ABSTRACT. Introduction: Outcomes of private internet and smartphone use on social well-being have been a controversial issue in both public and academic debates. On the one hand, mediated interpersonal communication is acknowledged for improving social connectedness (e.g., Valkenburg & Peter, 2007). On the other hand, mediated interpersonal communication is blamed to increase social isolation (e.g., Turkle, 2011).

Problem: Against this backdrop, the present study assessed both negative and positive outcomes of internet and smartphone use on social well-being in a balanced way. It was examined if private internet and smartphone use is globally reducing or promoting social well-being (RQ1), and which specific negative (RQ2) and positive (RQ3) outcomes of private internet and smartphone use are recog-nized to what extent.

Method: N = 2,000 participants aged 18-69 years (51% male; age: M = 42.71, SD = 13.32) took part in a national online survey in Germany. Participants gave informed consent, provided sociodemographic information, and completed two single item measures assessing the recognized global negative and positive impact of internet and smartphone use on their social well-being (“Altogether, my private internet and smartphone use has a negative/positive effect on my social relations.”; Likert scale response format: 1 = “not at all” to 7 = “to a great extent”). The recognition of specific negative outcomes (e.g., “Internet and/or smartphone use replaces meetings with friends.”) and positive outcomes (e.g., “Via internet and/or smartphone, I keep in touch with long-distance friends.”) were measured with two self-constructed one-dimensional scales (negative: 13 items, Cronbach’s α = .921; positive: 15 items, Cronbach’s α = .903, Likert scale response format: 1 = “not at all” to 5 = “totally agree”). Items were based on previous research (e.g., Burke, Marlow, & Lento, 2010; Caplan, 2002, 2005). Data analysis was conducted with SPSS 24.

Results: Regarding RQ1 that compared negative and positive outcome on a glob-al level, the global positive outcome significantly outweighed the negative (positive: M = 4.13, SD = 1.55; negative: M = 2.31, SD = 1.44; t(1999) = 38.61, p < .001, d = .86). Regarding RQ2 that asked for specific negative outcomes, users most often recognized that their internet and smartphone use more and more frequently replaced meetings with friends (M = 2.08, SD = 1.12), made contacts more superficial (M = 2.05, SD = 1.12), created stress due to constant communication affordances (M = 1.88, SD = 1.06), and interrupted meetings with friends (M = 1.76, SD = 1.00). Regarding RQ3 that asked for specific positive outcomes, users responded that internet and smartphone helped them to stay in contact with long-distance friends (M = 3.64, SD = 1.34), to maintain friendships better (M = 3.09, SD = 1.24), to have more contact with one’s family (M = 2.99, SD = 1.37), and to revive former friendships (M = 2.94, SD = 1.31). A comparison of the two scales’ mean values also showed that the specific positive effects (M = 2.48, SD = 0.85) on social well-being were significantly stronger than the specific negative effects (M = 1.71, SD = 0.74; t(1999) = 43.39, p < .001, d = 0.97).

Conclusion: Cultivating friendships seems to be the most important goal of private internet and smartphone use. In accordance with the Positive Technology approach (Riva et al., 2012) users recognize that internet and smartphone can impede as well as support the cultivation of friendships. Nevertheless, the social benefits of private internet and smartphone use seem to supersede the social costs by far, at least when it comes to subjective evaluations. Experimental and longitudinal studies are necessary to validate these subjective impressions.

ABSTRACT. Ménière’s disease is a condition of the inner ear that can lead to sudden onset of a range of unpleasant and distressing symptoms including (but not limited to): vertigo, tinnitus, ear pressure and hearing loss. In recent years, a number of online support groups have been established to support the ongoing needs of individuals living with this disease (notably through asynchronous discussion forums). However, there has been very little research attention devoted to understanding the online experiences of individuals who use this increasingly popular source of online support. The aim of this study was to explore the experiences of individuals who participate in Ménière’s disease online forums with a view to understanding their motives for participation, perceive benefits and/or disadvantages and in particular how participation can impact on daily living and illness management. Following advertising of the study on a number of Ménière’s disease online discussion forums, a total of 26 individuals (15 females, 11 males aged 17 to 67 years, mean = 46.8) participated in this online asynchronous structured interview study. Participants reported having been living with Ménière’s disease for between 3 months and 20 years, with a mean duration of 6.6 years. The majority (n=22) of participants were from the United Kingdom with the remainder coming from the USA (n=2), Australia (n=1) and Morocco (n=1). On average, participants accessed their online support discussion forum 3 times per week. Responses to a series of open-ended questions were analysed using thematic analysis as per the guidelines set out by Braun & Clarke, (2006). The findings suggested motives for participation included: to learn new information about the disease, to find others in a similar situation, to find emotional support, feeling lonely, to share experiences, to seek advice, to support others, experiencing new symptoms or referred by a health professional. A number of potential advantages were described by the participants: mutual support through information provision and emotional support, reading about the experiences of others and a reduction in perceived isolation. Conversely, several potential disadvantages were noted including: concerns about the credibility and/or accuracy of medical information exchanged online, negative behaviour online, difficulties in forming relationships online, a focus on negative experiences. Respondents were mixed in terms of any potential impact on daily living as a result of participation with the forum with about half explaining that it had made no difference at all. In contrast, others reported that through participation they felt more knowledgeable and confident in their ongoing interactions with health professionals. For some individuals, participation appeared to be linked to an improvement in well-being and ability to cope with the disease on a day to day level. Overall, the findings of this qualitative interview study suggest that participation may bring with it a number of positive benefits and provide new opportunities for individuals living with Ménière’s disease to connect with each other. In addition, for those who experience isolation, participation may serve to alleviate this negative state. In future studies, there is a need to explore using a more longitudinal design how participation may impact on both the illness experience as well as the development and implementation of coping strategies. In addition, future work may usefully consider whether the medical information exchanged between individuals is inaccurate or not. Moreover, regardless of whether this information was deemed inaccurate, little is known about how group participants may act on information provided within online support forums.

ABSTRACT. Introduction: The use of social networking sites (SNSs) is pervasive in contemporary society. Research suggests that social anxiety (SA; the need to conceal self-attributes in social situations) and online privacy concern (OPC; the desire to control access to personal information online) limit people’s engagement in SNS activities involving personal information disclosure. Although related to different cognitions, these two anxieties may elicit similar emotions and behaviours in online SNS contexts. However, personal information disclosure on SNSs occurs in a variety of contexts with different features that may mitigate or exacerbate OPC- and SA-related fears. Thus, the extent to which people high in SA and/or OPC report similar or different emotions, cognitions, and behaviours online may depend on the specific SNS context they are engaging in. The purpose of this study was to investigate the extent to which OPC and/or SA predicted OPC- and SA-related cognitions, emotions, and behaviours during three different SNS contexts: 1) signing up, 2) creating a profile, and 3) interacting with another person on a SNS.

Methods: Online, participants (N = 324) first completed the Social Phobia Inventory (Connor et al, 2000) and an OPC questionnaire (adapted from Buchanan, Paine, Joinson & Reips, 2007). After, they read a scenario description for the first SNS context (i.e., signing up for a SNS). Next, participants rated their level of anxiety and willingness to share personal information in this context. They also completed measures assessing their level of privacy risk and control over personal information during this activity. We used the same order of questionnaires following the second (i.e., profile) and third (i.e., social interaction) context descriptions, except that we added a Brief Fear of Negative Evaluation scale (Carleton et al., 2007).

Results: Bivariate correlations revealed few similarities and several differences in people’s SNS experiences related to their level of OPC and SA. For example, higher OPC—but not higher SA— coincided with significantly greater privacy risk in all SNS contexts. We conducted separate 3 (OPC: low, moderate, high) x 3 (SA: low, moderate, high) x 3 (Context: sign-up, profile, social interaction) ANOVAs for anxiety, willingness, and each of the cognitions. The results indicated that participants’ anxiety, cognitions, and willingness significantly differed between the SNS contexts. These differences were more consistent than those due to OPC or SA group. In fact, OPC and SA did not predict willingness in any of the SNS contexts. Participants high in OPC reported significantly greater anxiety and privacy risk than those moderate and low in OPC; the latter group also reported significantly greater control than people high in OPC. There was a significant interaction between SA-group and SNS context for anxiety. Participants low in SA reported significantly lower anxiety in the profile context than those high and moderate in SA. Participants high in SA reported significantly greater anxiety than participants moderate in SA followed by those low in SA in the social interaction context. Additionally, overall, the SA groups significantly differed in fear of negative evaluation, such that participants high in SA reported more fear of negative evaluation followed by those moderate and then low.

Conclusions: OPC and SA are distinct fears that may deter people from participating in online social activities. However, SNS users’ concerns about and intentions to disclose personal information online may depend more on aspects of the disclosure context (e.g., anonymity, asychronicity, privacy) than individual characteristics, such as OPC and SA. We will discuss the implications of our findings for the development of cognitive-behavioral models of OPC and SA that include online contexts; exposure-based psychotherapies for SA; and SNS design recommendations.

ABSTRACT. Introduction: The use of social networking sites (SNS) holds the potential to enhance users’ social capital and psychological well-being. Through these platforms, users are able to build and maintain relationships by disclosing personal details to others online. However, SNS users conceal aspects of their identity during online social activities due to online privacy concern (OPC) and social anxiety (SA). Researchers have theorized that there are three different types of personal information that people may disclose or conceal on SNSs: self-identifying (e.g., name, date of birth), access (e.g., location, address), and expressive (e.g., personal interests, opinions). However, there is little research demonstrating the validity of this framework for users’ reported concerns about personal information online. Moreover, researchers have yet to investigate the extent to which OPC, SA, and their affective and behavioural outcomes predict users’ concerns about sharing different types of personal information on SNSs. The purpose of this study was to investigate SNS users’ concerns about sharing different personal information and how it relates to key psychological factors influencing self-disclosure online.

Method: University students (N = 324) completed an online survey regarding their concerns about sharing personal information online. Participants first completed an OPC questionnaire (adapted from Buchanan, Paine, Joinson & Reips, 2007) and the Social Phobia Inventory (Connor et al, 2000). Next, participants completed the Information Sensitivity Scale that was developed for the current study. The measure included a list of 29 types of personal information that people can disclose in online activities or social interactions. Participants rated their level of concern about disclosing each type of personal information online. Finally, participants were asked to imagine that they were customizing a personal SNS profile, and to rate their level of anxiety and willingness to share personal identifying information (e.g., name, phone number) and personal characteristic information (e.g., preferences, hobbies) in this context.

Results: An exploratory factor analysis of the Information Sensitivity Scale supported a four-factor solution representing subgroups of personal information: favourable qualities (e.g., sense of humour, agreeable opinions), unfavourable qualities (e.g., failures, controversial opinions), personal access (e.g., address, phone number), and indicators of social status (e.g., age, achievements). We conducted multiple linear regressions to evaluate the role of OPC, SA, anxiety and willingness in predicting participants’ concerns about disclosing each subgroup of personal information. All of the models were statistically significant (p < .001), accounting for 20 – 28% of the variance. Higher SA predicted significantly greater concern about showing favourable (β = .34, p < .001) and unfavourable qualities (β = .37, p < .001) during online social activities. Higher OPC predicted significantly greater concern about sharing favourable qualities (β = .20, p < .001), personal access information (β = .26, p < .001), and indicators of social status (β = .32, p < .001). Greater willingness to disclose personal characteristic information predicted significantly lower concern about showing indicators of social status (β = -.16, p = .005). Higher anxiety while sharing personal characteristic information was related to significantly greater concern of disclosing favourable qualities (β = .17, p = .005); greater anxiety over personal identifying information predicted significantly greater concern about personal access information (β = .21, p = .001).

Conclusion: Our findings suggest that SNS users categorize personal information based on the implications of its disclosure on their social (favourable qualities, unfavourable qualities, indicators of social status) and personal (personal access information) identity online. The extent of these concerns was related to online anxieties, such as OPC and SA. Our findings extend current understanding of factors impacting SNS users’ self-disclosure and relationship quality online.

ABSTRACT. Introduction.

Can immersive virtual reality applications, propelled by commercial interests, turn into life-saving interventions for adolescents and adults with autism spectrum disorder (ASD)? Civilian fatalities at the hands of police are more common in the United States than any other developed country, and these fatalities disproportionately affect people with disabilities (Perry & Carter-Long, 2016). Police departments have aimed to heighten their own autism awareness and safety protocols via training videos, in-person seminars, and informational pamphlets. However, given that 1 in 5 adults with ASD will be stopped and questioned by police before age 21 (Rava, Shattuck, Rast, & Roux, 2016), it is critical to prepare individuals with ASD themselves for police interactions. Existing text-based curricula and educational videos targeted at individuals with ASD rarely involve active participation, reducing generalizability to actual encounters with police. Training that involves direct practice (role-playing) in a simulated real-world situation – such as next-generation mobile immersive virtual reality (VR) – has significant potential to improve police interaction skills more effectively than traditional didactic approaches. Here, we report preliminary results from an ongoing safety and feasibility trial that lays the groundwork for a randomized controlled clinical trial to assess the efficacy of using immersive VR to improve police interaction skills in individuals with ASD (Phase I of an NIH-funded Small Business Technology Transfer project, NIMH 1R44MH115539-01).

Method/Tools.

Floreo, Inc. developed a unique product that pairs a human user and a human monitor, in real time, in the context of a mobile immersive virtual environment that includes interactive police officers and background distractors (Police Safety Module; PSM). Verbal participants with ASD aged 12 to 60 years engaged with Floreo PSM displayed via iPhone in a lightweight head mounted display (HMD). A trained monitor on a linked iPad facilitated one VR session (approximately 8 total minutes of VR, with breaks every 2 minutes; a 3-session safety and feasibility trial will begin in January 2018). After participating, participants rate their experience via the System Usability Scale (SUS), and report any side effects in a qualitative interview.

Results.

Sixteen participants (mean age=16 years, range=12-37 years) with IQs in the average range (mean IQ=102, range=88-120) consented to take part in 1 session of Floreo PSM. All 16 participants were able to complete the entire session, including wearing the HMD, suggesting that immersive VR is highly feasible in this population. There have been no serious adverse effects. One participant reported a mild side effect after the session (headache) that resolved by the time researchers followed up the next day. Critically, inconsistent/contradictory responses in a large percentage (36%) of participants indicated that the initial SUS needed to be modified. Examination of the data showed a strong association between inconsistent/contradictory responses on the SUS and autism symptom severity (Social Communication Questionnaire; Rutter, Bailey, & Lord, 2003), such that individuals with higher SCQ scores were more likely to respond inconsistently than participants with fewer symptoms. The new SUS-ASD was developed with advice from an independent panel of expert clinical psychologists and researchers, and will be valuable for other groups interested in collecting technology usability ratings from adolescents and adults with ASD.

Conclusion.

The initial results of this ongoing Phase I clinical trial suggest that Floreo PSM is safe and feasible for use in verbal adolescents and adults with ASD. Final results of both 1-session and 3-session useability and side effect trials will be reportable by June, 2018. The innovative mobile VR technology used in Floreo PSM could be applied to a variety of social and behavioral needs in ASD, thus holding promise as an inexpensive, flexible, scalable platform for future social and community skills interventions.

ABSTRACT. Autism spectrum encompass a variety of symptoms and clinical features. Of them is a potential deficit in social cognition, as expressed by difficulties detecting social cues, integrating social norms in context, understanding social interactions, engaging in nuanced social behavior, and social withdrawal (APA, 2013; Forgeot D'arc et al. 2016). Intervention programs designed for people with autism spectrum (AS) often include social skills training. However, it remains difficult to reproduce or role play complex social interactions and at the same time be actively engaged in coaching people with AS to facilitate skills generalization. Building on people with AS strengths in perception and information processing (Mottron et al. 2013), the Decoding Social Interaction Tack in VR (DSITinVR) task was developed to be used by mental health professionals to immersed people with AS in five complex social interactions. The first (a party) and last (customers commenting on the physical appearance of a waitress in a bar) social interactions have been used as opportunities to measure how users immersed in virtual reality (VR) (in the case, people with AS) freely decode social interactions. The other three immersions in VR (ordering food in a restaurant, dealing with an intrusive stranger in a bar, and at a bus stop) are used for social skills training. Users are coached by a mental health professional in decoding the social interactions and their contexts, interpret virtual human's emotions and intentions, explore a variety of actions to perform, and decide on which behavior and actions should be applied and practice by the user. All immersions were conducted in a fully immersive and wireless 6-wall CAVE-Like system. A pilot test was conducted to document the acceptability and potential of the DSITinVR task for people suffering from AS. Three adult's males diagnosed with AS disorder without intellectual disability participated in the pilot study. Pre and post application of the program, participants completed validated self-rating tools of social skills documenting pro-social and less efficient social behaviors (also completed independently by their parents), the Social Interaction Self-Statement Test assessing positive and negative thoughts about social interactions, and a behavioral rating of participant's ability to decode social interactions in the first and last immersions in VR. During the training in social skills in VR, users and the professional could take as long as they need and note were systematically written and drawn to visualize the decoding sequence. Results revealed that parents observed an overall increase in pro-social behaviors and a decrease in non-functional social behaviors. Behavioral ratings by the interviewer also suggest an increase in participant's ability to decode social interactions. However, participants noted the opposite, with no change or a worsening of their abilities to behave efficiently in social interactions, a worsening of their thoughts about social interactions. It is hypothesized that participants in the pilot study became more aware of the challenges associated with decoding social interactions, leading to potentially observable changes in behavior and increased sensitivity to potential inadequacies in social interactions. Based on the assessment of AS persons, parents and interviewer, suggestions for modifying the program are proposed, including more immersions dedicated to social skills training, planned practice of skills between sessions, and reframing increase in awareness to avoid sensitization.

ABSTRACT. Online gaming gives the players much fun that it can make them addicted to it. They find it difficult to control their impulses to play, causing problems related to decreased effectiveness of life. Two studies were done to test the use of mindfulness techniques for improving ability to control impulses. For these current studies, thirty young online gamers, consisting of 27 boys and 3 girls, joined mindfulness training. Eight of them being students aged 14-15 years old were involved in Study 1 and twenty-two students aged 19-21 years old were involved in the mindfulness training of the study 2. The training was delivered in eight sessions, each of which took two hours. Before and after the training, the participants were measured with online gaming addition scale and self-control scale. The Manova test showed that mindfulness training could decrease online gaming addiction and improve self-control.

ABSTRACT. In conjunction with the increasing and diversifying effect due to its anchorage in social media, a VR revolution is in march in all spheres of human activity, especially that of the sexual life. According to Market Watch: “By 2025, such adult content (i.e. synthetic pornography) is forecast to be a $1 billion business, the third-biggest virtual-reality sector, after videogames ($1.4 billion) and NFL-related content ($1.23 billion’’ (Booton, 2015). We do not know yet how this will affect our lives but burning questions lurk there: How different from standard pornography is interactive sexual intercourse as mediated by VR? Is there anything like a sexual presence and if so, how can it be measured? Do women and men respond in the same way to virtual sexuality? How does immersive VR will affect the shaping of sexual behavior in the future? Will we be facing the arrival of new VR-related paraphilias? How can we optimally harness this set of technologies to better understand and possibly help sex offenders control themselves? Our symposium comprises four presentations in line with what precedes. First, Sarah Michelle Neveu (Quebec University in Outaouais, Quebec University in Montreal, Philippe-Pinel Institute of Montreal) will help us better understand how CGC-based sexual preference assessment can be used to draw distinct profiles for child molesters and rapists. Second, Joanne-Lucine Rouleau (University of Montreal, Philippe-Pinel Institute of Montreal) will give a talk on how her team developed a series of CGC-based scenarios mimicking the standardized Quinsey audio stimuli for the assessment of child molesters, as well as how an audio-visual strategy is better than a simple audio one in assessing child molesters sexual preferences, using penile plethysmography and eye-tracking in a combined fashion. Thirdly, Jean-Pierre Guay (University of Montreal, Philippe-Pinel Institute of Montreal) will give us a talk about how his team is using VR to study predatory behaviors and especially how possible effects of the dark triad of personality on victim selection can be probed in immersion. Finally, Sara St-Pierre Côté (École des Technologies Supérieures, Philippe-Pinel Institute of Montreal) will address the question of sexual presence and how female and male interactors might differ in the experience of thereof.

ABSTRACT. Deviant sexual preference is the risk factor the most related to prediction of sexual recidivism. The use of virtual reality to assess deviant sexual preference has been investigated in the last ten years at the Virtual Reality Applications in Forensic Psychiatry Lab (VRAFP), at the Philippe-Pinel Institute in Montréal. A multimethod approach is now used, where several variables are simultaneously studied (penile response, cerebral response with qEEG and perceptuo-motor markers), while sex offenders view synthetic virtual characters depicting children and adults. The goal of the presentation is to first present the rationale behind a multimethod approach to evaluate deviant sexual arousal with two models (Extended mind theory and Integrated theory of sexual offending). During the second part of the presentation, results on penile response, perceptuo-motor markers and cerebral responses will be presented. Data collected so far points to the direction of distinct responses according to deviant sexual preferences, i.e. distinct cerebral activity during sexual response when preferred virtual stimuli are shown. The general purpose of this study is to find correlates of deviant sexual preferences that goes beyond the penile response. This study is an example of an integration of research and clinic in a maximum-security facility, where neurosciences and virtual reality are used in fundamental and clinical approaches.

ABSTRACT. The presence of sexual interests towards children remains one of the foremost factors predicting the risk of sexual recidivism and one of the diagnosis criteria for pedophilic disorder. To accomplish this, PPG depends on the ability of stimuli (e.g., visual or audio) to generate erectile responses. This dependence constitutes one of PPG’s strengths and weaknesses, since rigours ethical norms are applied to the use of real images of children and therefore, some of the stimuli currently used, have difficulty in generating valid results caused by a significant rates of invalid PPG profiles. In order to reduce the number of invalid profile, we combined standard audio stimuli with images of computer-generated characters in order to create a new set of audiovisual stimuli capable of producing stronger penile responses than both the audio or visual stimuli presented individually. This modality is composed of eight stimuli, including two neutral stimuli (N), one adult female stimulus (AdultF), one adult male stimulus (AdultM), one sexual assault without violence stimulus against a female child (GNV), one sexual assault without violence stimulus against a male child (BNV), one rape of a female child stimulus (GRape) and one rape of a male child stimulus (BRape). Each of the eight stimuli are composed of six images presented in the first person showing the sexual and non-sexual interactions taking place in the stories. While these images are presented, an audio track is played narrating in the second person the events taking place in the story. Each stimulus is 90 seconds long followed by a 30 second span where no stimuli (audio or visual) are presented. Erectile responses from two groups of participants (sexual offenders against children and non-offenders) were recorded and compared, while they were presented with three blocks of stimuli (audio, visual and audiovisual).To be included in the offender group participants had to have been convicted or had to have admitted to having sexual contact with a 13-year-old or younger child while being at least 16 years old and at least five years older than their victim. Participants in the non-offender group were recruited using an advertisement in a local newspaper. No history of sexual assault, either as the perpetrator or victim, was reported in the comparison group. In this presentation, our results in targeting the increase in the number of valid profiles in the phallometric assessment (PPG) of child molesters will be depicted. Three modalities (audio, visual and audiovisual) were compared using two groups (15 child molesters and 15 control participants). The discriminant validity was promising with a significant interaction between groups and stimuli types showing that the clinical group reacted more strongly to the deviant stimuli while the comparison group reacted to the non-deviant stimuli F(4,84) = 9.78, p ˂ .001. Classification accuracy analysis, using ROC curves, showed that the visual and audiovisual stimuli presented excellent discrimination (AUC = .83 and AUC = .89) while the audio stimuli did not reach significance (AUC = .69). Finally,by comparison to the audio modality, the audiovisual modality resulted in a significantly increase in mm change and in more valid profiles. Our results also suggest that the audiovisual stimuli using computer generated characters are good and ethical alternative to conventional visual stimuli. This study also emphasise the importance of new technologies as a means of enhancing tools already known, whilst maintaining rigorous ethical norms. In conclusion, outcomes of this research, support the use of the audiovisual modality in the assessment of child molesters while warranting and justifying further studies on this important matter.

ABSTRACT. In the field of violent crime and sexual offences, criminal premeditation and victim selection play an important role in the criminal process and explanatory theories regarding the offending process (Proulx, et al., 1999a; Proulx, et al., 1999b). Although much work focuses on criminal premeditation and predation, we know little about the general mechanisms of criminal predation, or more specifically, on the detection of criminal opportunities and the mechanisms used by sexual and violent offenders to identify targets (Black, Woodworth & Porter, in press). Unfortunately, most of the sparse knowledge we have about the psychological processes in general and criminal processes and actions in particular comes from self-reported recollections of past crimes or hypothetical scenarios of potential criminal situations (Baumeister, Vohs, & and Funder, 2007; Exum, Turner & Hartman, 2011). The main objective of this study was to develop a better understanding of the factors influencing perceived vulnerability with virtual reality, especially the possible effects of the dark triad of personality on victim selection. A better understanding of the mechanisms by which offenders identify potential targets could allow for the development of more effective prevention strategies as well as methods to discourage potential offenders.

ABSTRACT. Introduction: The ARViPL laboratory has developed innovative tools to assess sexual preferences in a forensic context. This set of technologies places participants in an immersive 3D cube (CAVE-like system), into a virtual experience, where characters with customizable anatomy are used to draw sexual preferences profiles. This method, although already used for forensic assessment purposes, presents significant technological limitations and needs improvement. The main limitations of the technology, in its current configuration, are a lack of portability, complex analysis of results that requires qualified personnel to interpret the data, as well as a use limited to male individuals.

Objective: The project aims 1) to optimize the use of sexual preference assessment technology through virtual reality using a light and portable head mounted display (HMD) system 2) an automation of the data processing and analysis, 3) the development and testing of sexual stimuli designed for female participants. It also aims 4) at comparing sexual presence (SP) between male and female participants.

Methods: Experimental design: This project is divided into three phases. Since the target population will be non-deviant and the current tool is used to evaluate pedophiles, the first part of this project requires the development of new virtual environments (VE) / characters. This phase will be completed by a validation, which will aim to determine if the developed tools generate a state of sexual arousal/presence in males and females. To reach this goal, we will develop an objective measurement of the SP on women using, among other things, vaginal photoplethysmography. In the second phase, we will evaluate the effects of three levels of immersion on the SP of men and women. In order to achieve this, the VE / avatar / animation combination, selected in the previous phase, will be integrated into three visualization devices (HMD, CAVE, 2D projection). Finally, the last phase is an automation of data processing and analysis through learning algorithms. A method related to the artificial neural-network technique for pattern recognition will be used. It will identify the presence of specific psychophysiological models linked to the SP level. Support vector machines, a technique for solving classification and statistical regression problems, will be used. Measurements: The logic of the approach consists of a triangulation of psychophysiological measures (oculometry, sexual plethysmography and EEGq). Immersive video-oculography is used to measure patterns of saccades and ocular fixations, as well as visuomotor dynamics in virtual immersion. Plethysmography values can help us quantify sexual arousal and EEGq is used to assess electrical activity in different brain regions. This electrical activity will allow for the identification and location of specific rhythms, defining a given psychological state. Analysis: Repeated measures MANOVA analyzes will be carried out for the validation of the device design and to verify the presence of differences of SP between the three different levels of immersion.

Results: Preliminary results of the objective measurement of the SP will be presented.

Conclusion: In conclusion, the HMD integration should facilitate the use of the device in a diversity of clinical contexts. The automation should allow a greatly simplified interpretation of the results for the operator, in addition to a a real-time visualization of the patient’s reactions. This real-time feature would allow us to tailor the virtual experience in reaction to the patient’s psychophysiological responses. Thus, this tool would not only enable the diagnosis of sexual deviancy but also open the door to an innovative treatment technique.

ABSTRACT. Studies have demonstrated a good efficiency of virtual reality technologies in treating anxiety and obsessive compulsive disorders. According to the literature exposure via virtual reality shows an efficiency comparable to that of classic exposure methods, as used in cognitive-behavioural therapy.

With the development of very mobile technologies (smartphone-based helmets, main-ly), a question arises around the advantages and limitations of these techniques in practical therapy.

360 degree images allow for clear pictures to be created, directly related to the patient’s difficulties, and for individualizing the therapeutic targets. This technology however does not provide the same full scope of interactions and navigation a true virtual reali-ty environment would offer.

Our approach is essentially exploratory. It aims at identifying the possibilities and limitations provided by these technologies and their combination, through a case study from our clinical practice (an obsessive compulsive patient).

The patient with whom we have tried our method is 44 years-old and has been diag-nosed with obsessive compulsive disorders (according to DSM-5), her main pattern of obsession being tragedy and misfortune (for herself and those around her). These obsessions go together with mental and behavioural compulsions (aimed at averting the tragedies). She is also showing avoidance to all stimuli evoking death. She has been followed for about 18 months within our therapeutic programme designed for OCD treatments. In this programme we have already done psychoeducation, as well as in vivo exposures with reply prevention following a hierarchy established with her cooperation. Death has already been addressed in the context of the exposure but remains a major obstacle for the patient.

An immersion test with a non activating environment for the patient has been done in order to ensure she is receptive to this technology. A neutral picture has been shown to her, a picture taken with the same camera as the one used for the therapeutic targets. The following material has been used: Giroptic Camera 360 Cam, Archos VR Glasses helmet, Huawei P10 smartphone. Results are still being collected. According to our clinical observations, 360° pictures individualize the exposures, while VR might generalize them. This could show the complementarity of the technologies in order to achieve the therapeutic objectives. The following question arises: Is the combination of these technologies the key to better sustain the benefits of therapeutic gains in the long run?

ABSTRACT. Mass causality incidents can suddenly leave large numbers needing treatment for post-traumatic stress disorder (PTSD). Those needing treatment are not restricted to immediate victims but include bystanders, responders and families. Exposure therapy is the most evidenced treatment for PTSD, yet treatment outcome, including drop-out rate, is largely dependent on engagement. Too little engagement limits learning, excise engagement might retraumatise. Virtual Reality Exposure Therapy (VRET) has been hailed as potentially more engaging to resistant populations and being delivered via a computer, offers an alternative method of controlling stimuli. Yet it efficacy is proving harder to demonstrate in treatment of PTSD than it is in phobia. Our standpoint is that current technologies and practice might encourage clients to “go it alone” too quickly, by replacing view of therapist and real surrounding by simulation from the outset. Furthermore, to respond to treatment needs of mass causality incidents, tailoring of stimuli, deployment, training and use all need to be timely, routine and scalable. The UK has had five mass causality incidents in the past year: a major fire in a tower block; and four terror attacks. The Manchester Resilience Hub has been set up to support victims of the Manchester Arena bombing. Given scale of need it is looking for more efficient methods of delivering exposure therapy, especially for those who prove resistant to conventional treatment. This paper describes a novel approach to VRET and its appraisal by this team for potential use with this cohort. The approach attempts to better fit the way therapists currently work with clients than that provided by conventional VRET. It also provides a solution that is far cheaper, can be deployed in a clinic or hospital with tailored stimuli very quickly and requires little training, setup or maintenance. The approach delivers surround pictures and videos of the trauma site on mobile phones that can be held in the hand or put within head mounted displays. It allows level of engagement to be managed through graduating that of immersion and emotive nature of stimuli across a course of treatment. Through such an approach, the client might stay grounded in safety offered by view of present environment and therapist until ready to “go it alone” in the headset.

ABSTRACT. Dental procedural pain and anxiety are problems that hit a conspicuous part of the population and may lead to a decrease of frequency of dental care. This is a problem that hits not only the patient, who, avoiding the figure of the dentist, goes to the attention of the professional when the situation is often desperate, but even the dentist, who has to face a certain resistance from the patient while doing his work. Some professionals use hypnosis to reduce the levels of anxiety and/or pain in the patient who is about to undergo dental care, but the hypnotizability must count on a high level of imagination from the patient, and even the operator has to be very skilled in inducing dissociation from the anxiogenic situation. The aim of this study is to demonstrate that, through the use of virtual reality (VR), it is possible to accomplish good results in terms of dissociation and, consequently, to reduce the levels of anxiety in the subjects who are about to be operated by the dentist. The Virtual Reality has been demonstrated to be capable to produce this results, by “distracting” the individual from the surroundings, and thus obtaining a decrease of the anxiety feelings. To achieve dissociation from the annoying stimuli associated with the dental care procedures and consequently reduce the intensity of the anxiety, a group of 7 patients have been requested to wear a VR headset in which was displayed an immersive virtual 3D world, during the intervention of the dentist. The training consisted in the exploration of a virtual environment, that has been created with the specific purpose to elicit relaxation and pain distraction. The intensity of anxiety has been assessed before and after the treatment through the registration of heart rate and through the use of the following tests: the Dental Anxiety Scale of Corah, Subjective Units of Distress Scale, State-Trait Anxiety Inventory and Beck Depression Inventory-II. Also, heart rate has been specifically registered even during the treatment, to monitore the progresses in the relaxation process of the subject. After the training has been outlined how, in all the patients, the perception of the anxiety has decreased significantly, therefore partial results are encouraging and demonstrate how useful and safe can the VR treatment be even in this specific field.

ABSTRACT. Introduction: Flying Phobia (FP) is a common and disabling disorder, showing a prevalence rate around 2.5% of the adult population. The treatment of choice for FP is in vivo exposure; however, it presents difficulties in its application, such as low treatment acceptance by patients, the limited access to the feared stimulus, among others. The use of computer-assisted exposure programs for evoking phobic stimuli configurations can help in this task and overcome some of its limitations. Virtual reality has proven its efficacy in treating FP. Furthermore, NO-FEAR Airlines, an Internet-based self-applied treatment program that allows peo-ple with FP to be exposed to images and sounds related to their phobic fears on a standard personal computer, also has proved its efficacy in reducing the symptoms of patients with FP in a recent study. Moreover, the program was effective with and without therapist guidance. However, in this study the degree of immersion and sense of presence of the images was not taken into account. Thus, this work presents the protocol study describing the plan to conduct a randomized controlled trial (RCT) to determine the efficacy of this program using two procedures to carry out the exposure: fixed images versus navigable images and, compared to a waiting list control group. Method: A three-armed simple-blind RCT recruiting a minimum of 60 participants will be conducted. Participants will be randomized into 3 experimental conditions: 1) NO-FEAR Airlines with fixed images (N = 20); 2) NO-FEAR Airlines with navigable images (N = 20), and 3) Waiting list control group (N = 20). Four moments of evaluation will be included: pre-treatment, post-treatment and two follow-up periods (3- and 12-month). The treatment protocol has 3 therapeutic components: psychoeducation, exposure and overlearning. Exposure is conducted through 6 scenarios that are composed by images and real sounds related to the flight process. The study is in process of registration at clini-caltrials.gov. Conclusions: We expect that the present work advances in the knowledge of how the degree of immersion of the system can affect the sense of presence and the reality judgment. Differences in treatment efficacy will also be explored as well as the participant’s satisfaction with treatment. The present study would also contribute to improve the dissemination and adherence of evidence-based treatments.

ABSTRACT. Acute Stress Disorder (ASD) was recognized as a disorder in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders. From the revised edition of the DSM-IV, it was identified through symptoms of posttraumatic stress disorder (PTSD). This first diagnosis describes stress responses within the first month after experiencing a traumatic event, where symptoms associated with PTSD are included, specifically symptoms of re-experiencing, avoidance and activation. The main difference considered among the diagnostic criteria for both disorders, in addition to the elapsed time, are some dissociative symptoms included in ASD.

 A more recent model for ASD is described in DSM-V, which is classified in the Trauma and Stress-related Disorders category. The proposed changes are focused on categories or diagnostic criteria, which highlights the fact that they are no longer necessary the characteristic dissociative symptoms, which were emphasized in the DSM-IV. Under the new definition, it is required to have at least 9 of the 14 intrusive symptoms described in criterion B, where the symptoms associated with the previous four clusters (re-experiencing, avoidance, activation and dissociative symptoms) are included; for example, individuals who experienced a traumatic event can experience a number of stress responses as a result of trauma, where they may or may not present dissociative symptoms. From this approach, there have been several studies conducted to identify in what grade ASD can predict PTSD related symptomatology. Although most studies showed that most cases with ASD developed PTSD in the future, it was also found that not all individuals who had PTSD had previously showed ASD. In recent studies, it was found that by downplaying dissociative symptoms, significantly increases the power of prediction of ASD over PTSD, also, through the diagnosis of DSM-V for ASD, there is a greater ability to identify those individuals who are at risk of developing PTSD, and it suggests that the new diagnostic criteria for ASD is very useful to offer early interventions and prevent the development of PTSD.

 As part of the most effective psychological treatments for trauma-related disorders, several rigorous controlled studies have found that cognitive-behavioral therapy, predominantly the exposure technique, constitutes the most appropriate therapeutic intervention. Thus, the program of prolonged exposure developed by Foa and Rothbaum (1998), being the intervention with more empirical evidence, is to relive the traumatic event, or to evoke associated memories through different stimuli, to achieve an emotional processing of it.

In the last two decades exposure therapy using Virtual Reality (VR) has increased significantly, particularly in the treatment of different anxiety and trauma-related disorders. The therapeutic goals of these programs are based on behavioral therapy, which focuses on exposing the patient to virtual environments that simulate feared situations in real life; through these programs, systematic exposure to stimuli related with relevant feared situations that cause significant anxiety is performed. One of the most studied application fields of VR within the psychological treatments has been focused in trauma-related disorders, directed toward PTSD.

The present paper describes the initial results of the implementation and evaluation of a cognitive-behavioral program by using the exposure technique for ASD in earthquake victims, where it is expected that the proposed treatment serves as an early intervention preventing the development of PTSD in people at risk. The treatment program consisted in a cognitive-behavioral therapy composed of 6 to 8 weekly sessions, focused on prolonged exposure. As an auxiliary to the tasks of in vivo exposure, virtual environments simulating areas of Mexico City were used, in which situations that the participants avoided were presented. In the paper we present the preliminary data of case studies, in which the participants were evaluated before and after the treatment with follow-up measures, in addition anxiety measures during the exposure sessions are presented. As there were no virtual environments focused on earthquakes, there were important limitations to conduct the exposure sessions, so the component of exposure to traumatic memories was applied by imagination, being the traditional technique. Considering the limitations and the positive initial results, it is expected to propose the development of new earthquake-related virtual environments to conduct exposure therapy in ASD.

ABSTRACT. Post Traumatic Stress Disorder (PTSD) is a significant problem in warriors returning from combat in Iraq and Afghanistan and also for combat veterans who have left the military. One recent study completed by the National Institute of Health, in 2009, identified 11% of Afghanistan veterans and 20% of veterans returning from Iraq as being diagnosed with PTSD. Several reports have recommended that the Department of Defense (DoD) and the Veterans Administration (VA) should aggressively develop early intervention strategies and treatments for preventing and treating PTSD.

Virtual Reality Graded Exposure Therapy with arousal control (VR-GET) is a promising, patient centered “strategy” and intervention that has been evaluated in active-duty service members as an early intervention treatment for warriors, diagnosed with combat-related PTSD and having been successfully treated within months of having returned to the United States from the combat theater. VR-GET utilizes three laptop computers to "expose" a participant to various computer-game grade combat environments where the participate engages in combat and the participant "moves" through the combat environments with the assistance of a hand held device. While "immersed" in the combat environment, the participant's breath rates, heart rates, skin conductance and peripheral temperatures are monitored. Utilizing the principles of of Exposure Therapy, the outcome of VR-GET is for the participant to gain control over their intrusive thoughts and feelings and for the participant to learn to tolerate events of stimuli that are associated with startles responses, hyper-arousability, nightmares and/or intrusive anxiety.

In this report, we describe the outcome, of only the second treatment case, of VR-GET for the treatment of combat-related PTSD, in a warrior who experienced no treatment for his PTSD during the multiple years following his return from his last combat duty. Utilizing VR-GET, this warrior was able to decrease his PTSD severity by 31% as measured by the PCL-5.

Keeping in mind the limitations inherient in the report of single case clinical studies, with the possibility that Virtual Reality Therapy and VR-GET can assist with reducing combat-related PTSD symptom severity many years after a combat tour or combat tours, VR-GET needs to be assessed more inclusively. Such an assessment may lead to the inclusion of Virtual Reality Therapy and VR-GET as being “strategies” that DOD and VA could adopt to improve the mental health care engagement and treatment for veterans needing services for PTSD. Lastly, during CYPSY23,VR-GET treatment limitations and treatment insights, gained from our discussion with our participant, will be presented.

ABSTRACT. Results from a pilot study on the use of virtual reality (VR) to treat snake phobia demonstrated that exposure is an effective therapeutic tool applicable to group settings. VR has demonstrated efficacy rates comparable to in vivo exposure and offers an interesting alternative to treat snake phobia. This study aimed at verifying if the skills acquired when treated in a group setting environment were retained after 3 months following exposure. A total of 6 participants who met the diagnostic criteria for snake phobia completed 8 two-hour cognitive-behavioural treatment sessions. During the exposure session, participants were randomly immersed one at a time in VR for 10 minutes while the others watched the client and the virtual environment projected on a large screen. All participants rated their anxiety levels (%) every 5 minutes. Fear, avoidance of snakes and self-efficacy were measured before and after each session. Questionnaires were also administrated after 3 months of exposure. Immersion in VR demonstrated significant positive changes within session even when not immersed in VR. Overall, treatment was also associated with a significant improvement in phobic symptoms for 5 participants. Even though this study was completed with a limited number of participants, it deserves duplication as acquired skills were retained for 5 participants after 3 months of initial exposure.

ABSTRACT. Context: Recent studies have revealed virtual reality (VR) is safe and can be useful in the treatment of psychosis, in combination with other therapeutic approaches such as pharmacotherapy. The main therapeutic applications of VR for people presenting psychotic features focus on social skills training, AVATAR therapy or cognitive behavior therapy combined with VR that facilitates cognitive restructuring, exposure or cognitive training. The possibilities afforded with VR are multiple and other applications also deserve considerations. One example is mindfulness-based interventions, which shows a growing interest and support. Objective: The long term goal of this research is to propose a treatment program that would allow people presenting first episodes of psychosis to practice mindfulness skills in virtual environments depicting progressively challenging day to day activities and stressors. The more humble aim of the current project is to assess the acceptability and feasibility of a few sessions combining mindfulness-based interventions for schizophrenia and immersions in VR. For this poster, we will present the treatment manual and results from our pilot patients. Method: The sample consist of five participants suffering from schizophrenia recruited from a first episode psychosis clinic. The mindfulness-based intervention program proposes five 60-minute sessions. Participants are invited to practice mindfulness skills in a virtual restaurant depicting everyday life situations that can be challenging for patients suffering from schizophrenia. The therapist: (a) coaches and supports the participants in learning the skills before the immersion, (b) helps the patient through guided-mastery techniques to apply the skills in progressively challenging VR immersions, (c) provides post-immersions feedback to improve patient’s awareness of the situation and how to apply the skills, and (d) facilitates generalisation through examples of how to apply the skills between sessions. To document acceptability and feasibility, measures of cybersickness, treatment satisfaction, working alliance, psychological distress and recovery are gathered throughout the application of the program. Patients’ and therapist’s impressions are systematically collected after each session. For this descriptive case study, analyses will consist only in reporting descriptive results. No inferential analyses will be conducted given nature of the study protocol. Discussion: This study is required to provide empirical data from patient’s experience to guide the development of a VR-assisted mindfulness-based intervention for schizophrenia. Results will facilitate modification of the program and preparation of grant proposals for efficacy and effectiveness studies were the impact of the proposed intervention on psychotic symptoms will be rigorously assessed.

ABSTRACT. Abstract. In the last decades, mainly in Primary Care (PC), Brazil has witnessed a significant increase in the prevalence of patients with multimorbidity. Multimorbidity refers to the presence of multiple chronic condition or diseases in a single person. One of the main consequences is the poor health-related quality of life. In the last decade, mindfulness-based interventions (MBI) have showed to be an evidence-based approach to increase quality of life and promote mental health in patients with specific chronic conditions such as depression, anxiety and chronic pain. In parallel, recently, the number of clinical centers that use immersive technology, such as virtual reality, has grown, aiming to improve their medical treatment efficacy. Our hypothesis is that MBI in association with immersive technology may contribute to a better quality of life and mental health of patients with Multimorbidity (MM). Objective: to verify the feasibility and preliminary efficacy of the application of MBI enhanced by immersion technology - virtual reality (VR) - to improve the quality of life of patients with MM in PC through two innovative studies: Study 1- A pilot controlled (waiting-list) and randomized study will validate a Mindfulness-based Health Promotion (MBHP) program delivered with VR (MBHP-RV) in a non-clinical population (college students recruited from the Universidade Federal de Sao Paulo (UNIFESP); and Study 2- a randomized controlled clinical trial will evaluate the efficacy of MBHP-RV in patients with MM recruited from PC facilities in city of Sao Paulo, Brazil; with 3 experimental groups: a) patients with MM under usual care (TAU) (control group), versus b) patients with MM treated with MBHP-VR (TAU + MBHP-VR), versus c) patients with MM Multimorbidity treated with face-to-face MBHP (TAU + MBHP). As a primary outcome, quality of life will be assessed (SF-36), and as a secondary outcome depression and anxiety symptoms will be assessed (HADS). Mindfulness level will be considered as an explanatory variable. The relevance of this study is explained by the fact that multimorbidity are very common in the population notably in major adults and PC patients, with increasing costs and an absence of efficacious approaches for this complex public health challenge.

ABSTRACT. Introduction: Depressive disorders are an important public health problem. In 2020 these disorders will become the second cause of disability in the world. Different stud-ies have reported that depression prevalence in Spanish Primary Care is between 13.9 and 29% and a 60% of depressed people are attended in primary care. Although only 5-10% of the patients are referred to mental health services, these are collapsed. The main problem in offering psychotherapy in primary care is the lack of time. Also, empirical support protocols are long, consisting of at least 12 to 16 weekly sessions. For this reason, brief psychotherapies seem to be an alternative that have proven to be effective. Furthermore, a number of systematic reviews have shown that Internet-based treatments are efficacious. Meta-analyses studies have also revealed that these protocols produce higher effect sizes compared to control groups and, that they are as efficacious as face-to-face traditional treatments. Mindfulness-based interventions, specifically, have shown efficacy in reducing anxious and depressive symptoms. This work presents the protocol study describing the plan to conduct a randomized controlled trial (RCT) to compare the effectiveness of a Brief Mindfulness Intervention applied in two different ways (group format face to face condition and individually applied Internet-based con-dition) versus a treatment as usual (TAU) condition for mild to moderate depression. A secondary objective is to compare both mindfulness-based interventions (face to face versus online application). Method: The RCT will recruit 120 participants who will be randomly allocated to one of three conditions: a) TAU + mindfulness-based face to face intervention (n=40), b) TAU group (n=40) and c) TAU + mindfulness Internet-based intervention (n=40). Assessment will be administered at pretreatment, post treatment and two follow-up periods (6 and 12 months). The primary outcome measures will be the change in the Patient Health Questionnaire and the Beck Depression Inventory. The Brief Mindfulness protocol has 4 modules: 1) getting to know mindfulness, 2) establishment of formal and informal mindfulness practice, 3) thought management, body scan practice and values, and 4) self-compassion. The study has been registered at clinicaltrials.gov: NCT03034343 (January 24, 2017). Conclusions: Although there are several studies that have studied mindfulness-based interventions for depressed people, this will be the first study testing brief interventions in primary care and including two treatment conditions: online and face to face. This will allow a pilot comparison be-tween both forms of intervention. We expect to provide efficacy data of the face to face brief intervention and its online application in comparison with TAU group. The pre-sent study would be an improvement for dissemination of evidence-based treatments for depression and could also be a way to reduce costs in primary care.

ABSTRACT. In recent years, studies have been increased to evaluate the effectiveness of mindfulness techniques for the treatment of several psychological disorders. Likewise, various adaptations of this third wave cognitive behavior therapy have been made, whether in the number of sessions, the target audience, the modality, etc. The results reported in the literature show that mindfulness techniques have been effective in the treatment of psychological problems derived from stress and anxiety, among others; nevertheless, the application format has been carried out mainly in face-to-face therapy, and there are still few studies that report its effectiveness in internet-assisted treatments (telepsychotherapy). That is why the aim of this study was to validate an adaptation of mindfulness-based stress reduction (MBSR) program for its application in telepsychotherapy. Volunteers of Mexican nationality, who requested psychological assistance for different problems related to stress and anxiety participated. Changes before and after the intervention were evaluated with the Five Facet Mindfulness Questionnaire, Mindful Attention Awareness Scale, Beck Anxiety Inventory, Beck Depression Inventory and Quality of Life Index.  The opinion about the intervention was also evaluated. The intervention consisted of one day of intensive practice and eight sessions adapted to be carried out in telepsychotherapy with the support of a specific online platform, which consists of an evaluation system and an interface for videoconference and chat. The evaluation and psychological intervention was carried out through a virtual office. The therapists received training for the adaptation of the MBSR program to the online modality and received supervision from a therapist with training and experience in that program. The results showed positive changes in the variables evaluated, validating the effectiveness of the intervention. We conclude that the use of technologies such as Internet is an effective tool for the adaptation of face-to-face treatment protocols and the integration of third wave of cognitive behavior therapies in the field of cyberpsychology, allowing these new therapeutic approaches to reach more people. In addition, in this study some limitations were identified which will be discussed.

ABSTRACT. Background. The wildfires on May 1, 2016 in Fort McMurray, Alberta (Canada), destroyed approximately 2,400 homes and buildings and led to massive displacement of approximately 88,000 people. Many individuals faced direct or potential threat to their life or health, or significant losses, and many months later, families were still living through ongoing adversity and uncertainty as they adapted to new or temporary homes, schools and workplaces. Alberta Health Services estimated in August 2016 that mental health staff in the city had received 20,000 referrals since May, compared to 1,200 referrals each year. The overarching aim of this project is to understand the needs of the Fort McMurray population in terms of mental health and to widely disseminate evidence-based tools to promote resilience. More specifically, with this study protocol, we will assess the efficacy of an online self-help intervention targeting post-traumatic resilience on specific symptoms (post-traumatic stress disorder [PTSD], insomnia, depression). Participants and Procedure. 1,510 phone surveys have been conducted in May-July 2017 to assess the prevalence of PTSD, insomnia and depression in the evacuees from the Fort McMurray wildfires (T0). After the survey, 697 participants expressed interest to participate in the longitudinal arm of the study, which will include four in-depth assessments with online questionnaires (T1 to T4) and a diagnostic interview (T1 only). A period of six months will separate all four times of assessment. Participants with post-traumatic stress symptoms (expected n = 150) will be randomised either to the treatment condition (n = 75) or to a waitlist control condition (n = 75) after completion of T2. Participants assigned to the 12-week intervention will complete one additional assessment after having completed the treatment (T2.5). Treatment Description. The treatment is a therapist-assisted self-help online cognitive-behaviour therapy focusing on post-traumatic stress, sleep and mood. It includes 12 sessions of evidence-based psychotherapeutic components, such as psychoeducation about PTSD, sleep and depression; relaxation and mindfulness exercises; prolonged exposure to avoided situations and memories; sleep management strategies (restriction of time in bed, stimulus control, sleep hygiene education); behavioural activation; problem-solving strategies; and cognitive restructuring. Access to the online intervention will last 12 weeks. In order to favour engagement, a small portion of material will be unlocked each week, and access to one module will be accessible after the completion of a previous one. As interaction and feedback has been demonstrated as essential for engagement with online treatment material, the platform will also offer (1) interactive tools (e.g., sleep diary, self-assessments, tools to plan and self-monitor exercises) accessible and useable anytime, and (2) brief regular weekly contacts with a therapist by e-mail or phone, according to the participant’s preference. Data Analyses. Primary outcomes will be post-traumatic, depressive and insomnia symptom severity, measured with validated self-report questionnaires. Secondary outcomes will include cognitive, behavioural and social indicators, as well as general mental health and post-traumatic growth. Several probable moderators of treatment will be examined, including sociodemographic characteristics (e.g., sex/gender, age, ethnicity, identification as a member of a First Nation, income), level of exposure, and continuing stressors (e.g., damages and losses, insurance claims). Foreseen Impacts. If found effective in reducing symptoms, the results of this study have the potential to impact positively the Fort McMurray community. Indeed, a direct and concrete deliverable of this research project will be to provide the community with an extended (at least two years) and free access to the online intervention specifically tailored to this population’s needs. Thereafter, the intervention platform will continue to be hosted on the Laval University servers, allowing for development and improvements, and thus making it readily available in case of another disaster in Canada.

ABSTRACT. Introduction: The head mount display (HMD) is an important equipment for virtual reality therapy, and we can use it to measure human’s behaviors. However, the current HMD has a smaller field of view (FoV) than human’s perceptual abilities. Recently, a sparse peripheral display HMD was suggested to extend the FoV of HMD, and it based on a concept that only a central area of vision required high resolutions and peripheral areas are not. Within line of this idea, we suggested a light emitting diode (LED) based sparse peripheral display HMD, and optimized it for visual search tasks.

Implementation: Eighty LEDs (each right and left side had 40 LEDs) were integrated to the Oculus CV1 (Oculus), and Mini Skinny NeoPixel Digital RGB LED Strip (Adafruit) was used for peripheral area visions. The FoV of HMD was extended from 90° horizontal and 80° vertical to 270° horizontal and 130° vertical. An Arduino Mega (Arduino) was used to control and communication between LEDs and desktop via serial communication. The position of LEDs was tightly matched with VR coordination (Unity) and a color value was also calibrated between the LED and Oculus displays.

Study 1: Thirty-one participants (mean age = 23.65, SD=3.21, female=16) were recruited for this study. We conducted a visual search task that suggested in our previous study (Jang et al., 2016). Eighty-five targets appeared randomly in the polar coordinate system around 240 horizontal and 60 vertical degrees visual area. Participants were asked to press two buttons according to target’s colors. Dependent measures were response time and accuracy. Participants performed three conditions including full sparse LED HMD (40 LEDs per eye), 7 sparse LED HMD (per eye), and original HMD conditions. All conditions were counterbalanced across participants. Result suggested that there was significant main effect of response time on conditions (F (2, 60) = 112.539, p < 0.001, n2 = 0.790), and post hoc analysis suggested the full sparse LED HMD had significant shorter response time than the 7 sparse LED HMD (p < 0.05), and the 7 sparse LED HMD had shorter response time than the original HMD condition (p < 0.0001). The accuracy was not significant different across conditions (p = 0.415), and we couldn’t find any time-accuracy trade off.

Study 2: Second study was designed to determine optimal numbers of LED for the sparse peripheral LED HMD. There conditions were included 7 sparse LED HMD, 3 sparse LED HMD, and 1 sparse LED HMD. Twenty-five participants (mean age = 23.36, SD=1.98, female=7) were recruited for Study 2. We also found a significant main effect of response time (F (2, 48) = 5.349, p < 0.01, n2 = 0.182), and post hoc analysis suggested that 1 sparse LED HMD had longer response time than 3 and 7 sparse LED HMD (all ps < 0.01). However, 3 sparse LED HMD was not significantly different with 7 sparse LED HMD (p = 0.891). The accuracy was not significant different across conditions (p = 0.837) as well.

Discussion: Two experiments suggested that the sparse peripheral LED HMD didn’t required lots of LEDs for the visual search task. We compared 40, 7, 3, and 1 sparse peripheral LED HMDs, and result suggested that 3 sparse peripheral LED HMD may have the best efficacy than other conditions. Our result suggested that only few LEDs can extend our visual field of HMD in the visual search task, and it may have an impact on virtual reality therapy that required a wider FoV. However, we need to extend our visual search task to other types of task in following studies.

ABSTRACT. We present a longitudinal pilot study of presence, comparing low- and high-fidelity virtual environments. We measured presence levels using a presence questionnaire, heart rate, and skin temperature over four sessions. We found no significant difference due to environment fidelity, nor any change in presence over four sessions. Subjective feedback suggests that that using the same tasks in multiple sessions frustrates users, so may also affect participants’ presence assessment.

ABSTRACT. Introduction: Some pioneers suggested that a virtual avatar can be used to treat patients with eating disorders, and it can correct participants’ distorted body image. The distorted body image refers a gap between ideal and perceived body sizes. However, research on this issue has been limited to studies with predefined or standard avatars because of limitation of VR methodologies, and we are not aware how much body changes of virtual avatar can be recognized by healthy adults. To address this issue, the aim of current study was to find perceptually noticeable differences of virtual avatar in healthy adults, and examined potential differences between standard avatars and body size matched avatars.

Method: Twenty-six participants were recruited (M=24.69; SD=1.69) for current study. The experiment was 2 x 2 within subject experiment design: with matched or unmatched body size of avatar; and with increasing or decreasing body size of avatar. In the size-matched condition, a virtual avatar was created based on each participant’s height, shoulder width, belly and pelvis sizes. In the size-unmated condition, standard avatars were used. The measurement of size perception was divided into two blocks: increasing and decreasing, in each block the avatar’s body sizes were randomly suggested from 0% to -+10% with 2% interval. The virtual environment was a small room with a mirror. Participants used a head mounted display to look around an environment and could see the virtual avatar’s body through the mirror. During the VR experiences, participants were asked to observe the virtual avatar in the mirror. To find out the cutoff points of recognizable difference of avatar, participants were asked to answer Yes or No whether they think the avatar’s body size was changed or not.

Pilot Results and Discussion: A key finding of current study was that the noticeable difference of virtual avatar in healthy adults was 5.00% (SD = 1.86) changes. People surely perceive the avatar’s size changes more than this changes, and they can’t recognize smaller changes than this point. These tendencies were same whether avatars were matched with actual sizes or not, and also maintained whether avatar sizes were increased or decreased (all ps > .20). The current results will be an important baseline values of developing programs for people with distorted body perception, and should have follow up studies for people with body image distortion disorders.

ABSTRACT. This paper describes a user study on the MADE Dashboard, our proposed data visualization dashboard that supports educators to inspect and reflect on the emotional states of students using web learning applications. Our goal was to support the system designer, and indirectly also teachers and students. Our dashboard follows affective learning models, and monitors online learner emotions. It uses an open source library that supports tracking of facial features and detection of emotions in real time, identifying six different emotions. We present a user study to determine whether the data visualization graph can be interpreted properly.

ABSTRACT. Procrastination is a persistent problem that affects many university students and is associated with a range of negative outcomes. Despite the ubiquity of academic procrastination, effective interventions to help students deal with their dilatory behaviors are scarce and traditionally offered in a face-to-face format. Standard interventions delivered face-to-face have major downsides such as large resource commitments and the inability to reach a large number of students. Low-cost interventions such as web-based interventions could potentially provide effective alternatives to reach a larger number of students. The purpose of this research is twofold. First, to investigate the efficacy of a Web-based Acceptance and Commitment Therapy (ACT) program to reduce academic procrastination among university students. Second, to study the acceptability and feasibility of the program. The program took place over a period of eight weeks during the Fall 2017 semester. Prior to the program, participants were randomly assigned to either the unguided group or the guided group. Participants from the unguided group had access to all the modules on Day 1 and received only one introductory email at the beginning of the program. Participants from the guided group were given access to a new module each week and received weekly emails. The program included eight modules which were comprised of information about different aspects of procrastination. In addition, each module had brief videos and exercises that participants were invited to complete. Data were collected at the beginning of the program and immediately after the program. Data regarding the acceptability and feasibility of the program were collected after the program. The preliminary sample is comprised of 19 university students (unguided group, n = 10; guided group, n = 9) in Québec (Canada). A mixed ANOVA that examined the effect of the intervention groups (unguided vs guided) and time (pre- vs post-intervention) on academic procrastination was conducted. There was no statistically significant interaction between the intervention groups and time on academic procrastination. The main effect for the intervention groups: F(1, 16) = 4.55, p < .05, η2G = .18 indicated a significant difference between the unguided group (M = 31.22, SD = 6.33) and the guided group (M = 37.56, SD = 6.27) on academic procrastination. The main effect for time: F(1, 16) = 9.73, p < .05, η2G = .14, indicated a significant difference between pre-intervention (M = 37.11, SD = 7.61) and post-intervention (M = 31.67, SD = 8.04) on academic procrastination. Regarding the acceptability and feasibility of the program, results revealed that, in both groups, participants completed on average 6 out of 8 modules. Moreover, an average system usability score of “A” was reported by participants across groups. Findings are discussed in relation to past studies on the efficacy of ACT program to reduce academic procrastination. Limitations of the present study, encountered obstacles, and future developments to enhance the quality of the program and the participant’ engagement in the program are then discussed.

ABSTRACT. Online Psychology students need a professional training that provides them skills and efficiency for dealing with emotional health problems. One of the most challenging and crucial skills that trainers should teach to new therapists is to establish a functional therapeutic relationship with patients. Some authors suggest that a "therapeutic presence" is a predictor of an effective therapeutic relationship (McDonough-Means, Kreitzer, & Bell, 2004). Mindfulness is a meditation practice that involves bringing the practitioner's awareness completely to the present moment without judging or evaluating that experience (Kabat-Zinn, 1990). In recent years, numerous therapists have been exploring the theoretical and practical connections between mindfulness and the therapeutic relationship (Hick & Bien, 2008), including applications in family therapy (Gehart & McCollum, 2008; Lysack, 2008), Acceptance and Commitment and cognitive-behavioral approach (Wilson & Sandoz, 2008). In this sense, the main purpose of this research was the design, development and evaluation of a mobile application for the training of clinical competences (emotional and cognitive empathy, psychological well-being and sense of presence) based on mindfulness techniques. The training program of the app has a five months extension and is grounded in a professional skills model. A pilot study was carried out with 10 undergraduate online psychology students of the last year. The results of the cognitive therapy scale (ETC), by Beck and Young (1980), showed that the participants improved their clinic skills after they accomplish the training program. Likewise, the results of the non-parametric test of Wilcoxon showed differences between the evaluation before and after the training program (z = 2,20; p =, 027). Regarding the satisfaction with the training program, the students considered that it is an innovative training scenario for the development of their clinical skills. Thus, it is pertinent to propose a promising alternative to the lack of professional practice scenarios and, in this way, to get students involved in real scenarios linked to their interests or to the curricular structure itself. In this sense, new perspectives of research and technological development are opened for practical teaching.

ABSTRACT. The Internet has become an important medium through which individuals seek social support. Much research has focused on the use of various social media application for seeking and providing social support, however, less is known about how newer online platforms may be used for this purpose. Live-streaming video applications, such as Twitch.tv or YouTube Live, have recently gained substantial popularity as online media connecting video content streamers and viewers in synchronous interactions. The goal of the present study was to examine the dynamics of social interactions in one of the most popular live-streaming platforms, Twitch.tv, to determine the features that may facilitate the exchange of social support in this context. Three hundred stream channels were randomly selected from the top ten most popular video game titles on Twitch.tv. Samples of chats of 20 min duration were extracted from the live streams of these channels and analyzed for the rate of message posting, message word count, messages directed at other users and the streamer, and the frequency of emotes in messages. A subset of the samples of chat were also analyzed for the message topics (gaming, real-life, community, social support). The above features of the chats were compared against the number of viewers of the stream, active participants of the chat, and the sex of the streamer. The number of stream viewers and active participants was positively correlated with the rate of chat messages and the number of messages directed specifically at another user and at the streamer (@ messages), but negatively correlated with the message word count. Chats from female streamers contained more emotes and messages directed at the streamer than chats from male streamers. The proportion of gaming-related messages was significantly higher in High viewership streams (> 300 viewers) compared to Low viewership streams (< 300 viewers), whereas the proportion of messages related to real-life topics was significantly higher in Low viewership streams. Furthermore, messages on the topic of social support were significantly more frequent in Low than in High viewership streams. Considering the popularity of live-streaming platforms, particularly among the video gaming community, the results of the present study have implications for understanding which features of this online medium may promote social support among users.

ABSTRACT. Mobile health (mHealth) interventions offer an opportunity for many more people to receive treatment for depression in the United States (Mohr, Burns, Schueller, Clarke, & Klinkman, 2016). Importantly, a recent meta-analysis found that mHealth interventions reduced depressive symptoms significantly more than control conditions (Firth et al., 2017). However, psychological well-being is more than the absence of psychopathology; it also includes increased psychological resources (e.g., positive affect, self-acceptance; Sin & Lyubomirsky, 2009).

The current study reviewed research on mHealth interventions to assess their effectiveness in reducing depression and increasing well-being. The review occurred between March 2017 and December 2017 using a combination of the search terms “well-being, depression, and smartphone.” Studies meeting the following criteria were included in analyses: 1) conducted between 2008 (when smartphone apps were developed) and December 2017; 2) randomly assigned participants to a smartphone app or a control group; 3) tested a smartphone app containing empirically-supported treatment components; 4) measured both depression and well-being before and after using the app; and 5) provided pre- and post-means and standard deviations for the intervention and control groups.

We identified 5545 studies with our search terms; 12 studies were selected based on their titles and abstracts; a total of five studies met eligibility criteria and were included in the current study. Of the five eligible studies, two studies compared a smartphone app to a no-treatment control group. Howells et al. (2016) compared a mindfulness-based app to a list-making control app and reported that the mindfulness app significantly reduced depression in comparison to the control app (2p =.03) but not well-being (2p =.003). Roepke et al. (2015) compared two versions of a smartphone app (cognitive behavioral therapy and CBT + positive psychology therapy) to a waitlist control and found that both versions of the app significantly reduced depressive symptoms compared to a waitlist control (Cohen’s d=.67), and that there were no significant differences between the two interventions in reducing depression. Effect sizes were not reported for well-being in this study, but HLM analyses indicated that well-being did not increase significantly for any condition.

Three of the studies compared two treatments for depression. Hoa Ly et al. (2014) compared smartphone-based behavioral activation (BA) to smartphone-based mindfulness. They found that both BA and mindfulness significantly improved depression and there were no significant between-group differences for depression (Cohen’s d=.25) or well-being (Cohen’s d=.05). Hoa Ly et al. (2015) compared a blended treatment of four face-to-face BA sessions plus a smartphone app between sessions to a full BA intervention of ten face-to-face sessions in a non-inferiority trial. They reported that both the blended treatment and the full BA treatment significantly improved depression and that the blended treatment was similar to the full BA treatment for depression (Cohen’s d=.10) and well-being (Cohen’s d=.03) Ivanova et al. (2016) compared a blended internet and smartphone intervention with Acceptance and Commitment Therapy (ACT) components with and without therapist guidance. They reported that guided ACT improved depression at a higher rate than unguided ACT (Cohen’s d=.23).

These results generally support the findings reported by Firth et al. (2017) that smartphone apps reduce depression symptoms. Additionally, these results provide initial evidence that smartphone apps also increase well-being. However, these results should be interpreted cautiously based on the small sample of studies reviewed and the lack of studies comparing an active treatment to a no treatment control group. Therefore, the lack of studies reviewed here suggest a need for further exploration of smartphone apps in improving both depression and well-being.

ABSTRACT. Depression is a debilitating and costly mental health disorder that goes largely untreated in the U.S. (González et al., 2010). One possible solution for reducing this treatment gap is the development and dissemination of technology-based interventions for depression. For example, internet CBT (iCBT) has been found to be an acceptable, efficacious, and cost-effective alternative to traditional therapies (e.g., Andersson & Cuijpers, 2009; Hedman et al., 2014; Bergman Nordgren et al., 2014). Since the development of mobile phone applications in 2008, mobile-based or mHealth interventions have become a topic of interest in depression treatment research. A recent meta-analysis demonstrated that these interventions reduced depression symptoms when compared to control conditions (Firth et al., 2017). However, little is known about how mHealth interventions reduce depressive symptoms. Torous and Firth (2016) proposed that something inherent about using technology may explain how technological interventions produce change, calling this phenomenon the “digital placebo effect.” However, to our knowledge, no study has formally tested this proposed concept in a randomized controlled trial.

Therefore, the current study seeks to explore the digital placebo effect in improving depression by randomizing participants to one of four conditions: 1) using the positive psychology-based smartphone application Happify daily for three weeks; 2) completing positive psychology interventions without using an app for three weeks; 3) using the mood-tracking app Daily Mood Tracker, which does not have any positive psychology components, for three weeks; or a 4) waitlist control for three weeks. This methodology will allow conclusions to be drawn about whether the active ingredients of the intervention produces depression symptom reduction, or whether something inherent about using an app produces these changes. Additionally, having a waitlist control group will demonstrate whether Happify, which has not been formally tested in an RCT previously, reduces symptoms of depression. Positive psychology interventions (PPIs) lend themselves well to this methodology because they are simple, require few materials, and do not require a trained clinician (Lyubomirsky & Layous, 2013). Therefore, the PPIs offered in Happify were easily translated to a format that did not require the use of an app. In this study, participants that completed positive psychology interventions without using an app were sent a single-page document in which they were instructed to complete PPIs in a similar way as they would if they were using the app Happify (i.e., the same frequency, duration, and context). Potential moderators and mediators of depression symptom reduction and well-being improvement were also assessed in this study. Therefore, a pre-test assessed demographics, initial depression symptom severity and levels of well-being, and personality characteristics. Daily surveys measured mood, depression, well-being, and whether participants completed the assigned tasks. Depressive symptoms and well-being were also assessed at post-test and at a 1-month follow-up. During the post-test, participants also provided quantitative and qualitative data about their satisfaction with the app.

Participants were recruited from a pool of undergraduate students enrolled in psychology courses at a large, ethnically diverse, public university in Virginia, USA. They were offered class credit as an incentive for participating. The first wave of recruitment and participation began in February 2018 and will be ongoing until May 2018; the second wave will occur in August 2018. In the first wave, 110 participants signed up for the study. Preliminary data from these 110 participants will be analyzed and reported at the conference in June 2018.

ABSTRACT. Background: As cyberbullying becomes an increasingly pervasive issue among adolescents, more research is needed to better understand its associated risk factors. The current study examined the relationship between aggression, resistance to peer influence, school belonging, and cyberbullying. Two Research Questions guided this work: 1) Are aggression, resistance to peer influence, and school belonging associated with cyberbullying? 2) Does school belonging moderate the relationship between covert aggression and cyberbullying?

Methods: 728 students (47 % girls) from the Lower Mainland of British Columbia aged 11 to 14 years (mean age= 12.43) participated in this research. The majority (70%) of participants were born in Canada with 39% being of Asian descent. Participants self-reported information regarding demographic background, online activity (10 items), school belonging (8 items), aggression (12 items), and the resistance to peer influence scale (20 items). Hierarchical Linear Regression analyses were used to explore the relationship between the dependent variable, cyberbullying, and the independent variables; average hours spent online, resistance to peer influence, school belonging, and covert aggression. The first model (Block 1) included average hours online and the demographic information of gender and ethnicity. Following this, the variable “true to self” from the resistance to peer influence scale, school belonging, and covert aggression were included (Block 2). The interaction between school belonging and covert aggression was examined in the final step (Block 3).

Results: In Block 1, average hours online (β = .134, p = 0.017) and gender (β -.109, p = 0.05) were significantly associated with cyberbullying, accounting for 3.1% of the variance, F (3, 724) = 3.419, p = 0.018. In Block 2, after controlling for demographic variables (Block 1), the variable “true to self” from the resistance to peer influence scale (β = -.142, p = 0.011) and covert aggression (β = .209, p < 0.001) were significantly related to cyberbullying, accounting for 19.3% of the variance, F (3, 721) = 20.990, p < .001. In Block 3, the interaction of covert aggression and school belonging (β = .282, p = 0.46) was positively associated with cyberbullying, accounting for 20.3% of the variance, F (1, 720) = 3.996, p = 0.046.

Significance: Findings indicate that being male and spending more time online is positively associated with cyberbullying. Additionally, over and above demographic factors, covert aggression is positively associated with cyberbullying, such that adolescents who score higher in terms of covert aggression are more likely to be involved in cyberbullying. Contrarily, being true to oneself is negatively related to cyberbullying, suggesting that adolescents who are more "true to self" may be less likely to engage in cyberbullying. Lastly, the relationship between covert aggression and cyberbullying is moderated by school belonging, such that for adolescents who feel isolated, thus with low school belonging scores, covert aggression is more likely to lead to cyberbullying. As such, future research should examine the potential buffering effect of school belonging on the relationship between covert aggression and cyberbullying to help inform policy and prevention programs.

ABSTRACT. Introduction : Social cognition refers to the cognitive processes that are used to perceive, process and understand social cues. Social cognition includes a wide range of abilities, such as moral reasoning (MR), defined as how individuals think about the moral dilemmas and conventions that govern social interactions. Traditional measures of MR have typically relied on written scenarios; however, efforts to improve the ecological validity of such assessments have led to the design of the the Socio-Moral Reasoning Aptitude Level (So-Moral) task, a visual, computer-based tool using static images of real actors. While this task is effective in the assessment of MR in both clinical and normative populations, it lacks the dynamism, immersion and emotional engagement afforded by advanced technologies such as virtual reality (VR). VR is particularly relevant to the study of MR because it allows participants to react, feel, think and behave as they would in physical reality. Thus, combining the So-Moral with VR has the potential to increase ecological validity by providing experimental conditions that are reasonably similar to those in a real-world environment. The aim of this study was to validate a VR version of the So-Moral task. Hypothesis : It was expected that the So-Moral-VR task would produce similar moral maturity levels as the original computer version, and that moral maturity would be positively associated with sense of presence and immersion. Method : 30 individuals aged between 12 and 25 years (M=17.7, SD=3.6, 13 males) completed both versions of the So-Moral task (computer and VR). Participants were presented with 9 or 10 dilemmas, depending on the version, and were asked to explain how they would react and why, if they were in that situation. Moral morality level was assessed for each dilemma based on a validated cognitive-developmental scale from 0 to 5. Participants also completed sense of presence and immersive tendencies questionnaires. Statistical analyses : Correlation and regression analyses will be performed to investigate the association between moral morality in the So-Moral-VR task, sense of presence and immersion.

ABSTRACT. Neurocognitive disorders such as Alzheimer disease affect each year a large number of Canadians aged over 65 years old. Screening and diagnosing those diseases at an early stage are essentials to implement intervention that could preserve autonomy and life quality as long as possible for affected elderly. Healthcare professional (doctors, nurses, psychologist, etc.) are overwhelmed with technical tasks but technology might be useful to make more efficient the time they spent with patients. The possibility of using a small humanoid robot, the NAO robot, for cognitive screening in elderly is tested through the present study. This possibility has never been explored in previous research, but others studies show that NAO robot is an effective platform to maximise collaboration and acceptance with elderly. A widely used screening test (Mini-mental state evaluation, MMSE) was implemented into the NAO robot. Scores of 36 participants (13 men / 23 women) aged 65 and over, on the MMSE taken two times: 1) with NAO and 2) with human, evaluated one weeks apart (order balanced) were compared. Perceptions and comments of participants concerning the interaction with the NAO robot were taken to look at modifications that can be made for the technology to be more functional. Participants indicated relatively high levels comfort and confidence (M=7,5/10) with the NAO robot but less than with human (M=9,39/10). Non-parametric tests have been used to compare results obtained from NAO robot and from human administrator. Results shows a significant difference between groups (p = 0,000) and a moderately strong correlation between them (r = 0,58, p = 0,000). Influencing factors (such as age, sex, reluctance to use technology, the performance level at the MMSE, the educational level, etc) are explored to understand results and maximise its functioning.

ABSTRACT. In recent decades, an increasing number of studies in psychology and neuropsychology have used Virtual Reality (VR) technologies with different populations. Nevertheless, the scientific literature about VR applications among elderly populations is scarce. There are several explanations for this gap. Elderly people present some psychophysiological differences that may influence their experience with VR, such as anxiety due to lesser familiarity with new technology, cognitive changes in normal aging and age effects on proprioceptive and sensorimotor skills, which are involved in cybersickness symptoms. However, the majority of studies on VR-based cognitive assessments and VR-based psychological interventions made no distinction between young adult and elderly populations, in terms of the type of technology used and duration of immersion. The aim of this study is to compare psychophysiological changes in a sample of elderly and adult subjects during a VR task. A minimum of 40 subjects (elderly: n = 15, 65-85 years; adult: n = 25, 18-35 years) will participate in the study. Each group will have a fully immersive experience (in a CAVE-like system, 6-wall immersive room) and a partially immersive one (using HTC VIVE technology). Participants will explore a virtual apartment and execute some tasks (e.g., reading, moving objects, answering questions, etc.) for 15 minutes. Psychophysiological measures (i.e., cortisol level, skin conductivity and heart rate) and self-reported data (i.e., cybersickness, anxiety, familiarity with technology) will be collected before, during and after the task. We hypothesize that VR immersion will produce different psychophysiological effects on elderly people than on younger adults, and that these differences will negatively influence their experience. The results of this study will help to adapt and increase the effectiveness of VR-based cognitive assessments, VR-based psychological interventions and future research protocols addressing elderly populations.

ABSTRACT. After transplantation of hematopoietic cells, patients require care in a sterile environment to prevent infection. Patients are isolated from the outside world during this period. Medical staff can enter the room to care for the patients and to provide medication; however, even close family members must interact with patients through glass. This situation adds a lot of stress to the patients who are not only anxious about the prognosis but also suffer from the adverse effects of this isolation. For this reason, we planned to develop a mental support system for such patients. As the first step in the development of this system, we interviewed patients in order to accurately grasp their needs, and to be able to create a patient-oriented system rather than a technology-oriented system. The participants were three men in their twenties, fifties, and sixties, and one woman in her forties who had transferred to a class-7 clean room after spending several weeks in a class-5 room. Patients reported that they did not feel like doing anything because of poor physical condition and a lack of vitality for a while after transplant. Before interviewing, we were considered developing a gaming exercise system aiming at both early rehabilitation and distraction from hardship. However, patients said that even if such a system existed, they would not be motivated to use it. When they regained their energy a little, they moved into the class-7 room and had to undergo monotonous rehabilitation therapies. We found that the system we were considering was unnecessary in the sterile room, but in demand after exiting the room. The system required shortly after a medical procedure needs to be more passive, and must not require much energy to use. As such, we proposed interactive videos as an alternative, and asked for comments. We found that this approach was relatively acceptable to patients. The content patients wanted to experience differed widely depending on their mental and physical conditions, life histories, family relationships, interests, and so on. Based on the findings, we developed a system in which patients can manipulate the interactive video, which is either projection mapped on the wall of the ward or presented via head mounted display (HMD) using their own smartphone. Projection mapping can be expected to have the effect of making a patient feel an increased sense of space around them, and a feeling of release. Using the HMDs can provide a sense of immersion, there is a possibility that this could be accepted by the younger generation. However, the HMD can also make its wearer feel restrained. We prepared two kinds of contents. One involved presenting a pre-shot 360-degree video of a scenic spot such as the sea and the mountains, a grassy field with animals, or a crowded street in the city. The patient can look around and zoom in and out with a simple operation. The other type of content involved sharing experiences with people outside the ward. An image from the 360-degree camera taken by the other person is sent to a nearby PC. The screen of this PC and obtained voice is shared with a PC in the ward through the network. Placing the captured image in the virtual space makes it possible to look around and zoom in and out, thereby enabling patients to be virtually present with family, and to participate in family activities like shopping or traveling. Before deploying the developed system to patients, the medical staff evaluated it. As most staff members supported the usefulness of this system, we plan to deploy it to patients as soon as ethics review approval is obtained.

ABSTRACT. Introduction: To examine and analyze the binocular imbalance status of adults, we examined and quantified the binocular imbalance parameters using a novel non-immersive virtual reality system and two different binocular integration stimulus models with different spatial-frequency and temporal-frequency domains. Methods: A retrospective study was conducted to collect subjects with corrected visual acuity greater than 0.8 and without ocular diseases through clinic assessments in Guangdong General Hospital since November 2017. 97 subjects (46 female, 51 male) completed the binocular visual function assessment using a non-immersive virtual reality system. The data of corneal opia, refractive status, and binocular imbalance status were obtained and analyzed by SPSS24.0. Results: We found that the population having binocular imbalance gradually decreased with the increase of spatial frequency in the subjects in the non-immersive virtual reality environment；Under the condition of contrast balance, the subjects more easily manifested a binocular unbalanced state in the horizontal model than the vertical model. In the temporal-frequency model, 29.29% of subjects showed binocular balance, 70.10% showed binocular imbalance, 62.89% showed severe binocular imbalance in the high temporal-frequency condition; while 17.53% of subjects showed binocular balance, 81.46% showed binocular imbalance, and 65.78% showed severe binocular imbalance in the low temporal-frequency condition. The VR is more sensitive for the low temporal-frequency binocular integration stimulus. Conclusion: In the non-immersive virtual reality environment, the binocular balance status of the subjects is not uniformly the same, and there is a large proportion of subjects having binocular imbalance. Our results indicated that the binocular integration stimulus model with different spatial frequencies and different temporal frequencies can detect the binocular imbalance status more accurately, providing a powerful new tool for the diagnosis and analysis of clinical binocular abnormalities.

ABSTRACT. Introduction/Problem: In vast countries such a Canada, the United States and Australia, access to evidence-based treatment is a significant challenge, especially for people living in rural areas. Videoconference technologies has proven its effectiveness as a tool to deliver psychotherapies, especially in the form of cognitive-behavior therapy (CBT), to people suffering from various anxiety disorders. This study is part of a broader multisite randomized trial assessing the effectiveness of CBT for generalized anxiety disorder (GAD) delivered face-to-face (FF) or by videoconference (VC). The present study focuses on patients’ perception of barriers related to access to CBT treatment. To assess patients’ perceptions, our team has developed a self-report questionnaire (Index des Barrières Reliées au Traitement – IBRT) that was inspired by Lingley-Pottie and al. (2011) and Kazdin et al. (1997) scales. It includes 39 items divided in three common and well-documented themes: (a) judgment from the therapist; (b) accessibility and commodity; and (c) stressors and obstacles to treatment. The aim of this study is to compare perceptions of GAD patients about potential barriers to access CBT when delivered FF or using VC systems. Method. A total of 117 adult patients with a primary diagnosis of GAD (mean age = 41.75, s.d. = 15.64), located in five large urban areas, were included in the study. They were randomly assigned to one of the two conditions and received 15 individual weekly sessions of CBT (FF=65; VC=52) delivered according to a standardized and validated manual for GAD. The ADIS-IV semi-structured clinical interview and questionnaires were administered to confirm GAD diagnosis and eligibility to the study. After the first and fifth sessions, motivation and satisfaction toward their treatment was measured. Following the last treatment session, participants completed the IBRT. Outcome measures were administered at pre and post-treatment, and at the 6- and 12-month follow-ups. Results. Outcome measures must be presented, but very briefly, as it is important to ensure the treatment was effective. Treatment efficacy was assessed with repeated measures ANOVAs and showed a significant improvement on all measures for both conditions, with VC being superior on occasions and never inferior to FF on measures of GAD severity, the Penn State Worry Questionnaire, the WHO Quality of life, the Beck Depression Inventory, etc. Independent t-tests were performed for the total score and the subscales of the IBRT and confirmed no significant different difference between the groups (with difference of very small sizes). Repeated measures of ANOVAs revealed a significant increase in motivation and satisfaction (p.<.001) no difference between conditions. Also, significant correlations were found with residualized change scores of improvement on the Penn State, with treatment being more effective when patients are satisfied (r = -.537, p<.001) and motivated toward their therapy (r= -.255, p<.01) at session 5. A positive correlation between the IBRT and Penn State is suggesting that the treatment is more effective when less barriers are reported on the IBRT (r= .218, p<.05). Discussion. Telepsychotherapy seem to be a very promising solution to access mental health services offered by skilled professionals, especially for CBT programs to treat anxiety disorders. Systematic efforts have been conducted to document for whom and under which circumstances VC should be recommended or not, and results are in favor of a widespread dissemination of this treatment modality.

ABSTRACT. Context. Bordin (1979) conceptualizes the working alliance as an agreement between the patient and the therapist on general goals and specific therapeutic tasks of the treatment, as well as the therapeutic bond between them. Previous meta-analyses have shown a relationship between therapeutic alliance and treatment efficacy in general. Cognitive and behaviour changes specific to each anxiety disorder also contribute to predict treatment outcome, over and above the role of the therapeutic alliance. In e-health, several authors suggest that the sense of presence also has an impact on the working alliance in videoconference. But the interplay between telepresence, working alliance and treatment outcome has not yet been experimentally tested. Aim. We examined the moderation effect of telepresence and working alliance on the treatment outcomes following a Cognitive-Behavioural Therapy (CBT) delivered in videoconference for Generalized Anxiety Disorder (GAD). We also examined the mediating role of intolerance of uncertainty on the relationship between working alliance and treatment efficacy. Method. Treatment involved 15 weekly sessions delivered across remote sites to 41 adults diagnosed with GAD. A manualized treatment was offered based on a validated CBT program recommended by the NICE guidelines. Therapists were trained and supervised regularly and therapy was delivered individually (i.e., point-to-point videoconference). Treatment efficacy was confirmed with standard repeated measures ANOVAs comparing pre- to post-treatment and to follow-up. The Telepresence in Videoconference Scale and the Working Alliance Inventory were completed by participants after the fifth session. The degree of change in intolerance of uncertainty from pre- to post-treatment was assessed with the Intolerance of Uncertainty Scale. The Penn State Worry Questionnaire was completed by participants at the pre- and post-treatment and at the 6-month follow-up to assess the degree of change in GAD symptoms. Moderation and mediation analyses were performed using multiple regressions. In order to test the moderation model, we performed multiple regression analyses between the change in GAD symptoms, as the predicted variable, and the telepresence, the working alliance and the interaction term (Telepresence x Therapeutic Alliance) as the predictor variables. Results. Results support the interaction effect of telepresence and working alliance to predict treatment outcomes (β = -.56, p < .01). A closer look at the interaction revealed that working alliance predicts treatment outcomes when the strength of the telepresence is rated as average (t = -2.81 p < .01) and the role of the alliance is even stronger when telepresence is rated as high (t = -3.33, p < .01). The analyses also document the role of intolerance of uncertainty as the primary predictor of change in the CBT of GAD when delivered in videoconference. Conclusion. Results support the importance of telepresence to support the contribution of working alliance to generate a therapeutic change during a CBT delivered in videoconference. Results should be replicated with other mental disorders and other psychotherapeutic approaches.

ABSTRACT. The use of video communications has become increasingly popular as technology has improved. In recent years, therapists have begun to offer telepsychotherapy by videoconference to meet with clients. However, very few scales have been developed to assess clients’ sense of presence during psychotherapy delivered in videoconference. The Telepresence in Videoconference Scale (TVS) was developed and tested over the years, but its psychometric properties have not been formally documented. The aim of this study was to examine the reliability and factor structure of the TVS. Telepresence can be defined as the feeling of being there, in another location, created by the use of video communications technology. A total of 157 participants completed the scale following a videoconference session with a psychotherapist, within the context of four studies. The scale inquired about the participants’ experience during the videoconference (e.g. their interactions with the therapist, whether they felt like they were physically present and actively participating during the session, etc.). The TVS was first submitted to an exploratory factor analysis using the Principal Components method and a Varimax rotation. The KMO and Bartlett test confirmed the factorability of the database (KMO = .72, X2 = 648.65, p < .001). The number of factors to extract was decided based on the convergence of three criteria: minimum eigenvalue, scree-test, and interpretability of the factor structure. Some items were removed in the process, to produce the final 7-item version of the TVS. Three factors were found: ‘’Physical Presence’’ (items 1, 2, and 3 of the scale), ‘’Interaction’’ (items 4 and 5), and ‘’Absorption’’ (items 6 and 7 of the final version of the scale). All items loaded clearly (> .70) on only one factor and the final factor solution explaining 84.86% of the variance. Inter-item correlations and Cronbach’s alpha were conducted to measure the internal consistency of the scale (alpha = .80). Discriminant validity and convergent validity were assessed with the Immersive Tendencies Questionnaire (r = .0, ns) and the Distance Communication Comfort Scale (r = -.25, p < .01 for comfort with face to face communications, r = .17, p < .05 for telephone communications, and r = .42, p < .01 for videoconference communications). The average score was 57.18% (SD = 21.07) and differences were found between genders only on the Absorption subscale, with males feeling more absorbed than females (t(153) = 2.67, p < .01). The correlation with age was non-significant (r = .15). In conclusion, the results suggest that this revised version of the Telepresence in Videoconference Scale is a reliable and valid tool to measure clients’ sense of presence during a videoconference session with a therapist. Future research could examine whether this scale may be used in different contexts and with different populations.

ABSTRACT. Therapeutic rapport is considered a fundamental part of the therapeutic interaction process, and highly related to successful therapeutic outcomes. Rapport can be defined as “the spontaneous, conscious feeling of harmonious responsiveness that promotes the development of a constructive therapeutic alliance” (Sadock, Sadock, Ruiz, & Kaplan, 2007, p.1). An integral part of therapeutic rapport is empathy, which is especially linked to nonverbal communication behavior, that is, the variety of communicative behaviors that do not carry linguistic content. These include eye contact, gaze direction, head nods, facial expressions, more general bodily behavior (e.g., postural position, postural synchrony, social touch) and paralinguistic cues (e.g., intonation, fluency, loudness, stress patterns).

With the introduction of communication technologies in psychotherapeutic practice, many practitioners have doubts whether mediated interactions sufficiently support the expression and reception of empathy, and the consequent development and maintenance of therapeutic rapport. Despite empirical findings that mediated communications may allow for similar levels of therapeutic rapport as unmediated settings, at least from the perspective of clients, therapists still report that ‘something’ is missing. This feeling seems to originate in having access to fewer social cues in mediated interaction. In addition, technological issues and risk of distraction may negatively impact the feeling of closeness and rapport. The aim of the current paper is to review and explore in what ways novel communication technologies can be used to improve empathy in therapeutic interactions, and ameliorate some of the associated perceived drawbacks of mediated settings.

In general, in order to support and enhance empathic interactions in mediated settings, two different approaches can be distinguished. One approach is to support or simulate face-to-face interactions as closely as possible, thereby attempting to overcome limitations imposed by the medium (e.g., supporting eye contact, or conveying gesture awareness). A second, complementary approach is to use unique affordances of the medium to transform the interaction into something that could add value above and beyond what would be possible in an unmediated encounter. This type of approach was argued for by Hollan and Stornetta already 25 years ago in their key 1992 CHI paper “Beyond being there”.

When applying this second approach to establishing empathic interactions in a clinical context, there are a variety of opportunities being offered by technologies currently used or proposed in psychotherapeutic settings. These opportunities arise as a consequence of the development of various new sensors and actuators for measuring and representing social and affective cues. In addition, the mediated nature of the interaction allows for the control and transformation of the communicated social and affective cues. Technology can add additional relevant information during therapy that would normally be unavailable, even in a face-to-face setting. One example is social biofeedback, which can make implicit socio-emotional information explicit. Indeed, first exploratory studies have shown that using physiological feedback as a communication cue significantly enhances empathic interaction. Another example is virtual reality, which offers the possibility to create shared virtual environments, which enables novel transformations that may augment the interaction, such as non-zero sum gaze.

In short, improving the use of social interaction technologies in therapeutic settings can be approached in two complementary ways: by ameliorating or repairing shortcomings in the communication technology, and/or by extending or enriching the current gamut of mediated social interaction. In a full paper, we will elaborate on the various possibilities with a more systematic review. Irrespective of the approach, the eventual goal is to support and enhance empathic interactions and rapport in therapeutic settings, and thereby improve current mental healthcare practice, which will benefit both professionals and clients.

ABSTRACT. Context:

Assessing the efficacy of online psychotherapies is an important issue in telepsychology. Our first study aimed to compare the efficacy of telepsychotherapies in videoconference in two different theoretical frameworks: cognitive-behavior therapy and psychodynamic. It also aimed to focus on telepresence as an indicator of intersubjectivity co-constructed online. The specific goal of the project is to assess acceptance of the technological setting by patients and its influence on the interactions between patients and psychologists. Previous researches show that telepresence predicts the strenght of the therapeutic relationship and suggest that telepresence should predict intersubjectivity. We propose an analysis of videorecordings of psychotherapy sessions to explore if a low level of telepresence / intersubjectivity would be an indicator of the breaks in acceptance of the telepsychotherapy setting, and if there are “communicational regularities” related to these breaks.

Methods :

We approached the problem from the phenomenology of breaks in acceptance. We considered that breaks in acceptance of the setting were easier to identify than overall acceptance; as acceptance involves factors that vary based on various reasons (psychotherapeutic method, mental state of the patient, etc), but breaks or ruptures in acceptance can be measured in session and are most likely to be caused by events occurring during the session. We took 4 cases from a sample of adult subjects who were not suffering of a psychotic disorder and expressed breaks in acceptance of the setting in videoconference telepsychotherapy. 2 cases were taken from CBT and 2 others from psychodynamic telepsychotherapies. The therapists selected the cases and all therapy sessions were videorecorded. We analysed the first sessions of videoconference telepsychotherapies. One external judge then watched the sessions and selected the segments considered to be significant in terms of breaking of intersubjectivity, therapeutic alliance, and likely breaking telepresence. We used items from the telepresence in videoconference scale in hetero evaluation to analyse the selected segments, in order to assess physical presence and social presence. As we wanted to find “communicational regularities” that were independent of the therapeutical approach, we looked at verbal and non-verbal interactions rather than the use of specific psychotherapeutic methods. This led us to the observation of the intersubjective level of the interactions, with the enonciative co-presence dimension.

Results :

Codification of the therapy sessions is still in progress and will be completed in six weeks. Preliminary impressions from the coders confirm we will be able to define and understand better some reasons of the breaks in acceptance of videoconference telepsychology. We will consider the fact that breaks in telepresence and working alliance also mean a continuation of the relationships in another framework (i.e., a return to non mediated traditional face-to-face psychotherapy communication settings). Working on the limits of telepsychotherapy framework can be useful to enhance quality of interactions with the media and the setting itself. It will also help to understand the different levels of interactions between users and their links with telepresence.

Conclusion :

This study on breaks in acceptance and their motivations is the first step towards a better evaluation of the level of acceptance of the technological setting by patients and its influence on the interactions between patients and psychologists. The results of this study are useful to guide future projects on the co-creation of shared subjectivity in telepsychotherapy. These results might also be helpful to improve the quality of videoconference telepsychotherapies, for example in the creation of guidelines and quality standards.

ABSTRACT. Anxiety and depression are highly prevalent mental health problems and chronic conditions. Despite the availability of evidence-based psychological treatments, access to these treatments remains a challenge. Access to traditional psychological care is particularly problematic for young adults. This age group has the highest prevalence rates of anxiety and depression, but also the lowest rate of utilization of traditional mental health services.

Evidence-based Internet-delivered cognitive-behavioural therapy (iCBT) can be an option to increase access to treatment. It may also be a more youth-friendly approach than traditional face-to-face psychological services. Over two decades of research support iCBT. While guided iCBT has received more support than self-guided iCBT, a few recent randomized controlled trials have revealed no significant differences between these two modes of delivery. Limited empirical evidence is nevertheless available on the efficacy of iCBT among young adults. Furthermore, access to iCBT has been very limited for several linguistic communities. To facilitate access to iCBT, translating available evidence-based iCBT programs into multiple languages has been advocated by the International Society for Research on Internet Interventions. Preliminary data suggest that it can be a highly cost-efficient strategy compared to developing new iCBT programs.

This study is the first phase of a research program conducted at the Telepsychotherapy Transformational Research Unit in New Brunswick, Canada. It aims to assess the feasibility of an evidence-based iCBT program for young adults, the Mood Mechanic Course, when translated into French and delivered in a self-guided format using weekly standardized emails. The Mood Mechanic Course is a transdiagnostic program delivered over eight weeks. It is comprised of five lessons, do-it-yourself guides and additional resources on various topics. A single group pre-post design with a 3-month follow-up was used. Feasibility outcomes included treatment adherence, attrition, treatment acceptability and preliminary efficacy. Primary outcome measures were the Patient Health Questionnaire 9-item (PHQ-9) and the Generalized Anxiety Disorder 7-item scale (GAD-7). The broader domains of resilience and life satisfaction were also assessed.

Twenty-seven participants, aged 18 to 25, were recruited in New Brunswick and included in the analyses. A first group (n = 11) was recruited among the general population. As a result of problems encountered in relation with adherence and attrition, methodological changes were made and a second group recruited among undergraduate students at the Université de Moncton (n = 16). More encouraging results were obtained. Outcome data will be analyzed using linear mixed-effect models and recovery rates calculated.

Findings from this study will ensure that all procedures are in place before proceeding with a roll out of this study among New Brunswick’s French communities (Phase II) followed by the course’s dissemination in the province with the original English version added (Phase III). This project involves a strong team of international as well as national experts. Not accessing mental health services when in need can have devastating consequences, especially at a young age. The translation of available evidence-based iCBT programs and their delivery in a self-guided format may help to bridge this gap so that young adults from different linguistic communities who face barriers in accessing psychological care can get the timely and effective help they need.

ABSTRACT. The aim of this study is to compare neural responses to antisocial behaviour evoked by virtual humans in an immersive virtual reality (VR) display and those evoked in a non-immersive display. N=20 participants undertook a between subject design experiment. The experimental task requires participants to hold conversations with a friendly virtual human confederate and a confrontational virtual confederate, thereby triggering neural responses in participants. The task is conducted using a virtual reality head mounted display in condition 1, and a non-immersive screen display in condition 2. In both conditions, the perspective scale and distance of the virtual confederates are kept constant. Neural response to the conversational stimuli are measured using the functional near infrared spectroscopy (fNIRS) device. The study focuses on four regions of interest (ROIs) within the prefrontal cortex (pfc) which include the left and right dorsolateral pfc (ldlfc, rdlpfc) and the left and right medial pfc (lmpfc, rmpfc). Quantitative data for condition 1 have been analysed using a paired sample t-Test and reported. Although the findings from this analysis showed increased activity around all ROIs as the conversation changes from the friendly to confrontational virtual confederate except the ldlpfc, data exclusion was high as a result of the difficulty of combining a HMD with other wearables such as the fNIRS. This findings shall be compared with the results of a corresponding analysis of condition 2. Our findings could potentially help with decision making in subsequent studies of this kind.

ABSTRACT. Introduction/Problem Distractions found in everyday life can disrupt activities of daily living in older adults. The conflicting evidence related to aging participants' reports of everyday memory functioning and results from traditional paper-and-pencil memory assessments may reflect the limited ecological validity of traditional memory assessments. Virtual reality-based neuropsychological assessments proffer the potential to address the limited ecological validity of pen-and-paper measures of memory.

Method/Tools To compare the performance of younger and older age cohorts on an episodic memory task with real world distractors, a newly developed virtual reality measure of memory, the Virtual Environment Grocery Store (VEGS), was administered to 19 older adults and 25 young adults. The VEGS includes a number of cognitive memory (episodic and prospective memory) tasks. Before the participant was immersed in the VEGS, they took part in a learning task (encoding phase) and a familiarization task. Immediate recall performance was recorded verbatim by a microphone and was logged for each of the immediate recall trials (Trials 1–3). Following the encoding and familiarization phases, the participant was informed that they were going to need to drop off a prescription once the VEGS protocol starts. They were also told that they needed to remember to go to the coupon machine after two minutes of shopping (VEGS Time-Based Prospective Memory). Furthermore, they were instructed that after they dropped off their prescription, they were to shop for items from the list that they learned earlier. After 10 min, the virtual pharmacist announced the participant’s prescription number. At that time, the participant needed to return to the virtual pharmacist and clicked on her to end the simulation (VEGS Event-based Prospective Memory score). At the completion of the VEGS, the participant was asked to perform free (VEGS Long Delay Free Recall) and cued delayed recall (Long Delay Cued Recall).

Results Participants included 19 older adults (Mean Age = 77.05; Standard Deviation = 7.12; Mean Education 15.89 years; Standard Deviation = 1.49; Mean Full Scale IQ = 107.58; Standard Deviation = 7.19) and 25 young adults (Mean Age = 21.08; Standard Deviation = 4.81; Mean Education 14.92 years; Standard Deviation = 2.76; Mean Full Scale IQ = 103.52; Standard Deviation = 8.82). Analysis of variance between younger and older-aged cohorts revealed that the older aged group performed significantly worse than the younger aged group on all measures of episodic memory: VEGS Short Delay Free Recall (F = 25.28; p < .001); Long Delay Free Recall (F = 17.46; p < .001); Long Delay Cued Recall (F = 9.76; p = 003). Moreover, analyses of variance between younger and older-aged cohorts revealed that the older aged group performed significantly worse than the younger aged group on prospective memory (time-based prospective memory F = 9.34; p = 004; event-based prospective memory F = 37.81; p < 001) and all measures of everyday shopping activities: # of times looked shop list (F = 20.41; p < .001) and Shopping List Items Picked Up (F = 4.10; p < .05).

Conclusion The VEGS has the advantage over traditional measures of providing objective measurement of individual components of memory in simulations of everyday activities that include everyday distractors. While traditional paper-and-pencil assessments are performed in sterile laboratory environments, the VEGS assesses episodic memory and in the presence of real-world distractors. Moreover, the findings suggest that there are significant differences between groups on all measures. This suggests that the VEGS is sensitive to age related differences in memory performance.

ABSTRACT. Introduction: The study of gait and its rehabilitation has of frequently been done using a treadmill rather than over-ground walking because of space constraints and the requirements of motion capture technologies. It has generally been recognized that some kinematics and temporal differences exist between treadmill and overground walking. These differences may be in part due to the stationary nature of treadmill walking, leading to an absence of optical flow. To compensate for this absence, different studies have explored the use of immersive virtual reality (VR), so that the user sees himself walking through a virtual environment (VE). Immersive VR, using a head-mounted display (HMD), prevents a user from seeing his own body in the virtual environment. Recently, studies have used embodiment of real-time self-avatars as a method to provide a user with visual feedback of his movements in gait rehabilitation. To our knowledge, no study has measured the impact of embodying a self-avatar, which inevitably has some system latency, on gait patterns. Methodology: In this study, we quantified the spatiotemporal gait parameters of 11 healthy participants in 6 different conditions. In the 1st condition, participants walked overground in a 50-meter long hallway. In the 2nd condition, they walked on a treadmill at a self-selected comfortable pace, without any VR feedback. In the 3rd condition, they walked on the treadmill while viewing a VE through an HMD. The VE was a replica of the physical laboratory the participants were in and they were not moving this VE (as if they were walking on a virtual treadmill). In the 4th and 5th conditions which were presented in randomized order, the participants walked in a virtual hallway, which was the replica of the physical hallway from condition 1, with (condition 4) and without a real-time self-avatar (condition 5). Through all conditions, participants wore inertial sensors (XSens) on their pelvis and lower limbs. Prior to the walking trial, they performed a series of calibration movements. Mean cadence, step length, gait cycle duration and step width were computed for each participant and for each condition. Between each condition with VR, participants answered a simulator sickness questionnaire (SSQ) and a presence questionnaire. Conditions were compared using paired T-Tests. RESULTS: When comparing the overground condition to the treadmill without visual feedback, results are in accordance with previous literature: participants have a smaller step length, higher step width, slower cadence and a longer gait cycle duration on the treadmill. Viewing a virtual replica of the laboratory through an HMD did not lead to any significant changes in the studied gait parameters. Viewing the dynamic VE where participants walked along a virtual corridor also did not results in any significant changes, compared with treadmill gait without visual feedback. The addition of the real-time self-avatar lead to significant differences in cadence and gait cycle duration. In fact, the participants had a reduced cadence and a longer gait cycle duration even though they walked at the same speed in both conditions. Conclusion: The results found in this study show that there is a potential difference and impact on gait when a user walks with a self-avatar compared to when his does not have one. The next step will be to examine the kinematic data collected during the experiment to obtain more information about the impact of the self-avatar on gait.

ABSTRACT. Prosthesis embodiment, the feeling of a prosthesis being 'part of' the user, is reported by some prosthesis users, whereas others feel their prosthesis is a 'foreign' object to just use as a tool. The former relates to a feeling of body ownership which goes beyond a change in 'body schema', the unconscious spatial representation of the body. Embodiment is believed to be influenced by a variety of factors, such as the feeling of agency.

Myoelectric prostheses are electrically powered and controlled via electrodes measuring electromyographic (EMG) signals from muscle within the user’s remaining limb. The difficulty in controlling such prostheses has been noted by users as reasons for prosthesis rejection, and may influence prosthesis embodiment.

The delay between intended and actual hand movement includes a fixed (electromechanical delay in the hand) and variable amount (reliability of electrodes picking up the EMG signal), introducing uncertainty over how the hand will behave, likely influencing embodiment. Further to this, embodiment is likely to be influenced by the control method of the prosthesis in general, as the hand is controlled by muscles not normally used to open or close an anatomical hand. As encouraging prosthesis embodiment has been proposed as a goal of rehabilitation, designers of prostheses need to understand the impact of such factors.

A version of a body ownership technique, the virtual hand illusion (VHI) or rubber hand illusion (RHI), involves visuo-motor stimulation (i.e., a person moving their hand and seeing the virtual/rubber hand move), which if synchronised, encourages a feeling of ownership over the hand. Research has shown the RHI effect (despite being less vivid) is still possible with modality-mismatched feedback (known as sensory substitution), for example, replacing touch with vibration. Whilst this utilised the traditional visuo-tactile stimulation RHI (e.g., feeling and seeing paintbrush strokes on hands), it is anticipated an equivalent effect may occur with visuo-motor stimulation, as with a prosthetic hand being opened with muscles flexes.

An Immersive Virtual Reality study was conducted to explore the impact of the above outlined control method on virtual prosthesis embodiment, by comparing between opening and closing a virtual prosthesis via myoelectric prosthetic hand and an anatomical hand. This involved a novel approach in testing prosthesis embodiment by using a myoelectric hand displayed virtually. VR provides controllability in assessing several questions in embodiment research.

The experiment included a head-mounted display (Oculus Rift) with myoelectric prosthetic hand or actual hand movements motion tracked (Leap Motion) and presented virtually. Thirty-one anatomically-intact participants opened and closed a virtual prosthesis (60 hand movements for a period of 2mins+) controlling a myoelectric prosthesis in one condition, and using their own hand in another condition, with a virtual threat applied to the hand at the end. Embodiment was measured via a slightly adapted questionnaire traditionally used in RHI/VHI research along with skin conductance responses.

For both control conditions, questionnaire scores of ownership, agency, and overall embodiment were significantly higher than respective control questions scores, along with significant skin conductance responses from a threat to the virtual prosthesis, suggesting the presence of all measures. Body ownership scores were positively correlated with agency, but no correlation with skin conductance scores, suggesting a relationship for the former but none for the latter. Comparing between conditions, only the ownership score was significantly higher in the hand condition compared to prosthesis condition. In addition, qualitative responses to questions collected during the experiment help inform interpretation of the statistical findings.

Aside from furthering knowledge on prosthesis embodiment, the findings of this study are being used to inform a follow-up experimental VR study, a plan of which was presented at the CyberPsychology conference 2017.

ABSTRACT. Virtual reality (VR) is defined as a technology that allows the simulation of different real-life situations. The usual process of information processing denotes that much of what we explicitly perceive is based on our previous experiences and the meaning that the brain gives to stimuli. This perceptual illusion could explain why users respond to VR stimuli as if they were real, and VR treatments are effective. For example, more than sixty clinical trials show that immersions in VR can be used to treat different anxiety disorders. The aim of this work was to study the perceptual experience without real stimulation of the sense of touch, while the participants interact with an object within a VR environment. Our hypothesis is based on the fact that the familiarity and emotional charge of VR objects facilitates and / or increases tactile illusions. Thirty volunteers participated with a mean age of 26.34, SD = 8.80 in a range of 19 to 52 years old, of which the 40% are women. The inclusion criteria were being over 18 years old, being francophone (the study was conducted in French), not suffering from severe transportation problems, not experiencing severe phobic fears, and giving a written consent. The study was approved by the Ethics Committee of Université du Québec en Outaouais (UQO). An experimental design of repeated measures was used, where 24 VR objects corresponding to two types of stimuli were presented twice in two random orders for each participant: (a) family stimuli, associated with an affective load (e.g., a cat or a tarantula) or (b) familiar and neutral stimuli (e.g., an orange). The study was carried out in the Cyberpsychology Lab of UQO and an immersive six-walled VR CAVE system was used. Participants were first asked to fill in the pre-experimentation assessment, which included socio-demographic, health status, phobic fears, cybersickness, and immersive tendencies measures. Later we will ask them to "try to touch" the VR objects with his / her dominant hand as if these were real (e.g., caress a cat); It was also be possible to walk around the VR object and watch it from every angle. Next, we evaluated sensations perceived by the sense of touch after the interaction (e.g., perception of hardness, roughness, temperature) and the emotions associated with each object. Finally, sense of presence and cybersickness were evaluated. The experiment was carried out in a single session, and lasted 60 minutes, with a maximum time of exposure to the VR environment of 30 minutes. Differences between the different types of stimuli were identified, therefore the results suggest that the illusionary perception of touching VR family objects, especially those that may have an emotional charge for the person (e.g., a spider that provokes anxiety), are capable of activate avoidance and anxiety reactions very similar to those that would activate the real objects. These findings agree with some others reported in previous studies in literature. Therefore, our hypothesis is confirmed. Additionally, the participants reported a high degree of sense of presence (M = 70.87, SD = 25.43), and did not manifest significant side effects (cybersickness) of the use of VR. Finally, mention that the results obtained could contribute to explore the potential of VR environments currently used in psychological treatments in order to potentiate its use and exploit all their qualities.

ABSTRACT. Recent public surveys indicate that awareness about the concept of phishing attacks and the associated risks is increasing, and yet the evolution of more sophisticated and targeted attacks means that the negative impacts associated with these remain. Many attackers are moving away from traditional phishing attack types, such as the Nigerian 419 scam, with attention now concentrated on social engineering, whereby emails are tailored to a specific recipient or group of recipients, for example employees of a large corporation. A range of deceptive and persuasive tactics mean that even the most security conscious recipient can be led to divulge confidential information or download an infected file. At the cornerstone of each successful attack, regardless of the email type, there is a human decision. Computer science approaches to this issue tend to focus predominantly on detecting fraudulent emails before they reach the user, but the continually advancing sophistication and believability of the emails being developed and circulated means that such technological solutions are often short lived. It is therefore important to consider the decision making processes involved at the point when the email reaches the user. Here, we report two studies that consider the potential for psychological markers of email response behaviour, in order to understand why multiple users can receive the same email, and yet only a small proportion will respond and become victims of fraud.

Study 1 (N = 224) considered the role of cognitive factors such as self-control, working memory, and inhibition as predictors of email response behaviour, using an explicit email legitimacy judgment task. Multiple linear regression analyses demonstrated the significant role of inhibition, cognitive reflection, and sensation seeking in email decision-making. In addition, a time pressure manipulation on email responses showed that rapid response led to a decrease in judgment accuracy. In order to build upon these findings, we designed a second study, which involved a three-hour office simulation, allowing assessment of email response behaviour in a more naturalistic environment (N = 51). Participants were required to complete a number of day-to-day administrative tasks, such as letter writing and purchase orders, as well as managing a personal email inbox. This set-up meant that participants remained naïve to the purpose of the experiment, having been told that this was examining task management behaviour. Across the duration of the simulation, each participant received five phishing emails and ten legitimate emails. These were designed for the purpose of the experiment, but were based closely on actual emails received by the research team in order to make them more realistic. Response behaviour to each of the phishing emails was recorded, with different levels of response (from opening the email to downloading a suspicious attachment) indicating the extent of a participant’s susceptibility. Those cognitive factors found to have a significant influence in Study 1 were assessed, as were a number of situational factors, including time pressure and priming about phishing. Results replicated those from Study 1, with multiple linear regression analyses demonstrating the significant influence of cognitive reflection and sensation seeking in predicting response behaviour. Our situational manipulations of time pressure and priming elicited null results, which in itself raises interesting questions about the applied implications of these findings. The findings emphasise the need to move away from generic warning messages about the presence of phishing as a way of educating users. Together, the two studies reported help to characterise a cognitive profile of those users most at risk to deceptive emails, as well as highlighting how situational influences may affect this risk.

ABSTRACT. Cybersecurity is a concern not only for the United States but for countries around the world. Many security companies regularly report cybercrime and attacks, ranking countries with the most cybercrime output. Previous research lacks how specific countries can be grouped under different typologies with cybercrime profiles. The purpose of this study is to address this gap by determining if there is a relationship between the Big 5 Personality Traits -Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness using the NEO-PI-R and total cybercrime output (spam, fraud, malware, and digital piracy). Archival datasets were used for the present study. The first dataset was derived from multiple open source locations consisting of reports, websites, spam email archives, and other sources between the years of 2012 to 2014. The final sample consisted of 190 countries and were separated into nine categories: four were cybercrime-related and included two digital piracy measures, three fraud measures, one spam variable, and one malware variable. An additional two non-cybercrime measures were derived from the World Bank website, GDP per million and percent of internet users per capita. The second dataset consisted of country aggregate personality traits derived from 51 cultures representing six continents on the NEO-PI-R. The sample consisted of college students who volunteered to participate anonymously and the majority were native-born citizens of their countries. For the purpose of this study, the datasets were reduced to only 49 countries. The reduction was made due to the limitation of the number of countries in both datasets. Additionally, spam, malware, piracy, and fraud were totaled to account for one measure of cybercrime. Typical demographics were not reported due to the information not provided in the archival datasets. Countries were then ranked on each measure of the Big Five Personality Traits to determine if they fell outside one standard deviation from the mean. Those countries who fell one standard deviation above the mean (Neuroticism = 51.6; Extroversion = 52.1; Openness = 51.6; Agreeableness = 51.1; and Conscientiousness = 51.7) were classified as being high on that measure of personality trait, and those who fell one standard deviation below the mean (Neuroticism = 48.2; Extroversion = 47.2; Openness = 47.9; Agreeableness = 47.8; and Conscientiousness = 47.7), were classified as being low on that measure of personality trait. Pattern recognition was used to determine if there was a relationship between the highest and lowest countries cybercrime output and personality traits. Additionally, GDP and net users were correlated with the highest and lowest ranking countries of outbound cybercrime. Results showed the top cybercrime country output were from the United States, Canada, the United Kingdom, and Australia, who scored high on Extraversion and are identified as being an individualist country. Brazil and Argentina also scored high on Extraversion and are identified as a collectivist country. Germany, Czech Republic, and Spain scored high on Agreeableness and are identified as being an individualist country, while India is identified as a collectivist country. According to the data, the lowest cybercrime country output was from Ethiopia, Lebanon, Nigeria, and Philippians, who scored low on Agreeableness and are identified as being a collectivist country, while Estonia is identified as an individualist country. Ethiopia, Nigeria, Uganda, Botswana, and Indonesia scored low on Extraversion and are identified as being a collectivist country. In addition, Botswana, Ethiopia, and Nigeria also scored low on Conscientiousness. Ethiopia and Nigeria are countries known for ransomware and kidnapping however, the data does not reflect this. Caution is warranted because the dataset did not account for ransomware. Additionally, due to IP address rerouting, the country source of cybercrime may not reflect the true location of cybercrime.

ABSTRACT. In an increasingly shared economy, whereby we are reliant on peers in a range of scenarios, from financial support to holiday rentals, we often come to trust the opinions and veritas of complete strangers. The type of information and support gathered in these scenarios might previously have come from well-known organisations, such as the banks or Government, but recent events such as the global financial crash in 2008 have led to a vast decrease in institutional trust. In the financial sector, this has resulted in the emergence of alternative methods for gaining monetary backing in business ventures, such as a focus on peer-to-peer lending and crowdfunding. In crowdfunding, campaigners gather small monetary pledges from numerous funders, and in return the funders receive either a reward (most commonly a pre-order version of the product being developed), or an ongoing equity stake in the company seeking funding. The research presented here investigates how users make investment decisions around crowdfunding, given the risk and uncertainty associated with this, which means that trust is a prerequisite of investment. Unfortunately, deceptive users sometimes take advantage of the natural human inclination to trust others and attempt to elicit personal or financial information from trusting users for their own gain, through false identities or illegitimate business practise. This research aimed to identify how a potential funder develops the trusting relationship that leads to investment in a complete stranger, with little knowledge of their legitimacy or competence to complete the project.

Across two studies  a number of consistent factors key to investment likelihood, and trust building were highlighted. Data from 11 semi-structured interviews elicited information about the importance of social influence factors such as social proof and item scarcity. Further quantitative data collection from a larger online survey of crowdfunding users replicated these findings, as well as providing additional insights into the role of individual differences between users, such as impulsivity and disposition to trust, on investment behaviour. Insights from these initial studies were then used to inform an interdisciplinary collaboration to develop a technological security tool that would enhance secure connectivity between funders and campaigners in crowdfunding.

One core finding from our initial research was the importance of a campaigner’s social media presence to perceptions of their legitimacy. Researching a crowdfunding campaigner on social media gives potential funders additional assurance that they are reputable and trustworthy, based on the number of followers and the way they interact with others through platforms such as Facebook and Twitter. Based on this, a security tool was developed that triangulates archival social media data across different platforms, using machine learning techniques to produce what is effectively a ‘social credit score’. This demonstrates the legitimacy of a campaigner based on the consistency and longevity of their social media activity, providing assurance that they did not, for example, set up a Facebook account yesterday for the sole purpose of running a fraudulent crowdfunding campaign. A prototype of this tool was tested, with participants being asked to make investment decisions on mock crowdfunding projects. A between subjects design was employed, so half of the participants had access to the tool whilst the other half simply had access to the web. The investment decisions that participants made demonstrate the effectiveness of the tool in improving accurate decision making about campaigner legitimacy, providing added assurance on top of the typical due diligence that a funder would normally perform themselves.

ABSTRACT. Introduction: Internet and particularly Online Social Networks (OSN), are becoming increasingly more relevant in our everyday lives. Using many different social networking sites/apps has been reported as having an impact on psychological adjustment, namely on dimensions such as depression, anxiety and stress. This paper reports on a study aimed at learning the effect of OSN on psychological adjustment and the impact of these three dimensions on “internet addiction” (IA) and cyberbullying (CB). Method: The sample consisted of 660 adult participants with a mean age of 29.99 years (SD = 12.78) and 66.5% women. 91.2% reported being heterosexual, and 85.6% white Caucasians. 65.2% stated accessing OSN several times a day (2.6% had no access) and 87.5% declared having basic to intermediate computer experience. The protocol was administered through GoogleDocs in a snowball sampling procedure through direct contact by chat or email. Results: Facebook users reported significantly higher values of IA and CB than non-users, but results were not statistically significant for depression, anxiety and stress. Twitter, Instagram and Snapchat users showed significantly higher results of depression, anxiety, stress, CB and IA. LinkedIn seems to have no effect on any of the outcome measures. When compared to participants that use less than three OSN, users of at least three OSN reported significantly higher results of depression, stress, anxiety, IA and CB, while claiming significantly lower results of perceived competence, autonomy and perception of self. Overall, the frequency of OSN access shows significant results for depression, stress, anxiety, IA and CB. Sexual orientation showed significant results for IA, CB, depression, anxiety and stress, with heterosexuals reporting significantly higher values in all dimensions. Discussion: Higher frequency of OSN use negatively impact on psychological adjustment, IA and CB. Moreover, results suggest that having access to multiple OSN simultaneously, is also a major factor in psychological adjustment, IA and CB. These results should be taken in consideration by relevant stakeholders, and future research should be conducted with a sample of teenagers, as this cohort is particularly at risk.

ABSTRACT. The "fear of missing out" (FOMO) is a newer personality-related construct defined by apprehension of being absent from other people's rewarding experiences, and the desire to persistently stay connected with others' experiences, including through digital means. Several recent studies have found inverse relationships between FOMO and perceived quality of life and well-being. Additional studies have found strong relationships between FOMO and depression and anxiety severity. Finally, FOMO has demonstrated relationships with in-person and online social engagement, and increased and excessive internet and smartphone use. We set out to further test FOMO's relationships with three categories of variables: negative affectivity, social engagement, and problematic smartphone use (PSU). We used an internet web-based survey with 296 undergraduate participants from the Midwestern United States, administering self-report surveys of FOMO (the FOMO scale), frequency and types of smartphone use, problematic smartphone use (PSU) (using the Smartphone Addiction Scale), proneness to boredom (Boredom Proneness Scale-Short Form), and scales of negative affectivity including depression, anxiety, stress (Depression Anxiety Stress Scale-21; DASS-21), and rumination (Ruminative Thought Style Questionnaire). We conducted bivariate analyses to explore correlates of FOMO scores. We also tested for mediation to explore the hypothesis that negative affectivity variables mediate relationships between levels of FOMO and PSU. Mediation testing was conducted using the cross-product of direct paths approach, with the Delta method, and bootstrapping standard errors. Finally, we conducted a confirmatory factor analysis of the FOMO scale to assess its factor structure, using weighted least squares estimation with a mean- and variance-adjusted chi-square, treating items as ordinal (with a polychoric covariance matrix, and probit factor loadings), and assessing measurement invariance based on gender. Results demonstrated that FOMO scores were related to demographic characteristics (younger age, female gender, and Caucasian race), but with small effect sizes. FOMO was related to all measures of negative affectivity, social use of a smartphone, as well as frequency of and PSU. Tests of mediation indicated that each negative affectivity construct mediated relationships between FOMO and PSU. Finally, results supported a single-factor latent construct for FOMO, but men and women participants yielded a different pattern of factor loadings. Negative affectivity may be a key mechanism by which FOMO may drive PSU. Gender-related social connectedness differences characterize FOMO.

ABSTRACT. Background: Rising concerns have been reported related to problematic cybersex or cybersex addiction. Objective: The aim of this study was to assess potential links between cybersex addiction and several psychological and psychopathological factors, including sexual desire, mood, self-esteem, attachment style, and impulsivity, by taking into account the age, sex, and sexual orientation of cybersex users. Methods: An online survey was conducted in which participants were assessed for sociodemographic variables and with the following instruments: Compulsive Internet Use Scale adapted for cybersex use, Sexual Desire Inventory, Short Depression-Happiness Scale, Self-Esteem Scale, and UPPS-P scale for impulsivity. Attachment style was assessed with the Experiences in Close Relationships-Revised questionnaire (Anxiety and Avoidance subscales). Results: A sample of 145 subjects completed the study. Cybersex addictive use was associated with male gender, depressive mood, higher levels of sexual desire, and avoidant attachment style, but not with impulsivity. Conclusion: Addictive cybersex use is a function of avoidant attachment, sexual desire, and depressive mood.

ABSTRACT. The majority of previous studies on excessive mobile phone use have been focused on personality traits and have used self-reports. The link between cognition and problematic mobile phone use has been neglected. The aim of this study was to empirically investigate this relationship. 60 participants (36 females) completed the Mobile Phone Problem Usage Scale (MPPUS; Bianchi & Philips, 2005) and a number of cognitive tasks measuring cognitive control, task switching, response inhibition, and working memory. Performance on cognitive tasks was negatively correlated with self-reported symptoms of problematic mobile phone use. No relationship between working memory, response inhibition, and problematic use was found. Cognitive control and task switching were the best predictors of problematic mobile phone use. Our results suggest that future research should further explore the link between cognition and problematic technology use.

ABSTRACT. The aim of this study was to examine the contribution of inattention and hyperactivity, as well as overall ADHD symptoms, to smartphone addiction and problematic mobile phone use. A sample of 273 adult volunteers completed the Adult ADHD Self-Report Scale (ASRS), the Mobile Phone Problem Usage Scale (MPPUS, Bianchi & Philips, 2005), and the Smartphone Addiction Scale (SAS, Kwon et al., 2013). A significant positive correlation was found between the ASRS and both scales. More specifically, Inattention symptoms and age predicted smartphone addiction risk and problematic mobile phone use. Our results suggest that there is a positive relationship between ADHD traits and problematic mobile phone use. In particular, younger adults who report more inattention symptoms could be at higher risk of developing smartphone addiction.

ABSTRACT. The present study is a part of a larger project based on a generalist model of assessment and treatment for mental disorders. According to the Grawe’s Consistency Model, people during the lifespan attempt to satisfy four basic psychological needs (attachment, self-esteem, orientation and control, and maximization of pleasure/distress minimization), in accordance with their past experiences, motivations and goals, and an enduring nonfulfillment could bring to the development of one or more mental disorder. In order to evaluate the validity of the model in various mental disorders, the project proposes an immersive serious game (SG) that uses stealth assessment (SA) as a method of evaluation. SA allows developing and measuring multiple psychological constructs, capturing behaviors in real time during the game experience. A narrative storytelling, settled in a spaceship with six avatars, has been created for leading participants in the play and various distress situations have been developed for eliciting needs-related behaviors. One of our project hypotheses is that if the subject has a higher physical and social presence than the traditional assessment, he will behave as he was in real life. Actually, the traditional measures as paper and pencil tests (PP) or self-reports present some limitations as the social desirability bias that can lead to incorrect reports about belief, attitudes, and behaviors or self-reports involve that subject has conscious knowledge about himself but it is not always so. Games developed with SA could provide dynamic behavioral measures of various psychological constructs more accurately than traditional assessment. Within the consistency model, an essential component of human behavior is represented by the cognitive domain that is supported by the executive functions (EFs), a set of processes including goal setting, monitoring, planning, and cognitive-behavioral flexible control. Attention, working memory, cognitive flexibility, reasoning, problem solving, and planning represent the core EFs components. Traditionally, many standardized questionnaires and tasks are used to assess EFs. As mentioned before, these tests are easy to administer, score, and interpret but present some limitations in terms of generalizability of behaviors in real life. Specifically, various studies showed that low scores on traditional measures, do not inevitably entail poor behaviors in real life and vice-versa. In order to have more closely corresponding in context and behaviors to real life, the present study aimed to examine EF performance in run using computerized contextualized SG. Seven games were designed, each one according to one of the standard tasks. Five of these tasks were aimed to measure attention (Dot Probe, Go/NoGo, Stroop, Trail Making Tasks) while two of the games were designed to measure cognitive flexibility (Wisconsin Card Sorting Test). 354 healthy subjects (177=women and 177=men; Mean Age=39.72, SD=8.90) performed the attention and cognitive flexibility game assessment, together with standard cognitive tests. Psychological PP measures for attention (Attentional Control Scale), impulsivity (Barratt Impulsivity Scale), and for cognitive flexibility (Cognitive Flexibility Scale) were also administered. During the SG, correct answers and time of reactions were collected. Our findings showed good correlations on reaction times between the standard tests and SG-based EF battery, suggesting its potential use for behavioral assessment. On the other, the absence of correlation with specific standard tasks on correct answers needs further investigation, with also mental disorder samples, for better defining SG-based EF battery sensitivity toward EF components. The seven games will include in the immersive narrative storytelling game for improving the ecological validity and the generalization of the results.

ABSTRACT. Background. Researchers and clinicians have written about the potential for mobile technologies to improve mental healthcare delivery and patient engagement with care (e.g., Clough & Casey, 2015, Prentice & Dobson, 2014). However, there is currently little research examining barriers, facilitators, or benefits for providers who are implementing these new tools as adjuncts to mental healthcare service delivery in clinical care settings. Additionally, little is known about how individual differences in online privacy concern (OPC; the desire to maintain control over their personal information online to prevent unauthorized use or distribution of this information) and technology adoption propensity (TAP; the likelihood of acceptance and use of new technologies) may impact healthcare providers’ and their patients’ use of these tools. For instance, some researchers suggest that individual levels of OPC and/or TAP may be related to individual use of new technology, thus impacting the use of these tools. The purpose of this study was to (i) explore clinical providers’ perceived facilitators and barriers to implementing a mobile patient engagement platform as an adjunct to treatment with their patients, and (ii) to examine the extent to which OPC and TAP predicted their attitudes towards and use of the platform.

Methods. We recruited clinical care providers from a tertiary mental healthcare setting, who were involved in implementing a mobile digital health platform as an adjunct to treatment-as-usual with their patients. Participants completed a longitudinal survey (delivered at 4 times; N=28), a paper survey (n=17), and/or an in-person focus group (n=7). The paper surveys and focus groups assessed providers’ self-reported attitudes (positive and negative) towards and use of the platform with patients (using 7-point Likert scales), as well as their perceived facilitators, barriers, and benefits to using the platform (using researcher-coded, open-ended response questions). On the longitudinal surveys, participants reported on their overall OPC (Internet Users’ Information Privacy Concerns [IUIPC] scale; Malhotra, Kim, & Agarwal, 2004) and TAP (TAP index; Ratchford, 2010), as well as their self-reported attitudes (positive and negative) towards and use of the platform with patients (using 7-point Likert scales).

Results. First, we conducted thematic analyses with data from the focus groups and descriptive statistics with data from the longitudinal and surveys. Our findings from this set of analyses suggested that participants experienced the following key facilitators to using the platform: technology-related factors (e.g., platform features), human factors (e.g., individual characteristics), and instructional factors (e.g., feeling supported using the platform). These results also indicated that participants experienced the following key barriers to using the platform: technology-related factors (e.g., platform implementation challenges), human factors (e.g., fear of technology), and institutional factors (e.g., existing workload). Second, we conducted regression analyses to examine the extent to which providers’ level of OPC and TAP predicted their attitudes towards and use of the platform. Findings indicated that neither OPC nor TAP were predictors of participants’ use of the platform with their patients, although descriptive statistics indicate that both constructs may still play a role. 

Conclusion/Impact. Our findings suggest that a variety of individual, technological, and institutional factors can support or hinder the successful implementation of new mobile, digital health technologies as an adjunct to treatment-as-usual in healthcare settings. The implications of these findings for tech-developers, decision-makers, healthcare practitioners, and patients will be discussed.

ABSTRACT. INTRODUCTION Research on attention restoration theory brought evidence on the recreational effect of natural environments on humans (White et al., 2013). Since virtual reality (VR) creates a compelling illusion of being present in the virtual world (Heeter, 1992), it is reasonable to use this technology to expose humans to such restorative environments (Berto, 2014). This approach can provide relief from everyday stress but is especially valuable for those suffering from acute stress and emotional strain whose access to nature is limited, for instance due to health-related issues or certain working environments (Anderson et al., 2017).

The purpose of the present study is to investigate the possibility to elicit positive feelings and provide relief from distress using VR and natural virtual environments (VE) during acute stressful situations (e.g. medical treatments). Furthermore, we explore whether a high level of immersion increases the recreational effect of natural VEs.

METHOD We developed a VR version of the commonly used Trier Social Stress Test (Kirschbaum, Pirke & Hellhammer, 1993) as a standardized instrument to evoke acute cognitive and social stress. In a preliminary study (N = 47) we compared our VR-TSST to the original real-world protocol to ascertain efficacy and validity of our method. We observed a significant increase of physiological stress (heart rate variability, HRV; cortisol) and psychological stress (anxiety, affect) compared to a baseline measurement. Thus, we consider our VR-TSST to be a reliable and efficient stress induction method. In the main study, subjects were stressed using our VR-TSST. A second stress induction was announced at the end of the VR-TSST to keep the stress level constant. Subsequently, subjects were randomly assigned to one of three conditions: participants in the VR group were exposed to a realistic simulation of an underwater environment shown on a head-mounted display (high immersion). The desktop group experienced the same VE on a non-immersive desktop screen (low immersion). Subjects in the control group were not exposed to the VE but were left waiting without medial distraction (no immersion). Objective (HRV, cortisol) and subjective (self-report) stress indicators were measured. Questionnaires were used to assess anxiety (State-Trait Anxiety Inventory), affect (Positive and Negative Affect Schedule), immersion (Game Experience Questionnaire), and presence (Igroup Presence Questionnaire).

RESULTS A total of 62 healthy subjects aged 18 - 48 years (M = 22.6, SD = 5.36) participated in the study. HRV changed significantly in all three groups over the course of the experiment with higher values (indicating low stress) during baseline and relaxation phase and lower values (indicating high stress) during the stress induction phase. Further, in the VR condition significantly higher HRV values were measured in the relaxation phase than the desktop and the control conditions. Mean cortisol levels decreased during the post-induction phase about 27.66% in the VR group, 28.74% in the desktop group, and 18.18% in the control group. Although these differences were not significant, we found a medium effect size (.70). Subjective measures showed similar tendencies. A significant decrease of anxiety and negative affect was observed in all groups in the relaxation phase. The VR group reached the lowest scores and differed significantly from desktop and control group. The mean positive affect score was highest in the VR group. Desktop and control group did not differ significantly in neither of the observed variables. Additionally, immersion and anxiety were negatively correlated, while immersion and positive affect were positively correlated.

CONCLUSION Natural virtual environments can be used to enhance mood and well-being. Our results highlight that deeper immersion facilitates relaxation. Thus, especially when access to nature is limited, VR is as an effective solution to reduce acute stress and anxiety.

ABSTRACT. Despite the growing use of various material such as video tutorials, textbooks are still a major component in education. Traditional printed books suffer from a linear structure and non-interactive nature. This makes them particularly ineffective as textbooks, especially for millennials used to interactive systems, searchable content, intelligent tools, and other digital era facilities. Electronic books have seen a significant growth thanks to portable formats such as EPUB and PDF, and services such as Amazon Kindle. Their advantages include easy search, translation, annotation, and similar tools. As course material, e-books and their web-based alternatives have options such as multimedia content, embedded quizzes, links, and some level of interactivity. While helpful, these do not solve some of the major issues with textbooks: • Despite navigation tools, the structure is still fairly linear and imposes a certain way of thinking to students. • Level of details is fixed, and the reader has no option other than skipping sections. • It is hard to see all related content without over-complicating the pages.

The fundamental reason for many of these design issues is that e-books are designed to mimic the structure of printed textbooks with added digital functionality. In a sense, they are “digitized” products as opposed to “digital” ones. A truly “digital book” allows readers to navigate in a multi-dimensional space of information and have an experience customized to their needs. Even when students have access to online content and multimedia material such as those in e-books and similar products, they still want to be able to use the tool they preferred, at the level and pace they were comfortable with, and follow a logical order that would fit their thought process. Previous attempts at electronic textbooks have not been successful in replacing print textbooks. Efforts have been made at organizing a hierarchical structure of content. Bruslovsky’s InterBook broke a domain down into constituent domain concepts and represented the concept structure with a concept map. While the notions of hierarchy and a web of content nodes was appealing and helpful, the system did not define a proper structure for these conceptual connections and was not customizable. Maps are among the most used and popular apps on mobile devices and desktop computers. They provide a visual and easy-to-use approach to navigating that has become familiar for the majority of users, especially the younger generation. We borrow the notion of conceptually-linked content units from InterBook, and the ideas of spatial dimensions and layers from digital maps, to propose a multi-dimensional layered structure for presenting educational content. Our proposed method defines the content as a series of concept units (nodes) that are connected to each other in three dimensions: • Causality shows where a concept has been originated and where it can be used. The relationship along this dimension is of the type “is used in” or “results in”. • Taxonomy shows how each concept is linked to its superset and subset classes and types. The relationship along this dimension is of the type “is a”. • Partonomy shows how each concept is linked to other concepts based on ownership. The relationship along this dimension is of the type “belongs to”.

In addition to these dimensions, we propose to use layers as a way of accessing different types of information: • Units form the base layer • Questions are the first layer of interaction • Notes created and shared by the reader • Discussions for collaboration • Assignments and exams providing formal submissions

The proposed system is being developed and tested for two pilot courses on psychology and computer programming, and early results have been promising.

ABSTRACT. The effectiveness of in virtuo exposure for the treatment of social anxiety disorder (SAD) of performance type has been demonstrated in several studies. However, few studies have validated virtual environments with participants who have a generalized SAD and even less with a sample coming from two different cultures. Thus, considering the lack of research on this phenomenon, this doctoral study aimed to validate a virtual environment involving social interactions with adults suffering from a generalized social anxiety disorder coming from Canada and Spain. The research hypothesis proposed that the virtual environment developed for the treatment of SAD (experimental environment) would induce a higher level of anxiety than a controlled environment (i.e, visit of an apartment without social stimuli) in people with SAD compared to non-socially anxious participants (NSA). The exploratory research question investigated the difference in the level of anxiety between Canadians and Spanish participants in an experimental environment. The research was conducted under the supervision of Stéphane Bouchard, professor and associate researcher at the Cyberpsychology Laboratory of the University of Quebec in Outaouais and Cristina Botella, professor and associate researcher at the Labpsitec of the University of Jaume I (UJI) in Spain. The sample of this research consisted of 69 participants, including 15 Canadians with social anxiety disorder (SAD), 17 Canadians non-socially anxious (NSA), 16 Spanish with SAD, and 21 Spanish NSA. These participants were immersed in two virtual environments: (a) a scene free of stimuli that could generate social anxiety (control scenario); and (b) a scene where participants had to interact with a virtual character while performing four tasks considered anxiety triggering for individuals with SAD (experimental scenario). The four tasks were based on the social interaction subtypes established by Holt et al. (1992): (a) informal interaction/ intimacy, (b) formal interaction/ performance, (c) self-assertion, and (d) being observed. The main variable of this study was the anxiety measured by the State-Trait Inventory for Cognitive and Somatic Anxiety, Visual Analogue Scales of Anxiety, and the variability in heart rate and in skin conductance. The data was collected before, during and after the experimental immersion. Mixed type repeated variance analysis were conducted on the self-reported questionnaires and the physiological measures. The results showed that the virtual environment developed for the treatment of SAD induced a higher level of anxiety than a controlled environment among participants with SAD compared with the NAS group. The level of anxiety was significantly higher for the participants with SAD for every task performed in the experimental virtual environment compared to the one reported at the controlled immersion. The heart rate was significantly higher during the informal and the self-assertion interaction compared to the physiological measures taken during the controlled immersion. In terms of anxiety responses, no significant differences were found between Canadian and Spanish participants. Minor differences between Canadian and Spanish participants were present in regards to descriptive, controlled and exploratory variables. These differences didn’t interfere with the capacity of generating anxiety in a sample presenting generalized social anxiety versus non-anxious persons. In sum, these results allowed us to validate a new exposure tool able of generating an anxiety response in individuals with a SAD from Canada and Spain.

ABSTRACT. Introduction: The scientific literature has demonstrated for decades that exposure to an anxiety-provoking situation reinforces the subject's belief about their ability to cope with it, which reduces the anxiety felt during subsequent encounters with the same stimulus. The more the exposure task disconfirms the perceived threat, the more patients become confident in their abilities to face that same situation again. A few decades after this discovery, we find ourselves today with a tool that allows creating artificial and controlled environments with which an individual can interact: virtual reality (VR). From this comes the possibility of facing fears through exposure in contexts that would be too dangerous, too expensive, unethical or simply unachievable within the realm of traditional in vivo exposure-based therapy. VR also allows conducting exposure to situations that strongly disconfirm feared expectations but would not be feasible in vivo.

Objective: This study aims to evaluate the benefits of a virtual reality treatment including an exposure task, possibly more anxiety-provoking for subjects with a phobia of heights, which would be infeasible in vivo. More specifically, acrophobic participants will expose themselves to jumping from a high cliff and experiencing a fall in virtual reality. Being able to decide when to jump or not should allow experiencing control over falling (or not), which should increase the effectiveness of the treatment.

Method: The brief treatment of five sessions involves mainly a pre-assessment of acrophobia and other DSM-5 disorder symptoms, psychoeducation about height phobia and its treatment, gradual exposure therapy in virtual environments and a final post-assessment. The exposure took place during two therapy sessions of 120 minutes each. Participants were randomly assigned to a Jump and no Jump conditions. In the Jump condition, participants were exposed to the same stimuli as the other participants, but they were also encouraged to jump repeatedly over the platform and into the void. All immersions were conducted in a fully immersive 6-wall CAVE-Like system and exposure was always gradual. The height of the platform was controlled by the therapist, present with the patient in the virtual environment. Subsequently, there will be a debriefing and re-evaluation period with each subject. Outcome was measured pre and post with questionnaires assessing fear of height and a behavioral avoidance test conducting using a firefighter ladder in a climbing wall theme park.

Results: Repeated measures of variance analysis (ANOVAs) will soon be performed to test if the Condition X Time interaction is statistically significant. We predict that the symptoms of acrophobia will be reduced in both groups as a result of exposure and that this improvement will be more pronounced for participants who jumped in virtual reality than those in the control group. Preliminary results are promising.

Conclusion: The study is underway and we hope that the proposed exposure approach will increase the effectiveness of virtual reality in the treatment of anxiety disorders.

ABSTRACT. Introduction/Problem: The proposed study aims at replicating and expanding re-sults from a previous study on predictors of change and documenting the ad-vantages of adding tactile and haptic feedback in a single exposure session con-ducted in virtual reality (Coté & Bouchard, 2009). It was predicted that change in the severity of spider phobia according to the Fear of Spiders Questionnaire (FSQ) would be significantly predicted by change in dysfunctional beliefs toward spiders and self-efficacy, over and above the variance explained by heart rate and presence during exposure. Aims. The study had two aims: (a) replicating and expanding re-sults from Côté and Bouchard (2009) on predictors of change; and (b) document-ing the advantages of adding tactile and haptic feedback in a single exposure ses-sion conducted in VR. Method/Tools, Participants (N = 59) were randomly as-signed to one of three experimental conditions: a) presentation of visual stimuli only, b) presentation of visual and tactile stimuli, and c) presentation of visual, tac-tile and haptic feedback stimuli. Of the 59 study participants, 41 were immersed in VR using the NVIS nVisor Sx head-mounted display and touched or crushed the virtual spider with a 5DT data glove. The rest of the experiment was carried out using a HTC Vive head-mounted display and a Leap Motion hand-tracking sensor due to technical difficulties. To simulate the shape and texture of the virtual spider, a spider was printed in 3D to be touched by participants. It was also possible to crush the virtual spider using a Novint Falcon force feedback device, resulting in a haptic stimulation with three-dimensional feedback that allowed the user to feel roughly the sensations of crushing a spider. Socio-demographic variables and im-mersive tendencies were measures prior to the experiment. To measure the impact of intervention, multiple questionnaire related to fear of spiders (FSQ), beliefs (SBQ) and self-efficacy (PSE-SQ towards spiders and a BAT using a tarantula were administered at pre-post. The average heart rate during the entire immersion in VR was measured by an electrocardiogram using products from Thought Tech-nology (Polar belt, a ProComp+ and the Infinity software). Results. A standard multiple regression was conducted to predict change on the FSQ using the follow-ing predictors: beliefs about spiders, beliefs about one’s own behavior when facing spiders, perceived self-efficacy, disgust, presence and heart rate. Only changes in beliefs about spiders and in perceived self-efficacy significantly predicted the re-duction in fear of spiders. This result enhances our understanding of the treatment mechanisms involved in exposure conducted in VR. ANOVAs show that the par-ticipants in the three experimental conditions reported a significant improvement in their clinical condition, but it did not differ with regards to the experimental condition. Conclusion. It cannot be concluded that haptic feedback stimulation is more effective in its current form and in a very brief intervention than the other two sensory modalities to improve the outcome of the exposure session.

ABSTRACT. Context. Conducting exposure in virtual reality (VR) has been shown to be an effective therapeutic tool in the treatment of social anxiety disorder (SAD). Previous studies have documented that individuals suffering from SAD feel anxious while immersed in a virtual social scenario. However, the contribution of having the therapist physically in the room during immersions dedicated to exposure to social stimuli may contribute to the anxiogenic effect of the procedure. Aim. The study has two goals: (a) assess if the experimenter’s presence in the same room as the participant immersed in VR increases the level of anxiety in an immersion designed to induce social anxiety; and (b) document the effect size of this manipulation before conducting a decisive experiment. Our expectations were that the presence of the experimenter during the immersion would increase anxiety, and this increase in anxiety would be higher for people diagnosed with SAD when compared to people not suffering from social anxiety (NSA). Methodology. Twenty participants aged between 18 and 65 years old (10 NSA; 10 SAD) were assessed using semi-structured ADIS-IV interview to confirm their eligibility to participate in one of the two conditions. All participants were immersed alone in a control virtual environment without social stimuli (an empty virtual apartment) using the same technology as in the experimental immersion. For the second and experimental immersion in VR, they were randomly assigned to one of the following two conditions: (a) the experimenter was physically visible and present with the participant in the 6-wall CAVE-Like immersive room during the immersion, or (b) the experimenter was physically in another room during immersion, leaving the participant alone in the 6-wall CAVE-Like immersive room during the immersion. During the experimental immersion, participants were asked to approach a cat in the virtual apartment and perform four tasks: informal greetings and talking about something mundane, calling the cat by name and asking to get closer, ordering the cat to leave the room and say something assertive, and looking for an object while being observed by the cat. A cat was selected as the social stimuli to avoid problems with finding a credible virtual human that do not have any features that could biased positively or negatively the participants. Plus, it has been used and well accepted by participants in a previous study. The four tasks performed in VR were selected to tackle the main domains of social anxiety as recommended by Holt et al (1992, formal interaction, informal interaction, assertiveness and being observed). Average heart rate and skin conductance were measured during the entire immersion in VR and several questionnaires were administered (e.g., Liebowitz, SUDS, Focus of Attention, ITC-SOPI, SSQ). The main dependent variables were the mean heart rate and STICSA-state anxiety. Results. Repeated measures ANOVAs revealed an impact of the immersion in the experimental condition on self-report (eta-squared = .20) and physiological (eta-squared = .11) measures of anxiety, and very small effect-sizes of the impact of the presence or absence of the experimenter in the room (eta-squared = .005 for the subjective and eta-squared = .01 for the physiological measures). Based on these results, calculations for the expected sample size required to detect a statistical difference at alpha = .05, with a power of .80 was found to be more than 600 participants. Conclusion. Having the experimenter present and visible when performing social tasks in VR do not seem to play a very large impact on user’s anxiety. Methodological recommendations are proposed but, given the small effect sizes, conducting a large scale experimental investigation may not be worth the efforts.

ABSTRACT. Mental health, youth and numeric technologies have been the object of recently news and discussions headlines. There has been a growing interest in treatments involving virtual reality (VR) exposure for a number of anxiety disorders and phobias. Contrary to expectations, some studies suggest that conducting exposure in VR is more frightening for phobic children than it is for phobic adults(Garcia-Palacios, Botella, Hoffman, & Fabregat, 2007; St-Jacques, Bouchard, & Bélanger, 2010). Prior results suggests that children show more apprehension about virtual aversive stimuli, expecting them to be more dangerous, disgusting and big than about a neutral, non-threatening virtual stimulus (Silva et al., 2018). In attempt to analyze to what extent anxiety and phobic fear predict apprehension of virtual phobogenic stimuli, 38 school-aged children participate in this study. After completing specific and general anxiety measures (see the results section for details), children who never experiment VR’s immersion were invited to visit a virtual apartment. A pre-recorded audio message introduced and informed participants about VR and its utility in the treatment of children’s anxiety disorders, specifically in exposure treatment for spider phobia. After this message and before entering the virtual apartment, participants answered several questions displayed in the HMD. The questions assesse the expected size, dangerousness, disgust and behaviors of both a virtual spider (experimental stimulus) and a virtual rabbit (control stimulus), that were described as being used in VR for exposure-based therapy. Participants were told that they would find these stimuli behind the door of the apartment they would be visiting in the following minutes. Once the data was collected, participants were allowed to visit the virtual apartment for five minutes. When they got to the kitchen, participants could approach a virtual spider crawling on the counter. Before leaving the virtual immersion, one last question was displayed in the HMD asking participants to rate how afraid they were of this virtual spider. Results confirmed that apprehension about the virtual spider was significantly higher than apprehension about the virtual rabbit [t(37) = 5.94, p < .000]. The correlations between apprehension of the virtual spider and the clinical measures are all significant. In order to test whether general anxiety measures or specific phobic-fear measures would best predict participants’ higher apprehension about virtual spiders, a residualized change score was obtained for the difference in apprehension between the rabbit and the spider. The multivariate regression was significant [F(4,36) = 3.63, p < .05, R2 = .56, Adjusted R2 = .23]. Only the specific measure of arachnophobia, using the Fear of Spiders Questionnaire, was a significant predictor (β = .43, t = 2.34, p < .05, part correlation = .34) of stronger apprehension about virtual spiders. Non-significant contributions were found for the Anxiety Control Questionnaire (β = -.12, t = -.64, ns, part correlation = -.09) and the SCARED (β = -.05, t = -.25, ns, part correlation = -.04). In sum, results confirmed that apprehension about feared virtual stimuli was significantly related to anxiety, and more particularly to phobic anxiety specific to the virtual stimuli. Results are discussed in terms of clinical interest and children’s cognitive development.

ABSTRACT. Background: Effective treatments exist for chronic posttraumatic stress disorder (PTSD), however a significant proportion of patients do not undertake treatment, others dropout of standardized treatments, and still others – up to 40% - do not respond to treatment. In recent years, Virtual Reality has been increasingly utilized in PTSD treatment, and its appeal and effectiveness in refractory patients make it an important treatment strategy. Method: Forty patients with combat related PTSD will be assessed via clinical interviews before and after treatment, using the CAPS to ascertain PTSD status, and the MINI to examine DSM5 psychiatric disorders. After assessment, patients are randomized to one of two conditions: Prolonged Exposure Therapy, or Virtual Reality Exposure Treatment, using the Virtual Gazza world. Qualitative interviews regarding the experience of using VR will be assessed in patients and therapists before and after therapy. Patients sign informed consent, and are able to leave the study at any point. Results: The effects of treatment for the first patients to undergo this treatment will be presented, including their qualitative data. Conclusions: It is likely that VR Gazza will be an effective way to treat chronic combat related PTSD. Clinical implications will be discussed.

ABSTRACT. Background: Posttraumatic Stress Disorder (PTSD) is a common and distressing possible outcome following traumatic event exposure, with wide-reaching long-term consequences. Most people who exhibit symptoms shortly following trauma exposure will recover naturally, therefore the optimal time for intervention may be shortly after exposure. Many symptomatic people avoid treatment; the Internet as a delivery method for interventions may help in overcoming these barriers to treatment. This randomized controlled trial used a specially designed platform that allowed internet based treatment, using Virtual Reality (i-VR) and examined whether i-VR CBT was more effective at reducing PTSD symptoms than the Waitlist Control. Method: 1000 adult patients, aged 18-65 who came to a Level I Emergency Room following a motor vehicle accident (MVA) were recruited. Patients were assessed in three stages – an initial telephone contact, online questionnaires, and a clinical interview by telephone. Patients who reported PTSD symptoms were randomized to either iVR or waitlist control. iVR involved five sessions of cognitive behavioural therapy, and included in-vivo exposure, imaginal exposure using Virtual Reality, and cognitive therapy. Patients were then assessed again following treatment and at six months follow up. The study received IRB approval from Hadassah Hospital (HMO 0056-013); ClinicalTrials.gov identifier is NCT01760213. Patients signed informed consent, and were able to leave the study at any point. Patients still symptomatic at the end of the research were referred to the Outpatient Psychiatry Department, Hadassah Hospital. Results: The first phase of this project was the development of the iVR environment, and its initial testing. This phase, which took around one year, included the development of the intervention, its implementation on the computers used by the patients and the therapists, and its recognition in the Helsinki Ethics Approval. RCT: 1000 patients who came to the Hadassah ER following a motor vehicle accident were initially assessed by the research team. The majority (N=730, 73%) did not fit inclusion criteria. 270 continued to the next stage of assessment, online questionnaires, however the majority dropped out at this stage (59%). Most of those who filled out the questionnaires (75%) had sufficient symptoms of PTSD to be invited for a full clinical interview by telephone. 67 subjects were invited to the clinical interview. N=31 (46%) declined to participate. N=22 (62%) did not have PTSD, or had PTSD related to a prior event, or had other exclusion criteria (e.g. suicidality). N=14 (39%) had PTSD and were suitable for the RCT. Treatment in the RCT: Three subjects were treated in a pilot. A further 14 were randomized to the two arms of the study. Follow Up: All subjects completed follow up assessments; some subjects did not complete all the follow up assessments, but all have at least one follow up assessment. The treatment group showed greater symptom improvement than the control group – their PTSD scores were 50% lower than pre-treatment, as opposed to 37%. This difference was not significantly different, probably due to the extremely small groups. Conclusions: A high number of subjects were not interested in participating in the project, and this together with those who did not have access to email, reduced the potential pool of subjects. The number of patients treated by iVR was smaller than anticipated, however the treatment was highly acceptable. iVR treatment led to significant symptom reductions; these were not greater than natural recovery, but this lack of statistical significance is likely due to the small numbers of patients treated. Since the trend is in the right direction, this system needs to be further examined in a larger population, as well as with patients suffering from chronic PTSD.