Stéphanie Dumoulin

Virtual reality compared with in vivo exposure in the treatment of social anxiety disorder: A three-arm randomised controlled trial

BackgroundPeople with social anxiety disorder (SAD) fear social interactions and may be reluctant to seek treatments involving exposure to social situations. Social exposure conducted in virtual reality (VR), embedded in individual cognitive-behavioural therapy (CBT), could be an answer.AimsTo show that conducting VR exposure in CBT for SAD is effective and is more practical for therapists than conducting exposure in vivoMethodParticipants were randomly assigned to either VR exposure (n = 17), in vivo exposure (n = 22) or waiting list (n = 20). Participants in the active arms received individual CBT for 14 weekly sessions and outcome was assessed with questionnaires and a behaviour avoidance test. (Trial registration number ISRCTN99747069)ResultsImprovements were found on the primary (Liebowitz Social Anxiety Scale) and all five secondary outcome measures in both CBT groups compared with the waiting list. Conducting exposure in VR was more effective at post-treatment than in vivo on the primary outcome measure and on one secondary measure. Improvements were maintained at the 6-month follow-up. VR was significantly more practical for therapists than in vivo exposure.ConclusionsUsing VR can be advantageous over standard CBT as a potential solution for treatment avoidance and as an efficient, cost-effective and practical medium of exposure.

Reliability and validity of a single-item measure of presence in VR

Measuring presence reliably and with minimal intrusion manner is not easy. The present study reports on six studies that have validated a measure of presence consisting of only one item. The content, face validity, test-retest, convergent and divergent validity as well as sensitivity were all confirming reliability and validity of a single-item measure.

Modes of immersion and stress induced by commercial (off-the-shelf) 3D games

Developing a stress-management training (SMT) system and protocol for soldiers can help them cope better with stress experienced in theatre operations. Using 3D horror games in virtual reality (VR) can present an attractive simulation method for soldiers. This study was conducted to find out whether it is possible to stress soldiers moderately using VR and which technology is more efficient to do so. A total of 47 soldiers returning from Afghanistan played two 3D first-person shooter (FPS)/horror games (Killing Floor and Left 4 Dead) on three different types of immersive technologies (a 22-inch stereoscopic monitor, a 73-inch stereoscopic TV and a CAVE™). As a control and reference comparison of induced stress, participants were exposed to the Trier Social Stress Test (TSST), a standardized stress-inducing procedure. Results were supporting of our work, devising an effective low-cost and high-buy-in approach to assist in teaching and practicing stress-management skills. Repeated measures analyses of variance (ANOVAs) revealed statistically significant increases in the soldiers’ respiration rates and heart rates while playing the 3D games and during the TSSTs. No significant interactions were found. Increases in physiological arousal among the soldiers were significant when comparing the baseline to the immersion and to the TSST, but not when comparing both stressors. Immersion in 3D games is proposed as a practical and cost-effective option to create a context that allows practicing SMT.

The Potential of Stress Management Training as a Coping Strategy for Stressors Experienced in Theater of Operation: A Systematic Review

This chapter provides a literature review on Stress Management Training (SMT) as a potential tool to help military personnel cope with stressors experienced in the theater of operations. It is hoped that SMT techniques can be used to prepare soldiers for potential highly stressful situations in an effort to diminish their negative reactions to stress. The ultimate long-term prospective benefits would be that training military personnel with SMT would increase resilience and lower the incidence of post-traumatic stress disorder (PTSD). There are several definitions of stress, but essentially it can be considered an affective state that occurs in response to perceived demands and challenges in the environment with which one feels unable to cope [1]. A variety of stress management techniques have been developed over the years in order to help individuals prevent, eliminate or cope with stress. All these techniques have the objective to modify factors associated with stress (behavioral, cognitive, physiological, emotional and environmental). Early references to SMT date back to the work of Gottlieb, Strite and Koller et al. [2] who applied stress reduction strategies in behavioral medicine. SMT now represents an extremely diverse set of strategies and our literature review confirmed that notion several times. Authors include almost any available techniques, from Yoga [3] to prayer [4], along with exposure to feared situations [5], cognitive restructuring [6], problem solving [7], etc. In general, SMT can be defined as the application of any set of techniques aiming to improve the way people cope with stress. Coping represents efforts to manage demands, conflicts and pressures that drain, or exceed, a person’s resources [1]. Murphy and Sauter [8] offered to better integrate the applications of SMT strategies to contemporary notions of prevention by dividing SMT into primary, secondary and tertiary interventions. Primary interventions focus on changing the sources of the stress response (e.g., by modifying the environment) before stress becomes a problem, while secondary interventions aim at reducing the severity of symptoms associated with stress (much like secondary prevention, before non-clinical