN, A. E., BOOTH, M. L., AINSWORTH, B. E., … OJA, P. (2003). International Physical Activity Questionnaire: 12-Country Reliability and Validity. Medicine & Science in Sports & Exercise, 35(8), 1381-1395. doi:10.1249/01.mss.0000078924.61453.fbGauthier, A. P., Lariviere, M., & Young, N. (2009). Psychometric Properties of the IPAQ: A Validation Study in a Sample of Northern Franco-Ontarians. Journal of Physical Activity and Health, 6(s1), S54-S60. doi:10.1123/jpah.6.s1.s54Markland, D., & Tobin, V. (2004). A Modification to the Behavioural Regulation in Exercise Questionnaire to Include an Assessment of Amotivation. Journal of Sport and Exercise Psychology, 26(2), 191-196. doi:10.1123/jsep.26.2.191Deci, E. L., & Ryan, R. 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La realidad virtual en las intervenciones psicológicas con pacientes oncológicos

El objetivo de este trabajo es presentar las principales aportaciones de la Realidad Virtual (RV) en el tratamiento psicológico con pacientes oncológicos, y describir un programa de intervención que utiliza esta tecnología para promover bienestar emocional en pacientes hospitalizados. La RV se presenta como una prometedora herramienta de apoyo al paciente oncológico. Diversos estudios plantean su utilidad para hacer algunos tratamientos médicos más tolerables, para reducir los niveles de distrés y dolor, así como promover mayores niveles de emociones positivas. Se ha empleado principalmente con pacientes ambulatorios, existiendo una menor proporción de propuestas dirigidas al período de hospitalización. La intervención que ha desarrollado nuestro grupo aborda esta condición desde un foco también poco explorado: la promoción de bienestar. Esta intervención se compone de 4 sesiones (módulos de distracción y reminiscencia) implementadas individualmente en la habitación del paciente. Antes y después de cada sesión se evaluó el estado emocional (escalas visuales), la percepción de paso del tiempo (en minutos), de cambio en el estado de ánimo y de satisfacción con el procedimiento. Los resultados iniciales señalan incrementos en las emociones positivas después de cada sesión, existiendo cambios significativos en la primera y tercera sesión. Además, la mayoría de pacientes informó que su estado de ánimo había mejorado después de las sesiones. A partir de estos hallazgos se observa que los entornos virtuales y las tecnologías de la información y la comunicación muestran utilidad no sólo para disminuir el malestar sino también para promover bienestar emocional, especialmente durante períodos de tratamiento y hospitalización

How the COVID-19 pandemic and its consequences affect the presence of and search for meaning of life: a longitudinal study

The presence of meaning in life (PML) and the search for meaning in life (SML) are crucial when facing difficult times. Although several theoretical frameworks have tried to explain the dynamics of meaning in life during adversity, empirical evidence about interactions among both constructs using longitudinal designs is scarce. This study examined the trajectories of both PML and SML during the COVID-19 lockdown period in Spain. In total, 220 adults fulfilled an online survey during two periods: a strict and a relaxed lockdown period. Latent growth models showed that both PML and SML declined slightly during the strict lockdown, but they reached a plateau during the relaxed lockdown. Results also showed that age and having a partner predicted higher PML and lower SML at baseline, whereas being male predicted higher scores on PML. PML and SML were negatively associated at baseline, higher SML at baseline was related to a steeper decreasing PML slope during the strict lockdown, and the PML and SML slopes in the relaxed lockdown period were negatively related. This study contributes to better understanding longitudinal fluctuations of meaning in life in situations of adversity

Perfil psicopatológico de niños con sobrepeso u obesidad en tratamiento de pérdida de peso

The aim of this study was to explore the psychopathological profile of overweight/obese children in treatment for weight loss in a specialized pediatric unit, in comparison with a group of non-overweight/obese children. A sample of 89 children (9 to 16 years-old) was evaluated for the presence of the following psychological variables: depression, anxiety, self-esteem and body satisfaction. The sample consisted of 44 overweight/obese children undergoing weight loss treatment and 45 normal-weight children. Compared to the children with normal weight, the overweight/ obese children presented more body dissatisfaction, lower academic and body self-esteem, and higher levels of anxiety. The variable which best discriminated between the groups was body dissatisfaction. The results support previous studies that have shown the presence of psychopathology in obese children, and the existence of differential psychopathological features.El objetivo de este estudio es explorar el perfil psicopatológico de los niños con obesidad/ sobrepeso que buscan un tratamiento de pérdida de peso en una unidad de pediatría especializada, en comparación con un grupo de niños sin obesidad/sobrepeso. Una muestra de 89 niños (de 9 a 16 años) fueron evaluados en las siguientes variables psicológicas: depresión, ansiedad, autoestima y satisfacción corporal. La muestra estuvo compuesta por 44 niños con obesidad/sobrepeso que estaban en tratamiento de pérdida de peso y 45 niños con peso normal. Comparado con los niños con normopeso, los niños son obesidad/sobrepeso presentaron mayor insatisfacción corporal, baja autoestima académica y corporal, y niveles de ansiedad más altos. La variable que mejor discriminó entre los dos grupos fue la satisfacción corporal. Los resultados apoyan estudios previos que han mostrado que la presencia de psicopatología en niños obesos, y la existencia de características psicopatológicas diferenciales.

Virtual reality versus computer-aided exposure treatments for fear of flying

Evidence is growing that two modalities of computer-based exposure therapies—virtual reality and computer-aided psychotherapy—are effective in treating anxiety disorders, including fear of flying. However, they have not yet been directly compared. The aim of this study was to analyze the efficacy of three computer-based exposure treatments for fear of flying: virtual reality exposure therapy (VRET), computer-aided exposure with a therapist’s (CAE-T) assistance throughout exposure sessions, and self-administered computer-aided exposure (CAE-SA). A total of 60 participants with flying phobia were randomly assigned to VRET, CAE-T, or CAE-SA. Results indicate that the three interventions were effective in reducing fear of flying at posttreatment and at 1-year follow-up; furthermore, there were no significant differences between them in any of the outcome measure. Large within-group effect sizes were found for all three treatment conditions at both posttreatment and at follow-up. The results suggest that therapist involvement might be minimized during computer-based treatments and that CAE can be as effective as VRET in reducing fear of flyin