ABSTRACT. Aging populations are at increased risk of insomnia and related health problems, including Alzheimer’s disease. Hypnotic medications pose polypharmacy risks as well as additional risks including drowsiness, falls and dementia. The recommended first-line treatment for insomnia is cognitive behavioral therapy for insomnia (CBTIi), but access is limited. Telehealth or Internet delivery of CBTi are alternative ways to increase access. To date, the three intervention modalities have never been compared within a single study. Further, few studies have examined a) predictors of response to the different modalities, b) if successfully treating insomnia can result in improvement of health-related biomarkers (e.g., neurodegenerative and systemic inflammation) thought to mediate the risk insomnia poses to poor health, c) mechanisms of change (e.g., circadian rhythm strengthening) in CBTi. This protocol was designed to compare the three CBTi modalities to each other and a waitlist control for adults aged 50-65 years (N = 100). Participants will be randomly assigned to one of four study arms: (1) In-Person CBTi (n=30); (2) Teletherapy CBTi (n=30); (3) Internet CBTi (e.g., SHUTi) (n=30); or (4) 12-week Waitlist Control (n=10). All participants will be assessed at screening, baseline, throughout 12-week treatment/waitlist control (WLC) phase, 12-week post-treatment, and 3-month follow up (except those randomized to WLC). The primary outcome will be insomnia symptom severity. Secondary and exploratory outcomes include a) predictors of response (within treatment groups), b) improvement in secondary health-related biomarkers, b) subjective and objective sleep parameters (e.g., efficiency, duration, timing, variability, architecture), psychosocial outcomes, and cognitive performance.

ABSTRACT. Trauma-related nightmares, which vividly replay distressing events, are common in individuals with PTSD, affecting 50-70% of this population. These nightmares significantly disrupt sleep and are linked to increased substance use, poorer physical health, heightened PTSD symptoms, and elevated suicide risk. Nightmares are particularly prevalent in military populations, with over 260,000 active-duty service members and 90,000 National Guard members estimated to suffer from untreated chronic nightmares. These untreated nightmares compromise military readiness and overall quality of life.

Cognitive Behavioral Therapy for Nightmares (CBTN), endorsed by the American Academy of Sleep Medicine, is an effective intervention that involves rewriting the nightmare’s storyline and imagining the new dream before sleep. However, there is a critical shortage of trained providers, and regular CBTN training opportunities are scarce. In 2022, we developed CBTNweb, a web-based platform designed to increase access to CBTN training for healthcare providers. Following initial feedback, the platform was refined, integrating cultural considerations and enhancing usability with more figures, animations, and demonstration videos. Preliminary testers provided positive feedback on the site’s content and usability. Ongoing beta testing will help ensure that CBTNweb meets the high demand for accessible, evidence-based training, thereby addressing the gap in treatment for trauma-related nightmares in military and civilian populations alike.

ABSTRACT. Context. Despite an abundance of evidence-based psychological treatments for common mental disorders (CMDs), outcomes are highly variable. Heterogeneity in response to treatment highlights the need to improve outcomes by better matching individuals to their optimal treatments, personalizing treatments, and developing novel, evidence-based treatments. Digital therapies for CMDs can be delivered scalably to address issues of access, while providing opportunities for data-driven personalization to improve treatment adherence and outcomes. In the current study, we use a quasi-experimental approach to compare outcomes for individuals presenting with a range of comorbid clinical problems undergoing digital therapy. Specifically, we compare outcomes for individuals with above-threshold symptoms of either Generalized Anxiety Disorder (GAD), Major Depressive Disorder (MDD), or Post-Traumatic Stress Disorder (PTSD). For each of these clinical problems, a subset of participants received targeted treatment, and others received treatment targeting a different comorbid disorder (e.g., Social Anxiety). We hypothesize that individuals receiving targeted treatment packages for GAD, MDD, and PTSD will exhibit greater symptom reductions for that target compared to individuals with similar patterns of comorbidity receiving treatment for a different target (e.g., Social Anxiety or Panic).

Methods. We will conduct secondary data analyses of community-college students participating in an ongoing randomized clinical trial to assess whether digital therapy packages targeting GAD, MDD, and PTSD are associated with greater symptom reductions for these targets, compared to packages targeting a different clinical problem. After baseline screening, participants with patterns of comorbidity for which multiple treatment packages are available (e.g., GAD vs Social Anxiety) are asked to select a package. In total, N=141 participants had at least two comorbid targets and selected a digital therapy package. Currently, N=60 participants selected a package targeting GAD and N=56 selected a package with a different target; N=91 participants selected a package targeting MDD and N=24 selected a package with a different target; N=35 selected a package targeting PTSD and N=32 selected a package with a different target. Symptoms are assessed biweekly across acute treatment and throughout the 40-week follow-up phase using validated self-report measures. Using a quasi-experimental approach, we will examine whether GAD, MDD, and PTSD symptom response is greater for individuals who receive a package targeting GAD, MDD, or PTSD by using hierarchical linear modeling (HLM) to compare the two groups across the 40-week follow-up period.

Results. The trial is ongoing. We will conduct analyses two weeks prior to the 27th Annual CyberPsychology, CyberTherapy, & Social Networking Conference to leverage the maximum number of participants to increase statistical power.

Conclusions. Understanding how individuals who exhibit above-threshold symptoms of GAD, MDD, PTSD, and comorbid disorders respond to different digital therapy packages is an important preliminary step in demonstrating the utility of precision mental healthcare. Additionally, this study aims to highlight the utility of quasi-experimental approaches, which can allow researchers to leverage nonrandomized data to generate causal hypotheses pertaining to treatment outcomes. Future studies could utilize similar approaches to generate hypotheses related to psychological processes and treatment mechanisms.

Limitations. Due to the nonrandomized nature of the data, this study is subject to several threats to internal validity. Importantly, this study is prone to selection bias because individuals chose which treatment package to engage in (e.g., PTSD vs. another comorbidity). However, the quasi-experimental approach provides clues about potential causal relationships between different components of cognitive behavioral therapies and outcomes that can inform future experimental investigations through SMART trials (e.g., factorial designs). Additionally, depending on the final sample size and survey compliance, our study may be underpowered to detect small differences in treatment response between groups.

ABSTRACT. Chronic insomnia is a debilitating condition linked to significant medical and mental health issues such as depression, substance abuse, PTSD, and suicide. It also affects workplace performance through absenteeism and accidents. The financial burden of insomnia is immense, with civilian costs estimated between $92 and $107 billion annually. Effective treatments, such as Cognitive Behavioral Therapy for Insomnia (CBTI), are shown to improve quality of life, reduce healthcare costs, and mitigate indirect costs over a lifetime. Unfortunately, most military personnel rely on hypnotic medications, which carry side effects like grogginess and slower reaction times—dangerous, especially during deployments. CBTI offers a superior alternative, providing better long-term outcomes for active duty, veterans, and civilians.

Despite its efficacy, there is a critical shortage of providers trained in CBTI due to limited training opportunities, high costs, and time constraints. Traditional training methods—reading manuals, attending in-person workshops, or viewing webinars—are inadequate for widespread dissemination. To address this, our team developed CBTIweb, a web-based training platform. After extensive testing, CBTIweb has proven to be a sustainable, low-cost solution for providers, offering knowledge gains equivalent to in-person workshops. The platform has been met with high levels of satisfaction from users and shows significant improvements in knowledge acquisition. Increasing accessibility to CBTI training through such platforms is essential to addressing the current gap in insomnia treatment.

ABSTRACT. Background. Numerous provider-focused continuing educational courses in evidence-based mental health interventions have been launched in recent years, though few have provided longitudinal data on the effectiveness of these programs. The present study evaluated a sample of providers immediately following their completion of CBTIweb and again approximately one year after completing the training. Evaluations included knowledge checks and surveys regarding acceptability of training, self-reported self-efficacy of practicing various CBTI components, and utilization of CBTI in their practice over time. Methods. CBTIweb was launched in April 2020, and in the subsequent 3 months, 2586 providers registered an account, completed a pre-test, and began the training. Of these registrants, 624 completed the training within the following three months. Immediately upon completion of training (Post-Training) participants completed a post-test and answered questions about their training experience. Approximately one year later (Follow-Up) the same providers were contacted to complete a survey, which included the same post-test and surveys, as well as questions regarding their utilization of CBTI and any barriers to implementing the treatment into their practice. Results. Post-Training: Analyses were run on all 624 completers. Chi-square tests of independence revealed no differences in completion rates by education or profession, though trainees were more likely to initiate and complete treatment than licensed providers. Paired t tests of pre- and post-tests revealed significant knowledge acquisition, and most providers positively rated the website navigation, content, aesthetics, and understanding of core CBT-I skills. Follow-Up: Of the initial 624, 233 completed the one-year follow-up. Post-test scores decreased from the Post-Training time-point but were still significantly higher than pre-test scores. Self-efficacy was positively associated with CBTI use. Common barriers endorsed by providers were low patient buy-in, difficulty finding supervision and consultation, accommodating comorbid conditions, and time required to prepare for sessions. Resources providers found to be helpful in implementing CBTI in their practice were patient materials, treatment manuals, figures to assist in psychoeducation, and tools for calculating sleep parameters. Providers reported low use of practice outside of their patients and supervision and consultation due to uncertainty of how to obtain these services and prohibitive cost and time constraints. Conclusion. This study demonstrated CBTIweb is an effective platform for training health professionals to be minimally proficient in the gold standard treatment for insomnia disorder. Training platforms for evidence-based psychotherapy could improve implementation by sending out periodic reminders to revisit the training materials, simplifying patient packets to reduce the amount of “prep-work” required, emphasizing education on how to accommodate comorbid conditions, and providing resources for practicing these skills and receiving feedback.

ABSTRACT. This is the general abstract for the symposium: Problematic Patterns of Online Dating and Social Media Use.

Online dating and social media platforms are designed to improve mental health and well-being by facilitating social connection. Yet evidence is beginning to accumulate that suggests they may be doing just the opposite. Media headlines over the past few year suggest a public fixation with their potential harms – for example, “Instagram Sued Over Harm to Young People’s Mental Health” (the BBC), “Facebook Is Addictive as Cigarettes, Former Executive Claims” (CBS News), and “How Online Dating Apps Can Lead to Burnout” (The New York Times). Amidst considerable debate over causality, at least two explanations for these effects have been proposed. On the one hand, it is possible that frequent users of online dating and social media are different from those who primarily conduct their relationships offline. Proponents of this social constructivist view argue that selection could explain why the people who use these platforms experience adverse effects. For example, dating app users may be disproportionately affected by anxiety because dating apps offer people with anxiety a less threatening environment for relationship initiation, making users more likely than non-users to suffer from poor mental health. On the other, it could also be that online dating and social media do in fact negatively affect their users by design. This argument invokes elements of technological determinism by assuming that platform features and affordances are solely responsible for problematic use. For instance, dating app users may be affected by features that encourage excessive swiping, social comparison, and other troublesome behaviors. There is, however, still debate surrounding the direction and magnitude of these effects, as well as their underlying mechanisms. In this symposium, we present data from five studies that examine problematic patterns of online dating and social media use across diverse samples, methodologies, and disciplines (communication, psychology, and user experience design). Specifically, these presentations explore the ways that dating apps and social media encourage problematic use and affect mental health and well-being. We discuss a variety of concepts that could be at play including gamification, emotional experiences, and rejection. We also explore novel methodologies for studying stressful relationship events using screenshots. Together, the presentations in this symposium point to specific problems with the user experience that undermine mental health and well-being while also inviting discussion aimed at identifying potential solutions.

ABSTRACT. This paper is part of the symposium: Problematic Patterns of Online Dating and Social Media Use.

Despite the large body of research examining social media addiction and its associated risk factors, the potentially problematic nature of dating apps has received little attention from scholars. However, given how dating apps have gamified the user experience, it is quite possible that markers of social media addiction would manifest similarly or even be exacerbated among dating app users. Through gamification, dating apps provide users with an abundance of motivational affordances including challenges, goals, and rewards (Deterding, 2011; Hamari et al., 2014). Important to understand, however, is that these motivational affordances can put users at risk for negative outcomes such as problematic use. Thus, the aim of the current study is to identify potential risk factors for problematic dating app use and the long-term effects of these behaviors on mental health. Building on existing work on social media (Andreassen et al., 2012), we conceptualize problematic dating app use as behaviors characterized by recurrent patterns of swiping that negatively impact one’s day-to-day living and control one’s thinking. This includes salience (i.e., the impact of dating apps on thoughts, feelings, and behaviors), mood modification (i.e., dating apps as a mechanism to modify mood), tolerance (i.e., a need to increase dating app use to attain comparable results), withdrawal (i.e., negative side effects resulting from cessation of dating app use), conflict (i.e., dating app use restricting day-today activities), and/or relapse (i.e., repetitive urges to use dating apps after abstinence). Dating app users were surveyed longitudinally at T1 (N = 493) and again six months later at T2 (N = 118). Regression analyses revealed that dating app intensity and fear of being single were positively associated with problematic dating app use at T1. We also showed that over six months, problematic dating app use was associated with more internalizing symptoms as indicated by greater depression and anxiety at T2. These results demonstrate the value of both fear-driven/compensation-seeking and reward-driven hypotheses for understanding the factors that motivate problematic dating app use (Wegmann & Brand, 2019). Findings from this study also have theoretical and practical implications when considering dating app users most at risk of problematic use while highlighting the trouble with how dating apps encourage engagement through gamification.

ABSTRACT. This paper is part of the symposium: Problematic Patterns of Online Dating and Social Media Use. Online dating has become a major source of personal connection for users worldwide. Applications range from niche areas based on religion or politics to wide open access for people of all walks of life. The User Interface and User Experience (UI/UX) of applications can influence, impact, and affect users in a multitude of ways. Using certain design elements such as particular colors, design hierarchies, and implicit associations, the designers of the applications can encourage particular behaviors, beliefs, and feelings in their users. With the right elements, they can instantly make users feel happy or sad, successful or like a failure (The Interaction Design Foundation, n.d.). One of the most common design elements that has become common place across applications is the “Swipe” feature. Users swipe left or right (dislike or like) on other users' profiles to indicate whether or not they are interested in that person. The simple swipe design, in combination with bright colors, simplicity of use, and other factors, encourages users to find Tinder to be more like a game or shopping experience (Faller, 2018; Nik, 2020; Stampler, 2014). The gamification and simple swipe creates a perfect storm where users are regularly caught in never ending loops searching for fulfillment and validation, driven by negative feelings (Sales, 2015), and lackluster results, fed by hope and simplicity. Recently, a class action lawsuit (Oksayan et al. v. MatchGroup, Inc., 2024) has been filed against the online dating conglomerate MatchGroup, Inc., where they are being accused of allegedly intentionally designing an addictive looping effect on users. There is much speculation on what design elements and user demographics play into how likely users are to get caught in the addictive loop and the potential side effects of the perpetual loop. This study aims to look at two potential elements that may encourage the looping effect, the swipe feature and the gamification of the experience. The current study focused on Tinder users and their habits and beliefs regarding swiping and gamification while using and interacting with the application, and how these two design elements affected their psychology. An online survey of 18-35-year-old Tinder users (N = 74) was conducted, coded, and analyzed. The results of the study support and provide a cursory understanding of the relationships between the swiping feature, gamification, and user psychology regarding online dating. The study found that users who believed the application felt more like a game or shopping experience were far more likely to mindlessly swipe and believe the application encouraged quick thinking, instant gratification, commoditization of other users, and perpetuated a lack of humanity. Overall the study found that the more users mindlessly swipe through profiles and the more they believed that using the application felt like a game or shopping experience, the more likely they are to experience negative impacts on their overall psychology.

ABSTRACT. This paper is part of the symposium: Problematic Patterns of Online Dating and Social Media Use.

Digital stress is an important emerging construct that may be more salient to adolescent well-being than general social media use, usually measured by variables such as screen-time and frequency of use. Digital stress refers to stressful experiences related to social media. Two aspects of digital stress, fear of missing out (FoMO) and approval anxiety, are social in nature. Approval anxiety relates to adolescent self-presentation online and the reaction of peers to this self-presentation, and FoMO relates to negative feelings experienced when perceiving their peers to be engaging in activities without them. Emerging research has found components of digital stress to be associated with negative psychosocial outcomes, such as increased anxiety and depressive symptoms, and feelings of being overwhelmed. Thus, investigating factors that may mitigate these associations is important for promoting adolescent well-being. Active parental mediation, or open communication between parent and child about technology and digital media concerns, may be one potential moderating factor. Active mediation has been found to reduce problematic social media use and depressive symptoms in adolescents. Thus, our study examined the association between digital stress, including FoMO and approval anxiety, and depressive symptoms in adolescents. We also investigated whether increased active mediation may moderate this association and buffer the effects of digital stress on depressive symptoms.

Participants are 510 majority-Latino adolescents (52.4% girls; Mage=15.74; 66.7% Latino, 24.9% Multiracial, 3.9% White, 4.5% Other race/ethnicity) from a public-school district in the Southwestern U.S. Adolescents completed self-reported questionnaires at school. Multiple regression analyses were used to investigate the research questions. After accounting for age, gender, and race, results revealed a significant, positive main effect of digital stress on depressive symptoms (β=0.23, p <. 001). Parental mediation did not have a significant main effect on depressive symptoms. The interaction between digital stress and parental mediation was significant (β=0.05, p = 02) and the slope at both one standard deviation above (β=0.28, p <. 05) and below (β=0.18, p <. 05) the mean was significantly different than zero. Plotting the interaction revealed at low levels of digital stress, depressive symptoms are lower with high parental mediation and higher with low parental mediation. However, at high levels of digital stress, depressive symptoms are higher with more parental mediation, and lower with less parental mediation.

Results revealed that digital stress was associated with increased depressive symptoms in an adolescent sample. Further, we found that active parental mediation plays a complex role in the association of digital stress and depressive symptoms. When adolescents are experiencing low levels of digital stress, higher active parental mediation is protective against depressive symptoms. However, when adolescents are experiencing high levels of digital stress, higher active parental mediation is associated with increased depressive symptoms. Thus, the level of digital stress may be important in considering when active mediation is helpful or harmful. Future research should investigate whether this is further moderated by age, as for younger adolescents, active parental mediation may be more salient than for older adolescents, as they increase their attempts for independence from their parents. Additionally, data collection for the second wave of this study is ongoing. Data from Wave 2 will also be presented once data collection is complete.

ABSTRACT. This paper is part of the symposium: Problematic Patterns of Online Dating and Social Media Use. Late adolescents heavily use smartphones in their romantic relationships (Coyne et al., 2011). The digital environment has become a common place for abuse (Ellyson et al., 2021). Research on observations of everyday digital exchanges is needed to understand how negative interactions manifest online and impact individuals and their relationships. Couples’ affective expressions during conflict relate to important relationship outcomes. For instance, coded contempt during conflict interactions is shown to predict divorce (Graber et. al., 2011). The current study adapted the gold standard of objective coding of couples’ conflict interactions, Specific Affect Coding (SPAFF; Gottman & Krokoff, 1989), to code screenshots uploaded by adolescents and examine whether digital behaviors are associated with relationship outcomes. A total of 288 late adolescents (Mage = 20.77; see Table 1) currently in a romantic relationship completed an online survey where they uploaded up to 10 screenshots from their smartphones regarding a time they experienced a stressful online event in their relationship. All screenshots were coded for three positive affective codes (affection, humor, interest) and five negative affective codes (complain/whine, withdrawn/sad, fear/tension, anger, and contempt) adapted from SPAFF . Each screenshot was given a score from 0 to 9 on each affective code based on the extent that the screenshot displayed each affect. Screenshots were coded by a team of undergraduate research assistants with reliability scores above 80%. Participants completed scales on relationship quality, conflict, intimate partner violence and cyber dating aggression. Positive affective codes (affection, humor, interest) of screenshots depicting stressful relational events were not associated with relationship measures. In contrast, higher ratings of negative codes (complain/whine, anger, contempt) were correlated with increased relationship violence and negative conflict strategies (Table 2). Fear/tension and complain/whine ratings were not related to any measures. Analyses are preliminary and follow-up analyses will control for nestedness of couples. Results suggest that our novel coding system can effectively capture negative relationship processes occurring online. This method is the one of the first objective measures on technology use in adolescent couples and will further our understanding of how digital interactions impact individuals’ adjustment and their relationships.

ABSTRACT. The integration of eXtended Reality (XR) technologies, including Virtual Reality (VR), Augmented Reality (AR), and Mixed Reality (MR), into higher education systems presents opportunities and challenges. Here, we report progress of the Metaversity Project, an initiative developed at the Università Cattolica del Sacro Cuore, which aims at leveraging these immersive and hybrid environments to increase student engagement, improve knowledge retention, and make learning interactive and accessible. The methodology of the Metaversity Project employs a multi-phased, user-centered design strategy, beginning with a needs assessment aimed at understanding both educators' and students' expectations for XR technology. The user research phase included hands-on workshops that provided direct exposure to XR technologies for a broad range of participants, including students, teachers, and top management. These workshops were designed not only to familiarize participants with XR capabilities but also to collect immediate feedback on their reactions and gather ideas for practical implementations in their curricula. In total, the workshops engaged over 170 participants: 90 teachers from various faculties, 60 students from diverse courses, and 20 members of the administrative and top management staff. Participants recognized the significant potential of XR to enhance engagement and learning across multiple disciplines. They identified content development, accessibility, and technical support as critical factors for the successful integration of XR technologies within university settings. Building on these insights, the project advanced to the framework development phase, where the MetaLab model was created. MetaLab is an instructional design model that integrates the theoretical foundations of Transformative and Experiential Learning theories with XR technology to foster deep, impactful immersive learning experiences. MetaLab emphasizes several key principles: (i) Transformative Learning Spaces: MetaLab environments use varied levels of virtualization to boost sensory, emotional, and cognitive engagement, challenging traditional learning dynamics and encouraging profound interaction with content. (ii) Immersion and Presence: the model enhances the educational content's interactivity and accessibility, utilizing the full spectrum of XR technologies to cater to diverse needs and technological accesses. (iii) Customizable Learning Pathways: MetaLab accommodates individual learning styles and paces through adaptable complexity and presentation styles, enhancing comprehension and retention. (iv) Collaborative learning: It fosters a community of learning by allowing real-time interactions in shared XR spaces, irrespective of physical distances, thus preparing students for the collaborative nature of modern workplaces. (v) Scalable and flexible implementation: designed for various educational settings, MetaLab's scalability ensures that institutions of all sizes can effectively implement the model, providing flexible integration options tailored to specific educational contexts. Following this framework's establishment, pilot courses were launched to evaluate MetaLab’s effectiveness in enhancing student engagement and learning retention. The feedback from these pilots will refine XR applications and assess their potential for broader application across the university. In conclusion, the Metaversity Project aims to showcase the transformative potential of XR technologies in higher education, supporting more engaging, effective, and inclusive learning experiences. The continuous refinement and expansion of XR applications, guided by the MetaLab framework, could leverage the full capabilities of XR in education, with future efforts directed toward overcoming current challenges and maximizing new immersive educational opportunities.

ABSTRACT. Conventional language learning applications like Duolingo, while accessible, often struggle with user engagement and retention (Loewen et al., 2019). Virtual Reality (VR) offers a promising alternative through immersive experiences. Prior studies (Hua and Wang, 2023; Seedhouse et al., 2019) have demonstrated the potential of task-based learning in VR. In Seefried et al. [Human-Computer Interaction (HCI) International, in press] we proposed a novel method—using a virtual kitchen environment for cooking tasks to facilitate Spanish language acquisition. This approach leverages VR’s immersive nature to enhance engagement and learning efficacy. We recruited 27 participants, dividing them randomly into three groups: a fully virtual reality group, a multi-modal group (combining VR and real-world elements), and a fully real-world group. All participants underwent a pre-test to assess their prior Spanish knowledge. Those with extensive familiarity were excluded to maintain the learning challenge. For the VR components, we utilized Unity software to develop a custom virtual kitchen environment and deployed this simulation on Meta Quest 2 headsets, allowing participants to freely move around in the study room. This setup was chosen to maximize the immersive experience and facilitate naturalistic interaction with the virtual environment. Additionally, prior to the session, participants were introduced to VR technology—those unfamiliar with VR were taught how to use the Meta Quest 2, including its controls and navigation. Each group received tailored instruction in Spanish vocabulary relevant to cooking, using different modalities: the VR group used ’Librarium’, a VR-based flashcard application, while the multi-modal and real-world groups used ’Quizlet’. After completing the vocabulary lesson, the VR and multi-modal groups were tasked with preparing fajitas in the virtual kitchen by following a recipe in Spanish. Meanwhile, the real-world group observed a video demonstration of the same task, with instructions displayed on-screen. Throughout these sessions, all participants were encouraged to verbalize their thoughts using the ’think aloud’ method, which was recorded for subsequent thematic analysis. In this work, we investigate our think aloud data with a novel thematic analysis composed of five key themes, each comprising two categories: experience, mechanics, resources, likes/dislikes, and miscellaneous feedback. The most frequent comments involved narration, where participants described their actions in detail, underscoring the immersive nature of the VR environment. Notably, participants expressed that the initial lesson was insufficient for task completion, highlighting a gap in vocabulary retention and application. This suggests the need for enhanced instructional design, possibly integrating interactive hints or comprehensive translations within the VR experience. Furthermore, feedback mechanisms within the VR environment proved to be a critical issue. Participants often struggled with certain tasks, like washing vegetables, where the lack of clear feedback left them unsure if they had successfully completed the step. This issue was exacerbated by technical bugs, such as ingredients getting stuck in virtual appliances, which disrupted the learning flow and caused frustration among users. Such feedback is crucial for reinforcing language learning through task completion and needs significant improvement. By eliciting this feedback from users, we can easily identify issues which hinder the learning process and can be resolved before deployment. Our study underscores the viability of VR for language learning, with participants showing a clear preference for the immersive VR environment over traditional methods. Our analysis highlighted crucial areas for improvement, including lesson depth and interaction feedback, which are essential for developing effective VR-based language learning applications. Think alouds are a strong tool for eliciting real-time user feedback while users are still engaged with VR, and they provide moment-to-moment insights to users that directly link to specific user experiences.

ABSTRACT. Introduction: Online learning is a convenient and cost-effective solution to deliver training in healthcare. In-person training has supported mental health practitioners in delivering cognitive health interventions, however, the increased need to deliver such interventions remotely has brought out the need to offer training that is equally remote, asynchronous, and maintain the quality of in-person training. This study outlines the design, development, and implementation of E-Cog, a novel online training platform supporting remote cognitive health intervention training. Methods: E-Cog was developed following the ADDIE educational design model, incorporating its five phases: analysis, design, development, implementation, and evaluation. During the analysis phase, key findings included the identification of training objectives, implementer actions, target audience, learning needs, and other factors affecting implementation. Additionally, a list of pre-defined high-level requirements for the technological structure was established to ensure platform customizability, optimal user experience, data security, accessibility, and gamification. In the design phase, the focus was on determining learning units, activities, and the design of the online platform. Development encompassed both content creation for modules and web development of the platform, with internal and external testing conducted to enhance the quality of the final product. Currently, the E-Cog platform offers two certifications (cognitive remediation and metacognitive training), composed of online modules developed by mental health experts, either adapted from existing in-person training or created from scratch. Implementation of E-Cog is occurring in the context of a multi-site implementation trial to deliver remote cognitive interventions to individuals diagnosed with psychosis across Canada (iCogCA). Results: Pilot users were asked to navigate the platform pre-release, enroll in certifications, and review module content. Subsequently, an anonymous user experience questionnaire comprising 15 Likert scale questions ranging from 1 to 10 was distributed among pilots, inquiring about several aspects of their learning experience (e.g. ease of use, information credibility, aesthetics, likelihood of future use, and peer recommendation). Respondents included a mix of students, staff, and therapists. Five pilot users consensually found it easy to use, with trustworthy content, and expressed an average 86% likelihood to use it again/recommend it to a friend. Currently, 11 therapists have completed training using E-Cog, and 24 users have completed at least one module. Technical challenges related to content progression were identified and resolved, with ongoing improvements based on user feedback. Conclusion: E-Cog has been successfully implemented as a tool to deliver remote training that is engaging, asynchronous, and cost-effective, maintaining the quality of in-person training. It presents substantial promise for impact by providing accessible education in psychological intervention, potentially augmenting patient outcomes. Its scalability enables broader participation among practitioners. Moreover, it contributes to equity and inclusion through several avenues. E-Cog has the capacity to surmount language barriers, as ongoing development includes the integration of multilingual options for diverse linguistic communities. Additionally, the decreased costs associated with online training enhance accessibility for individuals and organizations with limited resources. Culturally relevant content and case studies have been integrated to accommodate diverse cultural backgrounds and perspectives. Next steps involve a qualitative assessment of the platform's usability and its impact on cognitive health intervention delivery.

ABSTRACT. Two talks 1) Measuring Education Gains in XR across MultiModal Platforms

Johnson-Glenberg Instructional designers in XR should be creating health care and learning content that takes advantage of some of the profound affordances of XR, namely embodiment and the agency associated with manipulating content in 3D (Johnson-Glenberg, 2018). We know that manipulating or interacting with content in 2D is a powerful predictor of learning, but might these effects be enhanced when using 3D XR platforms? Manipulating objects in multiple dimensions can make the environment seem even more immersive and user-initiated actions can add to the experience of agency. Several embodied studies report that when action is designed in the lesson learners exhibit higher knowledge gains and better retention of content. However, with an increase in modal signals – that is, beyond the usual auditory and visual signals – with the addition of the sensori-motor gesture/action signal - there is an increase in the potential for cognitive overload. Different learners will be differentially affected by varying platforms and varying affordances of the systems. This is the definition of an interaction – when levels of X (e.g., prior knowledge) at different levels of Y (e.g., varying platforms) differentially affect outcomes. The field is in need of new methods of assessment based on action and embodiment while keeping in mind affordances along the XR spectrum. The field would also benefit from more sophisticated statistical analyses of interaction and mediator effects. 3 studies are presented that highlight aptitude by treatment effects (ATIs).

AR – Embodied Graphing. An original app was created to teach students graphing. In this RCT study pre-Med students used a LiDAR-enabled app called “motion visualizer”.

MR – Titration with Haptics. A 3D-printed burette device was tethered to laptop-based chemistry titration lesson. This plastic burette mimicked the look and feel of a real, tangible burette. Students were randomly assigned to two conditions.

VR – “Catch a Mimic - the Butterfly Game”. This VR game was designed to teach about mimicry and natural selection. From an RCT with 214 students, we will present further evidence that the amount of action and embodiment designed into a lesson affects learning and engagement.

SensaSea: Fostering Children’s Social Collaboration through MR Talk 2: Yanjun Lyu

The SensaSea System is a responsive multisensory Mixed Reality (MR) environment designed and is installed here at ASU. It is a room-sized interactive installation that incorporates wearable devices, interactive visual floor projections, auditory, and tactile modalities. SensaSea is designed as a physical environment for embodied interaction (Dourish, 2001) and free play suitable for multiple players; the system uses social proximity as the primary mechanism. Our objective is to promote active peer interaction and social connectedness. The multi-modal system also features an interactive soundscape and innovative real-time haptic feedback. Players are provided with customizable vests that include sensors and vibrohaptic feedback devices. Four-players can be tracked in SensaSea with infra-red cameras; they control colorful projections of the ocean and sea creatures. As players move and locomote, their actions “stir up the ocean”, causing sea creatures to follow in their wake. As the players approach one another, their associated creatures (turtle, sea horse, etc.) begin to interact.

Our usability and feasibility tests have revealed that the system results in positive emotions and elicits multiple pro-social behaviors. Children actively mimic the sea creature behaviors by jumping together with peers. We have seen spontaneous, collaborative actions such as holding hands and verbally inviting peers to join in. SensaSea also promises benefits in health and wellness from the following perspectives: Therapeutic Play, Social Connectedness, Rehabilitation, Parent and Caregiver Engagement, and Physical and Cognitive Benefits.

ABSTRACT. Under construction

ABSTRACT. Growing evidence indicates early intervention substantially improves short- and long-term outcomes for individuals who are at clinically elevated risk for developing or who are currently experiencing a first episode of serious mental illness (SMI). While contributing factors to these improved outcomes continues to be an area of intense investigation, the rational for early intervention treatment programs is based on current understandings about the neurodevelopmental course of severe psychopathology. Neurodevelopmental models suggest critical time periods during which intervention may be particularly potent for improving short- and long-term symptom severity and functional decline, as well as provide a general trajectory of symptom development from the first signs of functional decline in early adolescence and subsequent onset of psychiatric symptoms that lead up to the onset of a diagnosable SMI.

An important step forward in the development of early intervention programs for SMI occurred in 2009 when a multisite randomized controlled treatment trial (RCT) was conducted to determine feasibility and efficacy of an Early Treatment Program (ETP) for individuals experiencing their first episode of psychosis (FEP). This RCT funded by the NIMH was the RAISE Initiative (Recovery After an Initial Schizophrenia Episode) (Heinssen et al., 2014). RAISE-ETP was designed for implementation in community mental health settings where most individuals with SMI receive treatment. The RCT involved 34 community facilities and a total sample of 404 individuals who were treated and assessed for at least 2 years. Results indicated RAISE-ETP provided significantly better outcomes than treatment as usual and was feasible and efficacious in rural regions (Kane et al., 2016). Later renamed NAVIGATE, it is now implemented nationally and internationally. NAVIGATE uses a multi-component Coordinated Specialty Care (CSC) treatment approach that consists of 4 – 6 intervention modules including Medication Management, Family Education, Supported Employment and Education, Individual Resiliency Training, as well as Case Management and Peer Support (optional). Multidisciplinary teams provide these interventions. Based on a stress vulnerability model, NAVIGATE emphasizes recovery and resiliency, treatment tailored to the unique needs of each client, and shared decision making to select treatments.

Success of CSC with FEP led to its generalization to other clinical groups, including those exhibiting symptoms placing them at clinical high risk (CHR) for developing schizophrenia, as well as individuals with bipolar disorders experiencing their first manic or hypomanic episode, with growing evidence supporting effectiveness in these groups. As the number of CSC programs grows, it is apparent that most are located in urban areas. An ongoing challenge has been implementing them in rural and frontier (R&F) communities. Given the intensive nature of CSC services for most patients (i.e., 1 or more appointments a week) and the multidisciplinary nature of the programs, barriers to care access in R&F communities, such as geographical distance from available services and limited behavioral health care providers, are magnified. Moreover, since the research suggests that delayed intervention is associated with poorer short and long term outcomes, individuals in R&F communities who would benefit from CSC treatment are likely disproportionately negatively impacted by decreased access.

The current symposium highlights efforts in Nevada to address lack of access to CSC services in R&F regions using telehealth. Efforts include development of CSC programs for FEP, CHR, and bipolar disorders, partnering with national organizations, and adapting CSC assessment and interventions for telehealth. An overarching goal is to develop a CSC service delivery model that can be replicated and implemented throughout the state, leveraging expertise of CSC teams who provide in person services in the Las Vegas area. Once developed, CSC telehealth services may then be expanded to other strategically located towns to further increase access in R&F Nevada.

ABSTRACT. **This is part of a symposium that will be submitted by Daniel Allen, PhD. I do not yet see it as an option on the list.**

Barriers to the provision of psychological services in rural and underserved areas have presented a considerable source of inequity in communities in need of quality, evidence-based care. In particular, assessments can be challenging given the overwhelming reliance on paper-and-pencil examinations in the field and the staggeringly low numbers of licensed psychologists in rural areas. However, increased accessibility to virtual measures in recent years has offered a unique opportunity for psychologists to address healthcare disparities. Telehealth assessments administered through coordinated specialty care programs in Southern Nevada (i.e., POWER and CHARGE UP) provide a framework for national implementation to increase access and bridge the gap between rural needs and urban providers.

The importance of timely assessments cannot be overstated, as research has consistently highlighted the importance of early intervention for improving outcomes for a variety of diagnoses. POWER and CHARGE UP utilize assessments to determine program eligibility, though the evaluations also provide meaningful insight into a client’s functioning, needs, and strengths to guide conceptualization and treatment. The intelligence and achievement measures that comprise the battery were chosen to briefly assess cognition and reading comprehension without burdening the client to engage in time-consuming measures that may provide a more comprehensive, but potentially unnecessary, understanding of their profile. For example, given the verbal demands of the programs, a minimum Reading Composite standard score of 80 (+/- 2) on the WRAT-5 is required to increase the likelihood of clients benefiting from and understanding program material. This score is attained by administering two brief subtests, making it a feasible option for clients and examiners. Though these particular programs target early mental illness, the battery may translate well for programs targeting other diagnoses when knowledge of broad cognitive capabilities and reading comprehension is warranted. The measures to be discussed are easily accessible, validated with a wide range of individuals, and are priced lower than many assessments that require advanced software. Guidance on the virtual administration of specific measures, including ways to address challenges, will be further discussed.

Many best practice guidelines for psychological assessments can be generalized to telehealth assessments, but additional considerations are necessary, as there is an increased risk to privacy, confidentiality, and test security. Examiners should utilize HIPAA-compliant platforms, verify the identity of the client, minimize any distractions, and ensure the client is in a private space. Establishing rapport and trust with clients can also be challenging, though some clients may prefer the decreased social demands of telehealth. Best practices for bilingual assessments may be more easily achieved via telehealth due to the increased access to bilingual assessors or translators when access is not confined to one geographic area. Virtual behavioral observations can also be helpful diagnostically and can still be comprehensive through the screen. Specific recommendations will be addressed from various sources (e.g., APA) and research on the adaptation of assessment techniques to telehealth will be further examined.

In sum, telehealth assessments offer a unique opportunity for psychologists to advance equitable healthcare access and address disparities in rural, underserved communities. Despite the benefits of extant telehealth assessment resources, there is a significant need for innovative solutions to further address challenges and improve equitable access to services. Best practices, telehealth assessment methods, recommendations for test selection, and future needs will be further explored. The assessment measures proposed by POWER and CHARGE UP can be utilized as a framework for other programs interested in expanding services to increase equitable access for all.

ABSTRACT. Telepsychiatry has been shown to yield consistent diagnostic reliability, satisfactory clinical outcomes, and patient satisfaction (Sharma G, Devan K), and carries with it a set of opportunities and considerations when compared to in-person psychiatry. This talk will discuss how telepsychiatry has changed pre and post-pandemic, opportunities that telepsychiatry creates for Coordinated Specialty Care (CSC) service provision to those living in rural and frontier regions, and special considerations that must be addressed. This talk will also touch on some considerations in coordinating as part of a multidisciplinary team.

Prior to the pandemic, telehealth (including telepsychiatry) was permitted so long as the physician was in a clinic, and the patient was in a clinic in a different location. The patient would be checked in, have vital signs taken, and brought to an exam room, where the psychiatrist would “teleport” into the exam room via an interactive audio-video software. While this guaranteed certain critical aspects of care would be attended to, it limited access to patients who lived in or near an area that had such a clinic set up. As part of the emergency waiver in response to the COVID-19 pandemic, this provision was lifted, and allowed patients to be seen outside of a clinic (initially in their home only, later expanded to a “secure location”). This greatly increased access to care for individuals who resided in rural communities.

For obvious reasons, a stable internet connection is needed for telepsychiatry to be conducted effectively. Concerns have been raised about ensuring patient confidentiality, because in the office, it is easy to determine if there is anyone else in the room, whereas with telehealth, an individual could be located just off camera that the clinician does not know about. This individual may influence, without the awareness of the provider, the way in which the patient answers certain questions, which could potentially lead to misdiagnosis and inappropriate treatment recommendations.

The talk will include other considerations that must be considered in telepsychiatry and how our team has met some of these challenges. Vital signs are important as blood pressure and heart rate influence medication recommendations. Knowing where the patient is physically located is important because if it is determined that emergency services need to be called for the safety of the patient, the address needs to be able to be shared with emergency medical technicians. Some medications require periodic screening for abnormal involuntary movements, which cannot always be observed via telehealth camera. Most medications require laboratory monitoring on a regular basis, so transportation and access to a lab is important, and may impact or limit which medications can be recommended.

Another regulation that has been suspended as a result of the pandemic is the Ryan Haight Act, which mandates that an in-person medical evaluation be performed prior to the prescription of controlled substances. It is unclear if this regulation will be re-instated. If it is, it would potentially impact access to medications such as stimulants, benzodiazepines, and suboxone to patients living in rural and frontier regions. Furthermore, regulations on how controlled substances must be prescribed (i.e., electronically, hard copy, etc.) vary from state to state, which may also impact access to certain medications.

In the absence of a coordinated specialty care model, scheduling follow-up visits for telepsychiatry is fairly straightforward. Within a coordinated specialty care model, it is possible that the psychiatry, psychology, and social work teams will use different electronic medical records, so extra communication may be required between the teams so that scheduling is efficient and all providers are informed when and where the patient’s next appointment is scheduled.

ABSTRACT. There is a significant lack of access to specialty mental health care in rural areas in the United States (Kepley & Streeter, 2018). Moreover, it is estimated that over 60% of rural Americans live in designated mental health provider shortage area, which includes psychiatric and mental health supports (Andrilla et al., 2018). According to a 2024 report, Nevada ranked 51st, or lowest in the United States, for overall youth mental health (Mental Health America, 2024). Specifically, the largest overall effects on the rankings included “Youth with at Least One Major Depressive Episode (MDE) in the Past Year”, “Youth with Substance Use Disorder in the Past Year”, “Youth with Serious Thoughts of Suicide” and “Youth with Private Insurance That Did Not Cover Mental or Emotional Problems” (Mental Health America, 2024). Lastly, according to the American Foundation for Suicide Prevention, Nevada ranks 8th nation-wide for suicide as the leading cause of death in the United States. Additionally, it is the second leading cause of death for youth ages 10-24 (American Foundation for Suicide Prevention, 2023).

Telehealth has been shown to be a proven method of therapeutic intervention, especially for populations that have difficulty accessing mental health support (Varker et al., 2019). Specifically for rural communities, telehealth provides increased access to care, as rural areas often lack sufficient mental health providers, leading to long travel distances for in-person appointments (Hilty et al., 2013). Telehealth also provides a level of anonymity, as rural communities also struggle to access confidential care due to the small population size and concerns of stigma, especially for youth (Shigekawa et al., 2018). Telehealth also helps provide consistent access to care at reduced cost (e.g., travel, time off work etc.), and allows for more frequent check-ins and monitoring without geographic or transportation barriers (Yellowlees et al., 2020). Finally, rural patients often report high levels of satisfaction with telehealth services, noting the convenience, accessibility, and quality of care (Kruse et al., 2017).

The Rural Communities Mental Health Outreach Program (RHOP) is a partnership between Communities In Schools (CIS) of Northeastern Nevada, and the University of Nevada Las Vegas (UNLV) PRACTICE Community Mental Health Clinic. RHOP is funded through the State of Nevada DHHS, Division of Public and Behavioral Health providing mental health intervention to youth in communities in northern Nevada (e.g., Elko, Spring Creek, Winnemucca). RHOP graduate student clinicians at UNLV provide weekly, individualized telehealth services to clients ages 11-19 under licensed supervision. Graduate students receive training and supervision on a wide variety of evidence-based mental health interventions including Cognitive Behavioral Therapy (CBT), trauma-informed care, suicide prevention and screening, and crisis management. Clients are referred to the program by family, school staff (e.g., counselor, vice principal), or CIS coordinators, who are located within the school buildings. Coordinated on site by CIS, clients attend weekly telehealth sessions during school hours located in a confidential setting within the school building. Additionally, parents/ guardians sign a release of information (ROI) for RHOP clinicians to be able to communicate freely with school staff for better wraparound, community-based services.

From July 2023 – July 2024, a total of 69 clients from communities in northern Nevada were provided telehealth services as part of the RHOP program. The mean age of clients was 14, or 8th grade, and the majority of referrals came from school counselors or CIS coordinators, indicating the effectiveness of the school-community mental health partnership. Preliminary data analysis of outcome measures showed a significant reduction in overall clinical mental health needs, demonstrating the effectiveness of the RHOP program in using telehealth to address youth mental health needs in rural Nevada.

ABSTRACT. Telehealth has increasingly become an essential component of modern healthcare, offering a promising solution to the challenge of delivering medical services to remote and underserved populations [1]. This presentation explores the development of a cost-effective and scalable telehealth infrastructure using Amazon Web Services (AWS) to deploy and manage Application Machine Images (AMIs) preloaded with essential software for a web server hosting LimeSurvey, a robust open-source survey tool. This approach aims to facilitate the distribution of mental health questionnaires, enabling effective and timely mental health assessments for rural populations without necessitating patient travel. The proposed system utilizes AWS, a leader in cloud computing, to create a flexible and reliable backend infrastructure. By leveraging AWS's capabilities to manage AMIs, the system ensures that each instance is equipped with a pre-configured web server and the LimeSurvey application, ready for immediate deployment. This preloading of software not only streamlines the setup process but also significantly reduces the operational complexity for health professionals, allowing them to focus more on patient care rather than technical configurations. LimeSurvey offers a powerful platform for creating, distributing, and analyzing surveys. Its integration into the telehealth solution provides mental health professionals with the tools to customize assessments according to specific research needs or clinical requirements. The flexibility of LimeSurvey enables the creation of dynamic, interactive questionnaires that can adapt to the evolving needs of both practitioners and patients. Additionally, the architecture of the proposed solution is designed for high availability and low latency, critical factors in ensuring that mental health assessments are accessible at any time and without delays. The scalability of AWS allows the system to handle varying loads, accommodating an increase in user numbers during peak times without compromising performance. Security and privacy are paramount, especially in handling sensitive mental health data. The system adheres to strict data protection standards to maintain confidentiality and integrity [2]. AWS provides several built-in security features such as data encryption, network security, and compliance certifications that are utilized to safeguard patient information [3]. The broader implications of this telehealth initiative extend beyond just technical deployment. By reducing the need for physical travel and providing remote access to mental health services, the project addresses significant barriers to healthcare access in rural communities. It allows for timely interventions, which are crucial in mental health care, potentially reducing the incidence of acute crises in rural populations [1]. This solution not only supports the direct delivery of mental health services but also facilitates a collaborative environment where psychiatrists and researchers can jointly work on improving mental health outcomes. The backend system's capacity to collect and analyze large volumes of data in real-time can provide invaluable insights into mental health trends, treatment outcomes, and patient needs in rural areas. The deployment of a robust telehealth infrastructure using AWS and LimeSurvey represents a significant advancement in the field of mental health service delivery. This presentation will detail the technical specifications of the AMI configuration within AWS, the setup and capabilities of the LimeSurvey software, and the anticipated impact on enhancing the accessibility and quality of mental health services in rural settings. Through this innovative approach, the presentation contributes to the ongoing discussion about the transformative potential of telemental health, particularly as a strategic response to the unique challenges faced by rural communities. References [1] M. H. Mohan and M. E. Rana, "Revolutionizing Telehealthcare: Cloud Computing as the Catalyst for a New Medical Frontier," 2024 ASU International Conference in Emerging Technologies for Sustainability and Intelligent Systems (ICETSIS), Manama, Bahrain, 2024, pp. 1333-1341, doi: 10.1109/ICETSIS61505.2024.10459710. [2] J. Marron, “Implementing the Health Insurance Portability and Accountability Act (HIPAA) Security Rule: A Cybersecurity Resource Guide,” NIST SP 800-66 Rev. 2 [Online], February 2024, https://doi.org/10.6028/NIST.SP.800-66r2 [3] AWS Cloud Security. (2024) HIPAA-Compliance [Online]. Available: https://aws.amazon.com/compliance/hipaa-compliance/

ABSTRACT. Increasing rates of suicide-related thoughts and behaviors (CDC, 2022) and hospitalization for suicide-related crises among adolescents (Plemmons et al., 2018; Yard et al., 2021) necessitate innovative approaches for improving treatment and recovery. Following hospital discharge, adolescents are at heightened risk of additional attempts or re-hospitalization (Chun et al., 2017). Limited research has addressed how to prepare youth during this transition for handling stressors and reacclimating to school (Marraccini et al., 2021; Tougas et al., 2023).

Although inpatient programs use diverse treatment approaches, treatment is typically focused on stabilization and psychopharmacotherapy (Hayes et al., 2019; Frazier et al., 2016). One well-suited treatment , Cognitive Behavioral Therapy (CBT; Frazier et al., 2016), often includes teaching, modeling, and practicing therapeutic skills. Yet, within the confines of hospital treatment, meaningful practice opportunities that could translate to daily settings are difficult to execute because of time constraints and engagement difficulties. To address this, we have developed a Virtual Reality (VR) intervention that allows hospitalized adolescents to learn and practice CBT skills in VR.

Practice Experiences for School Reintegration (PrESR) aims to increase skill knowledge and use, to improve school reintegration and prevent suicide. Adolescent patients using PrESR can learn three skills (affect regulation, cognitive restructuring, problem-solving) and practice them in an immersive school scenario. This presentation expands on the model informing PrESR (Authors, under review) by including preliminary findings from a pilot optimization trial of the intervention.

Following ethics approval by the university institutional review board, development and testing of PrESR occurred over three phases. First, we recruited adolescents previously hospitalized for suicide-related crises (n=12) and school and hospital professionals (n=19) to provide input on the PrESR model. We refined the model based on iterative participant feedback, conducting qualitative analyses on transcripts of interviews. Second, we recruited a community sample of adolescents (n=6), adolescents currently or previously hospitalized for suicide-related crises (n=14), and hospital professionals (n=8) to review scenario scripts and/or playtest a PrESR prototype. Participants engaged in think-aloud protocols and provided structured feedback, which further refined PrESR. Third, we initiated a pilot optimization trial.

The pilot optimization trial is focused on feasibility and acceptability and is being conducted at an child/adolescent inpatient psychiatric unit. Recruitment involves contacting parents/legal guardians for permission, then inviting adolescents (ages 13-18) to provide assent. The target sample is 48 adolescents; at present, 17 have completed baseline procedures. Adolescents agreeing to participate are screened for motion sickness and then randomized to one of eight conditions (worksheets affect regulation, cognitive restructuring, and problem-solving with or without VR enhancement). Adolescents are invited to complete clinical interviews and self-report measures addressing suicide-related thoughts and behaviors, psychological functioning, self-efficacy, CBT knowledge, and other relevant constructs before and after the intervention during hospitalization, and two weeks and three months following return to school.

The intervention is delivered by trained clinicians adhering to fidelity checklists and the PrESR treatment manual. Sessions include rapport building, goal setting, VR experience(s), and a clinical debrief. Cybersickness following the first VR experience is assessed, and clinicians teach adolescents to use a subjective units of distress scale (SUDS) to gauge safety throughout the intervention. Following completion of the VR sessions, the clinician and adolescent collaborate to develop a school-focused safety planning intervention to share with schools (with permission from patients and families).

Recruitment is expected to be complete or nearly complete by the time of this presentation. Findings will address perceptions of feasibility and acceptability, research fidelity, measures related to safety (SUDS changes pre and post intervention, cybersickness), and descriptive statistics regarding self-efficacy and psychological functioning. Implications of VR therapy will be discussed.

References Centers for Disease Control and Prevention. (2022). Youth Risk Behavior Survey Data Summary & Trends Report: 2011-2021. Retrieved from: https://www.cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf Chung, D. T., Ryan, C. J., Hadzi-Pavlovic, D., Singh, S. P., Stanton, C., & Large, M. M. (2017). Suicide Rates After Discharge From Psychiatric Facilities: A Systematic Review and Meta-analysis. JAMA Pychiatry, 74(7), 649–702. https://doi.org/doi:10.1001/jamapsychiatry.2017.1044 Frazier, E., Thompson, A., Wolff, J., & Hunt, J. (2016). Implementing evidence-based psychotherapy in an adolescent inpatient setting. The Brown University Child and Adolescent Behavior Letter, 32(5), 1–6. https://doi.org/10.1002/cbl.30121 Hayes, C., Palmer, V., Hamilton, B., Simons, C., & Hopwood, M. (2019). What nonpharmacological therapeutic interventions are provided to adolescents admitted to general mental health inpatient units? A descriptive review. International Journal of Mental Health Nursing, 28(3), 671–686. https://doi.org/10.1111/inm.12575 Hubal, R. C., Fishbein, D. H., Sheppard, M. S., Paschall, M. J., Eldreth, D. L., & Hyde, C. T. (2008). How do varied populations interact with embodied conversational agents? Findings from inner-city adolescents and prisoners. Computers in Human Behavior, 24(3), 1104–1138. Marraccini, M. E., Pittleman, C., Toole, E. N., & Griffard, M. R. (2021). School supports for reintegration following a suicide-related crisis: A mixed methods study informing hospital recommendations for schools during discharge. Psychiatric quarterly, 1-37. Plemmons, G., Hall, M., Doupnik, S., Gay, J., Brown, C., Browning, W., ... & Williams, D. (2018). Hospitalization for suicide ideation or attempt: 2008–2015. Pediatrics, 141(6).Tougas, A. M., Houle, A. A., Leduc, K., Frenette‐Bergeron, É., & Marcil, K. (2023). Framework for successful school reintegration after psychiatric hospitalization: A systematic synthesis of expert recommendations. Psychology in the Schools, 60(3), 793-813. Yard, E., Radhakrishnan, L., Ballesteros, M. F., Sheppard, M., Gates, A., Stein, Z., ... & Stone, D. M. (2021). Emergency department visits for suspected suicide attempts among persons aged 12–25 years before and during the COVID-19 pandemic—United States, January 2019–May 2021. Morbidity and Mortality Weekly Report, 70(24), 888.

ABSTRACT. The COVID-19 pandemic in Peru led to the closure of almost all mental health services. In addition, the authorities forced citizens to stay at home for prolonged periods of time. Faced with this, the Universidad Continental designed and implemented, in 2020, the CALMA Program of online psychological first aid; the same that was conceived within the framework of the technical guide of psychological first aid of the World Health Organization (2012). This initiative, in force until today, was part of the university's social responsibility actions and has offered tele-care through digital media free of charge to more than 10,000 users under a focus on diversity, inclusiveness and multiculturalism in mental health services (Putallaz & Pérez, 2022). This program, initially designed to serve Peruvian citizens, was projected to the international context. At the beginning of the pandemic, 160 trained volunteers participated, including psychologists, interns, and students in their final years of studies; now there are 39 volunteers.

Users had to complete a form (Google Forms) with some of their personal data (where the name is not requested), sociodemographic information and the main reason for appointment. Also, they were asked if they preferred some alternative form of communication for the attention (language or sign language) or if they had any disability or neurodivergent condition that deserves to be known to offer this service.

This study characterizes the population served (N=10096) throughout these 4 years of CALMA's life. Of this group, 74.6% were women (n=7567) and 25.4% men (n=2567). Regarding the most represented nationalities, 9137 were Peruvians (90.5%), 318 Mexicans (3.1%), 132 Ecuadorians (1.3%), 109 Colombians (1.1%) and 97 Bolivians (1.1%). The 4 main reasons for seeking care were: pain, sadness or crying (21.1%); fear or terror (18.7%); loss of initiative (12.2%) and emotional crisis and panic (7.8%). These most frequent reasons were the same according to the sex variable. Thus, in women: pain, sadness or crying (22.6%); fear or terror (18.7%); loss of initiative (12.4%); and emotional crisis and panic (8.5%). In men we have pain, sadness or crying (16.4%); fear or terror (18.7%); loss of initiative (11.6%); and emotional crisis and panic (5.9%).

Likewise, we characterized the reasons for requesting this service in the time of pandemic by COVID-19 (from March 30, 2020, to July 31, 2022) and post-pandemic time from January 1, 2023, to March 21, 2024). Thus, in pandemic times (n = 6908) we found as the most frequent reasons: fear and terror (25.9%); pain, sadness, and flatness (23.5%); loss of initiative (15.2%); emotional crisis and panic (7.2%); and concerns about the need for survival (3.6%). On the other hand, in the post-pandemic period, the most frequent complaints were pain, fatigue and crying (15.0%); emotional crisis and panic (9.7%); low self-esteem (7.0%); loss of initiative (5.8%); and feelings of guilt (4.5%).

The results show that there are no differences between men and women in the reasons for appointments in general terms. On the other hand, in the post-pandemic we have two new reasons that were not present at the time of the pandemic: low self-esteem and feelings of guilt. The results are discussed in the framework of the challenges and changes highlighted by the APA (2023) in telepsychology after COVID-19 (Taylor, 2020).

ABSTRACT. Purpose: of this pilot study was to determine the practical use of AI-generated images for psychological diagnosis in an adult group. Methods. A set of abstract images generated by a text-to-image model was developed and applied. Prompting (creating a text input) included "polar words" that created a visual dichotomy, positive or non-positive coloration of the images presented: e.g., "calmness – excitement". The following psychological techniques were used in the experiment to test correlations: Satisfaction with Life Scale, Five Well-Being Index, Questionnaire for the determination of accentuated personalities (Schmieschek), Hospital Anxiety and Depression Scale. Results. The main findings are: (i) Correlations were found between preference for positive visual content in the high life satisfaction group with the “pacification and rabies” dichotomy and the “delight and despondency” dichotomy; and SWLS score with the “delight” prompt, as well as WHO5 volume (p<.05 and p<.05, respectively). (ii) When assessing the relationship between individual image dichotomies of concepts and psychological characteristics, it was revealed that 5 out of 10 personality accentuation scales were significantly correlated with the coloring of preferred generative content. Correlations were found for the visual dichotomy of “calmness and excitement” and the following personality accentuations (Schmieschek): demonstrative, hyperthymic, and dysthymic types. Conclusion. The study has demonstrated the potential use of AI-generated images in diagnosing (dis)satisfaction with life, distress, increased anxiety, as well as excitable personality traits. The identified connections suggest that this stimulus is effective for diagnosing states and psychological traits characterized by heightened sensitivity to external visual content.

ABSTRACT. During the COVID-19 pandemic, the Universidad Continental (Peru) initiated an online psychological first aid program (CALMA Program). This program was designed considering the technical guide of psychological first aid of the World Health Organization (2012). It is important to specify that online psychological first aid is a human and professional response of support to another person who is suffering and needs help in an unexpected situation, i.e., a crisis of an untimely type (Putallaz and Perez, 2022). Similarly, this initiative falls within the framework of telepsychology as an inclusive, easily accessible service that enables close access to mental health services through diverse digital means (Zhou et al., 2020; Goldschmidt et al., 2021; APA, 2023). This, and prompted by the pandemic, has sparked a revolution in the way professional care is delivered in the field of psychology (Taylor, 2020). The CALMA Program, an online psychological first aid program, is currently in place and has provided more than 10,000 free services through digital media. This program, initially designed to assist Peruvian citizens, was also projected to the international context. During the first year of the pandemic, more than 160 volunteers participated (without receiving any salary), including students, interns and trained psychologists.

This study offers a quantitative, observational (non-experimental) and survey technique approach to the knowledge of the satisfaction of 1,068 beneficiaries (out of a total of 1,006) who received care between March 2020 and March 2024. Therefore, we found a response rate of 10.6% of this anonymous form (Google Forms) and provided under informed consent.

The results show that 96.6% considered that their reason for consultation was attended to. Likewise, regarding the number of times they have used this program, it was reported that: 83.1% went once; 10.7% twice; 2.8% three times; and 3.4% more than three times. Regarding the level of satisfaction with the care provided, 2.8% were very dissatisfied; 1.5% were somewhat dissatisfied; 2.4% were neither satisfied nor dissatisfied; 11.8% were somewhat satisfied; and 81.6% were very satisfied. Regarding the advantages perceived by the participants with respect to online psychological first aid (and from their experience in the CALMA Program, the 3 main responses were the following: 1) Free, immediate, online, inclusive and respectful of human diversity by 28.1%; 2) Free, immediate and online psychological care by 12.8%; and 3) Free and immediate psychological care by 8.0%. The least chosen options appealed to empathy, active listening, ethical aspects and diversity of schedules for attending to consultants. The results also suggest differences in satisfaction and the time at which care was provided (pandemic vs. post-pandemic). Finally, in a Likert opinion question regarding “whether psychological first aid services help people in times of health crisis” we found that the two majority response categories were “strongly agree” with 67.6% and “agree” with 30.1%.

ABSTRACT. Introduction. Anxiety is a phenomenon affecting individuals' psychological well-being, often leading to seeking relief through psychedelic substances despite their associated risks. Emerging technologies like Virtual Reality (VR) offer alternatives for inducing relaxation. Immersive experiences have demonstrated effectiveness in reducing anxiety: it has been observed that VR relaxing videos can promote relaxation both when using self-reported measures and when considering Autonomic Nervous System (ANS) activity. Neural networks in computer vision (e.g., DeepDream) makes it possible to simulate psychedelic substances' visual experiences within immersive environments. These experiences positively impact cognitive functions and are perceived as relaxing by some participants. However, the specific effects of hallucinatory simulated experiences on anxiety remain unexplored.

Objectives: We investigated whether the conjunction of relaxing scenarios and visual hallucinations has a greater relaxing effect than relaxing video alone. We compared the effects of a relaxing video and its hallucinated version on anxiety levels as assessed both by self-report measures and ANS activity.

Methods: A pilot study was conducted with 20 healthy participants. Participants assessed their state anxiety (State Anxiety Inventory; STAI-S). Subsequently, Blood Volume Pulse (BVP) was recorded for 2.5 minutes to derive sympathetic (SNS) and parasympathetic (PNS) activities through HRV (Heart Rate Variability) features. Participants were then exposed to two versions of "The Secret Garden" video: the original (control) and its “hallucinated- DeepDream” version (experimental condition). After each viewing, they rated their state anxiety levels, and HRV features were recorded. It was a within-subjects experimental design (three conditions: baseline, control, and experimental condition). Analysis: repeated measures ANOVAs and post hoc comparisons with Bonferroni correction were used to investigate differences across conditions in STAI-S and ANS indexes. Greenhouse-Geisser was used when the assumption of sphericity was violated. Friedman test was instead used for non-normally distributed variables based on Shapiro-Wilk Test.

Results: Data revealed no significant differences in STAI-S scores between the experimental and control conditions (p=0.055), whereas differences emerged when these conditions were compared with baseline (p <0.001). That is, participants reported a similar self-reported reduction of anxiety levels after videos. Significant differences emerged in mean RR (i.e., mean time between beets) between control and experimental conditions compared to baseline (p = 0.003 and p = 0.022 respectively), with higher mean RR after videos. Concerning ANS activity, we observed that the PNS index did not vary across conditions. In contrast, the SNS index was significantly higher in the experimental condition than the control one (p = 0.036), whereas no other significant comparisons emerged.

Discussion: We investigated whether VR relaxing video simulating visual hallucinations could reduce anxiety levels better than VR relaxing video. Data revealed that the hallucinated and relaxing videos similarly reduced self-reported anxiety. This aligns with the longer time intervals between heartbeats after both video exposures, reflecting HRV decreased after video exposure and thus relaxation. However, the SNS index suggested that the hallucinated experience was more activating than the relaxing video. The fact that the PNS tends not to respond as quickly as the SNS may explain the lack of change in this parameter across conditions. Notably, psychophysiological data showed a linear trend: the SNS index decreased and PNS increased from baseline to control conditions, with intermediate values in the hallucinatory conditions. This might suggest that the VR experiences partially contrasted relaxation; in terms of predictive coding, VR experiences might create "surprise", activating the sympathetic system. Future research might investigate if serotonergic substances and hallucinated videos might have similar ANS effects and activate similar neural mechanisms. This might be relevant for conditions characterized by reduced SNS activity, such as Depressive Disorder. A larger sample size is needed to confirm these findings.

ABSTRACT. A series of brief talks will discuss how models of memory functioning are being challenged by data available from minimally invasive surgical procedures available in the context of neurosurgical intervention (e.g., structure-function relationships, memory subcomponents). We demonstrate the use of available technologies to assess memory in a more naturalistic and complete manner. Throughout the series of talks, we will provide an overview of many of the gaps that exist in the assessment of memory, and propose an approach to overcoming these shortcomings in terms of theory and task development, while emphasizing the important role that technology can play for advancing both diagnostic assessment and theory development. The first talk will provide an overview of some of the theoretical gaps, and these will be emphasized throughout the symposium. The first talk will also highlight the creation of a new videography-based task being used to explore the integration of sensory information in the learning process rather than simply studying material-specific aspects of memory. The task also allows one to examine the interplay of conceptual information in a spatial and temporal contextual plane. A combination of talks will explore the manner in which virtual reality paradigms can be used to further ecological validity and precision measurement of learning and associated physiological brain changes. This in tandem use of technologies create opportunities to parse memory into multiple subcomponents while furthering the opportunity to measure these functions over longer time periods that allow for tracking longer-term memory consolidation and degradation. We also demonstrate how informational gains can be used to shape test presentation, such as allowing examiners to vary item presentation to adjust to personal performance level both to maintain task engagement and to optimize test efficiency. We touch upon the use of physiological biomarkers and socio-emotional factors to alter retention patterns, explore how components of sleep may contribute to consolidation over time, and examine how novel measures of phenomenological aspects of memory (e.g., déjà vu, familiarity) may help us to craft novel models of memory theory (e.g., exploring how basic pattern recognition may interact with these variables to produce changes in both internal and external allocation of attention to determine what gets attended to and ultimately learned). Novel ideas about assessment techniques and memory theory should be fed back into the process of test development and the shaping of clinical practice. Our combination of chair and speakers include the fields of psychology, neurophilosophy, computer science, neuropsychology, neurology, and special effects in movie production. We hope to end with a panel discussion. (417 words)

ABSTRACT. While gaps in memory theory and assessment been recognized over the years, they have been strongly revealed by surprising memory outcomes recently observed in the context of minimally invasive neurosurgical procedures (e.g., stereotactic laser ablation [SLA}, neuromodulatory devices, focused ultrasound). Clinical neurosurgical practice continues to focus on the importance of the hippocampus in supporting memory, yet we will use this minimally invasive data to demonstrate that the structures and networks contributing to memory are broad and interactive. We support our hypotheses with a review of classic animal and human data (e.g., the bilateral hippocampal destruction of patient H.M.). We also highlight the frequent mismatch between neuropsychological data and functional outcome and some of the dissociations across memory subdomains that can occur. We will summarize existing gaps in knowledge and assessment tasks, and we will also exhibit our attempt to build improved diagnostic tools and tests to assess aspects of memory that have been neglected in the clinical context. We will highlight the potential role of technology in overcoming existing problems, which will include the use of videography, AI/machine learning for data management, processing, and scoring, and the ability to assess the oft neglected complexities of memory (including the indexing of discrete memories in dimensional space – e.g., temporal and spatial context).

ABSTRACT. We often have a simplified view of memory, with the hippocampus having a key role in non-motor learning. However, recent evidence suggests that distinct components of memory and meta-memory have distinct anatomical substrates with differing dependence on the hippocampus. In this talk, I will review the ontology of memory, the components of memory that are tested clinically, and those that are of theoretical importance. I will then discuss methods that can be used to make progress in this domain, including behavioral methods such as virtual reality and methods of determining neural dynamics during these tasks. The underlying circuitry required for these memory processes will be reviewed, with a focus on active research and open questions. Understanding these distinct components of memory could have significant implications for the diagnosis and treatment of memory-related disorders. Additionally, this presentation will highlight the valuable combination of VR methods with cutting-edge approaches to probing neural circuits in human subjects. A particular focus will be on stereo-electroencephalography, with the analysis of field potentials, functional connectivity, and single-unit recording in humans.

ABSTRACT. Virtual environments cover a variety of human interaction delivery systems including video games, simulations, virtual reality, augmented reality, or a mixture of them. While these virtual environments are often promoted for their entertainment value, they offer much more capability for research and practice. We have seen significant increases in applications for learning, cognitive training, psychological assessment, and rehabilitation of both physical and mental disorders [1][2]. Technological advances have allowed virtual environments to become more visually realistic. However, these environments primarily follow a one-size fits all development model. Recent technological advancements provide the possibility of making virtual environments capable of becoming dynamic platforms that adapt to the users in a manner that gives users an enhanced and interactive experience. The incorporation of low-cost sensors and advanced psychophysiological instruments into everyday devices has greatly enhanced the capability of Adaptive Virtual Environments (AVE). These sensors provide continuous data that feeds into AI models, enabling adaptations that are nuanced and responsive to the user’s cognitive, behavioral, and emotional states. This real-time adaptation aims to maximize cognitive performance by maintaining the optimal level of challenge for the user, adjusting tasks to become either more complex for high performers or simplified for those struggling. Converting a virtual environment to an AVE requires learning specific details about how the user is performing within the environment. Currently, the two best methods of identifying performance by a user is by monitoring both the user active and passive metrics. Active metrics are psychophysiology responses including measurements of heart rate, electroencephalography (EEG), galvanic skin response (GSR), and electromyography (EMG). Passive metrics are measurements taken within the virtual environment. Passive measures mainly focus on timing to complete specific tasks, error rate, level of cueing, and individual task encounters. Most AVEs implement either active or passive monitoring to perform the adaptation. The ideal AVE would implement both active and passive metrics to create a fluid user experience. The goal of the research is to identify a methodology to integrate the passive metric results with our active metrics measurements, specifically EEG. Data collected from our previous studies using multiple virtual environments was analyzed to identify common variables that could be potentially used as predictor variables for passive metrics. The predictor variables were fed into Support Vector Machine (SVM), Naïve Bayes (NB), and k-Nearest Neighbors (kNN) machine learning algorithms to identify which provided the best results for predicting the performance of the user. EEG algorithms have been developed that provide access to a user’s current measure of engagement, arousal and valence. Using these measures and a user’s calculated personalized threshold level we can identify the user’s current level of flow. While this provides a real-time data stream on the user’s affective state, we currently cannot detect performance of the user from their EEG data. However, integrating the passive metrics into the already established rules for flow we can optimize the model so that the correct difficulty can be better determined for each individual user. In summary, we were able to identify common metrics that can be implemented in virtual environments that will aid in future development of AVE. The framework we developed will allow for better detection of cognitive and affective states allowing the systems to fine tune difficulty settings for each individual user. The AVE will have the capability to accurately determine if the user is in a state of flow and make real-time adjustments to the tasks within the virtual environment. This results in a better user experience for the individual and a more accurate measurement of their performance in the environment.

ABSTRACT. Standard memory assessments typically do not measure all, or even most, facets of human memory. Although some of the more nuanced aspects of human memory, such as the ability to detect familiarity with something despite failing to recall specifics, might seem inconsequential to overall memory function, a growing body of research suggests that these more nuanced aspects of memory may be among the most important components to overall memory function. This talk covers some of the more nuanced aspects of memory function that are largely overlooked in standard approaches to assessing memory function, including the unique role that one’s surroundings may play in autobiographical and event memory, the important role that general familiarity-detection ability might play in directing the mind toward memory search effort, why memory oddities like déjà vu and tip-of-the-tongue experiences might be useful and important aspects of memory, and why the multi-modal nature of memory is important to consider.

ABSTRACT. Title of all the presentations in your symposium (with presenter names: 1. Nigel Newbutt: Paradigms and overview of neurodiversity: Insights to challenges facing this population and how technologies can play an important role. 2. Maria Eleonora Minissi:Inclusive Cognitive Commercial Training for Children: A Preliminary Evaluation of the KokoroKids App in Enhancing Visuospatial Abilities in Autistic and Neurotypical Children. 3. Neil Stafford: Games as a way to assess and treat communication and social interaction skills with children with autism. 4. Luna Maddalon: Serious VR game of spatial perspective for the treatment of children with ASD. 5. Amandeep Dhaliwal & Benjamin Wagley: Dash Dash Delivery: Assessment of prospective memory, time-management skills, and financial decision-making in middle school children on the Autism Spectrum.

Abstract: This symposium seeks to explore the field of neurodiversity and people who are neurodivergent. Neurodiversity is a concept recognizing the natural variation in human neurology. Moreover, this term recognizes neurological differences, such as those found in autism, ADHD, dyslexia, and other neurodevelopmental conditions; asserting they are simply part of the normal spectrum of human diversity rather than being pathological. Being neurodivergent recognizes that individuals have diverse ways of thinking, learning, processing information, and experiencing the world. It is also suggested that this inclusive perspective aligns well to social models of disability. Here, perspectives advocate for acceptance and inclusion of neurodivergent individuals in society while asserting both strengths and challenges with associated conditions/diagnoses. In recognizing that neurodiversity comes with both strengths and challenges and emphasizing the importance of focusing on individuals' strengths and providing support for their challenges.

As such, one area of research, that mostly comes from the field of autism, are the ways technology can support and enable neurodivergent groups/people. In this domain technology has been utilized and applied with these groups in range of ways to support, for example, communication, sensory challenges, social skill development, time management, access to education and learning support, and job training and employment. In particular, technologies such as virtual reality, virtual environments, augmented reality, and artificial intelligence have all been explored and leveraged to inface with neurodiverse groups. To this end, this symposium will bring together research with and for neurodivergent groups and people; examining the current state of the art along with future directions. In this symposium, we will examine apps to support memory and time-management, VR to support special perspectives, social interactions, and cogitative support.

In sum, this symposium aims to explore the intersection of neurodiversity and technology, highlighting innovative approaches and applications that promote inclusion, empowerment, and innovation for neurodivergent individuals. The symposium will bring together researchers, educators, clinicians, technologists, and advocates, to discuss cutting-edge developments, best practices, and future directions in the field.

ABSTRACT. 1. Introduction The increasing accessibility of technologies to children, such as mobile phones and tablets, offers a chance to transform cognitive training and education. Indeed, these technologies facilitate remote access to training materials at any time. Despite the growing interest in the effectiveness of digital games for boosting cognitive skills, few studies have explored whether the cognitive improvements offered by specific digital games are equally beneficial to both neurotypical and neurodivergent individuals. In this preliminary study, we evaluated several games from the Kokoro Kids commercial app to assess their effectiveness in enhancing visuospatial abilities within a diverse group of neurotypical children and children with autism spectrum disorder (ASD). 2. Method Ten children aged between 5 and 8 years participated in this preliminary study. Five of these children, with no diagnosis or risk of psychiatric, affective, learning, or neurodevelopmental disorders, were classified as neurotypical. The other five children, previously diagnosed with level 1 ASD, formed the ASD group. An online survey completed by the children’s caregivers provided information on participants' characteristics. Eleven digital cognitive games within the Kokoro Kids mobile app, identified by independent expert evaluators as targeting visuospatial skills according to the Cattell-Horn-Carroll theory, were used in the study. Participants engaged with these selected games for 15-20 minutes daily over a maximum of 15 consecutive days. The games varied in complexity, with 8 featuring progressively increasing difficulty and 3 remaining constant. To encourage self-engagement, participants were allowed to choose the order of the games in training sessions. However, to standardize the training experience, each game level was played only once; after completing all levels of a game, it was no longer available. The system tracked participants’ accuracy for each level, considering correct responses, errors, and used prompts. Additionally, five visuospatial subtests from the NEPSY-II (Route Finding and Arrows) and DTVP-3 (Figure-Ground, Visual Closure, and Form Constancy) were administered before and after the 15-day gaming period, in a randomized order during both sessions. Daily, the participants’ caregivers answered control questions to identify any factors that might have influenced the cognitive training. 3. Results Participants engaged in gaming for a training period that ranged from 9 to 15 days, with no significant differences in duration between the groups. In terms of gaming accuracy, both groups improved their scores across levels in 5 out of the 8 games with progressive difficulty, while no improvement was observed in the 3 games with constant difficulty. With respect to visuospatial abilities assessed through pre- and post-testing, a significant effect of digital cognitive training was noted in the Arrows subtest, irrespective of the group. In the post-tests, participants achieved higher scores than they did prior to the digital cognitive training. Furthermore, despite the lack of statistical significance, performance in both groups showed a tendency to improve in the Visual Closure and Figure-Ground subtests. Improvement was also observed in Route Finding and Form Constancy subtests for the neurotypical group only, although these were not statistically significant. 4. Conclusion These preliminary findings highlight the potential of specific digital games within the Kokoro Kids app to enhance targeted aspects of visuospatial cognition in a diverse group of children. Future research should expand the sample size and include a broader range of neurodiversity to thoroughly investigate how selected games can improve visuospatial abilities, building on the results and directions reported here.

ABSTRACT. 1. Introduction Autism Spectrum Disorder (ASD) has profound deficits in social-cognitive skills, requiring alternative treatment methods amid increasing diagnoses. Few studies focus on the nuances associated with the Theory of Mind, such as understanding others' perceptions, a crucial aspect in everyday life implications for interacting effectively with others. A key component is the spatial perspective-taking ability. This involves occupying the place of the other person and understanding the relative position of objects. Egocentric errors occur when the participant chooses his view instead of that of the other person, which is frequently observed in ASD children. Recognizing the imperative of early intervention, we developed a virtual reality (VR) task aimed at improving spatial perspective-taking skills in ASD children. Taking advantage of the immersive nature of virtual environments, our serious game aims to provide therapeutic benefits through an entertaining game. The study aims to explore the evolution of spatial perspective-taking skills throughout four sessions, laying the foundation for future interventions. Through systematic analysis of behavioral data, we seek to elucidate the effectiveness of our approach and its potential implications for ASD intervention strategies. This preliminary study is part of a larger approach to the adaptive treatment of social-cognitive deficits in ASD. 2. Method The study involved 15 children diagnosed with ASD severity level 1 using the Autism Diagnostic Observation Schedule 2 (ADOS-2). The sample, aged 6 to 8 years, was predominantly male, consistent with the disorder's higher prevalence in males. According to precedent studies, these skills are developed in preschool in typical development (~ages 3.5 - 5.5 years). Participants underwent a familiarization phase with the semi-immersive VR system at the start of the first session to ensure their ability to interact with the system. The system included an 86” screen monitor, a computer, and the Azure Kinect DK, enabling interaction by projecting the user's body as a virtual shape in a playground park environment. Subsequently, participants engaged in four sessions of a VR spatial perspective-taking serious game with increasing difficulty. Users interacted with a child-like avatar, who tasked them with identifying an object, followed by two questions: one regarding the avatar's perspective on the object and another about the participant's perception. Subsequently, 2, 3, or 4 answer options appeared (varying by difficulty level), situating the object in front, behind, to the right, or the left of a park element. Children were allowed to look at the virtual environment to answer the questions. If participants didn't achieve a 50% accuracy rate, they repeated the same level in the next session. To prevent a learning effect, two versions of each level were created, varying the objects and their positions. 3. Results Data analysis has yet to be performed. Behavioral data collected in this study will be analyzed and discussed. 4. Conclusion This study introduces a novel approach by utilizing VR to address deficits in social-cognitive skills observed in children with ASD. Specifically, we aimed to provide an engaging method that targets the enhancement of spatial perspective-taking abilities. We hope to observe performance improvements across sessions, thereby showcasing the potential effectiveness of this serious game in training spatial perspective-taking ability. Additionally, we intend to offer insights for practitioners regarding future directions, including the expansion of sample sizes and the diversification of perspective-taking tasks based on the findings of this study.

ABSTRACT. In contemporary contexts, effective communication and collaboration skills are paramount for success. Traditional assessment methods often fall short in capturing the intricacies of these skills. However, the widespread popularity of cooperative video games presents an innovative avenue for skill assessment. This abstract proposes utilizing cooperative video games as a tool for evaluating communication and collaboration skills in an engaging and immersive manner.

We are exploring the potential of cooperative video games in assessing these vital skills. By leveraging the interactive nature of these games, simulated environments mirroring real-life teamwork scenarios can be created. These scenarios demand constant communication, coordination, and problem-solving among players, providing insights into their abilities to collaborate effectively.

Methodologically, we select diverse cooperative video games such as "Super Mario World 3D," "Unravel 2," and "Portal 2" for their varying teamwork dynamics. Scenarios within these games simulate real-world teamwork situations, requiring participants to communicate clearly, delegate tasks, and adapt to challenges. Assessment metrics are being defined to evaluate participants' communication clarity, responsiveness, adaptability, decision-making efficacy, and conflict resolution abilities. Data collection methods include in-game analytics, observational techniques, and post-game surveys.

The benefits of this approach include high participant engagement, enhanced ecological validity, and scalability. Engaging participants in popular video games ensures authenticity in their behavioral responses. Simulating real-life scenarios in virtual environments increases the relevance of assessments. Furthermore, digital platforms facilitate the administration of assessments to large groups.

In conclusion, incorporating cooperative video games into skill assessment offers a promising approach to evaluate communication and collaboration skills dynamically. This abstract lays the groundwork for future research and practical implementation, bridging traditional assessment methods with the evolving landscape of digital gaming technologies.

ABSTRACT. The purpose of this study was to compare saccade latencies in emotional expression recognition with respect to the carriers of polymorphisms in the BDNF (rs6265) and COMT (rs4680) genes. The methods used photographic images of 'basic' emotional expressions from the POFA set (Ekman & Friesen, 1976), flipped 180°, as stimulus material. The digital images were displayed on a 19-inch ViewSonic 90Gf monitor (screen size 37x27 cm, resolution 1024x768 pixels, refresh rate 100 Hz) positioned 58 cm from the subject's eyes. The images were presented at the center of the screen and with a 10° offset to the left, right, up, and down. Each participant was exposed to a total of 140 experimental situations (7 emotional facial expressions), each lasting 200 ms, using the open-source software PxLab (Zegallo, 2016). The participant's task was the selection of the most appropriate option. Eye movements were recorded with an SMI high-speed eye tracker at a frequency of 500 Hz. Forty-nine subjects (29 females and 20 males) with a mean age of 25.4 (SD=9.3), provided voluntary consent to participate in the study. The participants were genotyped for candidate genes that had been extensively studied previously. In the experimental sample, the following variations of polymorphisms of the BDNF gene were recorded (subjects) ValVal - 37, ValMet - 10, MetMet - 2; COMT gene: ValVal - 13, ValMet - 27, MetMet - 9; and combinations of genotypes of two BDNF/COMT genes: ValVal/ValVal - 8; ValVal/ValMet - 21, ValVal/MetMet - 8, ValMet/ValVal - 5, ValMet/ValMet - 4, ValMet/MetMet - 1, MetMet/ValMet - 2. Saccade latency was measured using the I-VT algorithm with a threshold rate of 50°/sec. Artifact-free experimental situations in which subjects looked in the direction of the exposed image were selected for analysis. The distributions of saccade latencies were described by the Skewed Generalized T (SGT) distribution (Theodossiou, 1998) and visualized by 5 parameters for further analysis of the results: mu (μ equals the mean), sigma (σ controls the variance), lambda (λ controls the skewness), p and q (controls the kurtosis). Statistical processing was performed using the Fitdistrplus (Delignette-Muller & Dutang, 2015) and SGT R package. Results. SGT distributions of saccade latencies between populations of exposed digital images in carriers of ValVal BDNF genotype (mu=164.93), ValMet BDNF genotype (mu=173.52), MetMet BDNF genotype (mu=185.96) showed pairwise significant differences (p<0. 001) by Kolmogorov-Smirnov test; in carriers of ValVal COMT genotype (mu=164.15) and ValMet COMT genotype (mu=169.86), carriers of ValMet COMT genotype and MetMet COMT genotype (mu=162.87) showed significant differences (p<0.001). Pairwise significant differences in SGT distributions were also found in carriers of certain polymorphisms of the two BDNF/COMT genes (p<0.001). The mean speed of solution of the experimental task in carriers of the ValVal BDNF genotype (2294 ms) and carriers of the Met BDNF allele (2142 ms) is statistically significantly different (p<0.001), as are the mean speeds of solution in carriers of the ValVal COMT genotype (2401 ms), carriers of the ValMet genotype (2221 ms), and carriers of the MetMet genotype (2157 ms). Conclusions. The conducted study demonstrated the variability of the population representation of carrying one or another genotype, which may be associated with the variability of psychophysiological responses - reactions to emotional (face) digital stimuli. The revealed differences in SGT distributions of saccade latency and decision speed by genetic sign of carriers may indicate the individual nature of these indicators. In turn, decision-making speed is an important characteristic of human personality, which is manifested in individual dynamics in solving cognitively complex tasks with appropriate quality (success). The revealed differences suggest that gene heritability may influence the speed dynamics of states and sensitivity to emotional visual content.

ABSTRACT. Sample: A total of 31 participants, comprising (n =13) students diagnosed with autism spectrum disorder (ASD) and (n = 18) neurotypical adolescents matched in age and grade, were recruited from a local school district following Institutional Review Board (IRB) approval. Method: The study employed the Dash-Dash-Delivery (D3) simulation, designed as an integrated learning platform merging aspects of time management, prospective memory (PM), and financial education. Within the simulation, players assumed the role of delivery personnel in a virtual mall environment, engaging in a 30-minute session simulating an 8-hour workday. The intervention took place in a special education classroom during the spring semester of 2021, with the presence of a special education teacher and teacher aides to assist with setup and implementation. Over a period of seven days, students participated in thirty-minute sessions, completing five daily job assignments of varying difficulty levels, involving package pickup and delivery to a designated drop-off location within the simulation. Successful task completion and timely bill payments within the game yielded game currency for players. Distractions such as a game room, clothing store, and toy store were integrated into the simulation to assess impulse control and game performance. Following the intervention, a post-assessment was conducted, including a one-shot hypothetical debt repayment game and a 10-question financial literacy test, where students were permitted to use calculators for computations. Results: Both neurotypical students (M = 55.17, SD = 7.68) and autistic students (M = 49.69, SD = 11.58) performed equally well on their ability to pay on-time bills in the game F (1,29) = 2.51, p = .12. For improvement in game performance trend analysis was conducted, a significant linear fit, F(1, 29) = 102.66, p < .001 was observed. Results support that participants' performance on the seventh day was significantly better than the average of the previous six days F(1,29) = 62.82, p < .001. There was a statistically significant difference on daily bank balance between neurotypical students and autistic students, F(1,29) = 14.58, p < .001, ηp2 = .34. Neurotypical students (M = 592.95, SE = 29.74) earned and saved more game money than autistic students (M = 417.56, SE = 34.99). One-way ANOVA indicates a significant difference in overall game performance between autistic students and neurotypical students F(1,29) = 25.95, p < .001. Neurotypical students (M = 1.25, SE = .36) performed significantly better than autistic students (M = -1.75, SE = .48), Autistic students performed close to 2 standard deviations below the mean. No significant difference in the post-assessment evaluation of financial literacy between student groups, F(1,29) = 1.43, p = .24 was found. Both autistic (M = 8.31, SD = .95) and neurotypical students (M = 8.72, SD = .96) scored above 80% on the test questions. It took 16 trials (4 days) for autistic and neurotypical students to learn how to perform the time-based PM task, as indicated by all four bills paid within the first 20 seconds of the payable window on the fifth day. These results contrast with previous research, which indicated that autistic individuals performed poorly on time-based prospective memory tasks (Williams et al., 2012). Although we saw an improvement in the time-based PM task, the results should be interpreted cautiously because performance on a similar PM game (VirtualWeek) did not significantly improve time-based PM. This could mean that students just learned to play the game, not necessarily improved their prospective memory ability.

ABSTRACT. In 1992, Kane and Kay published in Neuropsychology Review a review of computerized testing in neuropsychology. They reviewed 63 tests, variations of which were found in 13 computerized tests systems. They also covered a small group of stand-alone measures. At the time of this review work in automated testing was being done in select laboratories, many of them Department of Defense, and by individual investigators. The early work in computerized testing was not well known or visible to most neuropsychologists and the intent of the article was to inform neuropsychologists of work in this arena. Kane and Kay also provided readers with basic technical information about computerized testing and they offered a method by which to review and evaluate computer administered tests. These authors made no predictions about the future of automated testing in their paper. However, a neuropsychologist reading this paper in 1992 might have concluded that the computer would in a short time transform how testing was accomplished in clinical neuropsychology. Much of the work reviewed in the Kane and Kay paper began in the 1980s. The 27th Annual Cyber Psychology meeting is taking place in 2024, 32 years after the Kane and Kay article was published. The intent of this presentation is to examine the question of where neuropsychology is now in its use of computers and technology for both assessment and research. The picture varies with work taking place that is creative and forward thinking. But in general, the penetrance of technology into clinical assessment and research has been cautious and uninspired. Along with examining the state of technology in neuropsychology, this presentation will address potential reasons for the marginal penetration of computerized tests and advanced technologies into the clinical arena.

There are examples where computerized testing has made a clear impact on practice and opened avenues of assessment and research that would have been difficult or not possible to otherwise achieve. The US National Defense Authorization Act passed in 2007 required baseline testing for individuals being deployed outside of the US. The DoD employs a specific set of tests from the Automated Neuropsychological Assessment Metrics (ANAM) system. Over 3.75 million of these assessment have taken place including baseline and follow-up testing. Assessment at this scale would not have been possible without implementing a computerized system. NASA obtains baseline testing on astronauts and employs a computerized cognitive assessment tool on the International Space Station with plans to incorporate this system on moon missions. The CogScreen test has become a staple in aviation and for FAA medical certification evaluations in the US and it is used internationally in aviation. Computerized testing is used in sports for baseline and post-concussion assessment. Computerized testing has also been employed in pharmaceutical research and in clinical studies. However, except for the automation of certain traditional tests previously administered with card stacks or slide projectors, substituting tablets for some booklets, or streamlining test scoring processes, automation has had little effect on the day-to-day practice of neuropsychology. The reasons for this are varied and include, but are not limited to, graduate school training, questions about norms, lack of clarity on how the data from automated procedures fits the understanding of clinical syndromes, failure of test publishers and developers to think creatively about test development, and the lack of language processing capabilities that would automate and enhance the assessment of critical cognitive domains. This presentation will discuss the status of computerized testing in clinical practice, ways to increase the penetrance of technology into clinical practice, and future directions.

ABSTRACT. ASU Showcase - The content ranges from AR (wrist fracture rehab) physical therapy to VR (gamified needle phobia extinction)

60 (or 90 minutes Symposium, if hands-on Demo section is added)

Johnson-Glenberg, M., Swaminathan, S., Garcia, M., Falz, M., Hobbs, C. and Baia, S.

This panel/symposium will feature several ASU students presenting their innovative modules/apps designed to solve some of societies thornier problems using mediated XR technologies and AI. These talented, inclusive-minded undergraduates from Arizona State University (ASU) (your host!) care deeply about creating applied content for societal good. Many of these students come from an ongoing class that Dr. Johnson-Glenberg teaches through Barrett Honors College. The projects are in various stages of deployment, some can be immediately downloaded from GitHub and some are in the form of rigorous Game Design Documents (GDDs). Presenters will be given 7 minutes to present, discuss the future, and answer questions. If time at the end, hands-on demos of the VR and AR modules will be offered. 1) Hand Rehab - Sri Swaminathan – VR Hand Rehabilitation. This is a gamified therapy designed for the remediation of ulnar fractures. It is functional on the Oculus 3 VR headset using the finger-tracking function. The sequential mini-games are motivating and the hand rotations have been incorporated to “cast spells” over warlocks and woodland creatures. The prediction is that repetitive finger and wrist exercises will be done more often in the headset (i.e., rehabilitation adherence increase). Additionally, we will test how AI can be an effective assistant as a diagnostician. 2) Accessible Interfaces in VR - CP - Mario Garcia – Mr. Garcia has created a fully functional keyboard and monitor implemented in VR that those with hemiplegia can customize. This VR Interface includes with 3D-printed adaptive hand controls for those with Cerebral Palsy (CP)/Hemiplegia. 3) Needle Phobia – Escape from Sanguia Island. Marti Faltz –Ms. Faltz has designed a step-wise VR exposure therapy program for adolescents (and young adults) who have a profound fear of needles. This optimized patient-centered therapy is created with multiple exposure levels for desensitization and includes a 3D-printed syringe which the patient will eventually be able to grasp and manipulate. The app will include appropriate pass-through AR instances showing the “real world”. When the patient is ready to haptically manipulate a syringe, the game reveals a 3D-printed syringe The app constantly monitors breathing and anxiety levels. 4) Sports Psychology - Caleb Hobbs – The Psychology of Team Sports. This AR app uses realtime Unity physics so players can overlay basketball courts in any room (your closet!). Player/coaches can analyze and strategize about where balls will land and players should be placed. This collaborative AR project is embodied, and it could also serve as an ice-breaker for new students in sports groups, they can practice being a coach without all the real world stress and consequences. 5) LiDAR – AR for Physics – The team (along with Vieyra Software) has designed a public-facing app and a study to assess the efficacy of a physics education game called Motion Visualizer. This free game app instructs in position-over-time graphs in an embodied manner. Participants use a LiDAR-enabled smartphone to walk towards and away from a target; in real-time they observe how their body/position becomes the plotted function. This is gamified to 14 levels of difficulty. An ongoing RCT study explores the affordances of 1) dyadic conversations, and 2) full-body locomotion. The study crosses number of participants (1 vs 2), with active, embodied learning conditions (walking vs seated).

ABSTRACT. This study explores using an AI model to identify and predict frailty in elderly individuals by analyzing digital biomarkers of head and hand movements during virtual reality (VR) tasks. A sample of 20 participants, divided equally into healthy and frail groups, was assessed using traditional questionnaires and VR-based cognitive activities. The study utilized machine learning (ML) algorithms, including Decision Tree, Random Forest, and Logistic Regression, to analyze the digital biomarkers and predict the health status of the subjects. The results demonstrated that the Logistic Regression model achieved an accuracy of 0.83 and a ROC-AUC of 0.83, indicating its reliability in classifying frailty and healthy elderly. The research highlights the potential of combining digital biomarkers and VR with ML techniques for the detection of frailty condition, suggesting a novel assessment modality that could enhance early interventions and improve the quality of life for the elderly.

ABSTRACT. Introduction

Functional seizures (FS) is a clinical condition in which patients experience seizure symptoms without any EEG-supported basis for them. Patients living with FS tend to have difficulty describing and processing emotions, especially negative ones such as anger and shame. Verbal language use by FS has been examined thematically and suggests trouble recalling details during their seizures compared to epilepsy patients (ES). No study has compared text by FS and trauma controls (TC) for past autobiographical or relived emotional memories, which is akin to what patients experience during social interactions, including in psychotherapy. Since both FS and TC have similarly traumatic, negative memories to draw from, we wanted to investigate systematic differences in their language use when prompted to describe personal situations evoking anger and shame, respectively. We were particularly interested in machine learning as a means of classifying the two patient groups based on language use. We hypothesized that valence, word count, and rated task difficulty would yield the most accurate models to differentiate FS from TC compared to models with arousal and dominance language.

Method

In this study, we examined sentiment analysis features and difficulty ratings for a relived emotion task among FS and TC using supervised machine learning (ML) models. Participants (N=60) with FS (N=11) or TC (N=49) wrote short descriptions of memories evoking neutral, happiness, anger, and shame emotions; here, we focus on the latter two. A sentiment analysis was conducted by matching participant description words to emotion words found in ANEW, an English text database with ratings for valence, arousal, and dominance. Word count and mean valence, arousal, and dominance were computed per participant and emotion condition. Using supervised ML with a binary logistic regression classification engine in R with the tidyModels package, we trained the models and evaluated performance on test data.

Results

The model with 10 features, specifically valence, arousal, dominance, word count, and difficulty combined across the anger and shame experimental conditions (AUC=0.89) was among the most accurate in differentiating the two patient groups. Other top performing models included two features or fewer: shame valence and difficulty (AUC=.89, though it outperformed on testing compared to training data); anger word count and difficulty (AUC=.88), combined anger and shame difficulty (AUC=.84); anger difficulty (AUC=.83); anger valence and difficulty (AUC=.81); and shame valence (AUC=.79). Models with arousal and dominance for anger, shame, or combined anger and shame were less accurate by comparison. Given the small sample, models with two features or fewer are more likely to generalize to a larger sample than the model with 10 features. The most accurate models for testing data generally overfit training data, which also warrants extreme caution.

Discussion

Ultimately, these ML models serve as a proof of concept that FS use reliably fewer emotion words in describing emotional memories, find negative emotions more difficult, and use more negatively valenced words for shame compared to TC. With this alone, models were able to distinguish FS from non-FS participants. This is likely due to emotional processing difficulties and alexithymia experienced by those with FS, which are most salient for negative emotions such as shame. With a larger dataset to train the models and with an expanded sample of FS, TC, and ES in the future, this can be leveraged to help clinicians better identify whether a patient is experiencing epileptic or functional seizures and/or whether a patient is more avoidant of negative emotions when recalling events.

ABSTRACT. Over the last two decades, the fields of clinical and experimental (neuro)psychology have experienced rapid growth in the availability of technologies developed to replace or augment current standards of practice. The largest growth, arguably, has been in the application of technology to assist with the assessment and diagnosis activities that are often the hallmark of these fields. Approaches have been evolving and range from computerized implementations of traditional examiner-administered tests to novel tests and assessments utilizing emergent technologies as well as integration with other measurement modalities (e.g., wearables).

The application of the technology-psychology interface to cognitive performance assessment is proving to be the future of (neuro)psychology due to a number of advantages it provides over traditional assessment modalities and approaches. Among these are ease of use, greater accessibility, increased measurement precision, enhanced sensitivity to cognitive dysfunction, ability to monitor changes over time, reduced examiner bias, improved cost- and time-efficiency, and automated scoring and reporting. Additionally, computer-based approaches often allow increased flexibility for integration with virtual reality, imaging, wearables, and other technologies.

A number of computer-based cognitive assessment tools are commercially available and have gained traction for use. Among the most common is the Automated Neuropsychological Assessment Metrics, or ANAM (Vista LifeSciences, Inc.). ANAM represents over four decades of computer-based test development that has resulted in a highly flexible library of cognitive tests that bridges the gap between research and practice in human performance, readiness, and clinical and experimental (neuro)psychology. ANAM tests provide a high level of precision measurement of reaction time compared to many traditional neuropsychological tests, thereby providing greater measurement sensitivity to detect neurocognitive or performance changes/deficits.

The ANAM Test System comprises a computer-based suite of neurocognitive and behavioral health assessment tests as well as complementary reporting and data management tools. ANAM tests have been shown to measure underlying cognitive constructs similar to those measured by traditional paper and pencil tests, including attention and concentration, processing speed, working memory, executive function, spatial processing, and motor ability. ANAM tests meet common professional standards of test construction with scientifically verified psychometric properties. The ANAM Test System has received two 510(k) clearances by FDA and is also listed as a Computerized Cognitive Assessment Aid.

ANAM is distinctive among computer-based test systems because its historical use in the U.S Department of Defense as well as civilian applications has led to a large volume of scientific studies. ANAM has undergone extensive development to become among the most reliable and valid neuropsychological assessment tools with extensive use for measurement of the cognitive effects of stressful, extreme, or hazardous conditions; to document the effects and progression of neurological and other medical disorders; and to measure cognition resulting from exposure to risk factors that might render individuals less effective or in a compromised state.

The use of technology continues to expand in (neuro)psychology providing ongoing opportunities to improve upon the traditional assessment approaches of the past. The aim of this review is to provide an overview of the role of technology in the assessment of cognitive performance using one technology, ANAM, as an exemplar. The latest technological upgrades and enhancements will be described, integration approaches with other emergent technologies and advanced data techniques will be explored, and future development opportunities identified. While technology-driven assessment approaches provide a number of advantages, they also have some unique limitations, that will be highlighted and discussed.

ABSTRACT. Real-world health-related applications use knowledge graphs, knowledge networks, semantic networks, constraint-based models, augmented transition networks, concept maps, and neural networks. These representations are all the same, as they encode relationships between entities via edges/links and nodes/vertices. These representations, at the same time, are very different, as they employ mechanisms as varied as logic rules, annotation, graph mining, graph reasoning, inference, clustering, embedding, weighting, finite states, spreading activation, propagation, and random walks. This presentation will present actual examples where different representations are used, describe when and why different representations apply, and impose some order on different representations and their mechanisms with a structured categorization framework.

ABSTRACT. Clinical application of genomics for complex disease is an important goal for personalized medicine. Its implementation will intersect with existing social, structural, and interpersonal dynamics in heretofore unexplored ways. Using immersive simulation technologies, it is possible to investigate potential influences of future applications like polygenic scores (PS; models that consider the entire genome to derive risk for common diseases). In immersive simulations, we can identify areas where PS might exacerbate or attenuate biased behavior and attitudes towards historically marginalized patients. A series of studies investigates how the emergence of PS for common conditions could influence healthcare provider beliefs, behavior, and biases, and whether these influences vary depending upon the characteristics of the patient to whom the PS are applied. The first study engaged 84 3rd and 4th year medical students (64% female; 42% White) in simulated encounters with a virtual reality patient who was presented as Black or White depending upon randomly assigned condition, and in some cases with PS for five diseases. Following the simulation, participants completed a battery of questionnaires. Here, PS reports unintentionally affected many aspects of care recommendations, and differentially influenced bias-related beliefs and behavior depending upon the virtual patient’s apparent race. Medical student participants tended to express more negative attitudes toward the White virtual patient than the Black virtual patient (both of whom had obesity) when PS were absent from the encounter. When PS information was provided, this more often mitigated bias for the White virtual patient, whereas negative attitudes and bias against the Black virtual patient either remained consistent or increased (F=3.41, p<.01). Participants exhibited more gaze toward the Black patient than the White patient (F=4.36, p<.05), with no interactions with PS availability or time. In terms of interpersonal distance, participants kept the most distance from the White patient when PS was absent over the course of the visit (F=2.72, p<.05). Participants also tended to engage in language style matching least when interacting with this version of the patient (F=7.88, p<.01). This pattern underscores the complexity of intersectional identities in clinical settings wherein obesity tends to be more highly stigmatized for White women than for Black women. Provision of PS information was enough of a contextual shift to alter medical student attitudes and behavior. Use of an immersive setting enabled bias evaluation through implicit, interpersonal behavior (gaze behavior, interpersonal distance, timing) in addition to self-report.

To further understand PS influences, a larger, ongoing experiment immersing medical residents in telemedicine simulations with a virtual human patient evaluates the effects of PS of varying severity, integrated into the medical record on care decisions and interpersonal treatment of the virtual patient who varies in apparent race and also in body size. This study uses a human-powered wizard-of-oz approach to control the virtual patient, which was determined following extensive evaluation and pilot testing. Pilot evaluations suggest feasibility of this telemedicine simulation approach to support investigation of future genomic scenarios in an experimentally controlled and more scalable way.

ABSTRACT. The global upheaval induced by the COVID-19 pandemic has placed unprecedented stress on construction projects, with Taiwan's industry facing unique challenges. Implementing social distancing and health protocols necessitated a critical reassessment of conventional construction practices, especially in managing onsite personnel and maintaining quality standards under isolated working conditions. This study critically examines how the construction industry, mainly through first-level subcontractor inspections within private housing projects, has adapted its quality management processes to meet the complex demands of operations amidst the pandemic. Previous research has underscored deficiencies in traditional construction quality management (CQM) methodologies, proving insufficient to address the dynamic complexities inherent in construction projects. Building on these findings, this study undertakes an exploratory analysis, integrating a literature review with in-depth interviews of small to medium-sized subcontractors in private housing projects. The goal is to uncover practical quality management strategies employed in the field and understand the unique challenges posed by the pandemic. This iterative process led to an enhanced quality inspection framework, culminating in a streamlined checklist tailored for subcontractors in private housing projects. Drawing on real-world feedback, this tool aims to improve the inspection process's efficiency and effectiveness, especially under restrictive conditions. A significant advancement was developing a paperless inspection application using the AppSheet platform, designed to reduce direct human interaction and meet the pandemic's health and safety requirements. This application, trialed by a subcontractor, received positive feedback on its practical utility and feasibility. Employing qualitative methods, including a literature review and thematic analysis of interviews, this study explores the complex challenges and adaptive strategies of CQM during the pandemic. The findings suggest that the newly developed checklist and inspection application significantly enhance CQM efforts in private housing projects during these challenging times. Transitioning to a paperless system mitigates health risks and streamlines the quality inspection process, increasing efficiency and minimizing errors. This research delves into adaptive quality inspection in construction, focusing on managing complexity among subcontractors in private housing projects during COVID-19. It introduces innovative solutions for CQM tailored to crisis conditions, contributing to theoretical and practical knowledge. The study proposes a platform for meticulously managing and coordinating various operational aspects, ensuring safety, health, and quality amidst adversity.

ABSTRACT. Real-world health-related applications use knowledge graphs, knowledge networks, semantic networks, constraint-based models, augmented transition networks, concept maps, and neural networks. These representations are all the same, as they encode relationships between entities via edges/links and nodes/vertices. These representations, at the same time, are very different, as they employ mechanisms as varied as logic rules, annotation, graph mining, graph reasoning, inference, clustering, embedding, weighting, finite states, spreading activation, propagation, and random walks.

This track is dedicated to exploring current healthcare-related applications using knowledge networks. The goal is to present actual examples where different representations are used, describe when and why different representations apply, and impose some order on different representations and their mechanisms with a structured categorization framework.

The discussion will align with Government-supported initiatives. One is NSF's Prototype Open Knowledge Network (www.proto-okn.net) currently involving work in biology and health, as well as environment, justice, and other areas. Another is NCATS' Biomedical Data Translator (ncats.nih.gov/research/research-activities/translator) that integrates many data sources to understanding healthcare-related research.

ABSTRACT. Databases of biomedical knowledge are rapidly proliferating, with recent advances (such as the RTX-KG2 knowledge base that we recently developed [1]) becoming standardized at the schema level and semantic layer [2]. This has paved the way for AI-based computational systems that can systematically discover novel "drug repurposing" connections between drugs and diseases or to answer other kinds of translational questions (e.g., "What anticonvulsants are likely to have drug-drug interactions with cannabinoids?" or “What drugs would downregulate expression of RHOBTB2 in the central nervous system?). But progress in the development of usable AI-based biomedical reasoning systems has been hindered by (1) the lack of an expressive analysis workflow language for translational reasoning and (2) the lack of a reasoning engine that federates semantically integrated knowledge bases. As a part of the NCATS Translator project [3], we have developed ARAX [4], which is a new computational reasoning system for translational biomedicine that combines (1) an innovative knowledge graph analysis workflow language (ARAXi), (2) a comprehensive and semantically-unified biomedical knowledge graph (RTX-KG2), (3) a versatile and novel method for scoring and ranking analysis results, and (4) a machine-learning algorithm for predicting drug-disease indications [5]. Users or application-builders can query ARAX via a web browser interface or a web application programming interface. ARAX enables users to encode translational biomedical questions and integrate knowledge across sources to answer the user’s query and facilitate exploration of results. To illustrate ARAX’s application and utility in specific disease contexts, we will present and discuss several biomedical use-case examples. ARAX and RTX-KG2 are open-source software and are available on GitHub.

1. Wood EC, Glen AK, Kvarfordt LG, Womack F, Acevedo L, Yoon TS, et al. RTX-KG2: a system for building a semantically standardized knowledge graph for translational biomedicine. BMC Bioinformatics. 2022;23. doi:10.1186/s12859‐022‐04932‐3 2. Unni DR, Moxon SAT, Bada M, Brush M, Bruskiewich R, Caufield JH, et al. Biolink Model: A universal schema for knowledge graphs in clinical, biomedical, and translational science. Clin Transl Sci. 2022;15: 1848–1855. 3. Biomedical Data Translator Consortium. Toward A Universal Biomedical Data Translator. Clin Transl Sci. 2019;12: 86–90. 4. Glen AK, Ma C, Mendoza L, Womack F, Wood EC, Sinha M, et al. ARAX: a graph-based modular reasoning tool for translational biomedicine. bioRxiv. 2023. p. 2022.08.12.503810. doi:10.1101/2022.08.12.503810 5. Ma C, Zhou Z, Liu H, Koslicki D. KGML-xDTD: a knowledge graph-based machine learning framework for drug treatment prediction and mechanism description. Gigascience. 2022;12. doi:10.1093/gigascience/giad057

ABSTRACT. Introduction: ROBOKOP (Reasoning Over Biomedical Objects linked in Knowledge Oriented Pathways) and similar knowledge graph (KG)–based systems have emerged as pivotal solutions in the era of burgeoning biomedical and biopsychosocial data, where diverse knowledge sources (KSs) such as large databases or corpora of curated information often exist in isolation, thereby impeding the progress of translational research. To address this challenge, we developed ROBOKOP as a biomedical KG-based system, facilitating semantic integration and concurrent exploration of disparate KSs to drive discovery across the biomedical and biopsychosocial domains. Here, we describe a major release of ROBOKOP v1.0 and highlight several example use-case applications.

Methods: ROBOKOP's significance lies in its modular architecture, which fosters interoperability and facilitates diverse use-case applications within the biomedical and biopsychosocial domains. ROBOKOP comprises a user interface (UI), a question-builder tool, an integrated ROBOKOP KG, and a repository of harmonized and interoperable knowledge sources termed Automat. Unlike traditional monolithic KSs, ROBOKOP's modular approach offers advantages in scalability and maintenance, thereby mitigating challenges associated with updates and computational complexity. Moreover, ROBOKOP's modular architecture facilitates continuous improvement and expansion of its capabilities. For instance, guided by high-impact use cases, we are advancing ROBOKOP's functionalities to support graph embeddings, graph abstraction, and a variety of other features intended to accelerate biomedical and biopsychosocial research and discovery.

Results: To date, we have utilized ROBOKOP in 22 use cases, with 13 completed and 9 ongoing. Our use cases are categorized into technical types and scientific domains. The technical types include patient case studies or series to suggest causal explanations for undiagnosed diseases, infrastructure development to support new use cases, integration of ROBOKOP into the scientific workflows of external teams, and targeted research assistance to support external users. The scientific domains cover drug repurposing for rare diseases, environmental health and toxicology, adverse outcome pathways (AOPs), and applied exploratory research in a variety of scientific domains. Beyond these formal use cases, ROBOKOP infrastructure supports several large-scale research programs, such as the NCATS Biomedical Data Translator Program, UNC Obesity Hub, UNC AIxB Hub, EveryCure, BioDataCatalyst, HEAL, RADx, and NCATS LitCoin.

Conclusion: ROBOKOP leverages its user-friendly interface, harmonized and interoperable KSs, and advanced analytic tools to foster interdisciplinary collaboration and expedite biomedical and biopsychosocial discoveries.

Funding support: ROBOKOP is supported with joint funding from the National Institute of Environmental Health Sciences and the Office of Data Science Strategy within the National Institutes of Health (award #U24ES035214).

1. Bizon C, Cox S, Balhoff J, et al. ROBOKOP KG and KGB: integrated knowledge graphs from federated sources. J Chem Inf Model. 2019;59(12):4968-4973. doi: 10.1021/acs.jcim.9b00683. https://pubmed.ncbi.nlm.nih.gov/31769676/.

2. Morton K, Wang P, Bizon C, et al. ROBOKOP: an abstraction layer and user interface for knowledge graphs to support question answering. Bioinformatics. 2019;pii:btz604. doi: 10.1093/bioinformatics/btz604. https://pubmed.ncbi.nlm.nih.gov/31410449/.

ABSTRACT. Context: I will set the stage for the following talks by providing an overview of the important concepts supporting the remarkable method for the non-invasive rehabilitation therapy called Crucial Even Rehabilitation Therapy (CERT). We begin with a review of renewal statistics and refine that to the statistics of crucial events (CEs) which we argue is the basis of all the temporal inverse power law (IPL) fluctuations of healthy physiologic signals. These signals are CE time series (CETS) generated by the organ-networks (ONs) that constitute the network-of-ONs (NoONs) that is the human body. It is shown that the scaling indices of the CETS generated by the heart, lungs, and brain lock-onto one another as depicted in the figure. Hypotheses: An injured or diseased ON such as the brain, heart, or lungs can be rehabilitated to a healthy level of functionality using a complexity synchronization (CS) protocol. The CS-protocol is to systematically drive a compromised ON by a second, real or simulated sender-ON signal having the healthy multifractal dimension (MFD) propertied of the receiver-ON being rehabilitated. [1] Methods: Fractional calculus is used to establish the nature of scaling statistics. Each of the CETS generated by the physiologic triad named above has their individual complexity level quantified by a time-dependent IPL scaling index δj(t), j=1,…,66, determined by the scaling probability density function (PDF): (eq format does not copy) quantifies the MFD of the CETS. All 66 members of the triad generate MFDTS so that maximum information is exchanged among interacting ONs due to the multifractal character of the scaling index. The time series from the members of the triad look nothing like one another with vastly different time scales for fluctuations and overall forms but after being processed using diffusion entropy analysis reveals a remarkable result. Results: The results reveal a hidden synchronization among the scale factors characterizing the three kinds of time series which is very different from the synchrony we are accustomed to seeing in comparing the central tendency of stochastic signals. Conclusions: The CS is shown in the talks to be given to be hidden within phenomena whose only point of commonality is their complexity. This suggests the possibility of its being a universal property of signals in order that different complex modes (networks) can communicate either within a given NoON or between different NoONs. [1] BJ West, P Grigolini and M Bologna, Crucial Event Rehabilitation Therapy, Multifractal Medicine, SpringerBriefs in bioengineering, Springer (2023).

ABSTRACT. Background: Most systems in nature, as well as social and technological, are highly complex and dynamic, both structurally and functionally. Such complex systems are characterized by nonlinear dynamic network interactions exhibiting reciprocal, recursive, multiple causal processes giving rise to criticality and emergent states through spontaneous temporal self-organization. New theories and methods are needed to better understand information exchange among complex systems and to advance human-system interaction technologies. Here, we base our analysis of neurophysiological network interactions on multifractal theory and crucial events emerging from self-organized temporal criticality1,2. We recently, applied DEA to electroencephalographic (EEG), electrocardiographic (ECG), and respiratory (RESP) time series data simultaneously recorded during cognitive task performance1,2 as a means of investigating their interactions based on a measure of complexity. Preliminary results showed that using this approach we observed synchronization of complexity scaling indices across 64 channels of EEG, ECG, and RESP, despite the drastic differences in the temporal dynamics and frequency scales of these three heterogeneous organ network time series. However, analyses have been limited to data from just two participants during performance of two different tasks (neurofeedback training and Go-NoGo task), as a preliminary proof of concept. Here, we extend our analyses to additional subjects. Hypotheses: We hypothesized that heterogeneous neurophysiological networks are inter-related via their multifractal dimensions or complexity measured by time-varying inverse power law (IPL) scaling indices  measured by diffusion entropy analysis (DEA). We call this phenomenon complexity synchronization (CS). Methods: DEA was applied to all data in 30-s sliding windows with 20-s overlap using the following parameters: stripe size: EEG = .0490, ECG = .0192, RESP = .0024; fit regions: EEG = .2-.8, ECG = .2-.6, RESP = .34-.63. Stripe sizes were automatically determined using the Kolmorgorov-Smirnoff algorithm and fit regions were automatically determined using the algorithm developed by Schizas et al. (presented in this symposium). Results: We again observed CS among 64 channels of EEG, ECG, and RESP in additional subjects during cognitive task performance, providing additional support of our original observations (Figure 1 and Table 1). Table 1. Correlations among  scaling indices for averaged EEG, ECG, and RESP (all p <.001). EEG ECG RESP EEG - ECG 0.785 - RESP 0.705 0.866 - Conclusions: We define complexity as a property of crucial events (renewal processes), a form of temporal complexity, that is interpreted as a degree of multifractality, or multistable state fluctuations in the dynamic repertoires of complex neurophysiological systems. CS is characterized by high-order synchrony among the IPL scaling indices of interacting complex networks, which we hypothesize is the mechanism necessary for coordination among them1,2. We propose to further study CS as a foundational principle underlying how information is transmitted within and among complex networks from neurophysiological interactions within individuals to those comprising social interactions (human-human and human-agent teaming). We believe this approach provides the next level of abstraction regarding how information is transmitted among complex networks, going beyond the classic synchronization of time series via oscillatory mechanisms. Acknowledgement This work is supported by US Army Research Lab collaborative agreement W911NF-22-2-0097. We also acknowledge Dave Boothe for conceptual contributions. References 1. Mahmoodi, K., Kerick, S. E., Grigolini, P., Franaszczuk, P. J., & West, B. J. (2023). Complexity synchronization: a measure of interaction between the brain, heart and lungs. Scientific Reports, 13(1), 11433. 2. West, B. J., Grigolini, P., Kerick, S. E., Franaszczuk, P. J., & Mahmoodi, K. (2023). Complexity synchronization of organ networks. Entropy, 25(10), 1393.

ABSTRACT. Context: The recent advancements in Complexity Theory have dramatically improved our understanding of physiology, health, disease, and medicine. In a complex system the distribution functions of the observable quantities have inverse power law spectra (IPL), which entails theory for fractal phenomena capturing their fractal dimension, dynamics, and statistics. We are interested in the distribution function of the time intervals ('s) between the consecutive evens; an event being a transitions of the observable’s time series from one state to another (where the states are defined via stripes). If such distribution has an IPL, the index  of the IPL is a measure of “temporal complexity” of the system. To quantify the temporal complexity, we use an analytical technique, called Diffusion Entropy Analysis (DEA). We process the data using DEA to obtain the scaling  and from  we can calculate   =1+1/. Hypothesis: Previously, we have shown that mutually adaptive systems, either physiological such as time series simultaneously generated by the brain, heart and lungs [1] or artificial [2] have a quasiperiodic scaling t, as measured by scaling index over time. Additionally, the scaling time series of these interconnected systems are in synchrony with one another, we named this phenomenon Complexity Synchronization (CS). Methodology: Herein we tested the possible CS between the brain and movement of the finger of patients with Essential Tremor/Parkinson’s disease, as a measure of the connection between the brain’s dynamics and its output signal. We recorded local field potentials/electrocorticography from hand motor and premotor cortical area in human subjects (eight contact subdural electrocorticography (ECoG) strip) with essential tremor patients (N= 10) and Parkinson’s disease (N= 22) during deep brain stimulator implantation surgery [3]. To measure the complexity over time of these time series we used DEA with stripe size of 0.01 on sliding windows of length 5e4 data points (sample rate 2400 Hz). Results: Our results show strong correlation (> 0.6) between the simultaneously measured scaling time series of the ECoGs and with the scaling time series of the hand movement’s signal (p < .001), confirming the CS between them (Figure 1). This suggests the hypothesis that by designing adaptive complex networks with a complexity that is sufficiently similar to that of the brain we can modify its dynamics, as a non-invasive signal, for example as a targeted network synchrony-disruption approach. Conclusion: CS may be foundational in determining how the underlying information is transmitted within and among complex networks from human neurophysiological networks to complex networks of humans and technology systems (human-human and human-machine teaming).

References [1] Mahmoodi, K., Kerick, S. E., Grigolini, P., Franaszczuk, P. J., & West, B. J. (2023). Complexity synchronization: a measure of interaction between the brain, heart and lungs. Scientific Reports, 13(1), 11433. [2] Mahmoodi, K., Kerick, S. E., Franaszczuk, P. J., Parsons, T. D., Grigolini, P., & West, B. J. (2024). Complexity synchronization in emergent intelligence. Scientific Reports, 14(1), 6758. [3] O'Keeffe, A. B., Malekmohammadi, M., Sparks, H., & Pouratian, N. (2020). Synchrony drives motor cortex beta bursting, waveform dynamics, and phase-amplitude coupling in Parkinson's disease. Journal of Neuroscience, 40(30), 5833-5846.

ABSTRACT. Context. Interactions among complex networks such as the brain, lungs and heart which function at different time scales can be facilitated by utilizing complexity analysis of the associated time-series [1]. Complexity analysis studies the occurrence of events defined as the crossing times of the signal from one amplitude stripe (level) to another. If these events have no correlation, while the time-intervals between consecutive critical events follow an inverse power law (IPL) μ (1 < μ < 3) distribution, they are considered as crucial events (CEs). The diffusion time series generated from the extracted CEs (i.e., accumulative sum of CEs) has a scaling index δ which can be measured via the novel framework of modified diffusion entropy analysis (MDEA) [1]. Theoretically, the resulting δ is equal to μ-1 and 1/(μ-1) for 1 < μ < 2 and 2 < μ < 3, respectively. The MDEA approach works well in uncovering CS, under the condition that certain parameters such as the associated stripe size and the window length region used to extract CEs and evaluate the entropy slope are carefully selected by trial and error, which may be impractical and time consuming. We propose an automated framework for setting the two aforementioned parameters to extract CS.

Hypotheses. The proposed automated learning approach for the stripe size and window lengths relies on the property that CE time-interval should follow an IPL distribution, while extracting proper slope fitting regions in the entropy.

Methodology. The stripe size value affects the distribution of the time-intervals between CEs. A proper stripe size selection can drastically affect the distribution of CE time-intervals. If the stripe size is not properly selected then the empirical distribution will not follow an IPL, while when properly selected can result an empirical distribution closely fitted to an IPL for proper μ. We utilize the Kolmogorov-Smirnov (KS) statistic [2] to quantify how well the CE time-intervals follow an IPL for a given stripe size. The KS statistic quantifies the maximum absolute difference between the empirical CE time-interval distribution which is affected by the stripe size, and a candidate IPL. The optimal IPL parameter μ and stripe size are selected to minimize the KS statistic. The properly set stripe size is set to calculate the CE diffusion entropy from which its second-order derivative is estimated to identify regions in which the slope of the diffusion entropy remains approximately constant, pointing to roughly linear regions used to extract the complexity scale.

Results. Fig. 1 (left) depicts the bias and variance using synthetic data generated via the Mittag-Leffler waiting time distribution [2]. The estimator mean (blue) and variance (red), averaged over 100 Monte Carlo independent trials of the KS-based (solid curves) and MDEA-based μ estimator (dashed-curves) versus the number of data samples. As the number of samples increases, both the bias and variance of the KS-based estimator decreases; the same is also true for the MDEA estimator when the KS-based stripe size estimate is used as input. However, this is not the case for MDEA when the stripe size is not correctly selected. In Fig. 1 (right) we plot the complexity scaling factor δ returned by MDEA using the KS-based estimated stripe size values versus time for EEG time series corresponding to 8 different EEG channels. KS-based stripe size selection along with scale fitting region selection uncover CS patterns across the 8 different EEG time-series.

Conclusion. We have devised a KS-based stripe size selection algorithm that minimizes the fit between the CE time-interval empirical distribution and candidate IPLs, along with selecting proper scale fitting regions in the diffusion entropy. The combination of the two gives good CS synchronization results across EEG time series. Currently, we are studying how a proper window length range and scale can be extracted only utilizing the information provided by the CE time-interval distribution, as well as how the IPL parameters change as the time-duration of the observed window changes.

Acknowledgement This work is supported by US Army Research Lab collaborative agreement W911NF-22-2-0097. We also acknowledge Paolo Grigolini and Bruce J. West for conceptual contributions.

References

[1] Mahmoodi, K., Kerick, S.E., Grigolini, P. et al. Complexity synchronization: a measure of interaction between the brain, heart and lungs. Sci Rep 13, 11433 (2023). https://doi.org/10.1038/s41598-023-38622-8 [2] Corder, G. W.; Foreman, D. I. (2014). Nonparametric Statistics: A Step-by-Step Approach. Wiley. ISBN 978-1-118-84031-3.

ABSTRACT. The necessity to understand complex systems in today’s world has led the scientific community to develop methods for extracting features from these systems and to analyze them. We analyze the Survival Probability of a series of events, which is characterized by an inverse power law with index “mu” between 1 and infinity. In addition to the survival probability, we perform Diffusion Entropy Analysis (DEA) on these series of events to recover the scaling of the time series of the system. To test Crucial Events Rehabilitation Therapy (CERT), we produce two forms of non-invasive stimuli. Non-invasive stimuli may have the capability to inject crucial events into a system that lacks crucial events. We believe that healthy physiology is characterized by crucial events, and pathology is a lack of crucial events. Following the work of Fabio Vanni [1], who argues that music may reflect the state of mind, we intend to use music rich in crucial events to induce crucial events into the mind of a pathological individual. We use two approaches to produce a series of events to be analyzed. We use a truncated form of an idealized Manneville map as prescribed by David Adams [2], and we use Mitag-Leffler as used by Mauro Bologna [3], with truncations imposed. David Adam’s form of the intermittency generated by the Manneville map has inherent truncations and is used for “mu” less than 2 and greater than 1 in his paper. Mitag-Leffler may be used for “mu” less than 2 as well. However, we create a non-truncated series using Mitag-Leffler, and then we cut off values that are greater or less than a tolerance. Most natural processes which are found to follow Levy dynamics have truncations, so it is viable to truncate a series of events to mimic a natural process [4]. Truncations are important for creating a musical sequence of events. They allow for interpretation of the music in the classical measuring of time scales and beats per minute. We create music based on a 4/4 time scale at 120 beats per minute. This dictates 0.5 seconds for the minimum value in the time series, and 2 seconds for the maximum value in the time series. This truncation fits a hyperbolic survival probability more than a non-truncated form of Manneville or Mitag-Leffler. We produced a musical score with a harp, and we mimicked a formula 1 race car accelerating, decelerating, up shifting and down-shifting. For the harp music, we use one time series and we assign random notes from the C major scale spanning three octaves to each event. For the formula 1 race car, we create three time series using either David Adams, or Mitag-Leffler and then we concatenate and shuffle the arrays into one. This drastically changes the complexity of the system. The reason for concatenating three different time series for the formula 1 race car, is because there exists different time periods in lower, middle, and higher gears during a race . We weight the different time series depending on how often a driver spends in those gears per a given track. We assign different audio recordings from a real race to each group of gears (low, middle, high). Our results for the complexity measure of music coincide with our hypothesis. We are able to produce music with high complexity, which is suitable for CERT. In conclusion, non-invasive stimuli in the form of auditory stimulation may be generated with a desired complexity measure “mu”, and may be used to induce crucial events into a biological system characterized by a state of pathology. This induction of crucial events may stimulate a state of healthy physiology.

Acknowledgement We acknowledge Lucio Tonello, Scott Kerick, Piotr Franaszczuk, and Korosh Mahmoodi for conceptual contributions.

References 1. F. Vanni, P. Grigolini, “Music as a mirror of mind", Esthétique de la complexité: Pour un cognitivisme non-linéaire, Chapter: Music as a mirror of mind, Editors: HERMANN, ISBN: 978 2 7056 9378 7

2. D. Adams, P. Grigolini, “Music, New Aesthetic and Complexity”, J. (eds) Complex Sciences. Lecture Notes of the Institute for Computer Sciences, Social Informatics and Telecommunications Engineering, vol 5. Springer, Berlin, Heidelberg, (2009).

3. M. Bologna, “Distribution with a simple Laplace transform and its applications to non-Poissonian stochastic processes,” Journal of Stat. Mechanics, 073201, (2020).

4. Physical Review E. R. Bettin, R. Mannella, B.J. West, P. Grigolini, “influence of the environment on anomalous diffusion”, 51, 212 (1995)

ABSTRACT. Understanding the dynamic nature of trust in automation (TiA) is crucial for the successful adoption of automated technologies. Trust evolves over time based on ongoing experiences, playing a vital role in high-stakes environments where safety relies on human-automation interactions. While the dynamic nature of trust is acknowledged, capturing its real-time evolution experimentally and modeling its behavior remains challenging. This study aims to address these challenges by introducing a mathematical model that quantifies trust dynamics across multiple timescales and validating it using experimental data. We propose a mathematical model to integrate measurable components of trust (performance, risk, and historical reliance) across short and medium timescales. This model is validated with experimental data, treating trust as a latent variable. We leverage random forest models to estimate model parameters and assess the contribution of each trust timescale to overall trust dynamics. Using these parameters, we analyze how trust fluctuates under different automation conditions (levels of reliability and varying workloads) and its variations among individuals with differing performance levels. Our study demonstrates that the proposed model successfully replicates trust dynamics observed in prior studies. Further, incorporating trust timescales improves automation usage predictions, emphasizing the importance of trust in decision-making. Short-term trust experiences significantly impact overall trust dynamics. Generally, trust levels are higher in highly reliable automation scenarios, but with a delayed response that likely reflects the user's evaluation period. Interestingly, while the type of automation (implying varying workloads) doesn't significantly impact trust in highly reliable systems, it does increase trust in less reliable automation. This study offers a novel mathematical model for understanding the dynamic nature of trust in automation, validated through experimental data. It highlights the interplay between short-term and long-term experiences in shaping trust. Our findings inform the design of trustworthy automated systems that seamlessly align with human expectations. Future research should focus on models that generalize across diverse experimental contexts, further enhancing our understanding of trust dynamics in automation.

ABSTRACT. Social media use increased following the COVID-19 pandemic (Kemp, 2020). Virtual interactions about physical appearance (whether positive or negative) tends to increase body dissatisfaction in both gender (Griffiths et al., 2018). Whether comments on social media are positive or negative, if they focus on physical appearance, they lead, in the short term, to an increase in body dissatisfaction (Tiggeman and Barbato, 2018). In parallel, social media is increasingly a place to fight grossophobia (Tiggeman and Zinoviev, 2019). Indeed, viewing images imbued with body diversity (and therefore a more humanizing reality), featuring self-compassionate messages or unretouched photos promote body satisfaction and self-compassion (Tiggeman and Zinoviev, 2019).

The main objective is to explore the links between social media use, global self-esteem, body image and physical activity among participants in a project focusing on social media exposure to positive body image content.

This project is a cross-sectional study using baseline data from a larger study on exposition to positive content on social media. A total of 299 participants recruited via social media advertising completed online questionnaires that assessed social media use, global self-esteem, body image, intuitive eating, and intuitive exercise. After data cleaning, 262 participants were included in the present study. Descriptive and correlational analyses were performed on the main variables. Then, to create different profiles of social media users, ascending hierarchical cluster analyses were used (according to the method of Ward, 1963). Then, to obtain the importance of each predictor, "two-steps" clusters were made. Once the profiles were obtained, ANOVAs are performed to describe the different profiles.

Participants were mainly women (86.3%), with an average age of 41.35 (S.D.: 12.89). Most participants (79.4%) wanted to lose a little or a lot of weight. Almost all (98.5%) use social media. Participants report using them several times a day (87.4%). Most participants found that social media were detrimental to body image (57.3%). Correlational analyses show that the more participants use social media, the more their body esteem was low (r = -0,16, p = 0,01). On the other hand, results show that the more participants use social media, the more they move in a positive, mindful way (r = 0,14, p = 0,03). Cluster analyses have created three distinct subgroups. Using social media less often and for shorter periods, Group 1 has a more favorable profile than Group 2 and Group 3. Group 3 and Group 2 have a similar profile in terms of frequency and minutes of use, but Group 3 uses social media more actively (creating posts, sharing posts, etc.) than Group 2. ANOVAs between the three groups reveals partially significant differences on the Body Esteem Scale – appearance subscale (F(2, 252) = 2.729, p = 0.067) and significant differences on the Intuitive Exercise Scales – mindfulness subscale (F(2, 252) = 3.83, p = 0.023). Results of the post hoc analyses indicate that Group 3 scored lower (M = 1.823, SD = 0.752) on the Body Esteem Scale than Group 1 (M = 2.08, SD =0.756) (p = 0.072). On the Intuitive Exercise Scale – mindfulness subscale, Group 3 scored significantly higher (M = 3.679, SD = 1.033) than Group 1 (M = 3.246, SD = 1.066) (p = 0.019).

Results highlight several important points to bear in mind when it comes to social media. Firstly, the more one person uses social media, the more appearance-related body esteem is low. However, using social media actively, as opposed to passively, is associated with reduced negative effects on social media. In addition, people with this type of social media use seem to move in a more positive way by engaging in mindful physical activity.

ABSTRACT. The study assesses the reliability and validity of the Helping Behavior Scale developed to assess the tendency of students of King Saud University to intervene in cyberbullying instances. The scale includes four key dimensions: perceiving the situation as an emergency, feeling obligated, believing in the efficacy of one’s actions, and making decisions. Since the scale was newly developed, a convenient sample of 126 students was used to assess its reliability and validity. The internal consistency was also evaluated using Cronbach’s alpha, McDonald’s omega, and split-half reliability coefficients. The Cronbach’s alpha for the entire questionnaire was 0. 82, which is high, while the subscale alphas were 0. 37 to 0. 68; these are areas we can still fine-tune. Moreover, McDonald’s omega and split-half reliability also supported the high reliability of the scale. Various approaches were used to assess validity, such as internal consistency validity, which was established by the high Pearson correlation coefficients between items and the total score, as well as the items and the dimension of the scale. CFA established the construct validity and the fit statistics (CMIN=102. 463, DF=61, P=0. 000, GFI=0. 923, CFI=0. 957, RMSEA=0. 073) were within an acceptable range. Discriminant validity was confirmed through the scale scores' differences between the upper and lower quartiles. The results show that the Helping Behavior Scale is a significant tool that measures bystander helping behavior in cyberbullying. These psychometric properties demonstrate that they can be used both in research and practice to inform the design of interventions to increase positive bystander behaviors and decrease the impact of cyberbullying on university students. Notably, more studies with increased subject populations and different population types are suggested to improve these findings.

ABSTRACT. Background and Goals Shift work sleep disorder (SWSD) is a circadian rhythm sleep disorder characterized by disturbances in sleep patterns and excessive sleepiness due to working non-traditional hours or rotating shifts. Individuals with SWSD often experience difficulty falling asleep and maintaining sleep, which can lead to chronic sleep deprivation and impairments in cognitive function and overall well-being. Cognitive behavioral intervention for SWSD relies on careful tracking of sleep and wake timing across the 24-hour day to make scheduling and light exposure/avoidance recommendations. However, existing tools (e.g., paper sleep diaries, sleep diary apps) are unsuited to shift work schedules due to nontraditional sleep hours, multiple sleep bouts per 24h, and forced day-to-day variability in sleep schedules. Thus, our group sought to develop an app (working name: Lavender) to facilitate both patient and provider to track a patient’s sleep and work schedule, monitor adherence to the prescribed sleep schedule, and make tailored recommendations for sleep scheduling and light exposure and avoidance.

Methods and Technical Summary Lavender is a web application that is designed to address the challenges of SWSD. Lavender serves as a bridge between patients and their sleep psychologist provider. By allowing patients to input their daily sleep data into a sleep diary, the application automates the process of data collection and analysis. Lavender also generates optimized sleep schedules tailored to a patients’ work and scheduled activities that optimize alertness and time for sleep.

Sleep schedules are generated based on an algorithm that considers both hard and soft constraints. Hard constraints include the minimum number of hours a patient is suggested to sleep in their main sleep episode, while soft constraints include the ability to nap during a work shift. The app is currently being developed using the Employee Scheduling algorithm created by Google OR Tools. The problem takes into consideration that the 24 hour day is divided into shifts, and the algorithm uses the data input by the user to recommend the optimal sleep episode(s) during this period. The app contains four main components: the sleep diary, the sleep schedule, the sleep statistics, and add event. Patients begin by entering any “events” during their week, which can consist of work, traveling, or anything occurrence that will prevent them from sleeping at a certain time. Once the events are added, the app’s algorithm will create an ideal sleep schedule for the patient based off of their schedule. The provider will have freedom to edit the sleep schedule once generated. Once the sleep schedule for the week is generated, the patient will track their sleep episodes through the sleep diary page, which will retrieve their sleep data and store it into a database in order to form sleep statistics easily. The provider has the option to download this data as needed.

Conclusions and Future Directions By facilitating patient-provider connectivity and streamlining data analysis and output, Lavender has the potential to reduce the burden of treatment on both patients and providers. Future directions include learning modules in which a provider can assign topics for a patient to learn, and sleep consistency features such as timed notifications to remind the shift worker to sleep around their assigned sleep episodes, and calendar exports. Lavender has the potential to help support all providers treating shift workers. Our team is currently seeking funding to support further development and sustain and expand the app in the long term.

ABSTRACT. The Pan American Health Organization (PAHO, 2022) highlighted that, during the first year of the pandemic, the prevalence of anxiety and depression increased by 25%. In Mexico, an increase of between 20 and 30% of these effects was recorded. Furthermore, regarding the proportion of health personnel, in our country, it has been found that for every 100,000 inhabitants there is only one psychologist and four psychiatrists. The above panorama highlights the need to have interventions that reach most of the affected population and that resolve the problem of lack of coverage. A viable strategy is low-intensity treatments, which are those that do not require high health resources.

The present project considered the usefulness of internet-based interventions, it has been found that they are significantly more effective than untreated groups and equally effective than face-to-face therapies or usual treatments for anxiety disorder and depressive disorders to instrument, disseminate and evaluate a psychological support intervention based on online intervention protocols that have shown evidence and delivered over the Internet. Method: Participants were randomly distributed into two groups of N=18 for (1) TAO Program (online intervention) with minimal support from the therapist and (2) without therapist. Efficacy of the intervention will be assessed with BDI and BAI as primary result measures For both modalities, intra-subject measurements will be carried out before and after the administration of the intervention and during treatment, also follow-up measurements will also be carried out at three and six months. . Results: 1) It is expected that both treatment modalities will be equally effective, 2) that the BDI and BAI measures will reduce, 3) increase in the levels of activity and mindfulness and 4) that the online treatment will have adequate usability scores and acceptance.

The main advantages of this type of interventions are the reduction in contact time between client and therapist, addressing geographical barriers and reducing equity problems in access to mental health services. In addition, they ensure confidentiality and reduce the stigma associated with the need for psychological support.

ABSTRACT. Since late 2019, the COVID-19 pandemic has led to mandatory social distancing worldwide, thereby prompting a shift to online and remote work. Teleconferencing apps like Zoom became prevalent during this period but they lack human interaction crucial for effective collaboration. In response, Virtual Reality (VR) gained traction, offering immersive social and professional meetings, thus revitalizing human-human social interaction in virtual environments. In VR environments, the visual styles of virtual characters (VCs) significantly influence user performance. Appearance of VCs lead to attitudinal and behavioral changes. However, achieving highly realistic characters can sometimes evoke negative reactions, a challenge for designers known as the uncanny valley. Social VR apps facilitate virtual socialization like face-to-face interactions, supporting the social presence aspect of remote communication. Recent studies highlight the potential of social VR in collaborative research efforts. This research studies the design and user experience in collaborative VR applications through surveys and journal entries.

Study 1: Participants were recruited via university bulk email, social media postings, and word of mouth. To develop the survey, a total of 52 images of VCs from different VR applications were collected and categorized by body type and style, with 105 responses. Using a discrete choice experiment, nine images were selected, and participants were asked to rate the VC images on familiarity, engagement, trust, and humanness. Independent one-way ANOVAs were conducted to identify significant differences. The findings showed that full bodies and torsos were more familiar than half bodies, and stylized and non-human VCs were more familiar. In terms of engagement, users were more engaged with stylized and torso-bodies. Users trusted torso-bodied and stylized VCs more. Full-bodied, stylized, and non-human VCs were more human. To determine preferences, a Mixed Logit Model was conducted, revealing that users preferred female, full-bodied realistic or stylized VCs. These findings were used to create a VR application realistic and stylized VCs. 12 participants were recruited for the usability study. Users experienced the VR application and then completed a survey with the same constructs. Independent samples t-tests were conducted and no significant differences were found for realistic and stylized VCs.

Study 2: While the previous study helped understand VC design, it did not address how users collaborate in a VR environment. This second study assessed commercially available collaborative VR applications, selecting Spatial for its full-bodied stylized VCs. Spatial, a virtual workspace, allows users to share content and engage in whiteboard collaboration. A team of four, who had previously worked together, was recruited and given Oculus Quest 2 headsets to document their experiences. Qualitative analysis of 16 journal entries from four sessions was conducted using Constructivist Grounded Theory. Initially, participants noted humorous VCs due to tracking inaccuracies and difficulty uploading meeting materials, revealing limitations in Spatial's free version. After upgrading, logistical challenges improved, but file compatibility issues persisted. Over time, participants became more comfortable with the application but noted the absence of haptic communication and physical discomfort. Final reflections highlighted connectivity and audio issues, with technical difficulties causing meeting disruptions.

Overall, Study 1 provided insights into user preferences for VC design, while Study 2 underscored technical challenges impacting collaborative experiences in VR. These findings emphasize the ongoing need for improvements in both design and functionality to enhance user satisfaction and effectiveness in VR collaboration. The COVID-19 pandemic has accelerated the adoption of VR as a means of facilitating remote collaboration, offering immersive experiences that transcend the limitations of traditional teleconferencing. However, it is essential to address technical challenges and user preferences to ensure its effectiveness and widespread adoption in various contexts. Continued research and development efforts are crucial in advancing VR technology and its applications.

ABSTRACT. The integration of high-performance servers equipped with GPUs to stream 3D virtual environments for neurophysiological assessments marks a significant advancement in the field of digital health and cognitive science. This paper discusses the utilization of Unreal Engine's Pixel Streaming and Unity's Render Streaming as cutting-edge technologies that enable the delivery of high-fidelity virtual environments through standard web browsers. The primary advantage of this approach is that it eliminates the need for patients or participants to own or operate high-performance computing systems, making these advanced assessments more accessible and scalable. Background and Importance of Ecologically Valid Virtual Assessments Virtual environments have increasingly become vital tools in neurophysiological research, offering the ability to create ecologically valid scenarios that closely mimic real-world settings. These environments allow researchers to control and manipulate variables in ways that are impossible in physical environments, thus providing a more accurate and reliable assessment of cognitive and behavioral responses. Ecologically valid virtual assessments are beneficial because they enhance the external validity of research findings, ensuring that the results are more generalizable to real-life situations. This is particularly important in neurophysiological assessments where the context of the task can significantly influence outcomes. Virtual environments can simulate complex, dynamic, and immersive settings that engage participants more effectively than traditional laboratory-based tasks, leading to more accurate measurements of cognitive and emotional states. High-Performance Servers with GPUs and Streaming Technologies To achieve the high fidelity and interactivity required for these virtual assessments, high-performance servers equipped with GPUs are essential. These servers are capable of rendering complex 3D graphics and handling the substantial computational load associated with real-time simulations. Unreal Pixel Streaming and Unity Render Streaming are technologies that allow these high-performance servers to stream the rendered content to users' devices over the internet. The content is delivered via web browsers, making it accessible on a wide range of devices, including those with limited processing power. This approach significantly reduces the hardware requirements for end users. Participants can access and interact with the virtual environments using standard devices, such as laptops, tablets, or even smartphones, without compromising the quality or performance of the assessment. This democratization of access is particularly beneficial in clinical settings, where patients may not have access to high-end computing equipment but can still benefit from cutting-edge neurophysiological assessments. Low Latency and High Accuracy in Neurophysiological Measurements A critical aspect of streaming 3D virtual environments for neurophysiological assessments is ensuring low latency and high accuracy. Low latency is crucial because delays in rendering and streaming can disrupt the immersive experience and negatively affect the ecological validity of the assessments. High accuracy is equally important, as the precision of neurophysiological measurements, such as EEG, heart rate variability, and eye tracking, depends on real-time data processing and synchronization with the virtual environment. Advanced networking protocols and optimizations in Pixel Streaming and Render Streaming are designed to minimize latency, ensuring a seamless and responsive user experience. Additionally, the high-performance servers' GPUs handle complex computations in real-time, maintaining the accuracy and integrity of the neurophysiological data collected during the assessments. Conclusion The use of high-performance servers with GPUs to stream 3D virtual environments for neurophysiological assessments represents a significant leap forward in digital health technologies. By leveraging streaming, researchers and clinicians can deliver high-fidelity, ecologically valid assessments through standard web browsers, making these advanced tools more accessible. The integration of low-latency and high-accuracy streaming ensures that the assessments maintain their scientific rigor. Furthermore, AWS provides a scalable and efficient hosting solution, enabling the widespread adoption and deployment of these innovative assessments. This approach holds great promise for advancing neurophysiological research and improving patient care.

ABSTRACT. Introduction: Traumatic events, such as natural disasters, cause physical and psychological stress in direct or indirect victims and often result in significant mental health deterioration, including symptoms of depression, anxiety, substance abuse, and, in severe cases, Post-Traumatic Stress Disorder (PTSD). Currently, various studies have demonstrated the effectiveness of using Virtual Reality (VR) for PTSD treatment, with a predominance of applications for violence victims, such as war-related situations, terrorism, and crime. In Mexico, some studies have focused on the use of VR for the treatment of trauma-related disorders in criminal violence victims, also showing the effectiveness of such interventions. Regarding the development of virtual environments for earthquake simulation, various technological advancements have been identified; however, most of these developments are focused on simulation for awareness and appropriate action in related situations. Therefore, few studies have been found focusing on the use of VR in the clinical setting.

Objective: This work aims to describe the development of virtual environments for the treatment of earthquake-derived PTSD in the Mexican population and to evaluate the efficacy of a VR-based intervention through prolonged exposure for earthquake victims with PTSD symptoms. Considering that this is an ongoing project, this paper will describe the preliminary results of the project.

Method: Participants will be residents of Mexico City, who will be contacted through university dissemination channels and social networks. Inclusion criteria will consider participants who have been exposed to earthquakes throughout their lives and who present symptoms associated with trauma and stress disorders derived from the mentioned events, who are of legal age, and who participate voluntarily. As for exclusion criteria, individuals presenting criteria for any other psychological disorder or serious medical condition will be excluded. A quasi-experimental single-case design will be used with pre- and post-treatment evaluations, as well as follow-up measures at one, three, and six months, with direct treatment replications and repeated measures between sessions (Barlow & Hersen, 1984; Kazdin, 2011). This design is chosen because there is no estimate of current prevalence of earthquake-derived PTSD in the population, so initial data is expected from this first study, followed by proposing future studies with a larger number of participants.

Results: The study is ongoing, so preliminary results of the interventions currently underway are expected. Pre- and post-treatment evaluations will be presented, along with statistical analyses of mean comparison and effect size, as well as case-by-case analyses based on clinical significance (Jacobson & Truax, 1991) and visual inspection of repeated clinical measures (Kazdin, 2011).

Conclusions: It is expected that this study will represent an important contribution to the field of study regarding the use of virtual reality in PTSD treatment. Likewise, considering the few studies in the field focused on earthquakes and the mental health issues that such situations have represented in the Mexican population in recent years, evidence-based programs are expected to be available to address the affected population in a specialized and effective manner.

ABSTRACT. Proposal: Knee osteoarthritis is a leading cause of chronic pain and functional limitations for older adults globally as well as in the United States. One in 5 American adults over the age of 45, approximately 19 million individuals, suffers from knee osteoarthritis. Chronic pain, pain stress and movement fears that accompany knee osteoarthritis are characterized by prolonged sympathetic nervous system, “fight or flight”, stimulation. When sympathetic nervous output is dominant, heart rate variability, the beat-to-beat variation in tempo, maintains a “fight or flight” nervous system state. Regrettably, sympathetic nervous system stimulation prolongs and amplifies pain sensation through increased tissue sensitization. Parasympathetic nervous system dominance,(“rest and digest” mode), allows optimum physiologic balance and stress recovery. Slow-paced breathing can induce a slowing of heart rate called “respiratory sinus arrhythmia” to recruit parasympathetic (vagal nervous) output to downregulate the chronic pain nervous responses. Increasing vagal tone through slow-paced breath practice may alter pain sensation and improve stress resilience. Virtual reality immersion distracts from pain, pain stress and movement anxiety. Combining virtual reality with heart rate variability biofeedback to rebalance autonomic nervous output may result in decreased pain, improved interoception (self-regulation) of movement fear (kinesiophobia), and improved vagal tone in older adults with knee osteoarthritis. Smart phone apps combining virtual nature scenes and a breathing training guide with visual heart rate variability biofeedback using a Bluetooth heart rate photoplethysmography device may improve nervous balance. The goal of this pilot project is to evaluate the use of combined virtual reality (VR) and heart rate variability biofeedback (HRVB) breath training phone application (FlowlyTM) in older adults with knee osteoarthritis and chronic pain. Research Questions: 1. What is the feasibility of VR+HRVB breath training phone app use in older adults with knee osteoarthritis and chronic pain? 2. What is the acceptability of a VR+HRVB breath training phone app in older adults with knee osteoarthritis and chronic pain?

Methods: Single group mixed methods pilot of 36 adults (expected attrition 30%), Inclusion: age 45-74, with knee osteoarthritis, chronic pain (> 3 mo. duration) and moderate fear of movement (TSK 11 >15) (kinesiophobia), VR+HRVB naive; Exclusion: Respiratory disease limiting voluntary breath regulation; heart rate limiting drugs, pacemaker, dysrhythmic disease; known cybersickness risks, & acute or chronic illness. Intervention: Home-based VR+HRVB breath training phone app 10 minutes, 2 x/daily, 5 days/week/8 weeks + 4 week follow-up. Measurements: Recruitment/retention/completion data (Feasibility), App use data (intervention adherence & fidelity), TAMPA Scale of Kinesiophobia 11 (fear of movement), Patient Reported Outcomes Measurement System-29 V2.0 (physical/mental health/social function, pain) Stanford Brief Activity Scale (physical activity), Western Ontario and McMasters University Arthritis Index Stiffness Scale (stiffness), Multidimensional Assessment of Interoceptive Awareness (self-regulation), and heart rate variability readings for spectral analysis (vagal tone). Modified Technology Adoption Questionnaire, (acceptability) Tellegen Absorption Scale (openness to experience), Spatial Presence Scale (virtual reality immersion). Analysis: Feasibility benchmarks, Exit interviews (descriptive analysis of app usability/acceptability). Pre-post HRV/survey data for patterns of change.

Preliminary Results: (Data Collection is ongoing) Sample: 16 completed: Sample characteristics: Mean age 61.8 (8.6), range 46-72; 82% female, Race/ethnicity: 1-Hispanic, 2- Black, 13 -White; Baseline findings: avg pain rating (VAS Scale 0-10) = 6.4 (1.2), range 4.7-8.3, avg fear of movement rating (TSK 11 subscale: 15-22) = 17.8 (1.2), avg knee osteoarthritis diagnosis duration 7.2 yrs. (8.2), range 1-36 yrs.

We will be reporting 3 major themes from the descriptive analysis of participant exit interviews along with modified TAM survey results regarding usability/acceptability.

Conclusion: The goal of this pilot study is to inform a larger more rigorous randomized control trial for efficacy testing and to examine mediation and moderation effects.

ABSTRACT. Technologies have permeated every facet of people’s social life, and made significant impacts on people’s behaviors. It is hard to imagine people’s social activities without any component of interactions with technologies. In the meantime, it has been increasingly recognized that during such human-technology interactions, it is the human factors that ultimately determine the outcome of the interaction. At every step of the human-technology interactions, the human must make a myriad of decisions regarding the actions to take, and those decisions results in actual behaviors, which directly produce the outcomes of the interactions. It is critical for us to have a better understanding of the human factors in technological environment, and leverage such understanding in developing human-technology interaction that would result in improved experiences for all stakeholders.

We adapt Mai’s (2020) Integrated Model of Human-Centric Information Security (IMOHCIS) to present a basic conceptual framework for the research in human factors in technological environments. As illustrated in Figure 1 of the Appendix, this framework systematically incorporates various factors that influence human cognitive functions and decision-making processes and illustrates how human cognitive activities result in actual technology interaction behaviors.

Details of the various constructs of the conceptual framework are described as follows: Technology Artifacts: technology tools designed and developed to enhance people’s capability to perform specific tasks. Examples: systems, technologies, interfaces, and policies. Human Cognitive Activities: how the human brain processes information. Examples: psycho-physiological and neural functionalities. Human Nature: the innate biological characteristics shared by human groups, shaped by evolution. Examples: self-awareness and self-cognition, age, and gender. Environmental Factors: factors present in the individual’s external environment. Examples: physical objects and tasks, cultural norms, societal influences. Antecedents of Technology Interaction Behaviors: something that cues an individual to perform a specific behavior. Examples: emotions, attitudes, intentions, and biases. Technology Interaction Behaviors: the actual observed actions taken by the individual. These behaviors directly produce the outcomes of the human-technology interactions. Examples: interaction time, clickstreams, and decision making.

This basic framework focuses on human factors in technology environments at the individual level of the decision-makers. It can be extended to incorporate multi-decision-maker interactions in two significant dimensions (as illustrated in Figure 2 of the Appendix): quantitative dimension and qualitative dimension. Quantitative Dimension: individual decision-maker’s behaviors vs. group decision-makers’ behaviors. Qualitative Dimension: whether the multiple decision-makers are friendly or adversarial to each other. -Friendly: multiple decision-makers collaborating together to achieve a common goal during technology interactions. -Adversarial: multiple decision-makers competing with each other to achieve their own goals during technology itneractions.

In the extension to the basic conceptual framework, Quadrants 1 and 3 represent the situation of direct application of the basic conceptual framework: when we are studying technology interaction behaviors at the individual level, the basic conceptual framework can be directly applied. Quadrants 2 and 4 represent the application of the basic framework within the context of group decisions and group behaviors.

The basic conceptual framework and its extension provide a systematic approach to investigating significant research questions related to human factors in technological environment, both at the individual and group levels, as well as during their interactions. Some sample research questions are: At the Individual Level: how an individual’s emotional states impact their technology perception and behaviors. At the Group Level: how group collaboration medium choice impacts the collective technology interaction behavior patterns. Interactions in Qualitative Dimension: how friendly agents’ and adversary agents’ behaviors influence each other. Interactions in Quantitative Dimension: how group decision makers’ decisions and collective behaviors emerge based on individual decision maker’s behaviors.

ABSTRACT. This 32-month qualitative quarterly longitudinal study examines the structures of an online gaming clan community of the popular free to play massively multiplayer online game (MMO/MMOG) World of Tanks developed by Wargaming. During the participant observational period, from formation through several structural shifts, this study which originally started under a Qualitative Field research course has become a comprehensive online ethnography, documenting roles, responsibilities, organizational citizenship behaviors, as well as features of global virtual teams. 53 interviews were conducted with key personnel in the organization, durations varying from 15 minutes to an hour. Four distinct themes arose from the research: freedom, friendship, responsibility, and balance. This study grants insight into gaming organizations, which will better help understand the gaming culture from a foundational constructivist perspective.

ABSTRACT. Research Background: Cobots are AI-controlled assistive robots designed to support the physical work of human operators. In human-cobot collaborations, collision-based accidents are costly risks, which could lead to fatalities. Such problems can arise due to miscalibration of trust between human operators and cobots. The human operator develops an expectation of reliability in the cobot in terms of its performance, as well as safety. The degree of oversight the human operator gives to the cobot, which informs their mental model of the cobot operation, is a function of these trust dimensions. Such systems are inefficient when the human’s trust levels are lower than what is justified by the reliability of the technology. On the other hand, if the subjective level of trust is higher than is warranted, such systems are at higher risk of accident because the human is ill-prepared to potential safety hazards. An optimal human-cobot system design is thus one that can identify key system factors affecting the development of human trust, and improve those factors that optimize trust calibration during human-cobot collaborations.

Research Goals: The factors impacting the dynamic development of trust between the human and a cobot can be grouped into three broad categories: Human Factors; Cobot System Factors; and Context Factors.

In this project, we propose to select specific human, cobot, and contextual factors in human-cobot interactions, and to conduct experiments to determine their impacts on the dynamic calibration of trust, as well as on system performance and safety metrics. The conceptual research framework is presented in Figure 1 of Appendix.

More specifically, in this project, we plan to address the following research questions: RQ1: how do users’ emotional intelligence and personality traits impact the development of trust over time? RQ2a: how does cobot’s ability to adapt to human behavior moderate the impacts studied in RQ1? RQ2b, in a VR simulation environment of human-cobot collaboration, how do the designs of the Avatar as the interaction interface impact the development of trust? RQ3: how do the numbers of collaborating humans and cobots involved in a work task impact the development of trust?

Research Methods and Experiment Design: Human-cobot collaborative assembly task design: In our experiment, a task will require human participants to collaborate with a cobot to build an assembly “widget” from a specific set of components, while making use of several of the cobot’s functionalities (part picking, positioning, driving screws, etc). This task underscores the needs for precision, safety, and efficiency in manufacturing. In addition to measures of trust, we will also collect productivity and safety metrics.

Measurement of participants’ human factors: To measure participants’ personality traits, we use Gosling et al.’s Ten Item Personality Inventory (TIPI). To measure participants’ emotional intelligence, we use Bar-on’s Emotional Quotient Inventory (EQ-i).

Measurement of participants’ trust development: In addition to the periodic collections of subjective ratings of trust, we’ll use an EEG system to measure the participants’ neural correlates that have been shown to associate with trust development. We analyze the EEG signals and corresponding subjective data to infer the participants’ trust development over time.

Performance metrics for the human-cobot collaboration: The performance metrics will primarily focus on productivity in the assembly task: assembly time, throughput, variability in assembly rates, etc. Work quality metrics will be collected by tallying errors, defects, scrap, and rework.

Safety metrics for the human-cobot collaboration: The main safety risk in this system involves unintended human-cobot collisions. Therefore, the main safety metrics will concern measuring the risk of these collisions.

Research Status: We are currently in the process of securing funding to conduct the experiment and data analysis.

ABSTRACT. The aim of the current research is to study the feelings that stand behind the emoticons and their relationship to each of the motives and strategies of self-presentation in social networking sites and their role on persuasive messages. The descriptive, correlational, comparative approach was used on a sample of male and female students at King Saud University (N = 200 male and female students). A content analysis of a group chat for King Saud University students via the Telegram application revealed the most used emoji through the Visual Studio text writing program. Measures of motivation for using social networking sites, Self-presentation in social networking sites, motivation for using emoticons, The impact of emoticons on accepting the request were used. The study concluded that there is a positive relationship between the feelings that stand behind the use of emoticons. Expressiveness and the influence of emojis in persuading to assist as well as in subscribing to marketing offers. The results also showed that there was a positive relationship between the feelings behind the use of emoticons and the motives for using social media (Self- focus and maintenance relations). The study also showed a positive relationship between the feelings behind the use of emoticons and the strategy of self-promotion, the strategy of seeking social acceptance, the strategy of positive self-presentation, and the strategy of self-disclosure (life streaming). Differences between the responses of male and female students in the feelings that stand behind the use of emoji has shown. The findings of this study can be used for subsequent research, and for policy makers in the educational sector in terms of how to benefit from using social media platforms among university students.

ABSTRACT. When ghosted, individuals are left uncertain, confused, and hurt with how the relationship ended (LeFebvre, 2017). The individual is left wondering what happened to the relationship as well as struck with the notion of what to do next. The interpersonal communication discipline has begun researching ghosting extensively and other relational dissolution methods (i.e., sudden death, mutual fade out, external fade out) within romantic relationships (Guerrero et al., 2017). Ghosting is a relational dissolution method that involves one individual within the relationship to abruptly cease all communication with the other (Freedman et al., 2019). This includes no longer engaging in face-to-face communication as well as through mediated channels such as social media platforms. Although it’s a new term within the discipline, this form of relational dissolution has increased due to technology-mediated communication as well as overall (pop) media attention (Borgueta, 2016). When ghosting, this includes ignoring all attempts of communication (Safronova, 2015) by actively avoiding a particular individual (LeFebvre, 2017) including unfriending and blocking on social networking sites. Ghosting is essentially a conscious effort. This also includes still being connected online; however, the individuals do not comment, like, or react to one another’s post. Recent research (Avalos, 2023) has focused on individuals purging their accounts of specific followers/friends which allow ghosting mechanisms to become more accessible. Lastly, research thus far has discovered (a) negative mental health implications due to a lack of explicit explanation of the relational dissolution (Koessler et al., 2019), (b) insecurity with oneself and future romantic relationships (LeFebvre et al., 2019), and (c) negative physical health outcomes such as depression and stress (Gómez-López et al., 2019).

ABSTRACT. VR and AR can both provoke cybersickness, a critical problem as users attempt to navigate virtual spaces, a process known as locomotion. Both media formats take place simultaneously in two separate frames of three-dimensional space the virtual space and the real space, colloquially referred to as the “meatspace”. The challenge of virtual reality locomotion is the act of moving the user within virtual space either incongruously or separate from real space. Cybersickness acts as a barrier to adoption (Yildirim, 2019) with approximately 80% of VR users experiencing motion sickness after a 15-minute exposure (Vlahovic et al., 2022). The symptoms of cybersickness are inherently limiting to the types of experiences possible in VR and AR, and therefore the adoption of VR and AR technology. The prevalence of these symptoms has even led to calls for VR content to be limited to in-place activities entirely (Oh & Oh, 2019). While a large and growing body of literature exists which examines XR locomotion, many of the studies aiming to have significant impacts on the onset of motion sickness produce insignificant results, primarily caused by a misguided understanding of the underlying contributing factors to cybersickness. This talk will introduce an early model of a categorical nomenclature used to analyze cybersickness research. This taxonomy aims to identify the underlying aspects of locomotion which drive or hinder the onset of cybersickness. The taxonomy is informed by a comprehensive review of the literature and ongoing empirical data collections. In the process of reviewing studies that explore different and new locomotion systems, it was determined that many of these studies lacked a means by which to design or understand the root causes of cybersickness. Sources were separated into those that produced meaningful changes to the onset of cybersickness within their subject and those that did not. Trends were analyzed within both categories and used to chart what changes in cybersickness occurred given different software or hardware interventions. These categories are referred to as the “Components of Cybersickness”. Meta analyses will be presented that provide evidence that studies which strayed from these categories produced statistically insignificant results while those that operated within these categories caused significant impacts on the onset of cybersickness. These components provide a guideline for additional research and aims to create and chart a design space in which cybersickness in different locomotion options can be accurately predicted and prevented. Furthermore, the application of the categorization of these underlying causes help reveal gaps in literature surrounding each of these components and reveal which ones have the most room for additional research.

ABSTRACT. The use of gaming across diverse fields such as public health, education, cognitive research, and social development is creating major opportunities to enhance human well-being. Nowadays, people of all ages are engaging with video games, so much so that gaming technologies like applied games and virtual reality (VR) are becoming part of peoples’ daily life. Development on these platforms is becoming more accessible allowing for new applications that can cater to a broad demographic and facilitate substantial psychological benefits across the lifespan of a human. This symposium explores the versatile applications of games and VR technologies that go beyond just being for entertainment. The ecological validity of these new applications, along with the widespread adoption of video games across a larger age group, enhances the research conducted in these platforms. By engaging participants in environments that closely mimic real-world settings, these platforms allow researchers to observe true behaviors that are indicative of a person’s everyday activities. This methodological advantage is fundamental for studies aiming to understand complex cognitive processes, social dynamics, and behavioral patterns in realistic contexts. Thus, the immersive nature of gaming not only enriches the user experience but also bolsters the insights gained from the research. One of the benefits of serious games is that they utilize gamified elements for educational purposes. By simulating realistic scenarios, these games offer a platform for increasing knowledge and affecting behaviors in various contexts. For instance, they have been used to boost the understanding of medical information and decision making in youth populations. These applications have shown considerable potential in increasing engagement and retention of health-related information among youth. However, very little research has considered the ethical considerations, including the balance between influence and autonomy, in the creation of these educational tools. In cognitive research, games and simulations provide controlled lifelike environments that can accurately replicate complex everyday tasks. Both games and VR applications have been extended to study cognitive processes such as memory, attention, and decision-making under various conditions. These environments allow for highly accurate time-to-complete measurements, decision making reasoning, and cognitive assessment. This data could all be captured in a controlled space that would otherwise be difficult to capture in real-world environments. With the integration of Artificial Intelligence these applications soon will become adaptive allowing for more customized solutions for individuals. Additionally, the role of gaming in social well-being is becoming more apparent. Multiplayer and community-focused games create virtual social environments where individuals can establish new relationships. These virtual spaces are particularly beneficial for those who may face social barriers in the physical world, providing alternative avenues for social interaction. For the aging population, VR-based games that involve both physical and cognitive tasks have shown promise in encouraging mental health and physical activity. These gaming experiences are specifically designed to stimulate both the mind and body. These types of experiences can help address the common challenges associated with aging, such as cognitive decline and reduced physical mobility. This symposium is designed to demonstrate the current research and tools that utilize gaming and VR technologies for the betterment of society. There will be discussion about how these tools can be effectively harnessed to bridge minds, technology, and well-being, highlighting the transformative impact on society. The symposium will help further the understanding of the implications of using gaming to shape the future of education, cognitive research, and social connectivity. This discussion is both timely and crucial as we navigate the complexities of a rapidly evolving digital landscape and continue to find new ways to deploy this technology to enhance human well-being.

ABSTRACT. 1. Introduction Virtual reality (VR) has emerged as a promising tool in cognitive research, offering unparalleled opportunities to replicate complex, real-world tasks within controlled experimental settings. The ability to recreate realistic experiences, such as driving, in a virtual environment provides researchers with a robust platform to investigate cognitive processes with high ecological validity. The significance of VR in cognitive and traffic studies stems from its ability to elicit realistic behaviors from users, while allowing experimenters to control and standardize the environment across participants. In this study, we describe a newly developed VR driving simulator and present our findings from motion sickness analyses conducted on two versions of the virtual experience. 2. Method Two versions of a driving simulator were developed for VR head-mounted displays: the driving experience, where the user controls a virtual car using a steering wheel, and accelerator and brake pedals; and the passenger experience, where the participant is a passenger in an autonomous vehicle. In both versions, the car traverses a 3 km route at 40 km/h through an urban environment, with participants experiencing the journey from a first-person perspective in the driver's seat. To ensure a standardized experience for all participants and across both versions, the car follows a pre-set route based on GPS directions. In the driving experience, participants receive an error message if they fail to adhere to the GPS guidance or traffic rules, such as stopping at red lights before the stop line. Moreover, the car automatically corrects these errors in real time. Conversely, in the passenger experience, participants passively experience the virtual environment without the need to control the vehicle or the possibility of encountering errors. An initial round of testing with both versions was conducted to assess motion sickness (N for the driving experience = 13; N for the passenger experience = 5). Following the results, which prompted some modifications, a second round of testing evaluated whether the risk associated with motion sickness was mitigated (N for the driving experience = 5; N for the passenger experience = 5). In each test phase, participants completed the Simulator Sickness Questionnaire (SSQ) before and after the VR experience. Additionally, qualitative data were collected, including participants' prior VR experiences, perceived levels of motion sickness post-experience, whether the discomfort was primarily due to braking or turning, and whether they desired to terminate the experience prematurely. 3. Results In the initial round of testing, there was a statistically significant difference in SSQ scores before and after the VR experience for both versions of the application. Participants experienced greater motion sickness after the virtual experience compared to beforehand. However, post-experience SSQ scores indicated that the majority of users from both versions experienced only minimal sickness. Through self-report measures, participants primarily attributed their motion sickness to the car's braking and, in the passenger experience, also to two specific turns. As a result, we reduced the braking speed in both versions and the speed of the car at the two identified turns in the passenger version. The findings from the second round of testing indicated no statistically significant differences in SSQ scores before and after the experiences, with most participants reporting minimal sickness in post-experience SSQ, and null sickness at car’s braking. 4. Conclusion This study introduces a novel VR driving simulator designed for use in cognitive and psychological research, posing reduced risk of inducing motion sickness in participants. The paper will discuss the virtual environment's features and the system's specifications to assist researchers in developing similar applications.

ABSTRACT. Introduction: Anxiety and depressive disorders during adolescence have been linked to adverse outcomes across academic, social, and health domains. Interventions promoting emotion regulation (ER) serve as a preventive strategy for developing those disorders. ER entails the cognitive ability to adapt thoughts and behaviors to effectively handle emotional reactions across various situations. A key aspect to consider for the development and regulation of ER in adolescents are executive functions (EF), such as cognitive flexibility and inhibition control. In recent times, immersive virtual reality (IVR) has emerged as an innovative tool for enhancing the accessibility and efficacy of EF training interventions. IVR enables users to immerse themselves in three-dimensional environments, offering highly engaging and realistic interactions. While gamification parameters can be easily implemented to enhance adolescent’s motivation, focus, and participation in EF training activities. This study aims to assess the preliminary effect of a VR-gamified cognitive training for improving emotion regulation and reducing anxiety and depressive symptoms in young adolescent girls.

Methodology: This is a longitudinal, parallel, single-blind, randomized pilot study with a sample of 45 Spanish-speaking adolescent girls, aged 11-14 years old. Exclusion criteria included severe psychiatric or neurodevelopmental disorders, physical, motor, or sensory impairments that significantly interfere with the interventions. Adolescent girls were randomly allocated into two groups: an experimental group receiving the gamified IVR program (Enhance VR) and a control group receiving a comparable IVR relaxation experience. Both interventions lasted 5 weeks, 2 times a week, 30 minutes (10 sessions per participant). The experimental group participated in six games targeting cognitive flexibility, planning skills, inhibition control, working memory, attention, and processing speed. While, the control group experienced ten distinct VR environments inspired by nature and engaged in relaxation exercises (i.e., deep breathing exercises).Participants underwent a baseline and post-intervention assessment with the Revised Child Anxiety and Depression scale (RCADS), which assessed anxiety, depressive and global internalizing symptoms. And the subscale of emotional control from the Behavior Rating Inventory of Executive Functions, Second Edition (BRIEF-2) for assessing ER.

Results: Two-way mixed (group*time) ANOVAs were run. Results did not reveal any significant group*time interactions (p >.05) on internalizing symptoms, total anxiety symptoms, depressive symptoms and emotional control. However, there were significant main effect of time on internalizing symptoms (F(1, 43) = 6.389, p = .015, partial η² = .129) and on total anxiety symptoms (F(1, 43) = 7.376, p = .009, partial η² = .146). Pairwise comparisons results revealed statistically significant mean reductions on internalizing symptoms (MD = 5.440, SE = 2.152, p = .015), and total anxiety symptoms (MD = 4.741, SE= 1.746, p = .009) from pre to post-assessment. These reductions were more pronounced on the experimental group as compared to the control group. No statistically significant main effects of time (p>.05) were found on depressive symptoms and emotional control.

Conclusions: These results suggest that both interventions had a positive impact on participants’ anxiety and internalizing symptoms, with the experimental group showing a more pronounced reduction. The enhancement of EF, along with using relaxation techniques, contributed to reducing internalizing symptoms. This study focused on adolescent girls since they usually show higher vulnerability to developing anxiety and mood disorders compared to adolescent boys. Therefore, addressing their specific mental health needs through early interventions in school settings, is critical. Further research with a larger sample size, including also adolescent boys, longer intervention duration and follow-up assessment would provide valuable insights into preliminary results of these interventions.

ABSTRACT. With the official recognition of video game addiction by DSM-5 and ICD-11, the discussion continues whether or not pathological gaming is caused mostly by personality traits or gaming motives or if there are game elements that make certain games addictive, including shooters, role-playing, and gambling games (Elliott et al., 2012). Recently, significant attention was drawn to so-called "loot boxes," mostly found in online and mobile games and considered potentially harmful for psychological well-being (Griffiths, 2018). "Loot boxes" provide the player with a random in-game item in exchange for in-game or real-life currency and resemble gambling (Cerulli-Harms et al., 2020). The items can be purely cosmetic or impactful for the game, and they vary in rarity and value. A subtype of video games that rely on "loot boxes" mechanics is often referred to as gatcha-games. "Loot boxes" belong to a range of gaming design elements, so-called "dark patterns," used by the developers to coerce players into spending more time playing or additional money to progress (Zagal et al., 2013). There are quite a few known "dark patterns," but the question remains: what psychological traits make people more likely to behave accordingly, including various forms of optional in-game purchases? For this study, we focused on monetary patterns, as purchase-related behaviors were easier to identify. The research was conducted online via Google Forms on a Russian sample and used Russian versions of the following questionnaires: the Video Games Addiction Scale (Epishin et al., 2021), an ICD-11-criteria-based questionnaire to assess symptoms of gaming addiction; T.Ehlers' questionnaires of success and avoid failure motives (based on McClellands achievement motivation theory); Schubert's risk readiness questionnaire; the Barratt Impulsiveness Scale; and Schwarzer and Jerusalem's General Self-Efficacy Scale. The participants were recruited through game-related groups on social networks on an anonymous and voluntary basis. The participants were provided with the necessary information and explicitly stated their informed consent to proceed. A total of 345 participants aged 18–39 years old were recruited; 303 identified as female and 42 as male. The survey form included socio-demographic and gaming-related questions on game preferences and monetary in-game behavior. Logit models were built via jamovi 2.5.2 to predict the following monetary "dark pattern"-related behaviors: purchasing loot boxes; premium subscriptions in free-to-play games; cosmetic items to alter characters' looks; progress-accelerating items; items that boost player characters' abilities; additional trials for in-game events. Those behaviors were used as dependent variables, while the questionnaires' scales were used as predictors. Additionally, game preferences were used as factors. For study purposes, we identified the following sub-groups: "gatcha-players" (n=78, 4 males), "playing different games, prefer gatcha" (n=57, 1 male), and "playing different games, including gatcha, prefer other genres" (n=210, 37 males) based on their preferences in the last six months. Working models were only obtained for three dependent variables, with one significant predictor in each (see Table 1). The resulting models suggest that video game preferences do not predict the likelihood of in-game purchases, while personality traits (risk-readiness, failure avoidance motivation, and self-efficacy) have a small but significant impact. Risk readiness was found to be involved in loot box purchasing, which correlates with the previous studies on gamers and gamblers. The more failure-avoidant players were, the more likely they were to purchase boost items to help them in-game, while higher self-efficacy predicted players' readiness to purchase premium game status, resulting in various in-game benefits. In its current state, the study is limited by an imbalanced, predominantly female sample, likely caused by women being more active in social networks and more ready to participate in psychological studies, while the typical gaming audience in Russia has slightly more men than women.

ABSTRACT. Research has investigated the impact of video game play on cognitive processes and perceptions during and after gaming. These studies have primarily focused on cognitive functions such as perception, attention, working memory, and skill transfer. However, little attention has been paid to the short-term effects of gaming. Research on Game Transfer Phenomena (GTP) has emerged as a comprehensive, multi-modal approach to comprehending the temporary changes in sensory perception, cognition, and self-agency directly linked to video game experiences. GTP manifestations involve suddenly re-experiencing images, sounds, haptics, and perceptual distortions of surroundings, objects, and body perception after gaming. These experiences typically happen while being awake and are triggered by internal (thoughts) or external stimuli associated with the game. The prevalence of GTP ranges from 74.8% to 96% (in a 12-month period). However, GTP occurrences are mostly infrequent. Most GTP cases are reported by gamers without a history of substance use or mental disorders. Higher levels of GTP have been associated with distress, but in most cases, GTP is harmless. Discrepancies have been found between gaming time and GTP, and individual factors appear to play a more important role in predicting GTP than gaming time. The GTP framework has been supported by validation studies conducted on samples with different backgrounds (e.g., Turkish, Polish, Mexican, Norwegian, and Chinese).

Method After reviewing the GTP literature and related phenomena, seven theories were postulated regarding vulnerability factors, underlying mechanisms, and the etiology of GTP. Studies on GTP included 32 studies (N>8,000). Most of the studies utilized cross-sectional designs and gathered data through surveys, interviews, diaries, online forums, and experimental tasks.

Results GTP has been associated with cognitive factors: Cognitive Errors (ARCES, CF), Mindful Attention Awareness Scale (MAAS-Lo), Creativity in Alternate-Use Task, commission errors in SART, motor impulsivity (BIS-15), and Meta cognitions (MCQ-30). Self-control (BSCS) and Working Memory Capacity (WMC) was negative correlate. No correlation was found with Go/No-Go, Attention Network Task (ANT), Conceptual Priming Task (WFC), and Free Association Task (Forward Flow). Phenomena associated with GTP: usual sensory experiences (MUSEQ, CAPS, ISES), mind-popping (MPQ-4) and Daydreaming Frequency Scale (DDFS). Disorders associated with GTP: Mood disorders (DASS-21), Gaming disorder (IGD, GDT, PVG), ADHD, DES, fears of contamination (PI), substance use (AUDI, DUDI). Gaming-related variables associated with GTP: amotivation (GAMS), immersion (IEQ), game engagement (GEQ), and poor gaming-related sleep hygiene. Other factors associated with GTP: sensory hypersensitivity (SHS), disorganized/positive schizotypy (MSS-B), openness (BFI-5), and fatigue (FAS). Sleep efficiency was negatively correlated (PSQI). Proposed hypotheses: 1)GTP are facilitated by mind-wandering and low WMC; 2) susceptibility to involuntary cognitive and sensory phenomena facilitate GTP; 3) GTP are the result of priming effects or associative learning leading to reactivity toward game-related cues; 4) Sensory GTP experiences are explained by prediction errors and neural adaptations involving hypersensitivity; 5) GTP are of a dissociative nature as they can disrupt the track of thoughts, perception, motor control and body representation; 6) visual GTP experiences are a result of disinhibition of visual processors and dysfunction in the Central Nervous System; 7) GTP contributes to symptoms of GD, and can be a sign of GD symptomatology and dysregulation of neurotransmission.

Conclusions This paper presents theories on GTP to prompt new research avenues. GTP encompasses a broad range of phenomena, from sensory perceptions to high cognitive levels. Consequently, the etiology and underlying mechanisms of the various forms may exhibit differences. The interpretation of studies on GTP offer initial support, although further investigation is necessary to validate or refute the proposed theories.

ABSTRACT. Introduction: Serious game-based interventions are increasingly seen as valuable for enhancing public health, especially in boosting vaccination knowledge and shaping young individuals' attitudes and behaviors. These interactive and engaging tools have the potential to significantly impact how young people perceive and respond to vaccinations. However, it is essential to consider the ethical implications of such interventions, especially concerning the influence on the neurocognitive, affective, and social aspects of youth engaging with educational technologies.

Methods: The current study continued a prior randomized controlled trial assessing a game-based intervention for Coronavirus disease (COVID-19) vaccine education among unvaccinated 11–14-year-olds. The prior study assessed the feasibility, acceptability, and potential efficacy of the intervention. The study retained all 32 parent-youth pairs, divided equally into intervention and control groups, throughout its duration. Surveys were administered at three intervals—before, immediately after, and two months post-intervention. Semi-structured interviews post-intervention with 7 intervention dyads achieved data saturation.

In the previous study, 75% of intervention and 81% of control group participants were fathers, mostly Black or African American (91%). 78% held bachelor's degrees and 84% were employed, with almost half working over 35 hours weekly. The youths averaged 13 years old, with boys making up 84%. Post-intervention, they reported increased vaccine knowledge and belief (Cohen's d > 1). Two months later, 75% of the intervention group reported having vaccinated their children, versus 37.5% in the control group (X²(1, n = 32) = 4.57, p = .033). The game, designed for computers and tablets, encouraged vaccinating virtual characters and incentivized correct COVID-19 knowledge with content sourced from the Centers for Disease Control and Prevention. Participant feedback called for more complex educational content and tailored health information. The current study examined the ethical concerns and challenges of the intervention from a brain-based cyberlearning perspective.

Results: Despite the positive impact of the game-based intervention, ethical concerns identified in relation to educational technologies' influence on neurocognitive, affective, and social aspects, were identified as follows: 1) Neurocognitive concerns: the simplicity of the game's design might hinder the acquisition of crucial skills such as critical thinking and problem-solving. This obstacle to cognitive development, along with the potential violation of autonomy, could contradict the educational objective of nurturing intellectual growth; 2) Affective concerns: the lack of emotional depth in the game could potentially result in disengagement or inadequate emotional development. The absence of emotionally responsive learning environments that adapt to youth learners' engagement levels may limit the establishment of a meaningful emotional connection with the educational content, thereby impeding emotional development, which is an essential component of comprehensive learning; 3) Social concerns: even with parental oversight while youths played the game, they often sought help and guidance to play the game and achieve high scores within the time limits. However, the single-player game-based intervention may have inadequately addressed the promotion of collaboration, empathy, and the appreciation of diverse perspectives. This is especially concerning given the growing demand to prepare youths for the collaborative and diverse and interconnected nature of society.

Conclusion: The serious game-based interventions have demonstrated potential in improving self-reported vaccine knowledge, beliefs, and uptake among youths, indicating the potential benefits of educational technologies in public health. Nevertheless, these interventions require rigorous scrutiny to ethically optimize their impact. The current simplistic game design risks inhibiting neurocognitive growth and inadequately promoting emotional and social development. Therefore, a conscientious approach is vital in crafting such educational tools, one that focuses on the nuanced developmental needs of the youth. Through this approach, technology has the potential to enrich learning experiences while leveraging its appeal in a balanced and ethically responsible manner.

ABSTRACT. As individuals transition into retirement, they tend to experience a noticeable decline in both mental and physical activity (Sharifi et al., 2023). This decline is often accompanied by a diminished motivation to partake in cognitive and physical tasks. Predominantly, the current generation of senior citizens, often referred to as the Silent Generation and early Baby Boomers, shows a preference for passive forms of entertainment, such as television viewing (Fingerman et al., 2022). Motivated by these observations and by the existing literature (Guzman et al., 2024), this study explores the potential of high-immersion virtual reality (VR) gamified 3D puzzles to foster seniors’ cognitive and motor skills.

This pilot study reports on data based on 25 VR workshop participants (aged 60+; M = 72; Female = 20; Male = 5; Caucasian = 25;). First, a lecture provided an overview of VR technology and instructions on how to use VR equipment. Subsequently, participants engaged in assembling puzzle pieces to construct a 3D building in VR. Because such a task requires spatial rotation which is known to demand high-level cognitive processing (Huang, 2020), our hypothesis was that engaging in 3D puzzles in VR would significantly enhance cognitive skill activation. Constructing the puzzles requires the user to rotate and inspect the pieces in a 3D space to identify the correct piece placement. When selecting a piece that does not fit with any other piece, the user must set the piece aside for future use. We hypothesized that performing this task could exercise an individual's spatial memory. As individuals age, they experience a spatial memory decline, which is commonly associated with cognitive decline (Tuena et al., 2021). Spatial memory is critical for understanding the location of objects in an environment. Interacting within a 3D virtual environment provides a highly immersive experience that can stimulate memory functions (Huang, 2020). Additionally, the assembly of puzzle pieces, which involves a haptic system (i.e., hand controllers), was also hypothesized to contribute to motor skills.

Moreover, the 3D puzzle incorporates gamified elements such as time-tracking for completion and adjustable difficulty settings. Users can replay puzzles to improve their times, and the number of pieces can be increased to raise the challenge. Frequent sound effects as the user nears completion motivate continued play. These mechanics enhance enjoyment and foster a sense of challenge and accomplishment, keeping players engaged for extended periods (Suh et al., 2018). Last, the VR experience had ambient audio with relaxing music, which were hypothesized to increase enjoyment and mindfulness, simultaneously, decreasing anxiety. The integration of relaxing music can significantly enhance user engagement by deepening immersion (Kaplan-Rakowski et al., 2023). Along with relaxing music, the puzzle environment offers soft selectable color tones to promote a therapeutic environment. The ambient sound and calming color scheme help focus the user attention while reducing anxiety and managing cognitive load more effectively (Fu et al., 2020).

Upon the assembly of the puzzle, participants completed multiple questionnaires eliciting data on participants demographics, personality (Gosling et al., 2003), enjoyment (Ryan & Deci, 2000), sense of presence (Gandolfi et al., 2021), cognitive and affective mindfulness (Feldman et al., 2007), and state-trait anxiety (Spielberger, 1989). The analysis of descriptive statistics, the observation logs, and focus-group interviews provided preliminary insights into the impact of VR puzzle solving. Participants articulated high engagement (M = 4.34; SD = 0.59), high sense of presence (M = 3.13; SD = 0.91), increased mindfulness, and low levels of anxiety. Overall, the feedback on both VR and the 3D puzzle was predominantly positive, with participants indicating that these activities could have a beneficial impact on the aging process.

References

Feldman, G., Hayes, A., Kumar, S., Greeson, J., & Laurenceau, J. P. (2007). Mindfulness and emotion regulation: The development and initial validation of the Cognitive and Affective Mindfulness Scale Revised (CAMS-R). Journal of Psychopathology and Behavioral Assessment, 29(3), 177–190.

Fingerman, K. L., Kim, Y. K., Ng, Y. T., Zhang, S., Huo, M., & Birditt, K. S. (2022). Television viewing, physical activity, and loneliness in late life. The Gerontologist, 62(7), 1006–1017.

Fu, Q., Lv, J., Zhao, Z., & Yue, D. (2020). Research on optimization method of VR task scenario resources driven by user cognitive needs. Information (Basel), 11(2), 64. https://doi.org/10.3390/info11020064

Gandolfi, E., Kosko, K. W., & Ferdig, R. E. (2021). Situating presence within extended reality for teacher training: Validation of the Extended Reality Presence Scale (XRPS) in preservice teacher use of immersive 360 video. British Journal of Educational Technology, 52(2), 824–841.

Gosling, S. D., Rentfrow, P. J., & Swann, W. B., Jr. (2003). A Very Brief Measure of the Big Five Personality Domains. Journal of Research in Personality, 37, 504–528.

Guzmán, D. E., Rengifo, C. F., Guzmán, J. D., & Garcia Cena, C. E. (2024). Virtual reality games for cognitive rehabilitation of older adults: a review of adaptive games, domains and techniques. Virtual Reality, 28(2). https://doi.org/10.1007/s10055-024-00968-3

Huang, K.-T. (2020). Exergaming executive functions: An immersive virtual reality-based cognitive training for adults aged 50 and older. Cyberpsychology, Behavior and Social Networking, 23(3), 143–149. https:/doi.org/10.1089/cyber.2019.0269

Kaplan-Rakowski, R., Cockerham D., & Ferdig, R. E. (2023). The impact of sound and immersive experience on learners using high-immersion virtual reality and tablet: A mixed-methods study. British Journal of Educational Technology. https://doi.org/10.1111/bjet.13417

Ryan, R. M., & Deci, E. L. (2000). Intrinsic and extrinsic motivations: Classic definitions and new directions. Contemporary Educational Psychology, 25(1), 54–67.

Sharifi, M., Nodehi, D., & Bazgir, B. (2023). Physical activity and psychological adjustment among retirees: A systematic review. BMC Public Health, https:/doi.org/ 10.1186/s12889-023-15080-5

Spielberger, C. D. (1989). State-Trait Anxiety Inventory: Bibliography (2nd ed.). Consulting Psychologists Press.

Suh, A., Wagner, C., & Liu, L. (2018). Enhancing User Engagement through Gamification. Journal of Computer Information Systems, 58(3), 204–213. https://doi.org/10.1080/08874417.2016.1229143

Tuena, C., Serino, S., Pedroli, E., Stramba-Badiale, M., Riva, G., & Repetto, C. (2021). Building embodied spaces for spatial memory neurorehabilitation with virtual reality in normal and pathological aging. Brain Sciences, 11(8), 1067. https:/doi.org/10.3390/brainsci11081067

ABSTRACT. Artificial Intelligence (AI) tools such as GPT can be used to engage in verbal discussions via companion chatbots. Such technology may be used to reduce the feeling of social isolation in people with cognitive impairment living in long-term care (LTC). Before testing its impact on social isolation, it is important to document the feasibility and usability of such a tool.

This sample consisted of 10 LTC residents with mild-to-moderate cognitive impairment. A virtual female character chatbot using generative AI was presented to participants immersed in virtual reality. This “virtual companion” engaged participants in sustained discussions on topics of their choosing using AI-based algorithms enabling speech-to-text, identification of user’s intent and response generation, and text-to-speech. The immersions were conducted using a Meta Quest 2 and a PC computer. Participants provided feedback on their experience, thoughts on the companion’s personality, etc. Interaction details, participants' reactions, and discomfort were also recorded.

Sessions ranged from 0-54 minutes. Seven out of 10 participants actively engaged with the virtual companion, and five had prolonged discussions of topics of personal significance. Participants who conversed for longer periods expressed appreciation for the companion’s intelligence and thoroughly enjoyed their interactions. Specific technical issues were experienced.

The dementia population presents specific challenges for the development of a usable tool (e.g. cognitive and verbal deficits). Here, we showed that people with dementia can converse with an AI-based virtual companion in virtual reality, and enjoy the experience. Our next step is to document our virtual companion’s impact on LTC residents’ social isolation.

ABSTRACT. Innovative technologies are on the rise for the support of caregivers and professional providers of people with Alzheimer’s Disease and related dementias (ADRD). With the rising incidence of people with ADRD, there is a growing need to emphasize educating and training our community, not only students and the workforce but also family caregivers. In this scenario, virtual reality and simulation play a significant role in immersing caregivers into the world of individuals facing memory challenges, allowing them to walk in their shoes. The immersive experience can improve the caregiver’s dementia knowledge and greater empathy toward the person with ADRD. This work aims to bring together the different innovative simulation and virtual reality programs focused on professionals and family caregivers of people with dementia and its outcomes. An array of programs have been used since 2002 devoted to immersing the participants in the world of the person with ADRD. The Virtual Dementia Tour by Beville first introduced immersive activities in 2002. In their study, participants engaged in various tasks with different gear to simulate the difficulties faced by individuals with dementia, including arthritis, loss of vision, or hearing (Beville, 2002). With the advancement of technology, programs have become highly sophisticated at immersing the user in different scenarios with the support of virtual reality. Examples included the program Into D’mentia (Jütten et al., 2018) and the Virtual Dementia Experience (McGuire, 2020). Noteworthy, the majority of the studies are directed towards professional providers, and fewer focused on unpaid family caregivers, a key figure in the care of the person with memory loss. In terms of outcomes, dementia knowledge, and empathy appeared to be the most common elements, as the change in the perspective could impact the way caregivers provide care. Less studied outcomes include empathy, anxiety, communication, and relationship quality. Furthermore, qualitative studies focusing on understanding the feelings of family caregivers of individuals with ADRD are booming Given the novelty and lack of studies, there are some gaps to address such as the lack of strong theoretical foundations in the research design, the effectiveness of the interventions, (Hirt & Beer, 2020), the impact of interventions on family dynamics and care provided, and the maintenance of gains after the participation in the simulation or virtual reality experience. Given the advancements in technology, the future looks promising at enhancing the lived experience of dementia and bringing caregivers to the world of their loved ones to provide quality care that enhances the wellbeing of caregivers and care recipients.

References Beville, P. K. (2002). Virtual Dementia Tour helps sensitize healthcare providers. American Journal of Alzheimer’s Disease and Other Dementias, 17(3), 183–190. https://doi.org/10.1177/153331750201700301 Hirt, J., & Beer, T. (2020). Use and impact of virtual reality simulation in dementia care education: A scoping review. Nurse Education Today, 84, 104207. https://doi.org/10.1016/j.nedt.2019.104207 Jütten, L. H., Mark, R. E., & Sitskoorn, M. M. (2018). Can the Mixed Virtual Reality Simulator Into D’mentia Enhance Empathy and Understanding and Decrease Burden in Informal Dementia Caregivers? Dementia and Geriatric Cognitive Disorders EXTRA, 8(3), 453–466. https://doi.org/10.1159/000494660 McGuire, L. C. (2020). Virtual Empathic Experiences for Real-World Empathy in Dementia Care. 146.

ABSTRACT. The aging population has been an established trend, especially in developed countries. Aging is associated with multiple conditions in terms of physical and mental health. In pathological cases, the cognitive deficits are progressive and may reflect a neurodegenerative process occurring in the brain, ultimately leading to dementia. Engagement in cognitively demanding tasks has been considered a neuroprotective factor for cognitive decline because of the increase in neuroplasticity. Behavioral approaches for tackling cognitive deficits due to aging are based on this premise. The use of computerized approaches with ecological validity has proven to be more effective due to the potential to involve the users more effectively in the intervention and because they translate the demands of real-life situations more effectively. The objective of this study was to explore the effects of a computerized cognitive stimulation approach framed in a community project in Portugal for older adults and to study its impact on cognitive function, emotional adjustment and functionality. The sample comprised older adults participating in a community project conducted in Lisbon that seeks to promote a set of different skills for overall adjustment, including social skills, informatics literacy, and cognitive functioning. The cognitive functioning modality of this program is based on group sessions for cognitive stimulation using computerized cognitive exercises from the Systemic Lisbon Battery (SLB). The SLB is a computerized tool for cognitive intervention that simulates daily living tasks targeting different cognitive domains such as attention, memory, and executive functions. The sample for this study was composed of 17 participants (1 man and 16 women), aged between 67 and 83 years old, mostly (n = 13) with more than 9 years of schooling. Most participants (n = 13) had age-related conditions such as hypertension, diabetes, and high cholesterol. The study was approved by an ethics committee. Before the intervention, the participants were evaluated with neuropsychological tests for cognitive functioning, subjective memory complaints, depression symptoms and functionality. The cognitive intervention consisted of weekly sessions of 60 minutes over a period of 11 weeks. After the intervention, the participants were again assessed with the same neuropsychological instruments. The analysis was based on reliable change indices (RCIs) for each neuropsychological outcome. The RCI approach aims to detect how much each individual has changed between the assessments, resulting in a standardized score. Changes that were positive (Z > 1.96) or negative (Z < 1.96) in more than 2.5 percent of cases would probably be due to a treatment effect. The results revealed a high proportion of positive changes. The most reliable outcome was at the level of general cognitive functioning and memory complaints, where more than double the cases were identified with positive changes compared to negative changes (41% for positive vs. 18% for negative change). As for depression symptoms and functionality the results were less reliable but still point to a benefit (18% for positive vs. 6% for negative change; 18% for positive vs. 12% for negative change, respectively). These results suggest a benefit of the overall program in promoting cognitive functioning both evaluated and reported, but also functionality and emotional adjustment, with this last dimension being more related probably to other components of the program than simply the cognitive stimulation using computerized tasks. Despite this study not consider a control group, the overall preliminary results are promising and point to a benefit of using immersive technologies for cognitive stimulation.

ABSTRACT. Brief contact with nature can reduce stress and restore productivity (Kaplan, 1995; Ohly et al., 2016). However natural environments may not be easily accessible. Over two-thirds of Americans live in cities, and they may have less access to secure green places than other residents (Wolch et al., 2014). VR simulations can be used to generate stronger feelings of presence in a natural environment as compared to less immersive technology (Chirico et al., 2017). The degree to which someone considers themself to be immersed by, included in, and engaging with an environment is referred to as presence. (Witmer et al., 2005) The visual and auditory exposure provided by all-in-one VR headsets can deliver at least some of the benefits of nature immersion. Because of VR's high level of immersion, nature simulations may have a more of a beneficial effect than other virtual devices. (Witmer et al., 2005) Older adults may face potential barriers when using VR such as cybersickness, system workload and usability issues (i.e., frustration, fatigue, discomfort), and a lack of experience with technology are potential barriers to older adults' adoption of VR technology (Winter et al., 2021; Yen and Chiu, 2021). These potential barriers could impact the level of immersion and presence they feel in the VR world. However, a study from Dilanchian et al. found that older adults felt higher levels of presence in virtual settings and lower levels of cybersickness compared with younger adults while using the HTC Vive headset (2021). VR simulations are more realistic, give better therapeutic advantages and generate stronger feelings of presence that are important to attention restoration theory, as compared to less immersive technology (Chirico et al., 2017). The purpose of this study was to explore technology usability factors and compare older and younger adults and how this may influence the feelings of being present and immersed in the more realistic Meta Verse VR Nature world. A baseline assessment took place approximately a week before the intervention which included questions around nature exposure and computer comfortability. Participants completed a pre-assessment prior to the intervention. The researchers instructed participants on how to operate the Meta Quest 2 console and the Nature Treks application. After the intervention, subjects were asked to complete the post assessment, which included the presence, cybersickness, and computer comfortability assessments. Independent-samples Mann-Whitney U tests, nonparametric alternatives to independent-samples t-tests, were conducted to assess post-intervention differences in digital self-efficacy, presence levels, simulator sickness symptoms, and VR head-mounted display acceptance between young and older adults. Preliminary results showed statistically significant group differences in digital self-efficacy scores (U = 22.50, z = -1.98, p = .048), cybersickness scores (U = 15.50, z = -2.53, p = .010), global presence levels (U = 79.50, z = 2.27, p = .020), and spatial awareness (U = 78.00, z = 2.18, p = .031). However, no significant differences were found between groups for acceptance of VR head-mounted displays (U = 68.00, z = 1.42, p = .172). Post-intervention digital self-efficacy scores were significantly higher for young adults (Mdn = 88.00) compared to older adults (Mdn = 62.00). Similarly, cybersickness scores were significantly higher for young adults (Mdn = 3.50) compared to older adults (Mdn = 3.50). On the other hand, global presence and spatial awareness levels were higher in older adults (MdnGlobal_presence = 3.92; MdnSpatial_Awareness = 5.75) compared to young adults (MdnGlobal_presence = 3.25; MdnSpatial_Awareness = 4.62).

ABSTRACT. This research introduces a novel intervention that synergistically combines Mixed Reality (MR), haptic feedback, and Artificial Intelligence (AI) to improve hand dexterity in elderly patients with movement disorders, such as Parkinsonian tremor. This intervention leverages the immersive properties of MR, complemented by precise haptic feedback. It is enhanced by AI's ability to analyze extensive patient data, thereby facilitating the formulation of customized rehabilitation programs.

Diverging from conventional therapeutic strategies that typically focus on static symptom management, our methodology integrates ergonomic support for hand movements within an MR framework. This system is dynamically adaptable through AI algorithms that refine predictive analytics and feedback mechanisms, thus tailoring the intervention to the evolving needs of each patient. The overarching goal of this approach extends beyond mere enhancement of manual dexterity to encompass improvements in overall quality of life and emotional well-being, targeting a comprehensive improvement in geriatric health.

The rehabilitation protocol incorporates gamified exercises designed to engage patients actively, fostering motor and cognitive abilities crucial for daily functioning. These exercises are structured to provide an interactive and rewarding rehabilitation experience, promoting consistent participant engagement and effort.

Initial findings from the deployment of our intervention are promising. Participants, particularly those suffering from Parkinsonian tremors, showed marked improvements in hand dexterity and cognitive function. The fusion of MR and haptic feedback, augmented by AI-driven adjustments, cultivates an engaging rehabilitation environment that significantly advances motor and cognitive capacities.

Moreover, the system is enhanced with telehealth capabilities, enabling healthcare professionals to remotely monitor patient progress and tailor treatments accordingly. This feature facilitates a continuum of care and ensures that therapy regimens are adjusted to individual patient responses and improvements.

The development of this intervention marks a substantial contribution to geriatric care, neurorehabilitation, and assistive technology. It presents an integrated solution that exceeds the capabilities of existing models and illustrates the transformative impact of combining MR, haptic feedback, and AI in treating geriatric movement disorders. This initiative sets a new benchmark in personalized rehabilitation and could redefine therapeutic standards in elderly healthcare.

ABSTRACT. Mobile applications represent a growing area of interest in the realm of health promotion and disease prevention. With the growing acceptance of mobile applications across the entire age spectrum, and the development of new AI-based statistical techniques that can handle both large datasets and many intercorrelated variables, new opportunities are emerging to collect comprehensive health and symptomatic data, improve health literacy more widely, and start developing individualized, targeted interventions and health maintenance programs based on robust analyses of big data. We present initial observations from the first 18 months from the launch of the application “Terrapino”, designed to promote healthy lifestyle to help aging individuals support their cognitive health by focusing on three main areas: cognitive training, physical activity, and maintaining a healthy lifestyle. The application enrolled the first user on December 24, 2022 and, as of June 6, 2024, had 6,127 users who actively engaged with the app and 11,000+ users who at least logged in. Of the 6,186 users fully completed the main questionnaire that contains a broad range of items covering sociodemographic information, health habits including diet, exercise, smoking/drinking, meditation, and sleep, comorbidities, and memory- and stress management-related questions. Together, the items are combined to create an Alzheimer’s Risk Assessment (ARA) score. The app also includes mind games (wordle, funnel, pyramid, a variant of the stroop test etc), meditation exercises and news clips relevant to cognitive and brain health. Of the 6,186, 6,127 were at least 20 years of age and had a completed ARA score (average age 57±14 years; 73% female). The oldest user was 103 years of age and 210 users were 80+ years old. The body mass index (BMI) was 26.7±5.1, 57% were overweight and 21% were obese, which generally maps well on data from most developed countries. About 2% reported having dementia, 5% reported cancer, 2% stroke, 31% hypertension and 35% high cholesterol, 7% diabetes, and 15% reported being depressed. Women were more engaged with the app than men in general, completing on average 2.5 sessions/week compared to 2.1 sessions/week completed by men. Age had little if any influence on frequency of participation, although users 60+ years old were more likely to complete 5+ sessions/week compared to those younger than 60. Those with hypertension, high cholesterol, and diabetes were more likely to complete app-based activities weekly, but dementia, depression, cancer or stroke did not affect engagement with the app. ARA score had no relation to the level of engagement with the app. Men recorded more steps per day then women (5,500 vs. 4,900 steps) and women were better on an emotional prosody recognition task. Daily steps did not correlate with ARA score; emotional prosody recognition score was the strongest observed correlate of ARA score. Overall, the app appears to be well received by the users, both in terms of the number of those who signed up and the level of engagement with the app. The app provides a new, technology-driven avenue to promote cognitive health and collect valuable information useful in developing population-wide strategies for intervention.

ABSTRACT. Technologies on the extended reality (XR) spectrum, including immersive virtual reality (VR) and augmented reality (AR), provide new opportunities for users to express themselves. For example, male presenting users may use female presenting avatars in VR. Far from being mere explorations of one’s pre-existing identity, alternative self-representations made possible through XR raise deep metaphysical and ethical questions about the nature of the self and its manifestations. On the metaphysical side, XR raises the possibility that the self may be extended and distributed across these technologies, in ways somewhat analogous to the ways philosophers and psychologists (e.g. Andy Clark and David Chalmers) argue that the mind may extend beyond the skull. The possibility of an expanded self puts pressure on traditional notions of identity and ethics in need of further exploration. But the ethical ties between XR and the self are not limited to these metaphysical possibilities. Policy decisions and regulations regarding the presentation of one’s self-identity are wrought with ethical difficulties. As just one example, a user given the ability to filter out LGBTQ+ content from their XR interactions could effectively erase queer identities from their virtual world. It is a substantial ethical question whether they should be allowed such control, especially when it may involve erasing not just the representation of another, but an aspect of that other’s expanded self. It is a further question to determine who (Users? Software and hardware companies? Governments?) are best positioned to decide on such a question. To be clear, ethical problems raised by the self in XR are not limited to social experiences involving multiple-users interacting. It is common practice to make moral appraisals of a person’s character, but it is unclear the extent to which virtual behaviors should be included in such appraisals. Intuitions in these domains conflict. It is tempting to think that XR behavior need not reflect real-world character, and so should have little to no impact on moral assessments of others. On the other hand, the effects of realism, immersion, and presence suggest that users at least sometimes deploy their real-world sense of self when making moral decisions in XR. In this symposium, contributing authors from the recent Routledge Press collected volume Exploring Extended Realities: Metaphysical, Psychological, and Ethical Challenges (2023), explore these interactions between XR, ethics, and the metaphysics of the self.

ABSTRACT. In the ethics of virtual actions, there has been a broad tendency to adopt one of two camps. On the amoralist view, users are never appropriate targets for moral evaluation on the basis of their virtual actions, since no one is actually harmed and virtual actions do not reflect real-world desires. On the willing endorsement view, users may be appropriate targets of moral judgments for their virtual actions in those cases where the action is endorsed by the player’s real-world desires, independent of whether real-world harm is done. Emerging virtual reality technologies increase the possibility of virtually real experiences, experiences which users treat as if they were real. Despite their differences, the amoralist and willing endorser largely agree about the ethical impact of virtually real experiences. For the willing endorser, it is appropriate to judge users for their virtual actions in virtually real experiences. For the amoralist, it is appropriate to judge users on the basis that they are capable of performing those actions in real-world contexts. In this paper, I argue that the fundamental distinction between real-world and non-real-world desires is too blurry to be useful in evaluating users on the basis of their virtual actions. Instead, we should look to the degree to which the user sees their virtual behavior as constitutive of their narrative identity. Importantly, behavior in virtual settings may be constitutive of one’s narrative identity even when the virtual reality simulation does not generate a virtually real experience for them. As such, the ethical impact of emerging virtual reality technologies is largely independent of their ability to generate virtually real experiences. Nevertheless, virtual reality technologies provide greater opportunities for users to exercise genuine agency. As such, they afford greater opportunities to constitute narrative identity, and so greater opportunities for moral evaluation.

ABSTRACT. When does a distributed brain-body-world cognitive system constitute an extended self or person? When cognition is extended “beyond skin and skull,” then is the self also extended? Or is cognition simply offloaded to an external resource that is not part of the self or person? I argue that there are some cases in which it does make sense to speak of the self as extended, and that a criterion is needed. I consider several possibilities and ultimately propose a conception of extended selves rooted in neural mechanisms for proprioception and interoception.

David Chalmers (2019) distinguishes between two kinds of extended cognition, circuit extension and sensorimotor extension. I suggest a third possibility which crosscuts this distinction: visceral extension. Drawing on Anil Seth’s (2019) concept of the self as a “beast-machine” and Gallagher’s (2023) theory of the “self-pattern,” I argue that extending the embodied self is very different from extending cognition, in part because the self is not co-extensive with cognition. While various forms of the Parity Principle (e.g. Reiner & Nagel, 2017) can provide a criterion for cognitive extension, meeting this criterion is not sufficient to establish an extended self. But the self is not co-extensive with consciousness, either. The embodied self runs deeper than consciousness; the lived body is not simply the body as it appears in consciousness.

To extend the self is to become entwined or entangled with an assemblage in a distinctive way, such that it comes to constitute a self-pattern. Gallagher (2023, 2013) suggests that “the self” is a cluster concept, and that selves can be constituted by multiple and partially overlapping assemblages (“patterns”), including extended elements of the kind in view in the literature on extended cognition. But Gallagher’s treatment of extended selves is underdeveloped. I compare the concept of an extended self-pattern to (1) autopoietic or self-organizing systems, (2) dynamically coupled systems, and (3) intentional or valuational systems. I argue that none of these three familiar ideas are quite adequate to the requirements of the extended self. In this context, I argue that technology becomes a proper part of an embodied self-pattern when it is anchored in the control-oriented predictive processing mechanisms in the mid-line neural systems implicated in self-regulation and self-control. Thus, the way to visceral extension of the embodied self leads through the default mode network.

To illustrate, I consider the case of a telepresence robot (Parsons & Neisser, 2024). Dennett’s (1978) characteristically deflationary discussion of this sort of case remains equivocal – pointing to either eliminativism about the self or to an identification of the self with the neural correlates of consciousness. But perhaps this is too quick. Perhaps there really are embodied selves that can extend across the brain, animal body, and technology. Reflection on our entwining with technology can shed new light on the nature of the self.

The distinction between extended cognition and extended self may prove useful for writers confronting a range of emergent questions about personal integrity, autonomy, and privacy in that arise in the age of extended reality. For cases of extended cognition without an extended self, it may be that existing policy and case law might be applied quite directly. Extended cognition (without self-extension) might have the same general moral and legal status as other kinds of personal data – perhaps at one end of a spectrum of such data. Cases that do involve a genuinely extended self, however, might raise more interesting questions. Here, infringements by others may be understood more on the model of violence or assault.

ABSTRACT. Extended reality (XR) technologies superimpose content onto a user’s experience of the world. I argue that XR technologies, once incorporated into the basic structures of society, introduce three connected but distinct classes of ethical problems related to the self. These are of special interest to mental health practitioners because of the effects that XR embodiment (e.g., embodied experiences in extended reality) can have transformative, and traumatic, effects on users. I begin by analyzing how the ethics of body modification is currently structured especially as its connections with the values of autonomy, competence, and the body. I argue that although it may seem natural to extend these ethical principles onto XR technologies that allow embodiment, such an extension would produce an incomplete ethics of XR embodiment. Considerations about cosmetic surgeries, for example, require that surgeons attempt to assess the degree to which a patient’s expectations about their outcomes are reasonable. In part these concerns are grounded upon the biological limitations of surgical intervention to modify bodies. XR embodiment lacks such boundaries and body modifications are easily reversible. Despite this fact,which may imply easing restrictions on XR body modification, embodiment in XR can have ethically significant impacts on users.

I review research others have carried out about the effects of embodiment in virtual and augmented reality environments. These studies suggest that experiences of embodiment in XR can be transformative (i.e., they can radically change a person’s understanding of who they are and how they are related to their physical bodies). Other research suggests that XR embodiment can also be traumatic (e.g., virtual sexual harassment can be traumatic for some users as can becoming embodied in stereotypically over or under-weight bodies). This research suggests that the bodies we can become embodied within can affect us by triggering stereotyped behavior (e.g., the proteus effect) or biases (e.g., by being placed in an XR body of a different sex, gender, or race than one’s own). Extended reality simulations, whether used for research or clinical use, that make use of embodied experiences require special attention to the risks that embodiment adds to the user experience.

When a person’s sense of identity becomes blended in this way, conflicts can arise between an individual's physical and XR bodies. This phenomenon has already led some to propose new forms of dysmorphic disorders (e.g., “Snapchat” dysmorphia, “Zoom” dysmorphia) tied to this experience. The possibility of real, and long lasting, effects resulting from conflicts between physical and XR embodiment deserve additional ethical scrutiny especially in the context of non-consensual embodiment. Similarly, because experiences of embodiment in XR can become transformative raises independent issues about consent. Such issues have already complicated the nature of consent in the context of transformative medical procedures and raise similar concerns for XR embodiment. This work is an extension of research that was published in the edited collection “Exploring Extended Realities Metaphysical, Psychological, and Ethical Challenges.”

ABSTRACT. Context. Based on studies conducted by researchers from sociology, psychology, and communication fields in the context of the Horizon CounteR project (for which refer to https://counter-project.eu/), which resulted in four approved deliverables, radicalization emerged as a phenomenon that could be traced in a wide variety of environments, both real and digital. According to the same studies and the psychosocial perspective on communication adopted during the research process, radicalized ecosystems could be analyzed through four thematic areas: communication, identity, culture, and electronic technologies (i.e., the theoretical perspective). The precipitate of these four thematic areas is the onlife subjectivity. ‘Onlife’ indicates that it is impossible to establish whether a subject is online or offline because the subject always lives on the border of real and digital environments and is always in contact with digital technologies and interfaces. ‘Subjectivity’ is the subject’s identity that becomes intelligible and observable during a communicative interaction. It depends on the conscious or unconscious decisions the subject makes in interacting with the environments, artifacts, and other subjects to show who they is. Consequently, onlife subjectivity is the subjectivity that blooms from being in an onlife situation, and radicalized onlife subjectivity is characterized by a process of radicalization. The present contribution compares two radicalized ecosystems: Mohammed Zahir Khan’s and Maria Giulia Sergio’s. Sample. The two ecosystems (i.e., the cases) were originally included among the ten selected in Task 2.3 (carried out in 2022) of the Horizon CounteR project because of their relevance and variability in terms of characteristics (e.g., concerning gender). The law enforcement agencies involved in the project approved the selection of these ten cases. During Task 2.3, Mohammed Zahir Khan’s and Maria Giulia Sergio’s cases were synthesized. Each synthesis resulted from a systematic search of sources of evidence on each case. The search was conducted through five activities: Counter Extremist Project Database search, general open-source search via the internet (Google browser), European Media Monitor Tool search, Summon – Unicatt (tool for academic research provided by Università Cattolica del Sacro Cuore di Milano) search, and Yewno - Unicatt (tool for creation of knowledge maps) search. In particular, the research team retrieved 114 relevant sources of evidence for Mohammed Zahir Khan and 31 relevant sources of evidence for Maria Giulia Sergio. Method. The methodology adopted consisted of four steps. Firstly, two of the involved researchers (IV and CG, the psychologists included in the research team) independently read the synthesis of each case, which the research team wrote during Task 2.3 and included in the related deliverable. Secondly, they independently read the definition and description of each thematic area included in the theoretical perspective used to analyze radicalized ecosystems and wrote down the characteristics of Mohammed Zahir Khan’s case for each thematic area and they did the same for Maria Giulia Sergio’s case. Thirdly, they compared the characteristics attributed to each case for each thematic area. In case of disagreement, IV and CG discussed until they reached a common opinion. The authors of the contribution discussed what emerged from these three steps, and this discussion allowed them to structure the comparison between the two cases and the conclusions. Results. They will be an applicative example of the theoretical perspective and add additional knowledge (stemming from the comparative analysis) on the two cases. Conclusions. They will include practical fallouts for intelligence derived from applying the theoretical perspective and analyzing the two above-mentioned cases. Lastly, this contribution is the practical application and, consequently, a prosecution of the theoretical perspective described during CYPSY26 (oral presentation: Onlife Subjectivities Construction in Radicalization Processes. A Theoretical Perspective with some Practical Fallouts for Intelligence).

ABSTRACT. INTRODUCTION Cyberpsychology includes a number of problem areas referring to human beings’ connections in the era of digital technologies. A lively discussed theme dealing with the perspectives of the artificial intelligence (AI) is an actual topic. Scholars, practitioners as well as ordinary people keep widely discussing a likely AI progress towards overrunning of human intelligence. In result humans will supposedly lose control of the most valuable decisions made by various AI subsystems – decisions dealing with our personal and social being, business perspectives, adoption of technologies, ecology, selection of specialties in-demand to learn, etc. While this sort of discussions is not quite new (historical precedents are known such as anti-machinery Luddites movements or disputes pro & contra newborn cybernetics), during the last several decades certain consequences of the AI usage refer mainly on the idea of singularity (often called technological singularity). By singularity Vernor Vinge, Ray Kurzweil and their followers mean that digital technologies are about to build the so called superintelligence – the one that surpasses human intelligence and becomes capable of making complex decisions that would never (or rarely) occur to a person due to all the unexpectedness and/or huge time-consuming which lie behind such a decision. Enthusiasts estimate the appearance of artificial superintelligence (ASI), i.e. supercomputer systems connected via supernetworks, around 2045. Several ASI projects such as AlphaZero or ChatGPT, and many others, have declared themselves in the last few years as highly competent and useful, even for ordinary public. While being competent and useful, many projects meet nevertheless protests from prominent specialists, politicians, educators, and general public. TOPIC AND METHOD Most people greet both the idea of singularity and the particular AI/ASI projects with delight or fear, i.e. positively or negatively. The aim of the paper is to discuss the singularity problem from the standpoint of life styles of the rarely analyzed international sample of professional chessplayers: grandmasters and masters in chess. An analytical method is used: it includes reviewing the singularity issues within the chessplayers’ communities, compared to the majority of diverse communities. The number of world-wide chess grandmasters is about 2,000; two thirds of them are believed to be active, that is they systematically (though maybe rarely) fight in chess battles and verify their player strength, measured by the Elo rating system. Though the community is biased and includes much more males than females, the latter too belong to the chessplayers’ community. Besides grandmasters, it includes many masters (international or local) and experts who systematically or from time to time participate in chess competitions, and/or teach beginners, often coach strong chessplayers as their seconds. Even less qualified persons often organize and judge chess competitions, collect chess-related information and administer chessbases, update chess engines (such as Stockfish or Leela Chess Zero); grandmasters as well may take upon themselves all these functions. BRIEF RESULTS Beginning with the loss of world champion Garry Kasparov to a chess engine in 1997, chessplayers have got less and less chances to play against a chess engine at least a draw. That means, chessplayers have run upon singularity in their professional life: computers – even without AI components – often choose unexpected moves which may be difficult to explain. Thus the chessplayers’ community was among the first to adapt within the singularity burden. They adapted: humans compete humans, but when preparing at home, masters/grandmasters consult and select best strategies exploiting chess engines. Moreover: chessplayers including former champions Garry Kasparov and Vladimir Kramnik participate in chess engines’ improvement. Chessplayers use singularity to transform themselves mentally – as Lev Vygotsky suggested.

More reasons to be presented in the oral paper.

ABSTRACT. Generative AI affords a uniquely powerful space as a tool for integration in psychedelic-assisted therapy/treatment (PAT), offering the potential for creat- ing imagery, videos, and other forms of media with the highly noetic qualities commonly associated with induced experiences. This may appear to concep- tually conflict with the nature of integration as an intrapersonal endeavor, as generative AI presents a formation of many perspectives in lieu of the singular utilized within integration. However, there is a significant correlation in the nature by which generative AI develops perspective(s) and the means by which we develop our own, as well as the understanding that participants need not accept the produced output as wholly or even partially valid, perhaps instead seeing it as a preface to something larger. In this work-in-progress, we trace the developments in generative algorithms specifically for visual media over the past few years, and discuss how there is value in algorithms for generation that create physically implausible imagery (i.e. nonsense).

AI and PAT exist in dynamic interstices (real/unreal, “professional”/recreational, critiqued/lauded), and shared amongst them is a distinct rapidity in both their development and implementation. It is in recognition of this that we find poten- tial for exploration into the reciprocal forms of affordances and criticisms that these subjects present one another. Although the explicit term integration is present in various forms within the medical field, integration within the specific context of PAT can be defined as the processes by which an individual assim- ilates emotions, sensations, and insights experienced in non-ordinary states of consciousness (NOSC), typically onset by psychedelic substances. Integration is distinct in that its value is particular to the individual, intrinsic to one’s per- spective, and existing without precedent due to the generally ineffable nature of NOSCs.

In this particular theoretical work, we will detail the prospective usage of “generative AI” (here simply defined as an AI capable of generating text, im- agery, videos, etc, generally recognizable with systems like ChatGPT, Midjour- ney, and Dall-E), specifically looking to image-making as an example of inte- gration (especially as image-making through painting, collage, and other analog methodologies are a traditional approach). Within AI-aided creation, there is a current consensus that the measurable success of a generated output must demonstrate high fidelity and accuracy in line with the prompt provided, addi- tionally noting a particular emphasis on the hope of achieving realism, as ab- straction is often seen as inadequate/irrelevant (a sentiment that we do not im- mediately share). With this being the case, many of the generated results incen- tivize (or arguably necessitate) re-engagement by the prompt writer(s); whether this be through acts of refinement or even requiring starting over from scratch, and thereby delegating the “success” of a prompt to the writer(s), wherein the processes refinement and alteration remain the only consistent throughline.

We believe that the aforementioned qualities, as well as those discussed within this paper, expound upon the unique potential presented in the co- existence of these burgeoning fields. Current efforts, such as with the Multi- disciplinary Association for Psychedelic Studies (MAPS), along with a general shift in the public perspective of psychedelic substances (such as the now legal usage of psychedelic substances for medical use in Australia), and the near ubiq- uitous nature of new AI platforms and techniques present a very distinct place for intersection and discussion. Additionally, this work seeks not to designate a superior architecture for generative AI, instead challenging the preconceptions typically associated not only with its usage but also presenting a critique that may provide insight into existing and future methodologies.

ABSTRACT. Motivation. Interacting with AI-generated art may not significantly impact a machine's perceived moral standing (Lima et al., 2021). Nevertheless, exposure to AI-generated art presents new opportunities and challenges for artists, scholars, and audiences (Yusa et al., 2022). Future studies in this area are needed to investigate the social and political implications of AI-based art exposure.

Objective. This study investigates the impact of AI-generated art on attitudes toward gender equality and diversity, exploring whether and how artistic representations of gender themes can alter viewers’ perceptions and beliefs.

Methods. Participants were exposed to various DALL-E-generated artworks embodying various gender equality themes. Demographic data was analyzed to understand the diversity and potential biases within the participant pool. Attitudes towards equality and equity were measured using a pre- and post-exposure survey employing Likert-scale questions, with subsequent statistical analysis to assess changes.

Demographic Insights. The participant group consisted of 20 individuals, predominantly young adults (mean age 26.4), with a gender distribution of 70% men and 30% women, primarily of White or European descent (65%). Most had some college education but no degree (70%), and a majority were from fields related to computer science (55%). This demographic profile suggests a technologically savvy cohort likely to be receptive to digital and artistic innovations.

Results. Pre- and Post-Exposure Attitude Analysis: Equal Opportunities: No significant change was observed post-exposure (t=0.438, p=0.666), indicating strong pre-existing beliefs about equality or an ineffectiveness of the artworks to challenge these views significantly. Progress in Gender Equality: A trend towards changing attitudes was noted (t=1.831, p=0.083), suggesting a potential, albeit non-significant, impact of the artworks in modifying perceptions of gender equality progress. Importance of Equity Over Equality: No significant changes were detected (t=0.767, p=0.453), reflecting deeply ingrained beliefs about equity and equality that may require more profound or repeated engagements to alter.

Emotional and Cognitive Responses: Participants displayed a range of emotional responses, with significant mentions of feeling "uncomfortable" (70), "hopeful" (58), "inspired" (50), and "angry" (31), indicating that the artworks effectively evoked strong emotional reactions. Cognitive responses focused on themes of "people," "AI," "technology," and "women," showcasing the artworks’ ability to provoke thought and discussion around critical societal issues.

Discussion. The findings suggest that while AI-generated art can engage viewers emotionally and cognitively, altering deeply held beliefs through brief exposures to digital artworks presents challenges. Artworks evoked a spectrum of emotions and stimulated thoughts on the roles of technology and social identity in gender equity. However, the lack of significant changes in certain attitudes underscores the complexities of using art as a tool for social change.

Conclusion. Exposure to AI-generated art influences viewers' perceptions of gender equality, primarily by evoking strong emotional responses and stimulating reflective thinking. However, the transformation of foundational beliefs regarding equality and equity may require more than passive exposure, suggesting a need for interactive and repeated engagements with such themes. Future research should explore whether ethically aligned generative AI has the desired outcomes.

References: Lima, G., Zhunis, A., Манович, Л., & Cha, M. (2021). On the social-relational moral standing of ai: an empirical study using ai-generated art. Frontiers in Robotics and AI, 8. DOI: 10.3389/frobt.2021.719944 Yusa, I. M. M., Yu, Y., & Sovhyra, T. (2022). Reflections on the use of artificial intelligence in works of art. Journal of Aesthetics, Design, and Art Management, 2(2), 152-167. DOI: 10.58982/jadam.v2i2.334

ABSTRACT. We have developed a three-sided enclosure-type cyberspace that is easy to disassemble and reassemble in order to support human interaction, improve wellbeing, and alleviate stress for a variety of people. In this presentation, the features and advantages of the developed system, four case studies and future issues will be discussed. The system is an encircling projection system capable of life-size projection of just over two meters on each side. The space consists of three screens and a floor, with three projectors and a distortion correction device. The walls are foldable and the floor is divided into four sections, each of which can be carried by one person. Compared to a head-mounted display (HMD), the system gives less burden and has a lower risk of VR sickness, making it suitable for a wide range of users and applications, including the older people, children, and people with physical disabilities. Two sets of the same configuration were prepared. By connecting the two locations, it is possible to give people at a distance the experience of being in a connected space or in the same space. The first case study was on an avatar stroll through a forest created using Unity assets. The avatar's movement within the space is performed with hand gestures, key pad, or game controller. In addition, we have added an optional voice navigation system using 3D acoustics with Sound-XR (Yamaha corp.). Another example of connecting people who cannot see each other face to face is the use of two telepresence robots (i-Presence, co., Ltd.), each equipped with an iPad and able to remotely control motors and operate two axes of rotation via a network. While enjoying the scenery and contents of cyberspace, the users can also see the other's face, creating a natural conversation. The natural scenery is presented by attaching a 360-degree video to the inside of a full spherical dome in Unity space. The third example is the provision of a third place that is neither work, school, nor home. People who are far away from each other, or who for some reason cannot meet in person, can spend important time together and enjoy conversation in a place that is not accessible in real. This example takes advantage of the strengths of the virtual, such as the ability to choose one's own avatar depending on the person the user meets and the ability to easily change the scenery and interior design depending on the users’ mood. Fourth, cyberspace will also be used for ergonomic research on drivers. The DS contents are created using Forum8's UC-win/Road and operated with a steering wheel controller and pedals (Logitech). We developed a method for estimating the direction of the driver's sight by capturing and analyzing images of the driver's face using a web camera. We realized a system that encourages safe driving behavior by providing feedback on whether the driver is paying attention to objects that require attention. Compared to HMDs, this system is useful because it has a wider viewing angle and can simulate natural driving behavior. Future issues include the realization of communication between two locations without delay, cross-modal applications such as 3D sound presentation and the introduction of tactile and force sensations, and low-burden human condition measurement using mainly physiological measurements and real-time adaptation of content based on these measurements. As real-world applications, the system is expected to be introduced to family visiting rooms in hospitals, facilities for the elderly, fitness clubs, karaoke boxes, and so on. For those who are unable to visit the installation site, it is also necessary to propose a simpler configuration system.

ABSTRACT. This research explores the multifaceted dynamics of online relationships within the context of virtual reality (VR) experiences, with the primary aim of comprehensively understanding the evolving intersection of human connections and technology. The principal objective is to investigate how VR influences the initiation, development, and sustainability of online relationships. Employing a mixed-methods approach, the study integrates qualitative analysis of user experiences within VR environments with quantitative measures assessing relationship satisfaction, authenticity, and psychological well-being. Participants actively engaged in simulated social interactions within VR settings, providing valuable insights into the nuances of relationship formation and maintenance. Qualitative data, encompassing participant narratives and observational records, underwent thematic analysis to identify recurrent themes and patterns. Concurrently, quantitative data were gathered through surveys evaluating participants' perceived authenticity of interactions, emotional connection, and overall satisfaction with online relationships facilitated by VR. The qualitative analysis uncovered rich insights into the immersive nature of VR experiences, emphasizing elements that significantly contribute to the establishment of meaningful connections. Participants expressed heightened feelings of authenticity and emotional connection within the virtual realm. Quantitative findings revealed a positive correlation between the depth of engagement in VR-mediated interactions and participants' satisfaction with the authenticity of online relationships. The study concludes that virtual reality experiences exert a profound influence on the dynamics of online relationships, providing a unique and enriched platform for social interactions. The heightened sense of authenticity and emotional connection reported by participants underscores the potential of VR to enhance the quality of online relationships. Nevertheless, the study acknowledges the imperative for continued exploration of ethical considerations and privacy safeguards in the context of VR-mediated interactions. These findings contribute to the broader understanding of the synergies between online connections and virtual reality experiences, offering implications for both researchers and practitioners navigating the evolving landscape of digital relationships.

ABSTRACT. This scoping review aims to comprehensively explore the current state of research on the relationship between media multitasking and online prosocial and antisocial behavior, focusing on individual factors and contextual elements that moderate this association. Media multitasking, defined as the simultaneous conduct of two or more tasks, is a prevalent behavior in today's digital age. The systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist ensuring rigorous content selection and synthesis methodology. Specifically, this review seeks to answer three key questions: What is the current state of research on the relationship between media multitasking and online prosocial and antisocial behavior? What individual factors, such as personality traits or demographic characteristics, moderate this relationship? How do contextual factors, such as time pressure or task priority, shape the dynamics between media multitasking and prosocial/antisocial behaviors? Inclusion criteria span the years 2006 to 2023, focusing on English-language peer-reviewed publications. A narrative synthesis will be conducted on the extracted data findings, categorizing information into general themes, patterns, and standard categories. This approach provides a comprehensive overview of existing literature, identifying trends, gaps, and areas necessitating further investigation. By synthesizing findings, this scoping review contributes to understanding how media multitasking influences online prosocial and antisocial behaviors, shedding light on the nuanced interactions between individual characteristics, contextual factors, and media multitasking. The review aims to inform future research directions and contribute insights relevant to practitioners and policymakers in the digital media landscape. This study is supported by the Marie Sklodowska-Curie Actions (MSCA) Fellowship.